Emergency treatment of anaphylactic reactions

May 24, 2002 10:50 am

Purpose of this guideline

The UK incidence of anaphylactic reactions is rising. Despite previous guidelines, there is confusion about the diagnosis, treatment, investigation and follow-up of patients who have an anaphylactic reaction.

This guideline replaces the previous guidance from the Resuscitation Council UK:

The emergency medical treatment of anaphylactic reactions for first medical responders and for community nurses (originally published July 1999, revised January 2002, May 2005).

This guideline gives:

  • An updated consensus about the recognition and treatment of anaphylactic reactions.
  • A greater focus on the treatments that a patient having an anaphylactic reaction should receive. There is less emphasis on specifying treatments according to which specific groups of healthcare providers should give them.
  • Recommendations for treatment that are simple to learn and easy to implement, and that will be appropriate for most anaphylactic reactions.

There are no randomised controlled clinical trials in humans providing unequivocal evidence for the treatment of anaphylactic reactions; moreover, such evidence is unlikely to be forthcoming in the near future. Nonetheless, there is a wealth of experience and systematic reviews of the limited evidence that can be used as a resource.

This guideline will not cover every possible scenario involving an anaphylactic reaction; the guidance has been written to be as simple as possible to enable improved teaching, learning and implementation. Improved implementation should benefit more patients who have an anaphylactic reaction.

Scope of this guideline

This guideline is for healthcare providers who are expected to deal with an anaphylactic reaction during their usual clinical role (e.g., doctors, nurses, paramedics) working in the hospital or out-of-hospital setting. There is considerable variation and overlap between the skills and knowledge of different healthcare providers who are expected to treat an anaphylactic reaction. We have therefore deliberately not developed guidelines for specific groups of healthcare provider.

Individuals who are involved in resuscitation regularly are more likely to have advanced resuscitation skills than those who are not. This guideline does not expect individuals to obtain intravenous access in an emergency if this is not part of their usual role. Rather, individuals should use skills that they know and use regularly. This will make it more likely that these skills are used effectively on the rare occasions when they are needed to treat an anaphylactic reaction. Any extra skills specifically for the treatment of a patient with an anaphylactic reaction should be reasonably easy to learn, remember and implement (e.g., intramuscular (IM) injection of adrenaline).

The Association of Anaesthetists of Great Britain & Ireland and the British Society for Allergy and Clinical Immunology have published specific guidance for the treatment of anaphylactic reactions associated with anaesthesia (www.aagbi.org and www.bsaci.org).

There is also specific guidance for managing medicines in schools, nurseries and similar settings (www.allergyinschools.org.uk and www.medicalconditionsatschool.org.uk).

The treatment of a patient having an anaphylactic reaction in any setting is the same for children and adults. Any differences will be highlighted.

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