Emergency management of anaphylaxis and the impact of the new UK advanced life support guidelines
Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its advanced life support (ALS) guidelines for anaphylaxis in 2021, emphasising early and repeated adrenaline administration, intravenous (IV) f...
Gespeichert in:
| Veröffentlicht in: | Clinical medicine (London, England) Jg. 25; H. 6; S. 100519 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
Elsevier Ltd
01.11.2025
Elsevier |
| Schlagworte: | |
| ISSN: | 1470-2118, 1473-4893 |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its advanced life support (ALS) guidelines for anaphylaxis in 2021, emphasising early and repeated adrenaline administration, intravenous (IV) fluid use, and reduced reliance on antihistamines and steroids.
A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH), before (2018) and after (2022/23) the ALS guideline implementation. Adherence to NICE anaphylaxis guidance was also assessed.
Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% of patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centres. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations.
Anaphylaxis management in these centres has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor. |
|---|---|
| AbstractList | AbstractBackgroundAnaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its advanced life support (ALS) guidelines for anaphylaxis in 2021, emphasising early and repeated adrenaline administration, intravenous (IV) fluid use, and reduced reliance on antihistamines and steroids. MethodsA retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH), before (2018) and after (2022/23) the ALS guideline implementation. Adherence to NICE anaphylaxis guidance was also assessed. ResultsData from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% of patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centres. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations. ConclusionAnaphylaxis management in these centres has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor. Background: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its advanced life support (ALS) guidelines for anaphylaxis in 2021, emphasising early and repeated adrenaline administration, intravenous (IV) fluid use, and reduced reliance on antihistamines and steroids. Methods: A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH), before (2018) and after (2022/23) the ALS guideline implementation. Adherence to NICE anaphylaxis guidance was also assessed. Results: Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% of patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centres. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations. Conclusion: Anaphylaxis management in these centres has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor. Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its advanced life support (ALS) guidelines for anaphylaxis in 2021, emphasising early and repeated adrenaline administration, intravenous (IV) fluid use, and reduced reliance on antihistamines and steroids. A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH), before (2018) and after (2022/23) the ALS guideline implementation. Adherence to NICE anaphylaxis guidance was also assessed. Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% of patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centres. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations. Anaphylaxis management in these centres has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor. |
| ArticleNumber | 100519 |
| Author | Kadambi, Madhavi Goktas, Polat Goddard, Sarah Inani, Mohit Cooper, Angela Diwakar, Lavanya Hughes, Deborah Elshehawy, Mahmoud Clarke, Daniel |
