Severe allergic reactions
Recognise anaphylaxis, help someone use their own adrenaline auto-injector, call for help, and position them safely.
WHAT SETS IT OFF
Common triggers, and how fast it comes
The usual triggers are foods (peanuts, tree nuts, shellfish, milk, eggs, sesame), insect stings (bees, wasps), some medicines, and latex. A reaction can start within minutes of eating or being stung. Many people with a known severe allergy carry their own adrenaline auto-injector and know their triggers, so ask them.
At a wedding, Leila eats a pastry and a minute later her lips tingle. She knows she's allergic to nuts, and her pen is in her handbag.
Mild reaction or anaphylaxis?
Mild to moderate
Itchy rash or hives, swollen lips or eyes, a tingling mouth, tummy pain, vomiting. Stay with them and watch closely: they may take their own antihistamine, and it can get worse.
Anaphylaxis: think A, B, C
Airway: swollen tongue or throat, hoarse voice, trouble swallowing. Breathing: wheeze, persistent cough, breathlessness. Circulation: pale, clammy, dizzy, faint, collapse. Any one of these is an emergency. Skin signs may be absent.
Check yourself
Sort each sign: a mild reaction to watch, or anaphylaxis?
- An itchy rash on the arms
- A hoarse voice and trouble swallowing
- Tingling lips
- Wheezing and short of breath
- Pale, dizzy and about to faint
- Slightly puffy eyes, breathing easily
Show the answer
Mild: stay and watch: An itchy rash on the arms, Tingling lips, Slightly puffy eyes, breathing easily
Anaphylaxis: act now: A hoarse voice and trouble swallowing, Wheezing and short of breath, Pale, dizzy and about to faint
Check yourself
Reza has no rash at all, so the wheeze that started after his bee sting can't be anaphylaxis.
Show the answer
False
False. Skin signs are common but can be missing. Treat a breathing problem after a sting as anaphylaxis: call the emergency number and help him use his auto-injector if he has one.
Adrenaline auto-injector
A pen-shaped device, prescribed to someone with a severe allergy, that injects a single measured dose of adrenaline (epinephrine) into the thigh when pressed firmly against it. Adrenaline is the treatment for anaphylaxis: it opens the airways and supports the circulation. Antihistamines and asthma inhalers are not a substitute.
There are several brands, and they work slightly differently. The instructions are printed on the side of each one.
When it's anaphylaxis
- Call and say "anaphylaxis"
Or point at one person and have them call. That word tells the dispatcher exactly what's coming.
- Help them use their own pen, now
Into the outer thigh; it can go through clothing. Follow the instructions on the device, including how long to hold it in place, which varies by brand and is typically a few seconds.
- Note the time
The paramedics will want to know when the dose went in.
- Don't wait to see
Adrenaline goes first. Don't hold back to see whether an antihistamine or inhaler works.
Check yourself
Leila's throat feels tight and her voice has gone hoarse. She hands you her auto-injector. Where does it go?
- Into the outer thigh; through her trousers is fine
- Into the upper arm, after rolling up her sleeve
- Into the stomach, near the navel
- Into the buttock, after she lies face down
Show the answer
Into the outer thigh; through her trousers is fine
Right. The outer thigh, and it can go through clothing, so no time is lost undressing. Follow the instructions on the pen, then note the time.
Position them, and don't stand them up
- Don't make them stand or walk, even if they feel better. Standing up can make the blood pressure drop suddenly.
- Faint or dizzy: lie them flat with their legs raised.
- Breathing is hard: let them sit up, with their legs out in front.
- Pregnant: on her left side. Unresponsive and breathing: recovery position. Not breathing normally: CPR.
- Even if they recover, they must go to hospital: symptoms can come back hours later.
Check yourself
Ten minutes after using her pen, Leila feels much better and wants to walk home. What do you tell her?
- Fine, as long as someone walks with her
- Stay sitting or lying down and wait for the ambulance: she still needs hospital
- Take an antihistamine and she can skip the hospital
- Walk around a little to check she's really recovered
Show the answer
Stay sitting or lying down and wait for the ambulance: she still needs hospital
Right. Standing or walking can make her collapse, and anaphylaxis can come back hours later. She stays down, and she still goes to hospital.
Check yourself
Five minutes after her first pen, Sara is still wheezing and dizzy. The ambulance hasn't arrived, and there's a second pen in her bag. What now?
- Wait for the paramedics; one dose is the limit
- Use the second pen, into the outer thigh, and note the time
- Give her one of your own asthma inhalers instead
- Help her stand up to see if the dizziness passes
Show the answer
Use the second pen, into the outer thigh, and note the time
Yes. No improvement after 5 minutes and a second pen available: give the second dose, note the time, and keep her lying or sitting until help arrives.
Lesson recap
- Common triggers: foods like nuts, shellfish, milk, eggs and sesame, insect stings, some medicines and latex. It can start within minutes.
- Anaphylaxis means an Airway, Breathing or Circulation problem: hoarse voice or swollen throat, wheeze, or pale, faint, collapsing. There may be no rash.
- Call and say "anaphylaxis", and help them use their own auto-injector into the outer thigh right away. Note the time.
- Don't stand them up: lie flat with legs raised, or sit up if breathing is hard.
- No better after 5 minutes? A second pen if there is one. Even if they recover, they go to hospital.
- Only the person's own prescribed pen, never your medicines. Practise with a trainer pen on a certified first aid course.