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The RCPCH care pathway for children at risk of anaphylaxis: an evidence and consensus based national approach to caring for children with life-threatening allergies
  1. Andrew Clark1,
  2. Kate Lloyd2,
  3. Aziz Sheikh3,
  4. Mazin Alfaham4,
  5. Mandy East5,
  6. Pamela Ewan1,
  7. Fiona Jewkes6,
  8. Rosie King7,
  9. Susan Leech8,
  10. Ian Maconochie9,
  11. Louise Sinnott10,
  12. Dalbir Sohi11,
  13. Stephen Tomlin12,
  14. John Warner13 on behalf of the Science and Research Department, Royal College of Paediatrics and Child Health
  1. 1Department of Allergy, Addenbrooke's NHS Trust, Cambridge, UK
  2. 2Science and Research Department, Royal College of Paediatrics and Child Health, London, UK
  3. 3Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
  4. 4Children's Hospital, University Hospital of Wales, Cardiff, UK
  5. 5Anaphylaxis Campaign, Farnborough, UK
  6. 6Joint Royal Colleges Ambulance Liaison Committee, UK
  7. 7Southampton University Hospital Trust, Southampton, UK
  8. 8King's College Hospital, London, UK
  9. 9Emergency Department, Imperial College, St Mary's Hospital Campus, London, UK
  10. 10North West Specialised Commissioning Group, Warrington, UK
  11. 11Royal Free Hampstead NHS Trust, London, UK
  12. 12Evelina Children's Hospital, London, UK
  13. 13Section of Paediatrics, Imperial College, St Mary's Hospital Campus, London, UK
  1. Correspondence to Dr Andrew Clark, Department of Allergy, Addenbrooke's NHS Trust, Box 40, Cambridge CB2 0QQ, UK; atclark{at}


Aims Numerous studies have identified shortcomings in the management of children at risk of severe acute allergic reactions (anaphylaxis). The Science and Research Department at the Royal College of Paediatrics and Child Health (RCPCH) was commissioned by the Department of Health to develop competence based national care pathways for children with allergies. Anaphylaxis is the first completed pathway.

Methods The anaphylaxis pathway was developed by a multidisciplinary working group, reviewed by a broad group of stakeholders and approved by the Allergy Care Pathways Project Board and the RCPCH Clinical Standards Committee.

Results Pathway development is described under five headings: evidence review, mapping, external review, core knowledge documents and key recommendations. The full pathway can be downloaded from This document describes the entry points and the ideal pathway of care from self-care through to follow-up. The five key recommendations focus on: (1) prompt administration of adrenaline by intramuscular injection; (2) referral to specialists with competence in paediatric allergies; (3) risk analysis; (4) provision of a self-management plan; and (5) suggested creation of a national anaphylaxis death register.

Conclusions We present the first national care pathway for anaphylaxis, which is based on a critique of published evidence, expert consensus and multi-stakeholder input including patient representation via the Anaphylaxis Campaign. The Project Board urges health professionals to work together across networks to improve care for children at risk of anaphylaxis, in particular during the period after an acute reaction. Additionally, the Project Board strongly recommends the funding of a national anaphylaxis register.

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  • Funding This project was funded by the Department of Health.

  • Competing interests AC has carried out consultancy work for Schering Plough. ME is employed by Anaphylaxis UK. AS is involved in ongoing work funded by the government and charitable donors in relation to allergic disorders which include anaphylaxis, and has carried out consultancy work for Phadia, ALK and Schering Plough. JW has carried out consultancy work for Novartis, Danone, Airsonette, Merck, Allergy Therapeutics, Phadia Research, GSK, AstraZeneca, Merck, Allergy Therapeutics and ALK.

  • Copyright licence statement The pathways and associated competences remain the copyright of the Royal College of Paediatrics and Child Health.

  • Provenance and peer review Not commissioned; not externally peer reviewed.