| Author_xml | – sequence: 1 givenname: Mahmoud orcidid: 0009-0001-3678-7103 surname: Elshehawy fullname: Elshehawy, Mahmoud organization: Acute Medicine, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, United Kingdom – sequence: 2 givenname: Madhavi surname: Kadambi fullname: Kadambi, Madhavi organization: Specialist Registrar in Allergy, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom – sequence: 3 givenname: Deborah surname: Hughes fullname: Hughes, Deborah organization: Department of Immunology and Allergy, UHNM, Stoke on Trent, United Kingdom – sequence: 4 givenname: Daniel surname: Clarke fullname: Clarke, Daniel organization: Department of Immunology and Allergy, UHNM, Stoke on Trent, United Kingdom – sequence: 5 givenname: Angela surname: Cooper fullname: Cooper, Angela organization: Department of Immunology and Allergy, UHNM, Stoke on Trent, United Kingdom – sequence: 6 givenname: Mohit surname: Inani fullname: Inani, Mohit organization: Acute Medicine, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, United Kingdom – sequence: 7 givenname: Polat orcidid: 0000-0001-7183-6890 surname: Goktas fullname: Goktas, Polat organization: Associate Professor in Computer Science, Sabanci University, Ankara, Turkey – sequence: 8 givenname: Sarah orcidid: 0000-0002-5055-8446 surname: Goddard fullname: Goddard, Sarah organization: Department of Immunology and Allergy, UHNM, Stoke on Trent, United Kingdom – sequence: 9 givenname: Lavanya orcidid: 0000-0003-4369-6637 surname: Diwakar fullname: Diwakar, Lavanya email: l.diwakar@bham.ac.uk organization: Department of Immunology and Allergy, UHNM, Stoke on Trent, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/41038449$$D View this record in MEDLINE/PubMed |
| BookMark | eNqVUttu1DAQtVARvcAfIOQfyOJrNpEQEqoKVK3EA_TZmtjjrUNusrMt-_c4G-gbqnjyzPjM8ficOScnwzggIW8523DGy_ftxnZh6HEjmNC5xDSvX5AzrrayUFUtT44xKwTn1Sk5T6lljGtVl6_IqeJMVkrVZwSueow7HOyB9jDADnscZjp6mpPp_tDBr5By7Oh8jzT0E9jj7ZIN-Ejvbii4BxgsOtoFjzTtp2mMM93tg8M8H6bX5KWHLuGbP-cFuft89ePya3H77cv15afbwmrG5qJsNJdb0FaiLZmvtK9E4yQwbHzlfS183TApGy2FdbKyuq4ZWqWcYsA9enlBrldeN0Jrphh6iAczQjDHwhh3BuIcbIdGcN0wB056sKpC24iSNaDEFkTpGKjM9W7lmvZNj-6J7a9uGaBWgI1jShH9E4Qzs9hjWrPaYxZ7zGpPbvu4tmEW4iFgNMkGXNQLEe2cJw3_S7CAgoXuJx4wteM-Dllkw00ShpnvywYsCyCyxkJul599-DfB8-__BmElw6k |
| Cites_doi | 10.1111/all.15032 10.1046/j.1365-2222.2000.00864.x 10.7861/clinmed.2022-0073 10.1111/acem.13147 10.1097/WOX.0b013e318211496c |
| ContentType | Journal Article |
| Copyright | 2025 The Author(s) The Author(s) Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved. |
| Copyright_xml | – notice: 2025 The Author(s) – notice: The Author(s) – notice: Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved. |
| DBID | 6I. AAFTH AAYXX CITATION NPM DOA |
| DOI | 10.1016/j.clinme.2025.100519 |
| DatabaseName | ScienceDirect Open Access Titles Elsevier:ScienceDirect:Open Access CrossRef PubMed DOAJ: Directory of Open Access Journal (DOAJ) |
| DatabaseTitle | CrossRef PubMed |
| DatabaseTitleList | PubMed |
| Database_xml | – sequence: 1 dbid: DOA name: DOAJ Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1473-4893 |
| EndPage | 100519 |
| ExternalDocumentID | oai_doaj_org_article_215b0dad3fac48ecb260ba427a26d0a4 41038449 10_1016_j_clinme_2025_100519 S1470211825002374 1_s2_0_S1470211825002374 |
| Genre | Journal Article |
| GroupedDBID | .1- .FO .GJ 08P 0R~ 29B 2WC 354 53G 5RE 5RS 6J9 6PF 7X7 88E 8AO 8FI 8FJ 8R4 8R5 AALRI AAWTL AAXUO AAYEP AAYWO ABCQX ABUWG ACGFO ACIHN ACVFH ADBBV ADCNI ADPDF ADVLN AEAQA AENEX AEUPX AFFHD AFFNX AFKRA AFKWF AFPUW AFRHN AHMBA AIGII AITUG AJUYK AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ APXCP BAWUL BENPR BPHCQ BTFSW BVXVI CCPQU DU5 E3Z EBS EHMNL EJD F5P F8P FAC FDB FYUFA GROUPED_DOAJ H13 HMCUK HYE KQ8 M1P M41 M5~ OB4 OFXIZ OHH OK1 OVD OVEED OVIDX P2P PHGZM PHGZT PJZUB PONUX PPXIY PQQKQ PROAC PSQYO Q2X RHI ROL RPM RXW TAF TEORI U5U UKHRP UNMZH W2D Z5R ZGI ZXP 6I. AAFTH AAYXX CITATION NPM |
| ID | FETCH-LOGICAL-c500t-6b5137a5c3ec60f85f82bd3a0ebf8ff92f9b033b532cd38c5990ec44d40a1fef3 |
| IEDL.DBID | DOA |
| ISICitedReferencesCount | 0 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001605014300001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1470-2118 |
| IngestDate | Tue Oct 28 02:22:09 EDT 2025 Fri Nov 07 01:56:13 EST 2025 Thu Nov 27 01:03:34 EST 2025 Sat Nov 22 16:52:41 EST 2025 Sat Nov 29 12:11:17 EST 2025 Sat Nov 22 06:42:04 EST 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 6 |
| Language | English |
