Adrenaline in anaphylaxis: overtreatment in theory, undertreatment in reality

'Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its management'.1 Few health professionals would disagree with this opening sentence of new guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), which aim to provide evidence-based recommendations for recognition, risk assessment, and management of patients who have experienced, are experiencing or are at risk of experiencing anaphylaxis. This care requires correct recognition of anaphylaxis, appropriate acute management and optimal long-term care: all important but distinct skills. Guidelines clarify what treatment should be given to whom and when. It would be hoped that, over time with codification of best practice, doctors' abilities to accurately recognise and appropriately treat anaphylaxis would improve. However, Plumb and colleagues found, using brief written case scenarios, that junior doctors today seem to be no better at correctly identifying the clinical need for, and correct dose and route for administration of, adrenaline (epinephrine) than their predecessors a decade earlier.2