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Review of the 2021 Resuscitation Council United Kingdom guideline for the emergency treatment of anaphylaxis
  1. Emily Ball1,
  2. Thomas Purchase2,
  3. Jeff Morgan1
  1. 1 Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
  2. 2 Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Emily Ball, Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK; emily.ball{at}

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It is estimated that 1 in 300 people will experience anaphylaxis at some point1 with approximately 20–30 deaths per year in the UK from anaphylaxis.2 The treatment, investigation and follow-up of patients with anaphylaxis are frequently suboptimal, with approximately 50% of anaphylaxis episodes not treated appropriately with intramuscular epinephrine (adrenaline),3 despite previous guidance recommending epinephrine as first-line 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).

Box 1

Definition of anaphylaxis

“A serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterised by potentially life-threatening compromise in airway, breathing and/or the circulation, and may occur without typical skin features or circulatory shock being present.”13

Development of the current guideline

This guideline, published in May 2021, provides an updated consensus about the recognition and treatment of anaphylaxis in adults and children.

The guideline is aimed at all healthcare providers who are expected to recognise and treat anaphylaxis during their usual clinical role. Due to the variation in knowledge and skills among healthcare professionals, there has been a focus on creating an easy-to-implement guideline that focuses on treatments that all patients with anaphylaxis should receive. The aim is to improve anaphylaxis guidance implementation and reduce harm and death resulting from anaphylaxis.

The guideline was produced by the Executive Committee of Resuscitation Council UK (RCUK), which formed a Working Group including experts with a background in paediatric allergy, anaesthetics, intensive care and emergency medicine. It is based on a review of the previous guideline, new international, evidence-based guidelines and a database of frequently asked questions. The key changes from previous guidelines are outlined in box 2, with links to the full …

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  • Contributors EB wrote the first version of the manuscript. JM oversaw and proof-read the manuscript. TP proof-read and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.