| License | This is an open access article under the CC BY license. Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c500t-6b5137a5c3ec60f85f82bd3a0ebf8ff92f9b033b532cd38c5990ec44d40a1fef3 |
| ORCID | 0009-0001-3678-7103 0000-0002-5055-8446 0000-0001-7183-6890 0000-0003-4369-6637 |
| OpenAccessLink | https://doaj.org/article/215b0dad3fac48ecb260ba427a26d0a4 |
| PMID | 41038449 |
| PageCount | 1 |
| ParticipantIDs | doaj_primary_oai_doaj_org_article_215b0dad3fac48ecb260ba427a26d0a4 pubmed_primary_41038449 crossref_primary_10_1016_j_clinme_2025_100519 elsevier_sciencedirect_doi_10_1016_j_clinme_2025_100519 elsevier_clinicalkeyesjournals_1_s2_0_S1470211825002374 elsevier_clinicalkey_doi_10_1016_j_clinme_2025_100519 |
| PublicationCentury | 2000 |
| PublicationDate | 2025-11-01 |
| PublicationDateYYYYMMDD | 2025-11-01 |
| PublicationDate_xml | – month: 11 year: 2025 text: 2025-11-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | England |
| PublicationPlace_xml | – name: England |
| PublicationTitle | Clinical medicine (London, England) |
| PublicationTitleAlternate | Clin Med (Lond) |
| PublicationYear | 2025 |
| Publisher | Elsevier Ltd Elsevier |
| Publisher_xml | – name: Elsevier Ltd – name: Elsevier |
| References | Kawano, Scheuermeyer, Gibo (bib0007) 2017; 24 (bib0006) 2000; 30 Simons, Ardusso, Bilò (bib0004) 2011; 4 Muraro, Worm, Alviani (bib0002) 2022; 77 Whyte, Soar, Dodd (bib0001) 2022; 22 (bib0005) 2020 Greenhawt, Abrams, Oppenheimer (bib0003) 2021; 9 Greenhawt (10.1016/j.clinme.2025.100519_bib0003) 2021; 9 Whyte (10.1016/j.clinme.2025.100519_bib0001) 2022; 22 Simons (10.1016/j.clinme.2025.100519_bib0004) 2011; 4 Muraro (10.1016/j.clinme.2025.100519_bib0002) 2022; 77 (10.1016/j.clinme.2025.100519_bib0005) 2020 (10.1016/j.clinme.2025.100519_bib0006) 2000; 30 Kawano (10.1016/j.clinme.2025.100519_bib0007) 2017; 24 |
| References_xml | – volume: 4 start-page: 13 year: 2011 end-page: 37 ident: bib0004 article-title: World allergy organization guidelines for the assessment and management of anaphylaxis publication-title: World Aller Organiz J – volume: 30 start-page: 1144 year: 2000 end-page: 1150 ident: bib0006 article-title: Lessons for management of anaphylaxis from a study of fatal reactions publication-title: Clin Experim Allergy – volume: 24 start-page: 733 year: 2017 end-page: 741 ident: bib0007 article-title: H1-antihistamines reduce progression to anaphylaxis among emergency department patients with allergic reactions publication-title: Acad Emerg Med – volume: 22 start-page: 332 year: 2022 end-page: 339 ident: bib0001 article-title: Emergency treatment of anaphylaxis: concise clinical guidance publication-title: Clin Med – volume: 9 start-page: 1438 year: 2021 end-page: 1441 ident: bib0003 article-title: The COVID-19 pandemic in 2021: avoiding overdiagnosis of anaphylaxis risk while safely vaccinating the world publication-title: J Aller Clin Immunol: In Pract – year: 2020 ident: bib0005 article-title: Anaphylaxis: assessment and referral after emergency treatment – volume: 77 start-page: 357 year: 2022 end-page: 377 ident: bib0002 article-title: EAACI guidelines: anaphylaxis (2021 update) publication-title: Allergy – volume: 77 start-page: 357 issue: 2 year: 2022 ident: 10.1016/j.clinme.2025.100519_bib0002 article-title: EAACI guidelines: anaphylaxis (2021 update) publication-title: Allergy doi: 10.1111/all.15032 – volume: 30 start-page: 1144 issue: 8 year: 2000 ident: 10.1016/j.clinme.2025.100519_bib0006 article-title: Lessons for management of anaphylaxis from a study of fatal reactions publication-title: Clin Experim Allergy doi: 10.1046/j.1365-2222.2000.00864.x – volume: 9 start-page: 1438 issue: 4 year: 2021 ident: 10.1016/j.clinme.2025.100519_bib0003 article-title: The COVID-19 pandemic in 2021: avoiding overdiagnosis of anaphylaxis risk while safely vaccinating the world publication-title: J Aller Clin Immunol: In Pract – year: 2020 ident: 10.1016/j.clinme.2025.100519_bib0005 – volume: 22 start-page: 332 issue: 4 year: 2022 ident: 10.1016/j.clinme.2025.100519_bib0001 article-title: Emergency treatment of anaphylaxis: concise clinical guidance publication-title: Clin Med doi: 10.7861/clinmed.2022-0073 – volume: 24 start-page: 733 issue: 6 year: 2017 ident: 10.1016/j.clinme.2025.100519_bib0007 article-title: H1-antihistamines reduce progression to anaphylaxis among emergency department patients with allergic reactions publication-title: Acad Emerg Med doi: 10.1111/acem.13147 – volume: 4 start-page: 13 issue: 2 year: 2011 ident: 10.1016/j.clinme.2025.100519_bib0004 article-title: World allergy organization guidelines for the assessment and management of anaphylaxis publication-title: World Aller Organiz J doi: 10.1097/WOX.0b013e318211496c |
