Anaphylaxis assessment and adrenaline pen training
A specialist allergy appointment to work out what causes your severe reactions, plan how to avoid triggers, and train you to use an adrenaline pen safely in an emergency.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The appointment confirms your triggers, judges your risk, and gives you a written emergency plan plus hands-on adrenaline pen training.
- It does not cure allergy or guarantee you will never react again — avoidance and a fast adrenaline response are what protect you.
- In anaphylaxis: give adrenaline first, call 999 and say 'anaphylaxis', lie down with legs raised, and give a second pen after 5 minutes if no better.
- Carry two in-date pens at all times, check expiry dates, and have your technique and plan reviewed at least once a year.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
A clearer idea of what triggers your reactions and how to avoid them
If you are having a reaction right now, this is an emergency — use adrenaline if available and call 999 rather than waiting for an appointment.
You usually leave with a written anaphylaxis action plan, a trainer pen if offered, and a prescription for two adrenaline auto-injectors. Skin-test...
A written, personalised anaphylaxis action plan you and others can follow.
You usually leave with a written anaphylaxis action plan, a trainer pen if offered, and a prescription for two...
Any blood-test results come back and the plan may be fine-tuned. Collect your pens promptly and check the expiry...
Share your plan with family, school or work. Set expiry reminders. Practise with a trainer pen until the steps...
Have your technique, plan and pen expiry reviewed at least once a year, or sooner if you have another reaction or...
What is an anaphylaxis assessment and adrenaline pen training?
Anaphylaxis is a severe, fast allergic reaction that can affect breathing and blood pressure and can be life-threatening. An anaphylaxis assessment is an appointment with an allergy specialist to confirm what you are reacting to, judge how much risk you carry, and make a clear plan to keep you safe.
The appointment usually covers your history in detail, may include skin-prick or blood tests for specific triggers, and ends with a written emergency plan. A key part is training you (and the people around you) to use an adrenaline auto-injector — a pre-filled 'pen' such as EpiPen, Jext or Emerade — correctly and without hesitation.
This is not a cure for allergy. It cannot promise you will never react again. What it can do is reduce your chance of a serious reaction through avoidance, and make sure that if one happens, adrenaline is given quickly, which is the single most important treatment.
Adrenaline is the first-line treatment for anaphylaxis. Antihistamines and inhalers are not a substitute and must never delay adrenaline.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Adrenaline pen versus antihistamines and inhalers
| Adrenaline pen | Antihistamine / inhaler | |
|---|---|---|
| Treats anaphylaxis | Yes — first-line | No — not a substitute |
| How fast it works | Within minutes | Too slow for severe reactions |
| When to use | Any breathing or circulation symptoms | Mild, skin-only symptoms only |
| Can it replace calling 999 | No — always call 999 | No |
Antihistamines may help mild itching or hives, but they do not treat the breathing or blood-pressure problems of anaphylaxis. Never let them delay adrenaline.
Preparing for your treatment
- Write down exactly what happened in past reactions: what you ate or touched, how quickly symptoms came on, and how they were treated.
- Bring photos of any rash or swelling, and packaging or ingredient lists of suspected foods if you have them.
- Bring a full list of your medicines, including any beta-blockers or ACE inhibitors, which can affect treatment.
- Bring your current adrenaline pens (and any that have expired) so your technique and devices can be checked.
- Ask whether antihistamines need to be stopped before skin testing, as they can affect the results.
- If you have asthma, note how well controlled it is — poorly controlled asthma raises the risk from allergic reactions.
- Bring a partner, parent or carer if you can, so they can learn the emergency steps too.
What happens
The specialist takes a careful history of your reactions and your overall health. They will ask about timing, symptoms, suspected triggers, other allergies, asthma and family history.
You may have skin-prick testing, where tiny drops of allergen are placed on the skin and gently pricked, and/or a blood test for specific IgE. Results are always read together with your story, because tests can be positive in people who are not at risk.
You then practise with a trainer pen until you and anyone with you are confident. The specialist explains when to use adrenaline, that there is no harm in using it if you are unsure, and what to do afterwards. You usually leave with, or are sent, a written anaphylaxis action plan, and a prescription for two in-date pens.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- If you are having a reaction right now, this is an emergency — use adrenaline if available and call 999 rather than waiting for an appointment.
- Routine 'food intolerance' symptoms such as bloating without true allergic features are not anaphylaxis and need a different approach.
- Recent antihistamine use can make skin testing unreliable, so the test may need to be delayed.
- Skin testing may not be suitable if you have widespread skin disease or cannot stop interfering medicines.
