Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction that compromises the airway, respiration, and/or circulation. It may occur without typical skin features, circulatory shock, or compromised breathing being present ¹. Anaphylaxis should be recognized and treated immediately ². Emergency department (ED) anaphylaxis care involves proper triage, administration of adrenaline, and the general management of airway, breathing, and circulation ³. Therefore, guidelines for managing anaphylaxis in the ED must be based on the best available research evidence, theory, and expert consensus.

This evidence review was undertaken by the Anaphylaxis Guideline Development Group (GDG) of the Egyptian National Clinical Guidelines Centre, supporting the 2021 update of the Resuscitation Council United Kingdom (RCUK). The GDG used an internationally accepted approach for adoption, adaptation, and de novo guideline development based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework, referred to as GRADE-ADOLOPMENT ⁴. The EtD framework facilitates the use of evidence in a structured and transparent way to inform decisions in the context of clinical and public health recommendations and decisions ⁵.

➡️Purpose

To our knowledge, few registries of anaphylaxis exist in Egypt, and no specific Egyptian guidelines are available. Therefore, we aimed to design Egyptian guidelines to prevent treatment errors in the ED among Egyptians. This guideline may also benefit institutions worldwide, particularly in low-middle-income countries.

Intramuscular (IM) adrenaline is considered the first-line drug for the treatment of anaphylaxis ⁶, but there is considerable divergence between published guidelines regarding the role of adrenaline in comparison to other available medications ⁷. This may be due to a lack of high-certainty evidence to support treatment recommendations ⁸. However, based on prior publications and the experience of experts, this guideline selects and answers key questions that are key to multidisciplinary healthcare providers in the ED. Adherence to this guideline should improve the care of anaphylaxis patients at Egyptian medical institutions.

➡️Scope and Target Audience

This document's recommendations are directed to emergency physicians and other specialists working in the ED of Egyptian hospitals in the different sectors of the Egyptian healthcare system. The key research questions were identified from the previous RCUK guidelines. The EtD framework for each question/topic was discussed by the expert in emergency medicine to adapt those recommendations in the Egyptian ED setting (see Annex 1).