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Guideline review: Epinephrine use in anaphylaxis (AAP guideline 2017)
  1. Nicola Goodall
  1. Department of Paediatrics, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
  1. Correspondence to Dr Nicola Goodall; nikki.goodall256{at}

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Anaphylaxis is a severe, life-threatening, hypersensitivity reaction, which can progress rapidly and may cause death. The UK incidence was shown to increase over a 20-year period from 1992 to 2012, with a rise from one to seven cases arising in 1 year, per 100 000 population.1 However, anaphylaxis is not always appropriately recognised and so the true incidence is likely to be underestimated.

Clinical presentation varies and can differ in the same patient from one episode to another. Cutaneous manifestations occur in 80%–90% of children, respiratory involvement in 60%–70% and cardiovascular compromise is less common, with 10%–30% of children being affected.2 3

Information about the current guideline

In February 2017, the American Academy of Pediatrics (AAP) published a clinical report entitled ‘Epinephrine for First-aid Management of Anaphylaxis’4 (see box 1). This report focuses on helping clinicians identify patients at risk of anaphylaxis and updates prescribing information for epinephrine and autoinjectors. It also confirms that epinephrine is the medication of choice for the first aid treatment of anaphylaxis. This report does not discuss the use of second-line medications, such as antihistamines and steroids, which is covered in previous UK guidelines (box 1).

Box 1


  • American Academy of Pediatrics Clinical Report 2017

  • Resuscitation Council (UK) guidelines 2008

  • National Institute for Health and Care Excellence (NICE) clinical guideline

Previous guidelines

The Resuscitation Council (UK) published guidelines aimed at all healthcare providers for ‘Emergency treatment of anaphylactic reactions’ in January 2008, and then in 2012 added annotated links to the 2011 National Institute for Health and Care Excellence (NICE) guidance5 (box 1). The Resuscitation Council guidelines aimed to simplify the recognition and treatment of anaphylactic reactions using an ‘ABCDE’ approach with emphasis on early use of intramuscular epinephrine. The NICE guidance focuses on the assessment and referral after emergency treatment only.

There are also …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.