When responding to possible anaphylaxis:

In Australia, allergies are very common. Currently around one in three people will develop allergies at some time during their life. It is estimated that up to 2% of adults, 1 in 10 babies and 6% of children have a food allergy and some of them will experience a life-threatening allergic reaction (anaphylaxis).

Anaphylaxis, or anaphylactic shock, is the most serious allergic reaction and can cause death without prompt medical attention.

Anaphylaxis is a generalised allergic reaction, which often involves more than one body system (e.g. skin, respiratory, gastro-intestinal and cardiovascular). Food allergies, insect stings, medications (including prescriptions, over the counter, alternative therapies), and latex are the most common causes of anaphylactic reactions. A severe allergic reaction or Anaphylaxis usually occurs within 20 minutes to 2 hours of exposure to the trigger and can rapidly become life threatening.

Anaphylaxis requires immediate administration of an adrenaline auto-injector (AAI), and triple zero (000) should always be called.

Each year, approximately 10 people die from anaphylactic reactions of which some of these have been triggered by food.

Anaphylaxis can occur within minutes – the average is around 20 minutes after exposure to the allergen. Symptoms may be mild at first but tend to get worse rapidly.

• Facial swelling, including swelling of the lips and eyelids
• Swollen tongue
• Reddening of skin across the body
• Hives (red welts) appearing across the skin
• Abdominal discomfort or pain
• Vomiting
• Strained or noisy breathing
• Inability to talk or hoarseness
• Wheezing or coughing
• Drop in blood pressure
• Unconsciousness
• Young children may become floppy and pale

Triggers of anaphylaxis

Anaphylaxis occurs when the immune systems severely overreacts to a substance or ‘trigger’ in the person’s environment that is typically harmless. The immune system responds by making antibodies to attack the allergen and this starts off a range of immune system reactions. Anaphylaxis is the most severe allergic reaction and affects about one person in 200.

Some of the more common triggers (allergens) that can lead to anaphylaxis include:

• Food – any food can be a trigger. However, the most common trigger foods that account for about 90 per cent of allergic reactions include seafood (such as lobsters, prawns and crabs), eggs, milk, peanuts, tree nuts (such as almonds, cashews, pecans and walnuts) and sesame or soy products
• Insect venom – including bees, Jumping Jack ants, ticks, fire ants and wasps
• Medicines – from some prescription drugs (such as penicillin), over-the-counter medicines (such as aspirin) and herbal preparations
• Uncommon triggers – include exercise, anaesthesia or latex
• Unknown triggers – sometimes, despite exhaustive investigations, a person’s trigger or triggers cannot be identified

The best way to avoid anaphylaxis is to follow your anaphylaxis management plan. Common suggestion includes: Avoid triggers – the most important management strategy is to keep away from all known triggers

• Avoid triggers – the most important management strategy is to keep away from all known triggers
• Learn about and identify hidden triggers – trigger education with an accredited dietitian can help you to identify allergens that may be hidden inside processed and packaged foods.
• Tell your friends and workmates – it is important that the first aiders at your workplace (or other organisations where you regularly visit, as a volunteer or club member for example) know where your AAI is stored and how to use it in case you need help
• Carry an adrenaline auto-injector (EpiPen) at all times
• Complete Anaphylaxis First Aid Training

Anaphylaxis First Aid

An anaphylactic reaction is a life-threatening medical emergency and triple zero (000) must be called immediately.

In the event of an Anaphylactic episode, you should:

1. Follow the DRSABCD
2. Call triple zero (000)
3. Lay the casualty down or in a position which they find easiest to breathe (not standing)
4. Ask if they have their adrenaline auto-injector on them
5. If the casualty cannot administer the injection themselves help them

6. Record the time the adrenaline auto-injector was delivered7. If the casualty had not been previously diagnosed and therefore does not have the appropriate medication, wait for medical assistance to arrive8. Ensure the casualty remains lying flat. If breathing is difficult allow them to move into a comfortable position to breathe (sitting up)9. Monitor the casualty’s breathing

10. Once five minutes has passed, if there is no response or improvement, administer another dose whilst alerting the 000 operator who will instruct you further if needed

Anaphylaxis is the most severe allergic reaction and is a medical emergency requiring immediate treatment and urgent medical attention. To prevent an anaphylactic episode, it’s most important to avoid all triggers and to always carry your adrenaline auto-injector (AAI).

References :

FIRST AID FACT SHEET

What to do in the case of Anaphylaxis

A severe allergic reaction is the body’s immune system overreacting to a foreign substance. This is called Anaphylaxis and is potentially life-threatening.

What to do

1. Follow DRSABCD St John Action Plan.
2. Lay the casualty flat. If breathing is difficult allow them to sit. DO NOT allow them to stand or walk.
3. If the casualty is carrying an adrenaline autoinjector, use it immediately. Ask the casualty if they need your help to use the adrenaline auto-injector.
4. Urgent medical aid. Call Triple Zero (000) for an ambulance immediately.
5. If required assist the casualty with an adrenaline autoinjector (EpiPen®).++ Form a firm fist around the EpiPen® and pull off the BLUE SAFETY RELEASE.++ Place ORANGE END against outer mid-thigh at a 90° angle (can be injected through clothing).++ Push down hard until a click is heard or felt and hold in place for three (3) seconds.++ Remove EpiPen® and dispose of it safely being careful of the needle.  

