Review of the 2021 Resuscitation Council United Kingdom guideline for the emergency treatment of anaphylaxis

To cite: Ball E, Purchase T, Morgan J. Arch Dis Child Educ Pract Ed Epub ahead of print: [please include Day Month Year]. doi:10.1136/ archdischild2022324432 © Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. BACKGROUND It is estimated that 1 in 300 people will experience anaphylaxis at some point with approximately 20–30 deaths per year in the UK from anaphylaxis. The treatment, investigation and followup of patients with anaphylaxis are frequently suboptimal, with approximately 50% of anaphylaxis episodes not treated appropriately with intramuscular epinephrine (adrenaline), despite previous guidance recommending epinephrine as firstline treatment. This is often due to a failure to recognise anaphylaxis which can be difficult due to the variety of signs and symptoms that may occur, none of which are specific to anaphylaxis (defined in box 1).

[1]  J. Bartra,et al.  Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis , 2021, The Journal of allergy and clinical immunology.

[2]  A. Davies,et al.  Recommendations on the Use of Open Surgical and Endovascular Aneurysm Repair for the Management of Unruptured Abdominal Aortic Aneurysm from the Guideline Development Committee Appointed by the UK National Institute for Health and Care Excellence. , 2021, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[3]  A. Sheikh,et al.  World allergy organization anaphylaxis guidance 2020 , 2020, The World Allergy Organization journal.

[4]  M. Fernández-Rivas,et al.  Risk factors and characteristics of biphasic anaphylaxis. , 2020, The journal of allergy and clinical immunology. In practice.

[5]  Sage T. Hellerstedt,et al.  Anaphylaxis - a 2020 Practice Parameter Update, Systematic Review and GRADE Analysis. , 2020, The Journal of allergy and clinical immunology.

[6]  E. Grafstein,et al.  Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. , 2014, Annals of emergency medicine.

[7]  A. Sheikh,et al.  The epidemiology of anaphylaxis in Europe: a systematic review , 2013, Allergy.

[8]  J. Soar,et al.  Anaphylaxis admissions to UK critical care units between 2005 and 2009 , 2012, Anaesthesia.

[9]  J. Soar,et al.  Emergency treatment of anaphylactic reactions--guidelines for healthcare providers. , 2008, Resuscitation.

[10]  L. Schwartz Diagnostic value of tryptase in anaphylaxis and mastocytosis. , 2006, Immunology and allergy clinics of North America.

[11]  Pumphrey Lessons for management of anaphylaxis from a study of fatal reactions , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[12]  D. Campbell,et al.  Current Opinion in Allergy & Clinical Immunology Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis? , 2016 .

[13]  Vibha Sharma,et al.  Food , drug , insect sting allergy , and anaphylaxis Increase in anaphylaxis-related hospitalizations but no increase in fatalities : An analysis of United Kingdom national anaphylaxis data , 1992-2012 , 2022 .