Reviewing the content and design of anaphylaxis management plans published in English

Background: Guidelines recommend that patients at risk of anaphylaxis are given an anaphylaxis management plan (AMP) providing advice on symptom recognition and emergency management. However, the format and content of plans is not standardised. Objective: To review the design and contents of different AMPs available in English. Methods: A systematic internet search identified AMPs published online. Each plan was analysed for design and content (including signs and symptoms indicative of anaphylaxis and the actions to be taken). The content was compared with a Delphi derived statement of the key characteristics of an AMP. Results: The systematic search identified 41 plans from 29 different sources. The majority of plans identified were personalised management plans for individuals (78%), the others were designed for institutions. Most AMPs addressed both mild/moderate and severe allergic reactions and had different instructions related to the degree of severity. Thirty seven individual symptoms were mentioned as indicators of anaphylaxis. Only 55% of plans that recommended the administration of an adrenaline auto-injector gave further instructions on how to do this. Only 17% of plans contained comprehensive instructions on safe patient positioning. Conclusions: There are a wide variety of AMPs in English available online. Plans are similar in design, but differ in content. None of the currently available plans contain all the desirable components recommended in the literature. Because of the variation between plans, when practitioners are selecting an AMP for their patient they need to be attentive to the content of the plan and its appropriateness for that individual.