Allergy care pathway for anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction. This is one of several allergy care pathways, which tell health professionals what they need to know in order to provide the best care possible.


The College's care pathway for anaphylaxis is presented in two parts:

  1. an algorithm with the stages of ideal care, and
  2. a set of competences required to diagnose, treat and optimally manage anaphylaxis.

The algorithm has numbers which correspond to the competences outlined within the body of the document.

We recommend that this pathway is implemented locally by a multidisciplinary team with a focus on creating networks between staff in primary and community health care, social care, education and hospital-based practice to improve services for children with allergic conditions. All specialists should have paediatric training.

Download the full RCPCH Care Pathway for Children with Anaphylaxis below.


Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction which is likely when both of the following criteria are met:

  • sudden onset and rapid progression of symptoms, and
  • life-threatening airway and/or breathing and/or circulation problems.

Skin and/or mucosal changes (flushing, urticaria, angio-oedema) can also occur, but are absent in a significant proportion of cases.

Key recommendations

The Anaphylaxis Working Group (AWG) identified four key recommendations from the evidence base:

  1. prompt administration of adrenaline by intramuscular injection is the cornerstone of therapy both in the hospital and in the community
  2. children and young people at risk of anaphylaxis should be referred to clinics with specialist competence in paediatric allergies
  3. risk analysis should be performed for all patients with suspected anaphylaxis, and
  4. provision of a management plan may reduce the frequency and severity of further reactions and is a recommended part of anaphylaxis management.

Additionally, we recommend that all deaths from suspected anaphylaxis should be recorded on a local register. We strongly support the creation of a National Anaphylaxis Register.