EDITOR,--Malcolm Fisher's review highlights the need for adrenaline along with volume replacement in the management of severe systemic anaphylaxis.1 This observation was recognised by the Association of Anaesthetists of Great Britain and Ireland, which in 1990 produced a booklet for all members2 and a wall chart for the theatre area.

As Fisher states, cardiovascular collapse is a common feature of anaphylaxis, but, particularly in the context of surgery, it is not the only diagnosis that has to be considered: myocardial infarction, pulmonary embolus, and concealed hypovolaemia are some of the diagnoses that have to be excluded. The …