The Resus Council released new guidance on the management of anaphylaxis in 2021

The full guidance is available here:


To Summarise the Key Points:


  • Skin and mucosal changes alone do not indicate an anaphylactic reaction – the presence of Airways, Breathing or Circulation problems is required to make the diagnosis.
  • If in doubt (e.g. patient anxious/hyperventilating/dizziness) treat as anaphylaxis.
  • Skin and mucosal changes are absent in 20% of patients with anaphylaxis.


The first step of management is to call 999 – all patients with anaphylaxis need admission to hospital due to the risk of a biphasic reaction.

Position the patient correctly – lie flat with legs elevated or in a sitting position if short of breath.

Adrenaline is the mainstay of treatment and should be given IM as early as possible. Adrenaline should not be given IV in Primary Care settings.


Check airway and give high flow oxygen. Monitor pulse, oximetry, BP, ECG if available.

Repeat IM adrenaline after 5 minutes if no response and give IV fluids. Continue to do so until ambulance arrives.

There is no place for steroids in the new guidance.

Antihistamines may be used to reduce urticaria or angioedema, but have no effect on prevention of biphasic reactions.


Printable version available here: