[Treatment of anaphylactic reactions: a review of guidelines and recommendations]

In the present review, guidelines and recommendations for the treatment of anaphylactic reactions are presented and evaluated. Herefore, publications of German and non-German societies and expert groups have been selected and, in addition to that, we have chosen a number of articles that were cited frequently and, as far as we are concerned, have a relevant meaning for this theme. None of the traditionally applied remedies - epinephrine and intravascular volume, histamine receptor blockade, inhaled betamimetics and steroids - have been proven efficacious by means of evidence-based medicine. Due to the variability of the symptoms of anaphylaxis, it is widely accepted that such a clinical proof is unlikely to come. In contrast to this, there is lack of a consense as to substantial elements of the therapy, above all with regard to dosage and application mode for epinephrine and likewise concerning amount and kind of intravenous fluids. Hence, the physician in charge has to face the necessity either to follow the guidelines of his institution (if there are any) or to blend his own therapeutic regime according to his own convictions.