“My face and throat swelled up at the restaurant — A&E sent me to you for a ‘plan’”

Anaphylaxis aftercare is a structured, examinable package. First, confirm the episode was ANAPHYLAXIS — acute onset with AIRWAY (throat tightness/swelling), BREATHING (wheeze/dyspnoea) and/or CIRCULATION (lightheadedness/hypotension/collapse) involvement, usually with skin/mucosal changes — and reinforce that it is life-threatening and that future reactions can be worse, which justifies the plan and auto-injector. The critical teaching is that intramuscular ADRENALINE into the outer thigh is the FIRST-LINE, life-saving treatment given EARLY, and that antihistamines and steroids are NOT a substitute. PRESCRIBE and TEACH the adrenaline auto-injector — technique (cap off, firm injection into the outer mid-thigh, held in place, through clothing if needed), carrying TWO devices at all times (a second dose may be needed and devices can fail), checking expiry and replacing, and training household/partner — using a trainer pen with teach-back. Provide a personalised WRITTEN ACTION PLAN: recognise → adrenaline early → call 999 (state "anaphylaxis") → lie FLAT with legs raised (do not stand or walk — risk of fatal hypotension; sit up only if breathing is easier) → SECOND dose at 5 minutes if no improvement → stay with help — and counsel the BIPHASIC reaction risk, so 999/observation is needed even if the pen works. Recognise that A&E discharge without an auto-injector or specialist referral is a gap against NICE NG258, which advises offering auto-injectors as an interim measure and referral to a specialist allergy service after emergency treatment; arrange ALLERGY CLINIC referral for confirmatory specific-IgE/skin-prick testing, trigger identification (likely peanut ± cross-reactive tree nuts) and dietetic advice, and counsel AVOIDANCE (label-reading, cross-contamination, informing restaurants, allergy card/MedicAlert), asking about asthma and co-factors (alcohol, exercise, NSAIDs) that raise the risk of a severe reaction. Finally, acknowledge and address the psychological impact — anxiety and hypervigilance are common after a near-fatal event — ensure he leaves with two in-date devices and the written plan, confirm competence, and follow up.