SummaryRead the full fact sheet
- Anaphylaxis is a severe allergic reaction and is a medical emergency.
- Adrenaline (epinephrine) is required to treat anaphylaxis.
- The most important management strategy for anaphylaxis is to avoid all known triggers and to always carry your adrenaline autoinjector (EpiPen®).
Anaphylaxis is a severe allergic reaction and requires . Within minutes of exposure to the allergen, or ‘trigger’, a person can have potentially life-threatening symptoms such as breathing and/or heart symptoms. There is currently no cure for .
People at risk of anaphylaxis must always carry their ASCIA Action Plan and their adrenaline autoinjector (EpiPen®) with them at all times.
If you are thought to be at risk of anaphylaxis or you experience anaphylaxis for the first time, your doctor will refer you to a clinical immunology or allergy specialist, who will formally diagnose you and discuss management particular to your needs and circumstances.
Anaphylaxis is a severe allergic reaction
Allergy occurs when the overreacts to a substance or ‘trigger’ in the person’s environment that is typically harmless. The substance or trigger is called an allergen. The immune system responds by making an antibody to attack the allergen and this starts off a range of immune system reactions.
Allergies can be mild, moderate or severe. Anaphylaxis is the most severe type of allergic reaction. Hospital admissions for anaphylaxis have increased five-fold in the last 20 years and anaphylaxis from food allergy reactions has doubled in the last 10 years.
Signs and symptoms of anaphylaxis
Anaphylaxis can occur within minutes. It mostly occurs within 20 minutes to 2 hours after exposure to the allergen. Signs and symptoms may be mild at first, but can rapidly worsen. A small number of people suddenly develop signs and symptoms of a severe allergic reaction (anaphylaxis) without any signs of a mild to moderate allergic reaction.
Signs of a mild to moderate allergic reaction include:
- swelling of lips, face, eyes
- or welts appearing on the skin
- tingling mouth
- abdominal pain, vomiting (these are signs of anaphylaxis for insect allergy).
Signs of a severe reaction (anaphylaxis) include:
- difficult/noisy breathing
- swelling of tongue
- swelling/tightness in the throat
- difficulty talking and/or hoarse voice
- wheeze or persistent cough
- persistent dizziness or collapse
- pale and floppy (in young children).
Triggers for anaphylaxis
Some of the more common triggers (allergens) that can lead to anaphylaxis include:
- – any food can be a trigger. However, the foods that account for about 90% of allergic reactions are , , , , wheat, and
- – including bees, wasps, jack jumper ants, green ants and fire ants. Ticks (arachnids) can also trigger anaphylaxis
- medicines – some prescription drugs (such as penicillin), over-the-counter medicines (such as aspirin) and herbal preparations.
Sometimes, despite many investigations, a person’s trigger allergen/s cannot be identified. These are referred to as ‘unknown triggers’.
Risk factors for anaphylaxis
There are a number of factors that appear to increase the risk and/or severity of anaphylaxis at the time of exposure to the allergen/trigger. These include:
- poorly controlled
- – standing and walking
- hormonal changes (for example, in women that are )
- taking a non-steroidal anti-inflammatory medication such as aspirin or ibuprofen.
Diagnosis of allergy and possible risk of anaphylaxis
If you are thought to have a moderate/severe allergy, are at risk of anaphylaxis or you experience anaphylaxis for the first time, your general practitioner (GP) will:
- record the history of your allergic reaction and suspected trigger/s
- refer you to a clinical immunology/allergy specialist
- inform you about patient support services, such as .
The clinical immunology/allergy specialist will:
- progress investigations
- discuss past history
- formally diagnose you
- discuss management particular to your needs and circumstances
- complete an ASCIA Action Plan for Anaphylaxis/Allergic reactions that outlines emergency management.
Your clinical immunology/allergy specialist may prescribe an adrenaline autoinjector (EpiPen®). Not everyone with a food, insect or other allergy that may be severe is prescribed an adrenaline autoinjector. The specialist will review level of risk. Those with medication allergy are generally not prescribed an adrenaline autoinjector.
You will need regular follow-up visits with an allergy specialist.
Tests used in the diagnosis of allergy may include:
- medical history including detailed questioning about what led up to the event
- physical examination of signs and assessment of symptoms
- to check for the presence of particular antibodies
- to confirm or rule out suspected triggers
- tests to exclude other medical conditions that can look like an allergic reaction or anaphylaxis.
Some ‘allergy tests’ are not proven
Some ‘tests’ that claim to diagnose allergies are not scientifically or medically proven. Tests that are not proven to provide accurate information on your trigger/s for allergic reactions, including anaphylaxis, can be dangerous. Relying on an unproven test may mean you don’t get the medical attention you need. It may also delay you receiving a diagnosis and anaphylaxis management advice. It can also result in unnecessary dietary and lifestyle restrictions.
