Anaphylaxis is a severe, life-threatening allergic reaction. It requires immediate emergency attention. Learn the symptoms of anaphylaxis and how to respond.
When someone has a severe, life-threatening allergic reaction, this is known as anaphylaxis. Anaphylaxis affects multiple systems of the body at once, and usually appears suddenly.
Your child will need immediate emergency attention if they develop anaphylaxis. Inject epinephrine (an Epi-pen) immediately, and call 911.
Learn more about anaphylaxis and epinephrine from Nationwide Children’s Hospital. (For immediate instructions on how to give epinephrine, skip to 2:52.)
What causes anaphylaxis?
Any allergic reaction to food, medicine, or an insect sting could develop into anaphylaxis.
This article will focus on anaphylaxis from food allergies, because food allergies are the most common cause of anaphylaxis.
Allergic reactions to peanuts and tree nuts are most commonly associated with emergency room visits and anaphylaxis. But peanuts and tree nuts aren't the only foods that cause anaphylaxis.
Any food could potentially cause anaphylaxis when eaten, if someone has an allergy to that food.
Anaphylaxis On The Rise
Anaphylaxis caused by food allergies is on the rise.
FARE (Food Allergy Research and Education) reports that over 40% of children with food allergies, and over 50% of adults with food allergies, have either experienced anaphylaxis or another severe allergic reaction.
Also, between the late 1990s and mid-2000s, children's hospital visits due to food allergy anaphylaxis more than tripled.
And among both children and adults, "medical procedures to treat anaphylaxis resulting from food allergy increased by 380 percent between 2007 and 2016."
In fact, food allergies send someone to the emergency room every three minutes.
Any Food Allergy Reaction Could Develop Into Anaphylaxis
Any food allergy reaction could develop into anaphylaxis.
People with food allergies can sometimes have drastically different symptoms from one food allergic reaction to the next.
This means that you can't predict whether someone's future food allergy reactions will be mild, moderate, or life-threatening.
If your child has only experienced mild or moderate food allergy reactions before, they could still experience anaphylaxis in the future. Your child's first allergic reaction to a food could also develop into anaphylaxis.
And even allergic reactions that start out mild or moderate could rapidly develop into anaphylaxis. Treat every allergic reaction seriously, and monitor your child closely whenever they develop any allergic reaction.
Remember: Any food allergic reaction could develop into anaphylaxis.
Anaphylaxis Symptoms: How To Know If Your Child Has Anaphylaxis
When the symptoms of a food allergic reaction are severe, and they involve two or more organ systems, this reaction is classified as anaphylaxis. Anaphylaxis can be life-threatening.
In most cases, anaphylaxis symptoms appear seconds to minutes after someone eats a food that they are allergic to.
However, anaphylaxis may sometimes develop an hour or two after someone eats a problem food.
If your child develops any of these severe allergic reaction symptoms, your child may have anaphylaxis:
Skin:
- Hives that spread to many areas the body
- Pale appearance
Throat and tongue:
- Swelling or tightness of the throat
- Swelling of the tongue
Respiratory:
- Difficulty breathing/shortness of breath
- Repeated, significant coughing
- Noisy breathing (wheezing)
Voice/cry:
- Change in cry or voice
- Struggling to vocalize
Digestive:
- Trouble swallowing
- Repeated vomiting
- Diarrhea
Cardiovascular:
- Rapid heartbeat
- Blood pressure drop
- Dizziness
- Fainting/collapse
- Loss of consciousness
Other:
- Feeling floppy (babies and young children only)
Remember: severe symptoms in more than one organ system = anaphylaxis.
Treating Anaphylaxis: Give Epinephrine Immediately
*Always consult with your health care provider to determine your child’s food allergy and anaphylaxis emergency care plan
Anaphylaxis can be life-threatening. It requires immediate treatment and emergency attention.
When your child develops anaphylaxis, give epinephrine immediately, and call 911.
Epinephrine (adrenaline) is the only medicine that can stop anaphylaxis.
- To give epinephrine, use an auto-injector (an Epi-pen).
It’s crucial to give your child epinephrine as soon as possible. Epinephrine is lifesaving!
If you think your child has anaphylaxis, inject the Epi-pen right away.
- Follow this rule: use the Epi-pen whenever your child shows any severe allergic reaction symptoms.
- An Epi-pen can only help your child. It won’t harm your child, even if they aren’t experiencing anaphylaxis.
- As Nationwide Children’s Hospital attests, “No child has ever had serious problems from a standard dose of epinephrine when using an EpiPen.” It’s waiting too long to use the Epi-pen that can be harmful.
Giving epinephrine to your baby
- Lay your baby flat in your arms.
- Do not hold baby upright.
- Do not let baby stand or walk.
- If baby has difficulty breathing, sit them up.
- If baby has fainted, or is vomiting, lay them on their side.
- Remember that you can inject the Epi-pen through clothing.
- You don't need to remove any of baby's clothing, or roll up their bottoms.
- Pop off the Epi-pen’s cap.
- Make a fist as you hold the Epi-pen.
- Do not put your thumb on either of the ends.
- Hold baby and their leg still.
- Locate the big muscle in your baby's outer thigh.
- It is on the side of the leg that faces out.
- The best place to inject the Epi-pen is into this muscle, about halfway between the hip and knee.
- Push the needle end of the Epi-pen down on the middle of baby’s outer thigh, so the needle goes into the thigh muscle.
- Listen for the click.
