OBJECTIVES: Anaphylaxis is a severe life threatening acute event that can have a number of triggers.  Specialist services are believed to be important in preventing recurrence and current lack of referral might mean high recurrence rates and unnecessary cost.  Also, lack of timely and correct use of adrenaline injectors might lead to significant excess mortality.  The study objective was therefore to assess the cost effectiveness of specialist service versus standard care with or without prescription of adrenaline injectors.  METHODS: A Markov model validated by clinical experts was constructed, which modeled anaphylaxis according to trigger, either food, drug, insect or idiopathic. Anaphylaxis mortality was modeled as a function of time to die and time for emergency response. Probabilistic sensitivity analysis on key parameters was performed. RESULTS: Standard care with injectors was dominated by specialist service with or without injectors. Specialist service with no injectors would be cost effective if the threshold for a Quality Adjusted Life Year was greater than about £740 and with injectors would be cost effective if the threshold was greater than £1800. These results were robust to all sensitivity analyses except at relatively extreme values of a small number of parameters. CONCLUSIONS: This is the first study to address the cost effectiveness of specialist service or adrenaline injectors in anaphylaxis.  The results showed that specialist service with adrenaline injectors was cost effective at a threshold of £20,000 per Quality Adjusted Life Year. More well designed prospective studies on the effectiveness of specialist services are needed to confirm these findings.