Anaphylaxis: a distributive emergency

Anaphylaxis, even for those prepared and experienced in its management, is a frightening scenario for patients and clinicians alike. It is best managed by simultaneous team-based emergency resuscitation, and the fundamentals to success remain the following: recognition; prompt assistance; early treatment with adrenaline (epinephrine); vigilance, monitoring and escalation if required; and recovery, safety netting and referral (with investigations and history). Anaphylaxis has a varied clinical phenotype, which means that it is often poorly identified, undertreated and thus inadequately followed up. The Resuscitation Council UK's definition is pragmatic with good sensitivity. Adrenaline is the life-saving drug but unfamiliarity with its location, dosing and preparation can lead to delay in administration and dosing errors. Patients exposed to easily avoidable triggers may not necessarily need to be discharged with an adrenaline autoinjector. Alongside local protocols, British Society for Allergy and Clinical Immunology and the National Institute for Health and Care Excellence guidelines should be consulted.