The new guidelines for the practical approach to management of pulmonary embolism (PE) are clearly welcome to help all clinicians dealing with such patients.1 I would, however, like to take issue with the statement advising the administration of hydrocortisone in conjunction with streptokinase to reduce the risk of allergic complications.

Allergic reactions are a well recognised adverse effect of intravenous streptokinase treatment and are probably due to immediate hypersensitivity reactions mediated by IgE antibodies to streptokinase.2 The incidence …