Anaphylaxis — structured viva

Structured oral on anaphylaxis: defending intramuscular adrenaline against the intravenous shortcut, dismantling the antihistamine-and-steroid habit with trial evidence, applying observation tiers to biphasic risk, and defending the discharge package with device-training data.

Prompt

The examiner opens: 'Your practice nurse still gives Piriton and hydrocortisone with every allergic reaction and calls that treatment. Talk me through what you will change and why.' The viva branches through acute treatment, the downgraded drugs, observation and biphasic risk, investigations, and the discharge package.

Stem

You are the GP. The practice nurse says every allergic reaction she sees gets chlorphenamine and hydrocortisone 'and they all settle'. ^[13]

References12Show

[1]Cardona V, Ansotegui IJ, Ebisawa M et al. World allergy organization anaphylaxis guidance 2020. The World Allergy Organization journal, 2020.PMID 33204386
[4]Simons FE, Ardusso LR, Bilò MB et al. International consensus on (ICON) anaphylaxis. The World Allergy Organization journal, 2014.PMID 24920969
[5]Campbell RL, Bellolio MF, Knutson BD et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. The Journal of allergy and clinical immunology. In practice, 2015.PMID 25577622
[6]Lee S, Bellolio MF, Hess EP et al. Time of Onset and Predictors of Biphasic Anaphylactic Reactions: A Systematic Review and Meta-analysis. The Journal of allergy and clinical immunology. In practice, 2015.PMID 25680923
[11]Choo KJ, Simons FE, Sheikh A Glucocorticoids for the treatment of anaphylaxis. Evidence-based child health, 2013.PMID 23877942
[13]Delli Colli L, Al Ali A, Gabrielli S et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Annals of allergy, asthma & immunology, 2023.PMID 37689113
[15]Vitte J, Sabato V, Tacquard C et al. Use and Interpretation of Acute and Baseline Tryptase in Perioperative Hypersensitivity and Anaphylaxis. The Journal of allergy and clinical immunology. In practice, 2021.PMID 33746087
[19]McKenzie BA, Marshall SD, Sanci LA et al. Mechanism of Cardiac Arrest in Fatal Anaphylaxis. Clinical and experimental allergy, 2026.PMID 41876126
[24]Patel N, Isaacs E, Duca B et al. Optimal dose of adrenaline auto-injector for children and young people at risk of anaphylaxis: A phase IV randomized controlled crossover study. Allergy, 2023.PMID 36794963
[29]Galvan-Blasco P, Pereira-Gonzalez J, Cardona V Update on refractory anaphylaxis. Current opinion in allergy and clinical immunology, 2025.PMID 40747971
[33]Kadivec S, Košnik M The Ability to Use Epinephrine Autoinjector in Patients Who Receive Prescription Immediately after Anaphylaxis. International archives of allergy and immunology, 2021.PMID 33486490
[36]Dzingina M, Stegenga H, Heath M et al. Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance. BMJ, 2011.PMID 22171344

Anaphylaxis — structured viva

Stem

You are the GP. The practice nurse says every allergic reaction she sees gets chlorphenamine and hydrocortisone 'and they all settle'. ^[13]

References12Show

[1]Cardona V, Ansotegui IJ, Ebisawa M et al. World allergy organization anaphylaxis guidance 2020. The World Allergy Organization journal, 2020.PMID 33204386
[4]Simons FE, Ardusso LR, Bilò MB et al. International consensus on (ICON) anaphylaxis. The World Allergy Organization journal, 2014.PMID 24920969
[5]Campbell RL, Bellolio MF, Knutson BD et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. The Journal of allergy and clinical immunology. In practice, 2015.PMID 25577622
[6]Lee S, Bellolio MF, Hess EP et al. Time of Onset and Predictors of Biphasic Anaphylactic Reactions: A Systematic Review and Meta-analysis. The Journal of allergy and clinical immunology. In practice, 2015.PMID 25680923
[11]Choo KJ, Simons FE, Sheikh A Glucocorticoids for the treatment of anaphylaxis. Evidence-based child health, 2013.PMID 23877942
[13]Delli Colli L, Al Ali A, Gabrielli S et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Annals of allergy, asthma & immunology, 2023.PMID 37689113
[15]Vitte J, Sabato V, Tacquard C et al. Use and Interpretation of Acute and Baseline Tryptase in Perioperative Hypersensitivity and Anaphylaxis. The Journal of allergy and clinical immunology. In practice, 2021.PMID 33746087
[19]McKenzie BA, Marshall SD, Sanci LA et al. Mechanism of Cardiac Arrest in Fatal Anaphylaxis. Clinical and experimental allergy, 2026.PMID 41876126
[24]Patel N, Isaacs E, Duca B et al. Optimal dose of adrenaline auto-injector for children and young people at risk of anaphylaxis: A phase IV randomized controlled crossover study. Allergy, 2023.PMID 36794963
[29]Galvan-Blasco P, Pereira-Gonzalez J, Cardona V Update on refractory anaphylaxis. Current opinion in allergy and clinical immunology, 2025.PMID 40747971
[33]Kadivec S, Košnik M The Ability to Use Epinephrine Autoinjector in Patients Who Receive Prescription Immediately after Anaphylaxis. International archives of allergy and immunology, 2021.PMID 33486490
[36]Dzingina M, Stegenga H, Heath M et al. Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance. BMJ, 2011.PMID 22171344