Delay or rearrange if…
- You have an active severe infection or are acutely unwell.
- You have recently had a reaction and your skin or system needs time to settle before testing.
- You are taking antihistamines that would mask skin-test results and cannot yet stop them.
- Your asthma is poorly controlled — this should be optimised, as it raises the risk from any reaction.
Alternatives to discuss
- A thorough history alone with a written plan and pens, where testing is not needed or not possible.
- Specific IgE blood testing instead of skin testing if skin tests cannot be done.
- Referral for desensitisation (immunotherapy) for selected triggers such as insect venom.
- Dietitian input for food triggers, alongside the allergy plan.
- No testing if the trigger is already clear and avoidable, focusing on the plan and pens.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- A clearer idea of what triggers your reactions and how to avoid them
- A personalised, written plan you and others can follow in an emergency
- Confidence and correct technique in using an adrenaline pen
- Family members or carers trained to act quickly if you cannot
- A chance to review whether your asthma and other risks are well controlled
- Advice on medical-alert jewellery and informing schools or workplaces
Risks & complications
- Mild discomfort, itching or small bumps where skin testing is done
- Anxiety about future reactions, which a clear plan can help reduce
- Test results that need careful interpretation and do not always give a yes/no answer
- A larger local reaction to skin testing that settles with treatment
- Uncertainty about the exact trigger when several foods or factors are involved
- Needing further appointments or a supervised challenge to confirm or rule out a trigger
- A more significant allergic reaction during skin testing — clinics are equipped to treat this immediately
- A trigger that cannot be identified despite full assessment (idiopathic anaphylaxis)
The biggest real-world risk is not the assessment itself but a future reaction being treated too slowly. Make sure you leave with two in-date pens, a written plan, and confidence about exactly when to use adrenaline. Ask the specialist how poorly controlled asthma, beta-blockers or ACE inhibitors affect your plan.
Published figures to discuss
Anaphylaxis risk is hard to express as a single number because it depends on the trigger, the dose, your other conditions (especially asthma), and how quickly adrenaline is given. Skin and blood tests can be positive in people who never react, and negative in some who do, so they are read alongside your history rather than as a pass/fail. Figures below are broad and for context only.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Skin-prick testing causing a systemic reaction | Rare | Allergy clinics are equipped to treat reactions immediately; serious events are uncommon but the reason testing is done in a suitable setting. | Guide sourcesClinical context |
| Recurrence of anaphylaxis over time in people with a confirmed trigger | Varies widely by trigger and exposure | This is why carrying two pens and avoiding triggers matters even after a long symptom-free period. | Guide sourcesClinical context |
| Need for a second adrenaline dose | A minority of reactions; guidance advises a second dose after 5 minutes if symptoms are not improving | This is why UK guidance recommends carrying two in-date adrenaline auto-injectors. | Guide sourcesClinical context |
| Biphasic or protracted anaphylaxis | Uncommon but recognised; reported rates vary widely between studies | Symptoms can return after initial improvement, so emergency assessment after adrenaline remains necessary. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the appointment. 'Afterwards' is mostly about putting the plan into practice — carrying your pens, sharing the plan, and arranging review.
- Feeling more anxious for a while as you take in the diagnosis — this usually eases with a clear plan
- Small itchy bumps from skin testing that settle within hours
- Needing to re-read your plan a few times before it feels familiar
- Practising the trainer pen more than once to feel confident
Aftercare
- Carry two in-date adrenaline pens with you at all times, not in a car or left at home.
- Check expiry dates regularly and reorder before they run out.
- Keep your written anaphylaxis plan with your pens and a copy on your phone.
- Tell family, friends, school or workplace where your pens are and how to use them.
- Use adrenaline first in a reaction — do not wait to 'see if it settles' or rely on antihistamines.
- After using a pen, always call 999 and go to hospital, even if you feel better.
- Consider medical-alert jewellery stating your allergy.
- Book an annual review of your plan, technique and pen expiry dates.
- Two in-date adrenaline pens obtained and carried
- Written anaphylaxis action plan saved (paper and phone)
- Expiry-date reminder set
- Family or carers shown how and when to use the pen
- School or workplace informed and supplied if relevant
- Trainer pen practised until confident
- Medical-alert jewellery considered
- Annual review booked
⚠ Get urgent help if…
- Difficulty breathing, wheezing, or noisy breathing
- Swelling of the throat, tongue or lips, or a hoarse voice or trouble swallowing
- Feeling faint, dizzy, or collapsing
- Skin or lips turning pale, grey or blue
- A sense of impending doom alongside a spreading rash
- Any of these signs: give adrenaline immediately, call 999 and say 'anaphylaxis', and lie down with legs raised
- No improvement 5 minutes after the first pen: give the second pen
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is a confident understanding of your triggers, a clear written plan, and the skill to use adrenaline without hesitation. For many people, testing confirms one or two specific triggers that can be avoided.
