Subcutaneous or intramuscular adrenaline is used as the first-line treatment for anaphylactic reaction to food and other allergens.11 The intramuscular route is preferable if there is evidence of circulatory collapse, as the absorption is better than from the subcutaneous site. Patients who are at risk of anaphylactic reactions, for example those with nut allergies, should be provided with a self-injectable adrenaline device. This delivers a set dose of adrenaline by intramuscular route. The adult dose is 300 /ig and the paediatric dose is 150 ^g; repeatable after 15 minutes. Patients and their carers should be given instructions in the use of the device in case of emergency. When absorption from the intramuscular route is not adequate, for example in severe hypotension and shock, slow intravenous injection may be used by trained personnel. Inhaled adrenaline is not useful for the treatment of anaphylaxis. However, it may be effective for angioedema or laryngeal oedema in the absence of systemic symptoms.
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