First Aid for Anaphylaxis

Anaphylaxis is a severe and potentially life-threatening allergic reaction that requires immediate medical attention. It can develop within seconds or minutes after exposure to an allergen, such as certain foods, insect stings, medications, or latex. Without prompt treatment, it can quickly lead to shock, loss of consciousness, or even death. Knowing how to recognize and respond to anaphylaxis can save a life.

Common Triggers of Anaphylaxis

Some of the most frequent causes of anaphylactic reactions include:

• Foods: Peanuts, tree nuts, shellfish, milk, eggs, wheat, and soy.
• Insect Stings: Bees, wasps, hornets, and fire ants.
• Medications: Certain antibiotics, pain relievers, and intravenous contrast agents.
• Latex: Found in gloves, balloons, or medical equipment.
• Exercise-Induced Reactions: Sometimes linked with specific foods or medications.

People with asthma or a history of anaphylaxis are at higher risk for severe outcomes.

Signs and Symptoms

Anaphylaxis symptoms can affect many systems in the body and may appear quickly after exposure. Watch for:

• Hives or rash
• Swelling of the face, lips, throat, or tongue
• Trouble breathing or wheezing
• Rapid heartbeat
• Vomiting, diarrhea, or stomach cramps
• Dizziness or fainting
• Low blood pressure
• A feeling of doom or confusion

Mild symptoms can quickly turn severe, so early recognition is critical.

Immediate First Aid Steps

If you suspect someone is experiencing anaphylaxis:

1. Call 911 or local emergency services immediately. Even if symptoms appear mild, call for help right away—anaphylaxis can worsen fast.
2. Administer an epinephrine auto-injector (if available). Epinephrine, also called adrenaline, is a prescription medication that helps reverse the severe effects of an allergic reaction. It works by relaxing airway muscles, increasing blood pressure, and reducing swelling. If the person carries an auto-injector, help them use it as instructed.
3. Help the person lie down and stay still. Keep their legs elevated unless they are having trouble breathing. Do not let them walk around, as this can increase the risk of shock.
4. Loosen tight clothing and remove any items that make breathing harder.
5. Monitor breathing and consciousness. If the person becomes unresponsive or stops breathing, begin CPR right away and continue until help arrives.
6. Watch for vomiting. If vomiting occurs, turn the person onto their side to prevent choking.
7. Second dose of epinephrine (if available). If symptoms return or don’t improve within 5 to 15 minutes, a second dose may be given, according to medical guidelines. This should only be done using a second auto-injector and under medical direction when possible.

What Not to Do

Avoid these actions during an anaphylactic emergency:

• Do not give antihistamines (like diphenhydramine) as a substitute. Antihistamines work too slowly and are not effective at stopping a severe reaction.
• Do not delay medical care. Even if epinephrine is given and symptoms improve, the person must still go to the hospital. Delayed reactions can happen hours later.
• Do not offer food, drink, or medication by mouth if the person is having trouble breathing or is not fully alert.

Aftercare and Hospital Follow-Up

Once in the emergency room, doctors may give:

• Additional epinephrine if symptoms persist.
• Oxygen therapy to help with breathing.
• Intravenous fluids to stabilize blood pressure.
• Bronchodilators (airway-opening medications) if wheezing continues.
• Corticosteroids to reduce long-term inflammation.
• Antihistamines for lingering allergic symptoms.

Observation for several hours is common, as a second wave of symptoms—called biphasic anaphylaxis—can occur even after initial treatment.

Prevention and Preparedness

People with a known allergy should:

• Carry an epinephrine auto-injector at all times.
• Wear a medical alert bracelet or tag.
• Read food labels carefully.
• Let friends, coworkers, teachers, or caregivers know about their allergy.
• Avoid known triggers completely whenever possible.

If prescribed an auto-injector, the person should also receive training on how and when to use it. Family members and caregivers should also learn the steps.

Special Considerations for Children

Children may not always be able to describe their symptoms clearly. Watch for:

• Sudden quietness
• Scratchy voice or hoarseness
• Pulling at the tongue or throat
• Widespread rash or flushed skin
• Acting sleepy or confused

Always treat any suspected reaction seriously. In schools, camps, and childcare settings, epinephrine should be readily available, and trained adults should be on-site.

Note: Epinephrine is a prescription medication and should only be used under the guidance of a healthcare provider. Generic names may be used in place of brand names, but no over-the-counter option exists for this type of emergency treatment.