Anaphylaxis is a severe, life‐threatening allergic reaction that requires rapid and decisive first aid. It can occur within seconds to minutes after exposure to an allergen, and quick action is essential to prevent respiratory failure, shock, or even death.
Anaphylaxis is a severe, life-threatening allergic reaction that can be triggered by many things including venomous stings, certain foods (like peanuts, tree nuts, shellfish, milk, eggs, soy and wheel), animal dander, plant pollen, latex or certain medications (like penicillin and sulfa drugs).
Symptoms of Anaphylaxis
The symptoms of an anaphylactic reaction could resemble the typical signs of an allergy at first, such as skin rash or a runny nose. However, more serious signs become visible in about 30 minutes.
These symptoms may include:
- Wheezing or coughing
- Weakness, confusion, dizziness, or fainting
- Rapid heartbeat and trouble breathing or shortness of breath
- Paleness
- Weak pulse
- Unconsciousness
- Belly pain or cramps
- Diarrhea and vomiting
- Itchy or swollen tongue or lips
- Slurred speech
- Sneezing and stuffy or runny nose
- Tightness, itching, or pain in the chest
- Red, swollen, or itchy skin
- Tightness in the throat or trouble swallowing
- Hoarse voice and itchy or swollen throat
Causes of Anaphylaxis
One of the main causes of anaphylaxis is food allergies. Some of the foods that can lead to a severe anaphylactic reaction are:
- Eggs
- Soy
- Seeds
- Wheat
- Cow’s milk
- Shellfish
- Tree nuts
- Peanuts
Some of the other allergens that can induce anaphylaxis include:
- Certain substances and medications, such as the dye used for CT scans, nonsteroidal anti-inflammatory drugs (NSAIDs), and penicillin.
- Insect stings from creatures such as bees, yellowjackets, hornets, and wasps.
- Latex
How to Diagnose Anaphylaxis
When you go to a doctor to get a diagnosis for anaphylaxis, they will ask you if you have previously had allergic reactions to substances or elements such as insect stings, latex, medications, and particular foods.
In order to confirm the diagnosis, you could be asked to get a blood test done. You could also be tested for allergies with blood tests or skin tests that could aid in determining your trigger.
First Aid for Anaphylaxis
Here’s a step‐by‐step guide on what to do if you suspect someone is having an anaphylactic reaction:
1. Recognize the Signs and Symptoms
Be alert for symptoms that may include one or more of the following:
- Skin reactions: Hives, itching, flushing, or pale skin.
- Swelling: Particularly of the lips, face, tongue, or throat—this can cause difficulty breathing.
- Respiratory issues: Wheezing, shortness of breath, or tightness in the chest.
- Circulatory problems: A weak, rapid pulse, dizziness, or fainting.
- Gastrointestinal distress: Nausea, vomiting, diarrhea, or cramping.
If the person shows any signs of severe allergic reaction, especially if they have difficulty breathing or their airway seems compromised, treat it as an emergency (2).
2. Call Emergency Services Immediately
- Dial 911 (or your local emergency number): Do not wait, even if symptoms seem to improve. Anaphylaxis can rapidly progress, and immediate professional help is critical.
- Provide Precise Details: Inform the dispatcher about the nature of the allergic reaction, the suspected trigger (if known), and the symptoms the person is exhibiting. Mention if the person has used an epinephrine auto-injector earlier.
3. Administer Epinephrine
- Check for an Epinephrine Auto-Injector: Ask the person whether they carry one. Many individuals with known severe allergies will have an epinephrine auto-injector (e.g., an EpiPen, Auvi-Q) with them.
- Help with the Injection: If they are unable or if you are instructed by them, assist in using the auto-injector. Typically, the injector is pressed firmly into the outer thigh, and the medication is automatically delivered.
- Repeat if Necessary: If symptoms do not improve within 5–15 minutes and emergency services have not yet arrived, a second dose may be necessary. Always follow the instructions provided with the device and any advice from emergency responders (4).
4. Position the Person Safely
- Lay Them Down: Have the person lie flat on their back, unless they are having difficulty breathing. In that case, they should be allowed to sit up slightly—with their legs extended—to ease breathing. If the person is unconscious, place them into the recovery position to maintain an open airway and prevent choking, especially if vomiting occurs.
- Loosen Tight Clothing: Remove or loosen restrictive items like belts or collars, which can impede breathing.
5. Maintain Close Observation and Support
- Monitor Vital Signs: Keep a close watch on the person’s breathing, responsiveness, and pulse. If the person becomes unresponsive and stops breathing, initiate CPR immediately if you are trained.
- Keep the Person Calm: Reassure them as best as you can. Anxiety and panic can worsen the reaction. Encourage slow, steady breathing while you wait for emergency services to arrive.
6. Do Not Give Food or Drink
- Avoid Oral Intake: Do not provide any food or liquids as swallowing might become difficult, and there is a risk of choking, especially if the airway is compromised.
7. Follow Up After an Episode
- Hospital Observation: Even if the symptoms seem to improve after administering epinephrine, it’s important to have the person evaluated in a hospital. A secondary reaction (biphasic anaphylaxis) can occur after initial recovery, which may require further treatment.
- Medical Review: Encourage the person to consult with their healthcare provider about their allergies and the steps to avoid future episodes. Revisiting their emergency action plan and possibly updating their prescription for auto-injectors is crucial for ongoing safety.
How to Prevent Anaphylaxis
One of the most significant ways to prevent anaphylaxis is by staying away from the substances that could lead to such an allergic reaction. The other ways to prevent anaphylaxis are as follows:
- Have your medical alert necklace or bracelet on you at all times so that anyone who is around you is always aware of you being allergic to certain drugs or substances.
- Remember to let your providers know about the medication reactions you may have experienced.
- Carry an emergency kit with you all the time, with the kit containing all the prescribed medications. Your healthcare provider can guide you regarding the content of this particular kit. If you use an epinephrine autoinjector, be sure to check its expiration date and refill your prescription prior to its expiry date.
- Be cautious around stinging insects in case you’re allergic to them. Don’t walk barefoot on grass and stay away from brightly colored clothes. Wear pants and long-sleeved shirts and stay away from scented lotions, colognes, and perfumes. Don’t drink from open soda cans while you’re outdoors.
- Whenever you buy a food item or right before you consume something, always read the label carefully. If you’re eating at a restaurant, it’s advised to ask about the ingredients. This is especially important for the ones who suffer from food allergies.
REFERENCES
- McHugh K, et al. Anaphylaxis: Emergency department treatment. Emergency Medical Clinics of North America. 2022; doi:10.1016/j.emc.2021.08.004.
- Burks AW, et al. Anaphylaxis. In: Middleton’s Allergy: Principles and Practice. 9th ed. Elsevier; 2020. https://www.clinicalkey.com.
- Characterizing biphasic food-related allergic reactions: US food allergy registry. (2021).
https://www.aaaai.org/tools-for-the-public/latest-research-summaries/the-journal-of-allergy-and-clinical-immunology-in/2021/biphasic. - ASCIA first aid plan for anaphylaxis. (2025).
https://www.allergy.org.au/health-professionals/anaphylaxis-resources/first-aid-for-anaphylaxis - Dribin TE, et al. (2023). Who needs epinephrine? Anaphylaxis, autoinjectors, and parachutes.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10259181/
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