Anaphylaxis

The incidence of anaphylaxis in the United Kingdom is unknown but estimated to be between 10-20 cases per 100 000 population a year, with half of these iatrogenic.1 About 20 deaths are reported a year and a series of complications and deaths have been reported as a result of the administration of adrenaline (epinephrine).2 Case studies have reported complications after the incorrect administration of adrenaline, including acute myocardial infarction and ventricular tachycardia, even with low dose intravenous adrenaline (0.1mg 1:10 000).34

Confusion exists among junior doctors about the dose and route of administration of adrenaline in anaphylaxis.56 A survey in the United Kingdom found that almost all junior doctors would use adrenaline as the life saving drug of choice but only 16.8% would give it as recommended by the UK Resuscitation Council.5

After it was found that training in resuscitation and intensive care were neglected in UK undergraduate education, the acute care undergraduate teaching initiative was developed in 2005 to improve the care of acutely ill patients. One of the important competencies is to recognise and start treatment for an anaphylactic reaction.7