Update on the emergency medical treatment of anaphylactic reactions for first medical responders and for community nurses.

Consensus guidelines on the emergency treatment of anaphylactic reactions were published in 1999 in the Journal of Accident and Emergency Medicine, and in Resuscitation. These guidelines were intended for first medical responders, and more specifically those without expert knowledge or specialist interest. In general they have been well received. After the publications, we received a large number of letters from community nurses. They explained that adherence to the new guidelines was diYcult in their situation because they did not have access to the drugs that were mentioned, apart from adrenaline (epinephrine). Moreover, many were troubled by the recommendations for children’s doses that included a suggestion of using the twofold dilution for the lowest dose. The British National Formulary also oVers advice on anaphylaxis, and there was some concern on all sides that the doses of adrenaline (epinephrine) were diVerent in the British National Formulary from those given in the consensus guidelines. In order to resolve both of these problems, a meeting was held between representatives of the Project Team, of the British National Formulary, and of the Department of Health (representing the interests of community nurses). The meeting was wholly successful, and as a result we have made some very small changes