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NICE: New guidelines for managing drug allergy

New guidelines on preventing harm to people with drug allergies should be the "foundation stone" for better understanding and management of drug allergy across primary, secondary and tertiary care, healthcare leaders claim. 

The first guideline on drug allergy in adults, children and young people aims to showcase best practice in assessment, documentation, communication, non-specialist management and referral to specialist services. 

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.

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).

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, including:

 - Hives

 - Wheezing 

 - Redness or swelling of the skin

 - Fever

 - Liver dysfunction 

 - Eczema.

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 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.

Maureen Jenkins, Clinical Director, Allergy UK, said: “Drug allergies can cause severe, sometimes life-threatening reactions but are often undiagnosed.  At Allergy UK, we frequently have calls about the lack of awareness about drug allergy, inadequate documentation and communication between health professionals, which can put patients' lives at risk.  We welcome these NICE Guidelines, that will lay the foundation stone for better understanding and management of drug allergy across primary, secondary and tertiary care.”

The guideline is available to view on the NICE website