I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Monday, 29 July 2013


For all the blog posts written about anaphylaxis, please click here.

The CEM Curricular Guidelines are very clear about what you need to know about Anaphylaxis.It is difficult to separate adults from children.

PMP1 Anaphylaxis - CEM CurriculumI've made a summary of treatment, including the curricular knowledge. Please comment with any suggestions or additions:

Anaphylaxis Pathophysiology Summary

For more anaphylaxis posts, start by looking here.


  1. http://emtutorials.com/2013/09/life-threatening-anaphylaxis/ - interesting thoughts about mixing up anaphylaxis.

  2. http://calgaryguide.ucalgary.ca/clinicalimmunology.aspx

  3. My notes from the RSM PEM conference:

    Allergy and Anaphylaxis in children
    Dr Nicholas Sargant, PEM Consultant
    This was a very good update on anaphylaxis. There’s so much I didn’t even realise I didn’t know! There are lots of numbers, and if I could get a copy of the slides I’d be very happy!

    * 7 fold increase in admissions for anaphylaxis
    * Up to 20% of “medical” presentations are allergy related
    * If you’re not allergic to the big six and have no history of atopy, it is questionable whether you are really having an anaphylactic reaction - it might be an adverse drug reaction instead.
    Eggs, milk, tree nuts, wheat, peanuts, soy and fish
    * There is AAAI diagnostic criteria, and Brighton collaborative case definition.
    * 20 deaths/ year due to anaphylaxis.
    * Every child in the UK who has died from anaphylaxis also has asthma.
    * Risk of death from anaphylaxis < dying from being struck by lightening.
    * Clinical features in kids vs. adults - more likely to get respiratory symptoms.
    Derm 82 vs 80 - 90%, CV 29% vs 10 - 45%, resp 95 vs 70%, GI 20-45 vs 30 - 45%.
    * 4% of asthma admissions to ICU actually almost certainly had anaphylaxis.

    * When you ask your history, ask if there are any co-factors and list all foods taken in the last 6 hours.
    - exercise
    - NSAIDs, URTI, alcohol
    * You CAN get anaphylaxis if you have two triggers - one documented anaphylaxis to scampi + exercise! So the history is REALLY important.
    Exercise induced anaphylaxis is more common in adults than children. There is normally a co-factor like pollen exposure, or pollen.
    * Remember not to just tell parents to cut out dairy - their children may then develop rickets!

    * Urticaria is most likely to be viral, then idiopathic, and THEN allergic. If you can’t easily identify the trigger (within the last 90minutes), it is more likely to be viral / idiopathic.
    * Egg allergy causes an impressive urticaria rash.
    * Urticaria multiforme / purple urticaria / acute annular urticaria presents with pruritis, fever + migrating lesions. It is confused with erythema multiforme but tends to have a more raised edge. It is self limiting for 8 - 10 days. There is an association with antibiotics - ? Because of concurrent viral infections ?actually because of antibiotics.
    * Serum tryptases are an unreliable marker in kids and in food allergy. Not in the guidelines for children. Recommended if venom / drug reaction.


  4. http://www.emergucate.com/bite-sized-basics/anaphylaxis-management/

  5. David Marcus (@EMIMDoc) tweeted at 5:12 PM on Sun, Mar 30, 2014:
    Cantor: Food is the most common trigger of anaphylaxis in infants. Egg/cow's milk common. #resus14

  6. http://dontforgetthebubbles.com/anaphylaxis-qa/#more-6415