Resuscitation council update on anaphylaxis

4 June 2021

This guideline replaces the previous guideline from Resuscitation Council UK (RCUK): Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers (originally published January 2008, annotated July 2012 with links to NICE guidance).

  • Greater emphasis on intramuscular adrenaline to treat anaphylaxis and repeated after 5 minutes if Airway/Breathing/Circulation problems persist.
  • A specific dose of adrenaline is now included for children below 6 months of age.
  • Increased emphasis on the importance of avoiding sudden changes in posture and maintaining a supine position (or semi-recumbent position if that makes breathing easier for the patient) during treatment.
  • There are 2 algorithms: 
    • Initial treatment of anaphylaxis, with emphasis on repeating the dose of adrenaline after 5 minutes and giving an IV fluid bolus if Airway/Breathing/Circulation problems persist.
    • Treatment of refractory anaphylaxis, defined as anaphylaxis where there is no improvement in respiratory or cardiovascular symptoms despite two appropriate doses of IM adrenaline.
  • IV fluids are recommended for refractory anaphylaxis, and must be given early if hypotension or shock is present.
  • Antihistamines are considered a third-line intervention and should not be used to treat Airway/Breathing/Circulation problems during initial emergency treatment. Non-sedating oral antihistamines, in preference to chlorphenamine, may be given following initial stabilisation especially in patients with persisting skin symptoms (urticaria and/or angioedema).
  • Corticosteroids (e.g. hydrocortisone) are no longer advised for the routine emergency treatment of anaphylaxis.
  • New guidance is offered relating to the duration of observation following anaphylaxis, and timing of discharge

Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers | Resuscitation Council UK