Some alternative testing methods that may lead to inappropriate or inadequate treatment include:
- Alcat testing
- allergen elimination techniques
- cytotoxic food testing
- hair or stool analysis
- IgG food antibody testing
- pulse testing
- Rinkel’s intradermal testing
- Vega testing.
Treatment for anaphylaxis
1. Lay the person flat (do not allow them to stand or walk).
2. Give adrenaline autoinjector.
3. Phone ambulance – dial triple zero (000).
4. Phone family/emergency contact.
5. Further adrenaline doses may be given if no response after 5 minutes.
6. Transfer person to hospital for at least 4 hours of observation from time of last dose of adrenaline.
Always give adrenaline autoinjector first, and then asthma reliever puffer if someone with known asthma and severe allergy to food, insect or medication has sudden breathing difficulty, even if no skin signs (hives or welts) are present.
Adrenaline injection is used to treat anaphylaxis. Adrenaline is injected into the muscle of the outer mid-thigh (that is, midway between the knee and hip joints on the outer side of the thigh) using an adrenaline autoinjector (EpiPen®).
Once you are diagnosed at risk of anaphylaxis, it is important to always carry your adrenaline autoinjector and your ASCIA Action Plan for Anaphylaxis, which is completed and signed by your doctor.
In Australia, the only device currently available is EpiPen®. EpiPen® is prescribed on an ‘authority prescription’, allowing people to get 2 government-subsidised devices (on the ). They are also available over the counter at the pharmacy.
The spring-loaded automatic adrenaline autoinjectors are designed to deliver a single pre-measured dose of adrenaline. EpiPen® comes in 2 doses:
- EpiPen® for children over 20kg and adults
- EpiPen Jnr® for children who weigh between 7.5kg and 20kg.
Prevention of anaphylaxis
The best way to avoid anaphylaxis is to:
- avoid triggers – the most important management strategy is to avoid all known triggers (allergens)
- if you have a food allergy, always read food labels and disclose your allergy when eating out (that means letting the staff know about your allergy).
Other recommendations include:
- Complete the free, online .
- Tell people about your allergy:
- Let your workplace know about your allergy, and make a few select work colleagues aware of where your emergency medication is kept, and how to administer it to you.
- If you have a medication allergy, be sure to always disclose your allergy to every treating doctor and pharmacist.
- Wear a medical identification bracelet – if you lose consciousness, your medical identification bracelet will advise ambulance officers or hospital staff of your condition.
- If you are finding your food allergy difficult to manage, or if you have multiple food allergies, consider making an appointment with an accredited dietitian.
- Seek information and support from - an evidence-based organisation with information, resources and support from trained health educators.
If your child has severe allergies
Suggestions for parents include:
- Educate your child, taking their age and level of understanding into account. If your child has food allergy, stress the importance of only accepting food from trusted adults such as parents or caregivers, never sharing food and washing hands before and after eating.
- Advise the childcare service, kindergarten, school and other carers of your child’s condition.
- Give the organisation a current copy of your child’s ASCIA Action Plan for Anaphylaxis, which includes a recent photograph of your child.
- Make sure you provide an in-date adrenaline autoinjector.
- Work with your child’s to implement a management plan to reduce the risk of allergic reactions, including anaphylaxis. Confirm whether they have current anaphylaxis training and understand how to identify and respond to an allergic reaction. It is important for the school or childcare setting to raise awareness of severe allergies in the school and the broader community.
- Complete free online .
Long-term outlook for anaphylaxis
Most children grow out of allergies to milk, egg, wheat and soy. However, allergies to peanut, tree nuts, sesame, fish, shellfish and lupin are usually lifelong.
Eating even a small amount of an allergen can cause an allergic reaction, including anaphylaxis, so education on avoidance of food trigger/s is vital.
It is very important to carry an adrenaline autoinjector (EpiPen®) and to not hesitate to use it following instructions on your or your child’s ASCIA Action Plan for Anaphylaxis.
People with need to always be aware of environments that may increase the risk of insect sting or bite, and do what they can to minimise exposure. People that have experienced anaphylaxis because of insect allergy should discuss immunotherapy or desensitisation with their doctor.
Anaphylaxis training options include:
- – this is online training for members of the community, such as parents, friends, carers, workplace colleagues, students and club members.
- – starting with the All about allergens course, this series of training (developed as part of the National Allergy Strategy) is for owners and workers in food businesses, including cooks, chefs and camp staff.