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Anaphylaxis treatment protocols amended

The Resuscitation Council (UK) has revised its guidelines for the treatment of anaphylactic reactions.

The Resuscitation Council (UK) has revised its guidelines for the treatment of anaphylactic reactions.

The incidence of anaphylactic reactions is rising, with a 700% increase in admissions from 0.5 to 3.6 per 100,000 between 1990 and 2004. Mortality is low with about 20 deaths annually, and, reassuringly, no vaccines were implicated in fatal anaphylactic reactions between 1992 and 2001.

Stings, nuts, anaesthetic agents and antibiotics are the commonest fatal triggers.

The recognition of an anaphylactic reaction has now been simplified and the ABCDE approach is now incorporated in the algorithm.

Minor changes have been introduced in treatment protocols. Chlorpheniramine is now renamed chlorphenamine, a change already applied in the BNF.

Standard doses are substituted both for chlorphenamine (10mg in an adult) and hydrocortisone (200mg in an adult), replacing variable dosing, and both can be given IV or IM.

Adrenaline is always given IM unless an experienced specialist is present when it can be given IV.

Doses for children are incorporated.

Mast cell tryptase can be measured to confirm diagnosis but only starts to increase after 30 minutes, peaks at 1-2 hours, and returns to normal after 6-8 hours.

Correct needle length ensures that IM injections are given into muscle (anterolateral aspect of the middle third of the thigh) and not fat.

Sixteen mm needles should only be used for preterm or very small infants, and 25mm needles are suitable for all ages except the obese for whom 38mm needles may be required.

A PDF format of the guidelines can be downloaded here.

Nuts

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