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Anaphylaxis and severe allergic reaction
What is anaphylaxis?
Anaphylaxis typically involves sudden breathing difficulty, swelling of the tongue or throat, widespread rash, wheeze, hoarse voice, collapse or profound dizziness, often with a known allergen exposure. Mild allergic reactions may present with localised rash or itching only, but anaphylaxis affects breathing, circulation or both and is a medical emergency.
UK Resuscitation Council guidance emphasises early recognition, prompt intramuscular adrenaline into the outer thigh, repeated doses if necessary and early 999 activation, with positioning and airway management tailored to breathing and circulation. People at risk are often prescribed adrenaline auto-injectors (AAIs) such as EpiPen, which should be carried at all times and used without delay when anaphylaxis is suspected.
Anaphylaxis is a severe, life-threatening allergic reaction that can develop rapidly after exposure to a trigger such as food, drugs or insect stings and requires immediate treatment with intramuscular adrenaline and emergency care.
Who needs this skill?
Health & Social Care
In health and social care, staff must follow anaphylaxis algorithms and medicine management policies, recognising high-risk situations such as antibiotic administration, contrast media and immunotherapy, and ensuring AAIs and resuscitation equipment are immediately available. Clinical staff must also complete MHRA device training for AAIs and understand dose and repeat timing.Licensed venues & nightlife
In nightlife and licensed venues, food, drink and environmental exposures such as nuts, seafood and latex can trigger reactions; staff should take complaints of 'throat closing', breathing difficulty or sudden collapse seriously and call 999, supporting use of AAIs where available rather than assuming panic or intoxication.Schools
Allergy and anaphylaxis are key risks in education settings, from school dinners to bake sales and trips; staff need clear, practised routines for recognising reactions and using pupils' AAIs or stock devices where permitted.Workplaces
In workplaces, especially those with catering, food manufacturing or high insect-sting exposure, first aiders should be able to recognise anaphylaxis, help casualties use their own AAIs and understand organisational policies on stock AAIs where applicable. Employers should incorporate allergy risks into COSHH and general risk assessments.How to manage anaphylaxis
- 1Recognise signs of anaphylaxisLook for rapidly developing breathing or swallowing difficulty, hoarse voice, wheeze, swelling of tongue or throat, widespread rash or flushing, vomiting, abdominal pain, collapse or marked dizziness after a possible allergen exposure.Treat any combination of airway or breathing difficulty and circulatory compromise as anaphylaxis until proven otherwise, even if skin signs are mild or absent.
- 2Call 999 immediatelyCall 999 as soon as anaphylaxis is suspected, stating clearly that you think it is anaphylaxis and whether adrenaline has been given, and follow the call-handler's advice.Do not wait to see if symptoms worsen before calling; delays increase the risk of cardiac arrest.
- 3Give intramuscular adrenaline using an AAI if available and within trainingHelp the casualty to use their prescribed AAI without delay, or administer it yourself if you are trained and it is permitted by local policy, injecting into the outer mid-thigh through clothing if necessary.Note the time of the injection, keep the used device for ambulance staff and be prepared to give a second dose in 5-15 minutes if symptoms persist or worsen, following guidance and device instructions.
- 4Position and support airway and breathingIf breathing is difficult, sit the person up with legs extended; if they feel faint or have signs of shock, lie them flat with legs raised unless this makes breathing worse.Pregnant casualties should be placed on their left side if possible, and anyone who becomes unresponsive but is breathing normally should be placed in the recovery position.
- 5Monitor and prepare for deteriorationStay with the casualty, monitor breathing, pulse and consciousness continuously, and be ready to start CPR if they stop breathing normally or lose signs of life.Have a second AAI available if they carry one or if your organisation stocks them, and pass all devices and timings to the ambulance crew.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about anaphylaxis training.
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UK guidance allows appropriately trained individuals to administer AAIs in an emergency to anyone believed to be experiencing anaphylaxis, using either their own prescribed device or, in some settings such as schools, stock AAIs supplied for this purpose. Follow your organisation’s policies and record the event carefully.
Everyone treated for anaphylaxis should be observed in hospital because symptoms can recur, and referred to an allergy specialist for assessment, trigger identification and long-term management. Organisations should review the incident, check AAI availability and training, and update care plans where needed.