Editor,—The consensus guidelines on the emergency medical treatment of anaphylactic reactions by the Project Team of the Resuscitation Council (UK) are an excellent guide for first medical responders, whether general practitioners or emergency department staff.¹ They are pragmatic, safe, and emphasise the importance of first line treatment with oxygen, adrenaline (epinephrine) and fluids, and as Hughes and Fitzharris in their BMJ editorial suggest, rightly deserve to “ . . . adorn the walls of emergency departments, general practitioners' surgeries, and outpatient clinics . . .”.²

The guidelines usefully remind us that a panic attack or a vasovagal syncopal episode may be confused with anaphylaxis with the danger of inappropriate treatment. Additional differentiating features not mentioned in the text that suggest a faint rather than anaphylactic collapse are the rapidity of onset, maintenance of a central pulse, and prompt response to the recumbent position.^{3, 4}

It is refreshing to see the debate over the delivery …