- Hold the Epi-pen down on the thigh for 10 seconds. Then, release.
- Massage the place where you injected the Epi-pen for 10 seconds.
- Record the exact time you injected the Epi-pen.
Giving epinephrine to your child
- Have your child lie down on their back, or have them sit.
- If you have a toddler or younger child, you could have them sit in your lap, to help keep them still.
- If your child is vomiting, or has fainted, lay them on their side.
- Tell your child to stay still during the injection process. Be ready to hold them to keep them still, if needed.
- Remember that you can inject the Epi-pen through clothing.
- Pop off the Epi-pen’s cap.
- Make a fist as you hold the Epi-pen.
- Do not put your thumb on either of the ends.
- Hold your child’s leg still.
- Locate the big muscle in your child's outer thigh.
- It is on the side of the leg that faces out.
- The best place to inject the Epi-pen is into this muscle, about halfway between the hip and knee.
- Push the needle end of the Epi-pen down on the middle of your child's outer thigh, so the needle goes into the thigh muscle.
- Listen for the click.
- Hold the Epi-pen down on the thigh for 10 seconds. Then, release.
- Massage the place where you injected the Epi-pen for 10 seconds.
- Record the exact time you injected the Epi-pen.
Different epinephrine brands may have slightly different instructions for injection. Follow the exact instructions that come with your auto-injectors.
You can also practice with a training auto-injector. The trainer is only for practice---it doesn't contain epinephrine, so you can practice with it as many times as you need.
Ask your doctor if you have any questions about using an auto-injector.
What to do after giving epinephrine?
After giving epinephrine, call 911 right away.
- Tell the emergency operator that your child is having an anaphylactic reaction.
- Request an ambulance with epinephrine.
Stay with your child, and monitor their symptoms until the rescue squad arrives.
- Keep your child lying on their back. You can also keep them on their side, or sitting, based on their position when you gave epinephrine.
If your child’s anaphylaxis doesn’t improve within 5 minutes after you've injected an Epi-pen, or gets worse, give them a second Epi-pen injection from a different Epi-pen.
- Have at least two Epi-pens ready at all times, in case your child would ever need a second dose.
When the rescue squad arrives, give them the used Epi-pen(s), and tell them the exact time you last gave your child epinephrine.
What If I Don't Have Epinephrine?
Epinephrine is the only medicine that can stop anaphylaxis.
Antihistamines like Benadryl and Zyrtec, and other medicines, cannot stop anaphylaxis. Never use any other medicine in place of epinephrine!
Dr. Katie Marks-Cogan, Board-certified Allergist and our Chief Allergist, explains, “I only recommend Benadryl or Zyrtec for children who are having a mild allergic reaction. Benadryl or Zyrtec will not stop anaphylaxis from happening---only epinephrine will. It’s an important thing to educate parents on, because many parents think that Benadryl will actually stop anaphylaxis, but that is not the case.”
If your child shows signs of anaphylaxis, but you do not have epinephrine, call 911 right away. Tell the emergency operator that your child is having an anaphylactic reaction and that they need epinephrine promptly. Then, ask for an ambulance with epinephrine.
Be Alert For Biphasic Reactions
Keep in mind that anaphylaxis could potentially return 4-24 hours after your child receives epinephrine, and after the first round of severe symptoms goes away.
This second reaction is known as a biphasic reaction.
- If this happens, your child will need a second dose of epinephrine.
- It’s crucial to have at least two Epi-pens ready for your child at all times, in case a biphasic reaction occurs.
Planning For Possible Anaphylaxis
How to plan for possible anaphylaxis? Have a current prescription for an Epi-pen, and have at least two Epi-pens ready at all times.
If your child has a food allergy and doesn’t yet have an epinephrine prescription, consult your doctor.
(Unfortunately, epinephrine can be expensive. Talk to your doctor if you need assistance affording this lifesaving care, as savings programs are available. You can also consult this article from SnackSafely that covers epinephrine savings programs, or this article from FARE that covers epinephrine affordability assistance.)
Your child’s school, daycare, and any other place your child receives care outside the home must have at least two Epi-pens on hand in case your child develops anaphylaxis.
Also, all of your child’s caregivers need to know how to recognize anaphylaxis, and how to inject an Epi-pen in an emergency.
The American Academy of Pediatrics (AAP) recommends using a written anaphylaxis emergency action plan, like this sample one, to prepare caregivers for a food allergy emergency. Talk to your pediatrician or allergist about developing a personalized action plan for your child.
When your child has a food allergy, making sure your child avoids foods they are allergic to is the only way to keep anaphylaxis from developing in the first place. But emergencies can occur, so it's vital to have two Epi-pens on hand at all times.
A Note On Anaphylaxis And Babies
Babies are the age group least likely to develop anaphylaxis, according to a recent study.
According to this study, which was conducted by Dr. Jonathan Spergel and others:
- Severe allergic reactions (including anaphylaxis) were least common in babies under 1 year of age.
- Infants were the group least likely to need an Epi-pen to treat an allergic reaction.
- When infants under age 1 have allergic reactions, the reactions tend to be mild.
- There were no food allergy-related deaths in children under the age of 1.
This low likelihood of anaphylaxis means it's safest to start feeding baby common allergenic foods, like peanut, egg, tree nuts, and milk, before your baby turns 1. Ready. Set. Food! can help you safely introduce foods like these early and often, to help start baby on the road to a lifetime of adventurous eating.
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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.
These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.