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Anaphylaxis is the quintessence of emergency medicine. It occurs unexpectedly often in the young and otherwise healthy,1 may progress rapidly from an innocuous presentation, is potentially fatal particularly if mistreated, has no bedside diagnostic test of value mandating pure clinical recognition, responds dramatically to treatment (adrenaline (epinephrine)), and usually allows discharge within six to eight hours in the absence of a biphasic response.2
When the Project Team of the Resuscitation Council (UK) first published their consensus guidelines on the Emergency medical treatment of anaphylactic reactions aimed exclusively at first medical responders, inexperienced in the management of this emergency,3 they drew the customary howls of dissent that seem to beset all reasonable attempts to define good medical practice in the treatment of acute anaphylaxis.4 The same happened after Fisher published his excellent paper on Treatment of acute anaphylaxis in the British Medical Journal,5 which was followed by no less than 10 letters in response, many of which contained errors of logic.2 More pertinently …