Preventing harm to people with drug allergies – New NICE guidelines September 2014

Every year, around 62,000 people in England have a serious allergic reaction to a drug which puts them in hospital. NICE has published its first guideline on drug allergy in adults, children and young people, which aims to dispel confusion around best practice in assessment, documentation, communication and referral.

Every year, around 62,000 people in England have a serious allergic reaction to a drug which puts them in hospital. A recent analysis from the National Reporting and Learning System revealed that in many of the instances where people suffered harm, they had been given a drug to which they were already known to be allergic.

NICE has published its first guideline on drug allergy in adults, children and young people, which aims to dispel confusion around best practice in assessment, documentation, communication, non-specialist management and referral to specialist services.

All drugs have the potential to cause side effects (adverse drug reactions), but not all of these side effects are considered to be allergic. An allergic reaction occurs when the body thinks the medicine is a threat and the immune system responds to it. The drugs often linked to immune responses include commonly used treatments such as antibiotics, general anaesthesia and certain painkillers (e.g. aspirin and ibuprofen).

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “About half a million people admitted into NHS hospitals each year will have a diagnosed drug allergy. If we know that giving someone a particular drug could cause them harm, or in the worst instances may even kill them, the utmost care must be taken to ensure they are not prescribed or administered that drug.

“This new guideline encourages all healthcare professionals to be alert to the possibility of drug allergies and offers best practice on clinical management to ensure every individual is spared from serious harm.”

The recommendations prioritise the thorough assessment of any person who is suspected of having a drug allergy and details what signs to look out for. These include symptoms that come on rapidly such as hives, wheezing, redness or swelling of the skin and symptoms which can take several days to show such as fever, liver dysfunction or eczema.

The guideline identified major issues in clinical documentation of drug allergy with insufficient information being recorded and shared with other healthcare professionals or people with allergies themselves. The guideline outlines a structured approach to collecting information on new drug allergies. It also makes a recommendation to redesign prescriptions (paper or electronic) issued in any setting to include information on drugs or drug classes people with a known drug allergy should avoid.

According to the guideline insufficient awareness of available services can cause considerable differences in how drug allergies are managed and access to treatment across the country.

The recommendations describe when people can have non-specialist treatment, for instance considering a different drug from the same class in those who have had a mild allergic reaction. And it also highlights the importance of referring people, who have had severe reactions or need ongoing treatment, to find out what alternatives can be taken safely.

Lynne Regent, Anaphylaxis Campaign CEO, said: “We are delighted that these new guidelines will now be available to healthcare professionals offering evidence-based advice on the diagnosis and management of drug allergy in adults, children and young people. For too long we have heard anecdotal evidence about the poor care and attention taken in treating those with drug allergies and the devastating results that can occur. We would urge all healthcare professionals to take heed of these new guidelines and improve care for all those affected.”

You can find more information on drug allergy in our Information Standard certified Drug Allergy Factsheet here.