Fortnightly Review: Treatment of acute anaphylaxis

Benign allergic reactions should not be treated with adrenaline

“…EDITOR,--The case report of an anaphylactic reaction, presumably to nuts, and Malcolm Fisher's review of anaphylaxis and its treatment are timely 1. The management of children's anaphylactic reactions to foods has recently been reviewed,2 3 and our experience in childhood allergy--in particular, peanut allergy--prompts us to emphasise some additional points and to urge clarification of terminology.…”

“…Fatal and near fatal anaphylaxis related to foods most commonly occurs in patients who have had previous severe reactions, which makes the history crucial rather than “of little value,” as Fisher seems to suggest 1. A high risk of anaphylaxis related to food is associated with poorly controlled asthma and the requirement of oral corticosteroids and with delay in the administration of adrenaline 4…”

Avoid subcutaneous or intramuscular adrenaline

“…EDITOR,--Malcolm Fisher states that intravenous adrenaline should be used only in severe cases of anaphylaxis as it may cause arrhythmias1 and cites a publication by Waldhausen et al2 In this paper the doses given intravenously were up to 20 times the initial dose recommended by the Association of Anaesthetists of Great Britain and Ireland 3. Previous authors have also expressed misgivings about using intravenous adrenaline on the basis of anecdotal reports in which the speed of administration was not stated and other causes of arrhythmias were not excluded 4.…”

Treatment of acute anaphylaxis

“…EDITOR,--Malcolm Fisher's article on acute anaphylaxis was prompted by an anecdote concerning a doctor's panic when his young daughter developed an acute allergic reaction 1. The father ended up “ranting and raving” in the emergency department because his daughter had not received adrenaline immediately.…”