The Resuscitation Council UK has updated its Guideline for healthcare providers on the Emergency treatment of anaphylaxis. As part of this process, an evidence review was undertaken by the Guideline Working Group, using an internationally-accepted approach for adoption, adaptation, and de novo guideline development based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework, referred to as GRADE-ADOLOPMENT. A number of significant changes have been made, which will be reflected in the updated Guideline.These include: emphasis on repeating intramuscular adrenaline doses after 5 min if symptoms of anaphylaxis do not resolve; corticosteroids (e.g. hydrocortisone) no longer being routinely recommended for the emergency treatment of anaphylaxis; interventions for reactions which are refractory to initial treatment with adrenaline; a recommendation against the use of antihistamines for the acute management of anaphylaxis; and guidance relating to the duration of observation following anaphylaxis, and timing of discharge.

There is no established definition for refractory anaphylaxis. The European Anaphylaxis Registry use a definition of "anaphylaxis which, despite treatment with at least two doses of minimum 300 μg adrenaline, does not achieve normalization" of symptoms. 1 A US-based panel recently proposed a reaction which "must be treated with 3+ appropriate doses of epinephrine (or initiation of an intravenous epinephrine infusion)" 2 -a definition which does not specifically refer to treatment response, although this is implied. The Resuscitation Council UK (RCUK) recently updated its guideline on the emergency treatment of anaphylaxis, defining refractory anaphylaxis as a reaction "requiring ongoing treatment despite two (appropriate) doses of intramuscular adrenaline" and proposes an algorithm to facilitate management (Figure 1). 3Refractory anaphylaxis is rare: the European Registry reported a rate of 0.37% of all anaphylaxis cases reported in the registry, with

We report a Delphi Consensus modification and first validation study of the Autism Diagnostic Observation Schedule – 2 with deaf children and young people (ADOS-2 Deaf adaptation). Validation included 122 deaf participants (aged 2–18 years), 63 with an Autism Spectrum Disorder (ASD). This was compared to a National Institute for Health and Clinical Excellence (NICE) guideline standard clinical assessment by blinded independent specialist clinicians. Results showed overall sensitivity 73% (95%CI 60%, 83%); specificity 71% (95%CI 58%, 82%), and for the more common modules 1–3 (combined as in previous studies) sensitivity 79% (95% CI 65–89%); specificity 79% (95% CI 66–89%) suggesting this instrument will be a helpful addition for use with deaf children and young people.

There are approximately 20-30 deaths reported each year due to anaphylaxis in the UK, but this may be a significant underestimate; approximately 10 anaphylaxis deaths each year are due to foods, and another 10 due to perioperative anaphylaxis. 6 The most common triggers are food, drugs and venom. 4 Food is the most common trigger in young people: teenagers and adults up to the age of 30 years appear to be at greatest risk of fatal food-induced reactions. 4,5 In contrast, the rate of druginduced anaphylaxis is highest in the elderly, probably due to the combination of comorbidities (such as cardiovascular disease) and polypharmacy (including beta-blockers and angiotensinconverting-enzyme (ACE) inhibitors). 4,7 The diagnosis is supported if there is exposure to a known trigger, however, in up to 30% of cases, there may be no obvious trigger ('idiopathic' or 'spontaneous' anaphylaxis). The characteristics of anaphylaxis to the most common causes are shown in Table 1. 1,8 Anaphylaxis is a clinical diagnosis that lies along a spectrum of severity of allergic symptoms (Fig 1 ), and no symptom is entirely specific for the diagnosis.

Objectives: Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. Methods: We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Results: Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. Conclusion: In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.