National Institute for Health and Clinical Excellence (NICE)
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Preventing harm to people with drug allergies

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

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 allergic2.

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.

Dr Shuaib Nasser, Consultant Allergist, Addenbrooke’s Hospital, Cambridge and Chair of the Guideline Development Group, said: “Wrongly prescribing drugs to people with known allergies puts them at serious risk of harm but we know this can be avoided. It is important that this is done, as some allergic reactions can be fatal.

“The guideline stresses the care all healthcare professionals must take when documenting new drug allergies and the importance of sharing this information with patients and other healthcare professionals. People should be provided with structured written information on drugs to avoid and be advised to check with their pharmacist before taking over-the-counter medicines. In some cases specialist investigations will be required to confirm or exclude drug allergy.”

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.

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.”

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors


  1. Hospital Episode Statistics from 1996 to 2000 reported that drug allergies and adverse drug reactions accounted for approximately 62,000 hospital admissions in England each year.
  2. Analysis of patient safety incidents reported to the National Reporting and Learning System between 2005 and 2013 identified 18,079 incidents involving drug allergy. These included 6 deaths, 19 ‘severe harms’, 4,980 ‘other harms’ and 13,071 'near-misses'. The majority of these incidents involved a drug that was prescribed, dispensed or administered to a patient with a previously known allergy to that drug or drug class.
  3. The guideline Drug allergy: diagnosis and management of drug allergy in adults, children and young people will be available on the NICE website from Wednesday 3 September 2014.

About the guidance

Embargoed copies of the draft guidance are available from the NICE press office on request.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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