Table 7

Long term management of anaphylaxis1 12 15 52 54 59 60 65 66

Identification of trigger(s)Box 1
Avoidance and education
  • Avoidance of confirmed trigger cornerstone of long term management

  • Ensure (child's) relatives and school/nursery staff educated and trained in using auto-injectors; verbal, written and online education

Epinephrine autoinjector and treatment plan
  • Prescribed if ongoing risk of fatal reactions—for example, insect sting or nut allergy

  • Train to use

  • Written treatment plan is essential

Medic alert bracelet/jewelleryDocument known triggers (penicillins, NSAID, nuts, insect venom etc)
Review of regular medicationReplace/discontinue β-blockers, ACE inhibitors, sedatives, hypnotics, antidepressants unless no alternative
Management of risk factors for severe or fatal anaphylaxis
  • Age related factors, drugs (table 6)

  • Comorbidities (cardiovascular, asthma, mastocytosis, other clonal mast cell disorders (c-kit mutation), CNS impairment)

Referral to allergy specialistSee box 1
  • CNS, central nervous system; NSAID, non-steroidal anti-inflammatory drug.