Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.

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Antonella Muraro, Margitta Worm and Graham Roberts equally contributed as guideline chairs.This paper sets out the updated European Academy of Allergy and Clinical Immunology's (EAACI) guideline regarding the diagnosis, acute management, and prevention of anaphylaxis. Anaphylaxis is a clinical emergency and all healthcare professionals need to be familiar with its recognition and management. Anaphylaxis is a lifethreatening reaction characterized by acute onset of symptoms involving different organ systems and requiring immediate medical intervention. 1 Although the fatality rate due to anaphylaxis remains low, 2 the frequency of hospitalization from food and drug-induced anaphylaxis has been increasing in recent years. 3 The symptoms of anaphylaxis are highly variable. 4,5 Data from patients experiencing anaphylaxis revealed that skin and mucosal symptoms occur most frequently (>90% of cases) followed by symptoms involving the respiratory and cardiovascular systems (>50%). Food, drug, and Hymenoptera venom are the most common elicitors of anaphylactic reactions. 5,6 The prevalence of the various causes of anaphylaxis are age-dependent and vary in different geographical regions. In Europe, typical causes of food-induced anaphylaxis in children are peanut, hazelnut, milk, and egg and in adults, wheat, celery, and shellfish; fruits such as peach are also typical causes of food-induced anaphylaxis in adults in some European countries such as Spain and Italy. 7,8 Venom-induced anaphylaxis is typically caused by wasp and bee venom. 9 Drug-induced anaphylaxis is typically caused by antibiotics and non-steroidal anti-inflammatory drugs. 10,11 Among antibiotics, beta-lactam antibiotics are the leading eliciting allergens. 12 At times, there is an occupational cause. 13 Co-factors may be aggravating factors in anaphylaxis, examples are exercise, stress, infection, non-steroidal anti-inflammatory drugs, and alcohol. [14][15][16] In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered. [17][18][19] This guideline, updated from 2014, 20 provides evidence-based guidance to help manage anaphylaxis. The primary audience is clinical allergists (specialists and subspecialists), primary care, paediatricians, emergency physicians, anaesthetists and intensivists, nurses, dieticians, and other healthcare professionals. The guideline was