title: 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.
abstract: OBJECTIVE
  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 www.rcpch.ac.uk/allergy/anaphylaxis. 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.
authors: Department of Allergy, Addenbrooke's NHS Trust, Box 40, Cambridge CB2 0QQ, UK. atclark@doctors.org.uk
authors: Andrew
authors: A
authors: Clark
authors: Kate
authors: K
authors: Lloyd
authors: Aziz
authors: A
authors: Sheikh
authors: Mazin
authors: M
authors: Alfaham
authors: Mandy
authors: M
authors: East
authors: Pamela
authors: P
authors: Ewan
authors: Fiona
authors: F
authors: Jewkes
authors: Rosie
authors: R
authors: King
authors: Susan
authors: S
authors: Leech
authors: Ian
authors: I
authors: Maconochie
authors: Louise
authors: L
authors: Sinnott
authors: Dalbir
authors: D
authors: Sohi
authors: Stephen
authors: S
authors: Tomlin
authors: John
authors: J
authors: Warner
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D019091:Critical Pathways / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004837:Epinephrine / Q000627:therapeutic use*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012017:Referral and Consultation; D012042:Registries; D018570:Risk Assessment; D012648:Self Care / Q000379:methods; D012955:Societies, Medical; D006113:United Kingdom; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine