Some patients with anaphylaxis will not respond to adrenaline auto-injectors. These patients are likely to be in shock, when adrenaline fails to be absorbed from the muscle. In this situation, keep the patient lying down! IV fluids and adrenaline with careful monitoring may be required. A Rostrum on the topic has recently been published by Pousessel et al, in J Allergy Clin Immunol Pract ( May 2023 DOI: 10.1016/j.jaip.2023.04.037).