Box 1.
Summary recommendations from 2021 Resuscitation Council UK guideline, Emergency treatment of anaphylaxis: Guidelines for healthcare providers1
| Anaphylaxis is a potentially life-threatening allergic reaction characterised by sudden onset and rapid progression of airway, breathing and circulation (ABC) problems. |
| Skin and/or mucosal changes are common but can be absent in 10%–20% of cases of anaphylaxis. |
| Correct posturing is essential in the treatment of suspected anaphylaxis: changes in posture from supine to standing are associated with cardiovascular collapse and death. |
| Intramuscular (IM) adrenaline is the most important treatment of anaphylaxis and should be given as early as possible. |
| If ABC problems persist, a second dose of IM adrenaline should be given after 5 minutes. |
| Intravenous (IV) fluids are an important adjunct in the presence of shock or poor response to an initial dose of adrenaline. |
| Refractory anaphylaxis is when ABC problems persist despite two appropriate doses of IM adrenaline. |
| A refractory anaphylaxis algorithm is provided: IV adrenaline infusions form the basis of treatment for refractory anaphylaxis; seek urgent expert help to establish a low-dose, IV adrenaline infusion. IV adrenaline should be given only by experienced specialists in an appropriate setting. |
| Antihistamines can be helpful for treating the skin features of the allergic reaction, but must not be used to treat ABC problems or delay the use of adrenaline. |
| Corticosteroids (eg hydrocortisone) are no longer advised for the routine treatment of anaphylaxis, except after initial resuscitation for refractory reactions or ongoing asthma/shock. |
| A risk-stratified approach is recommended to guide the duration of observation following treatment of anaphylaxis. |