   ++ Monitor the casualty, if no improvement, administer a second dose after 5 minutes.

6. Commence CPR and defibrillation at any time if the casualty is unconscious and is not breathing normally.

Caused by

• Food: Nuts, cow’s milk, eggs, fish, shellfish and soy products.
• Medications: Penicillin, Sulphur, antibiotics, Aspirin, Ibuprofen, Codeine or Morphine.
• Venom: Bites from ticks, stings from bees, wasps and ants.
  

Signs and symptoms

• Difficult and/or noisy breathing.
• Wheeze or persistent cough.
• Swelling of the face and tongue.
• Swelling/tightness of the throat.
• Difficulty talking and/or “hoarse” voice.
• Persistent dizziness or collapse.
• Young children may become pale and floppy.
• Abdominal pain and vomiting.
• Hives, welts and body redness.

• In an emergency such as a severe allergic reaction (anaphylaxis) or an asthma attack where breathing is difficult, call triple zero (000) and ask for an ambulance.
• Anaphylaxis needs emergency first aid. The first line treatment is injection of adrenaline (epinephrine) into the outer mid-thigh. Do not allow the person to stand or walk. Give further doses of adrenaline if there is no response after 5 minutes.
• If your doctor says you are at risk of a severe allergic reaction, be sure to carry a device to inject adrenaline (EpiPen® or Anapen®) and a mobile phone to call for help.

Severe allergic reactions (anaphylaxis) and asthma attacks related to allergies need emergency first aid.

If you (or a family member) have previously had asthma, or a severe allergic reaction, your doctor (GP) or nurse practitioner will complete an Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis . Follow the plan if the symptoms of an allergic reaction appear.

Symptoms of a severe allergic reaction (anaphylaxis)

Symptoms of a severe allergic reaction include:

• difficult or noisy breathing
• swelling of the tongue
• swelling or tightness in the throat
• wheeze or persistent cough
• difficulty talking or hoarse voice
• persistent dizziness or collapse
• pale and floppy (young children)
• abdominal pain, vomiting – these are signs of anaphylaxis for insect allergy.

Signs of mild to moderate allergic reaction include:

• swelling of the lips, face and eyes
• hives or welts
• tingling mouth
• abdominal pain, vomiting – these are signs of anaphylaxis for insect allergy.

Mild to moderate allergic reactions (such as hives or swelling) may not always occur before anaphylaxis.

If you have experienced any of these symptoms, you are at greater risk of having another severe reaction. Ask your doctor to refer you to a clinical immunology/allergy specialist .

Emergency first aid for severe allergic reactions

A severe allergic reaction (anaphylaxis) is life-threatening and requires urgent action .

1. Lay the person flat – do not allow them to stand or walk.
2. Give adrenaline injector (such as EpiPen® or Anapen®) into the outer mid-thigh.
3. Phone an ambulance – call triple zero (000).
4. Phone family or emergency contact.
5. Further adrenaline may be given if there is no response after 5 minutes.
6. Transfer person to hospital for at least 4 hours of observation.

If in doubt, give adrenaline injector.

Commence CPR (cardiopulmonary resuscitation) at any time if person is unresponsive and not breathing normally.

Always give adrenaline injector first, and then asthma reliever puffer if someone with known asthma and allergy to food, insects or medication has sudden breathing difficulty (including wheeze, persistent cough or hoarse voice) even if there are no skin symptoms.

Be prepared for severe allergic reactions

If you are at risk of a severe allergic reaction, make sure you:

• Have an ASCIA Action Plan for Anaphylaxis .
• Carry a mobile phone to call for help when needed.
• Carry an adrenaline injector (EpiPen® or Anapen®) to treat a severe allergic reaction.
• Consider wearing medical identification jewellery – this increases the likelihood that adrenaline will be administered in an emergency.
• Avoid medication (where possible) that may increase the severity of an allergic reaction or complicate its treatment – such as beta blockers.
• Avoid the known allergen where possible.

Adrenaline injectors

Adrenaline works fast to reverse a severe allergic reaction, and adrenaline injectors (EpiPens® and Anapen®) are designed for use by people who are not medically trained. If you are at risk of anaphylaxis, your doctor will have prescribed an adrenaline injector.

Emergency first aid for asthma attacks

If you have asthma, your doctor will prescribe medication and help you to develop a plan to manage your asthma and an action plan for asthma attacks.

Asthma can be well controlled with medication in most people.

If you, or someone you know, are having an asthma attack, follow the asthma action plan. In case of emergency, call triple zero (000) and ask for an ambulance. Tell the operator that someone is having an asthma attack.

Read more about asthma emergency first aid.

Where to get help

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This page has been produced in consultation with and approved by:

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