Intended for healthcare professionals


Managing acute anaphylaxis

BMJ 2000; 320 doi: (Published 01 April 2000) Cite this as: BMJ 2000;320:937

This article has a correction. Please see:

Intravenous adrenaline should be considered because of the urgency of the condition

  1. Arv Sadana, senior consultant in emergency medicine,
  2. Charlie O'Donnell, consultant in emergency and intensive care medicine,
  3. Martin T Hunt, consultant in emergency medicine,
  4. M Gavalas, senior lecturer in emergency medicine
  1. Whipps Cross Hospital, London E11 1NR
  2. University College Hospital, London WC1E 6AU
  3. Department of Medicine, Wellington School of Medicine, Wellington, New Zealand
  4. Emergency Services, Wellington Hospital, Wellington, New Zealand

    EDITOR—The unequivocal support in the editorial by Hughes and Fitzharris for the Resuscitation Council's guidelines on the emergency medical treatment of anaphylactic reactions is perhaps a little rash.1 2 Though we were delighted to see the use of subcutaneous adrenaline finally laid to rest and the promotion of early intravenous fluids to overcome the rapidly evolving distributive shock, we think that in the case for intravenous adrenaline the urgency of the condition was not given due regard.

    We consider it a dangerous precedent not to recommend intravenous adrenaline in appropriate doses with appropriate monitoring to medical staff in emergency medicine (be they specialists in emergency medicine, general physicians doing acute medical takes, or intensivists). We agree that intravenous adrenaline can be dangerous, but the mortality associated with this condition is undoubtedly directly proportional to the failure of intramuscular or subcutaneous adrenaline to enter the circulation in patients with significant distributive shock and greatly …

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