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Anaphylaxis: know it, treat it fast

Anaphylaxis is a severe allergic reaction that can become life-threatening within minutes. Knowing the signs and acting fast with epinephrine saves lives.

Medical review: pending. This page is a draft and hasn't been reviewed by an allergist yet.

If you think it's anaphylaxis

  1. Give epinephrine now. Use the auto-injector in the outer thigh. It works through clothing.
  2. Call 911. Say “anaphylaxis” and that epinephrine has been given.
  3. Lie them down with legs raised. If breathing is hard, let them sit up. If they're vomiting, lay them on their side. Don't let them stand or walk.4
  4. Give a second dose if symptoms don't improve, or come back, 5 or more minutes after the first.
  5. Go to the hospital, even if they feel better. Symptoms can come back.

When in doubt, give epinephrine. It's far safer to use it when it turns out it wasn't needed than to wait too long.1

Signs to watch for

Anaphylaxis usually involves more than one part of the body. It can start with mild-looking signs, like an itchy mouth or a few hives, and get worse quickly. Trouble breathing or fainting is an emergency on its own, even without a rash.

Breathing

  • Shortness of breath, wheezing
  • Repeated coughing
  • Tight throat, hoarse voice, trouble swallowing

Skin and mouth

  • Hives over the body
  • Swelling of lips, tongue or face
  • Flushing, itching

Stomach

  • Repeated vomiting
  • Strong stomach pain or cramps
  • Diarrhea

Heart and circulation

  • Pale or bluish skin
  • Dizziness, fainting
  • Weak pulse

How they feel

  • Anxiety, confusion
  • “Something bad is happening”
  • Younger kids may say their mouth feels “spicy” or their tongue feels “too big”

How fast it happens

Reactions to food usually start within minutes to two hours of eating it. In a study of fatal reactions, the time from eating a food to the heart or breathing stopping was often around half an hour.2 At camp, where an ambulance may be 20 or 30 minutes away, that's why epinephrine has to be with the camper, not locked in an office across camp.

Symptoms can come back

Some people feel better and then get worse again hours later, without eating more of the food. This is called a biphasic reaction.1 It's why anyone given epinephrine for anaphylaxis should be checked at a hospital.

Why epinephrine comes first

Epinephrine (adrenaline) is the only medicine that stops anaphylaxis. It opens the airways, raises blood pressure and reduces swelling.1

Do

  • Give epinephrine at the first signs of anaphylaxis
  • Follow the camper's emergency action plan
  • Keep auto-injectors at room temperature and check expiry dates

Don't

  • Give an antihistamine (like Benadryl) and wait to see. Antihistamines can ease itching but don't stop anaphylaxis
  • Rely on an inhaler alone for breathing trouble
  • Wait for symptoms to “get bad enough”

Delays in giving epinephrine are linked to deaths from anaphylaxis.2,3

Who's at highest risk

  • Teens and young adults. Most deaths from food anaphylaxis happen in this age group, often when they're away from home and don't have epinephrine with them.3 That includes older campers and young counselors.
  • People with asthma, especially if it's not well controlled.3
  • People allergic to peanuts and tree nuts. These are behind most fatal food reactions.3
  • Anyone whose epinephrine is late or missing.

What camps should have in place

  • An emergency action plan from the doctor for every camper with a known allergy
  • Epinephrine with the camper or their counselor at all times, including on hikes, at the waterfront and on trips
  • Every counselor trained to recognize anaphylaxis and practiced with a trainer auto-injector
  • Stock epinephrine for unknown allergies, where state law allows
  • Directions for ambulances to every part of camp
  • A drill before campers arrive
See the model camp policy How exposure happens

Sources

  1. Shaker MS, Wallace DV, Golden DBK, et al. “Anaphylaxis—a 2020 practice parameter update, systematic review, and GRADE analysis.” Journal of Allergy and Clinical Immunology, 2020;145(4):1082–1123.
  2. Pumphrey RS. “Lessons for management of anaphylaxis from a study of fatal reactions.” Clinical & Experimental Allergy, 2000;30(8):1144–1150.
  3. Bock SA, Muñoz-Furlong A, Sampson HA. “Further fatalities caused by anaphylactic reactions to food, 2001–2006.” Journal of Allergy and Clinical Immunology, 2007;119(4):1016–1018.
  4. Pumphrey RS. “Fatal posture in anaphylactic shock.” Journal of Allergy and Clinical Immunology, 2003;112(2):451–452.

This page shares general information and is not medical advice. Always follow the emergency action plan from the person's doctor.