Anaphylaxis – recognising a severe allergic reaction

Most allergic reactions are mild: a rash, hives, itching, a runny nose, some swelling. Anaphylaxis is different. It involves the breathing or the circulation, it can develop within minutes, and it can kill.

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• Common triggers are foods such as peanuts, tree nuts, shellfish, eggs, milk and sesame; insect stings; medicines, especially some antibiotics and anti-inflammatories; and latex.
• A previous mild reaction does not predict a mild next one. Someone can react mildly for years and then have anaphylaxis.

1. 1Use the adrenaline auto-injector immediately if there is one. Do not wait to see whether it gets worse — adrenaline given early is what works, and giving it when it turns out not to be needed does far less harm than delaying.
2. 2Call an ambulance and say the word anaphylaxis.
3. 3Lie the person flat with their legs raised. If they are struggling to breathe, let them sit up. If they are pregnant, lie them on their left side. If unconscious but breathing, roll them onto their side.
4. 4Do not stand them up or let them walk, even if they feel better. Standing suddenly can cause the circulation to collapse.
5. 5If there is no improvement after five minutes and a second auto-injector is available, use it.
6. 6Stay with them until the ambulance arrives, and take the used injector and the suspected trigger with them.

An auto-injector is used into the outer thigh muscle, and it works through clothing. Follow the instructions on the device itself — hold it in place for the time the device specifies, then rub the area.

Symptoms can return hours after they seem to have settled, once the adrenaline wears off. Everyone who has had anaphylaxis needs to be observed in hospital even if they feel completely well again by the time help arrives.

• Ask for a replacement auto-injector before you leave, and check the expiry date on the ones you keep.
• Ask for referral to work out what caused it, if it is not obvious.
• Carry two auto-injectors rather than one, and keep them with the person rather than in a car or a cupboard.
• Tell school, work or family where they are and how to use them — the person having the reaction is often not able to.
• Wear or carry something that names the allergy.