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Managing acute anaphylaxis

BMJ 1999; 319 doi: (Published 03 July 1999) Cite this as: BMJ 1999;319:1

New guidelines emphasise importance of intramuscular adrenaline

  1. Geoff Hughes, Clinical director (,
  2. Penny Fitzharris, Clinical immunologist and allergist (
  1. Emergency Services, Wellington Hospital, Wellington, New Zealand
  2. Department of Medicine, Wellington School of Medicine, Wellington, New Zealand

    Acute anaphylaxis is all too often poorly recognised and treated. Reasons for this include the wide (and sometimes surprisingly subtle) clinical manifestations; the rarity of presentation to any individual medical practitioner; and confusion arising from conflicting advice about the role, route, and dose of adrenaline (epinephrine). Adrenaline may not be given at all, even when it is clearly indicated. Although reliable epidemiological data on the incidence of acute anaphylaxis are lacking, emergency departments and emergency specialists have the biggest collective expertise and experience in its management. Against this background the new guidelines for the emergency treatment of acute anaphylactic reactions from the United Kingdom Resuscitation Council, published this month,1 are most welcome.

    The guidelines provide clear guidance for first responders in general practice or emergency departments. Although they are not intended to replace specific guidelines developed for defined subgroups of patients receiving treatment with anaesthetic agents, contrast materials, or immunotherapy (desensitisation), they may well become popular among clinicians dealing with these patients.

    The team that drew up the guidelines represented all the relevant clinical disciplines; this is important because, as the team points out, …

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