| SSID | ssj0015496 |
| Score | 2.3972967 |
| Snippet | Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its... AbstractBackgroundAnaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation... Background: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council... |
| SourceID | doaj pubmed crossref elsevier |
| SourceType | Open Website Index Database Publisher |
| StartPage | 100519 |
| SubjectTerms | Internal Medicine |
| Title | Emergency management of anaphylaxis and the impact of the new UK advanced life support guidelines |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S1470211825002374 https://www.clinicalkey.es/playcontent/1-s2.0-S1470211825002374 https://dx.doi.org/10.1016/j.clinme.2025.100519 https://www.ncbi.nlm.nih.gov/pubmed/41038449 https://doaj.org/article/215b0dad3fac48ecb260ba427a26d0a4 |
| Volume | 25 |
| WOSCitedRecordID | wos001605014300001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals customDbUrl: eissn: 1473-4893 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0015496 issn: 1470-2118 databaseCode: DOA dateStart: 20240101 isFulltext: true titleUrlDefault: https://www.doaj.org/ providerName: Directory of Open Access Journals – providerCode: PRVPQU databaseName: Health & Medical Collection customDbUrl: eissn: 1473-4893 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0015496 issn: 1470-2118 databaseCode: 7X7 dateStart: 20060701 isFulltext: true titleUrlDefault: https://search.proquest.com/healthcomplete providerName: ProQuest – providerCode: PRVPQU databaseName: ProQuest Central (subscription) customDbUrl: eissn: 1473-4893 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0015496 issn: 1470-2118 databaseCode: BENPR dateStart: 20060701 isFulltext: true titleUrlDefault: https://www.proquest.com/central providerName: ProQuest – providerCode: PRVPQU databaseName: UK & Ireland Database (subscription) customDbUrl: eissn: 1473-4893 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0015496 issn: 1470-2118 databaseCode: EHMNL dateStart: 20060701 isFulltext: true titleUrlDefault: https://search.proquest.com/ukireland providerName: ProQuest |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1La-MwEBZtWcpelu6zabtBh72alfWw7GNbWgpLQ2AbyE1IslSyNGmpk7I_vzOWHXIIpIdejGVblv3pMZ_QzCdCflU2Z6EKPONO-EwWDjdy9zaDcZB7IMwsFL7dbEKPRuV0Wo03tvpCn7AkD5yA-w0mybHa1iJaL8vgHRBwZyXXlhc1s60SKLCefjLVrR_ArCfFFWmWwRSn7IPmWs8ujDmco0QmV-gkoFBlZ8Motdr922zThuG5PiKfOsZIz9OXfiZ7YfGFHN52a-Jfib3qIyjpfO3LQh8jhQRg-GD_zxo4rylQPZqCIvEupoBS08kf2vsB0IdZDLRZPSEnp_crVMBCr_hvZHJ9dXd5k3UbJ2ReMbbMCqdyoa3yIgDesVSx5K4WlgUXyxgrHivHhHBKcF-L0iswScFLWUtm8xii-E4OFo-LcExojFK63AVhXS2Vjy4Hiuh5iEURdVD5gGQ9cuYp6WOY3nHsn0lIG0TaJKQH5ALhXT-L6tbtBahz09W52VXnA6L6yjF9ACkMefCi2Y7C9bZ8oen6bWNy03DDzF9sONhugCACqdFyM2dHTRLleEOZP1LrWf-yRE16KauT94DilHzEwlJ05Bk5WD6vwk_ywb8sZ83zkOzrqR62XQOOo_HtK3NpErA |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Emergency+management+of+anaphylaxis+and+the+impact+of+the+new+UK+advanced+life+support+guidelines&rft.jtitle=Clinical+medicine+%28London%2C+England%29&rft.au=Elshehawy%2C+Mahmoud&rft.au=Kadambi%2C+Madhavi&rft.au=Hughes%2C+Deborah&rft.au=Clarke%2C+Daniel&rft.date=2025-11-01&rft.issn=1470-2118&rft.volume=25&rft.issue=6&rft.spage=100519&rft.epage=100519&rft_id=info:doi/10.1016%2Fj.clinme.2025.100519&rft.externalDBID=ECK1-s2.0-S1470211825002374&rft.externalDocID=1_s2_0_S1470211825002374 |
| thumbnail_m | http://cvtisr.summon.serialssolutions.com/2.0.0/image/custom?url=https%3A%2F%2Fcdn.clinicalkey.com%2Fck-thumbnails%2F14702118%2Fcov200h.gif |