The assessment cannot promise you will never react again, and it cannot always pin down a single cause. A normal or unclear test does not always mean you are not at risk, which is why the plan and your pens matter regardless. The aim is to make any future reaction as survivable as possible.
Your plan needs reviewing at least yearly, and sooner if you have another reaction, develop new allergies, become pregnant, change weight (which can affect pen choice in children), or your asthma control changes. Adrenaline pens expire and must be replaced before the expiry date, as out-of-date adrenaline may be less effective.
Related tests, treatments or support
An anaphylaxis assessment is often combined with a wider allergy review, asthma assessment, or food-allergy testing, because these conditions frequently travel together. Some people are also assessed for whether desensitisation (immunotherapy) to specific triggers, such as wasp or bee venom, might be suitable.
Follow-up & long-term care
You should leave with, or be sent, a written anaphylaxis action plan and a prescription for two pens. Blood results usually return within a couple of weeks. Most people are offered at least annual review of their plan and technique; ask who to contact if you have another reaction in the meantime.
- Replace adrenaline pens before they expire
- Re-check your technique at every review and after any reaction
- Update your plan if triggers, weight (in children) or asthma control change
- Refresh training for new carers, schools or employers
- Re-stock spare pens kept at school or work
Repeat, follow-on and what comes next
- Testing sometimes needs repeating, or a supervised challenge arranged, when results and history do not match.
- No trigger is found in a proportion of people despite full assessment (idiopathic anaphylaxis); the plan and pens still apply.
- Plans are revised over time as allergies change, especially in children who may outgrow some foods.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A written, personalised anaphylaxis action plan you and others can follow.
- Hands-on training with a trainer pen for you and your carers.
- Two in-date pens and a clear system for replacing them before expiry.
- A named route to contact the service after any reaction.
- At least annual review of triggers, technique, asthma control and the plan.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Length and complexity of the appointment (single trigger versus several)
- Number and type of tests, such as skin-prick testing or specific IgE blood tests
- Specialist component blood tests in selected cases
- Whether a written action plan and trainer pen are provided
- Cost of adrenaline pens themselves, which are prescribed separately
- Follow-up appointments and annual review
- Whether any desensitisation (immunotherapy) is later recommended
- The specialist's consultation fee
- Which tests are included and the cost of any extra blood tests
- Whether a written anaphylaxis action plan is provided
- Whether adrenaline pens are included or prescribed separately
- Cost of follow-up or annual review appointments
- What happens, and what it costs, if results are inconclusive and further testing is needed
- Cancellation policy
On the NHS? Allergy assessment and adrenaline auto-injectors are available on the NHS when clinically indicated; private clinics may be used for speed, choice of specialist or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being given pens without hands-on training or a clear written plan.
- Being told antihistamines or an inhaler are enough for a severe reaction.
- Leaving with only one pen rather than two.
- No advice on expiry dates, replacement, or annual review.
- Test results presented as a definite yes/no without explaining their limits.
Marketing red flags
- Claims that a blood test can 'rule out' all dangerous allergy.
- Selling unproven 'allergy' or 'intolerance' tests as a way to find anaphylaxis triggers.
- Promising a 'cure' for severe allergy.
- Suggesting you do not need to carry pens if avoidance is 'careful enough'.
- Downplaying the need to call 999 after using adrenaline.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What exactly am I allergic to, and how confident are you given my history and tests?
- Which adrenaline pen is right for me, and how do I use it step by step?
- How does my asthma, or any beta-blocker or ACE inhibitor, affect my plan?
- What counts as a reaction serious enough to use the pen?
- Could desensitisation (immunotherapy) help in my case?
- How often should my plan and technique be reviewed, and who do I contact after a reaction?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I have this assessment on the NHS?
Will the testing tell me exactly what I am allergic to?
Does using an adrenaline pen hurt, and what if I use it by mistake?
Why do I need to carry two pens?
Do I still need to call 999 if the pen works?
Can my allergy be cured?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Anaphylaxis NICE QS119 — Anaphylaxis quality standard (auto-injector training) NICE QS119 — Ongoing training in auto-injector use BSACI — Adrenaline auto-injector prescribing guidance (2023) Anaphylaxis UK — patient information and support Allergy UK — anaphylaxis information
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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