Refractory Anaphylaxis: Treatment Algorithm

There is no established definition for refractory anaphylaxis. The European Anaphylaxis Registry use a definition of "anaphylaxis which, despite treatment with at least two doses of minimum 300μg adrenaline, does not achieve normalization" of symptoms. A USA-based panel recently proposed a reaction which "must be treated with 3+ appropriate doses of epinephrine (or initiation of an intravenous epinephrine infusion)" - a definition which does not specifically refer totreatment response, although this is implied.