What are the recommended management strategies for a patient experiencing an anaphylactic reaction in a primary care setting?

Immediate management of an anaphylactic reaction in a primary care setting includes:

• Recognise the clinical features rapidly: airway compromise (pharyngeal or laryngeal oedema), breathing difficulties (bronchospasm with tachypnoea), circulatory problems (hypotension and/or tachycardia), and associated skin or mucosal changes.
• Administer intramuscular adrenaline promptly as the first-line treatment.
• Call emergency services immediately after administering adrenaline.
• Position the patient appropriately: lie flat with legs elevated unless breathing is difficult, in which case sitting up is acceptable; avoid sudden changes in position.
• Provide oxygen and support airway and breathing as needed.
• Monitor vital signs closely and be prepared to administer further doses of adrenaline if symptoms persist or worsen.
• Record the time of onset and clinical features of the reaction to assist diagnosis and future management.
• After initial emergency treatment, observe adults and young people (≥16 years) for 6 to 12 hours depending on response; children (<16 years) should be admitted under paediatric care.
• Arrange urgent referral to a specialist allergy service for further investigation, diagnosis, and ongoing management.
• Before discharge, provide the patient (or carers) with education on anaphylaxis recognition, adrenaline injector use (including a brand-specific demonstration), and the importance of carrying two adrenaline injectors at all times.
• Prescribe two additional adrenaline injectors as an interim measure before specialist review.
• Advise on avoidance of known triggers and inform about the risk of biphasic reactions.

These steps ensure immediate life-saving treatment and appropriate follow-up care to reduce future risk and improve patient safety.

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