The Resuscitation Council of the United Kingdom recently updated its guidelines on the emergency treatment of anaphylactic reactions.1 The guidelines stress the importance of an early call for help from a resuscitation team or an ambulance. They introduce the ABCDE approach (airway, breathing, circulation, disability (level of consciousness), and exposure (of the skin)). They emphasise that prompt intramuscular injection of adrenaline (epinephrine) is the initial treatment of choice, along with other measures as indicated. These may include placing the patient in a comfortable position, providing airway management, giving high flow oxygen, and rapidly administering a large volume of intravenous fluid. They also advise subsequent referral to an allergy specialist for risk assessment and institution of long term measures to reduce risk.

No new drugs are available for the acute treatment of anaphylaxis. Currently used agents such as adrenaline, glucocorticoids, H₁ antihistamines, and H₂ antihistamines were introduced before the era of randomised controlled trials and evidence based medicine. Systematic reviews of these drugs are being conducted to document the existing evidence base.2 3 4 This consists of clinical experience and expert opinion, …