What Is Anaphylaxis? Our Essential Parent's Guide to Severe Allergic Reactions
Anaphylaxis is a severe, life-threatening allergic reaction. This guide covers everything parents need to know about anaphylaxis.
What is anaphylaxis?
Anaphylaxis is a severe, life-threatening allergic reaction. It affects multiple systems of the body, and requires immediate emergency attention. It usually appears suddenly.
If your child develops anaphylaxis, they will need immediate emergency attention. Inject epinephrine (an Epi-pen) immediately, and call 911.
According to FARE (Food Allergy Research and Education), “more than 40 percent of children with food allergies and more than half of adults with food allergy have experienced a severe allergic reaction such as anaphylaxis.”
And based on a study published in the Journal of Allergy and Clinical Immunology, the overall number of U.S. children’s emergency room visits for anaphylaxis has increased in recent years.
What could cause anaphylaxis?
Any allergic reaction from food, an insect sting, or medicine could cause anaphylaxis.
Food allergies are the most common cause of anaphylaxis. Peanuts and tree nuts are the foods most commonly associated with anaphylactic reactions. However, any type of food could cause anaphylaxis if someone eats a food they are allergic to.
Insect stings, from bees, wasps, hornets or yellow jackets, can also cause anaphylaxis if someone is allergic to sting venom.
And sometimes, medicines can cause anaphylaxis if someone is allergic to a medicine.
With food allergies, the same person can have varying symptoms from one food allergic reaction to the next. So, it doesn’t matter if your child has only had mild or moderate food allergy reactions previously, or has never had a food allergic reaction.Any food allergic reaction could develop into anaphylaxis.
Most importantly, keep in mind that even an allergic reaction that starts out mild or moderate could quickly develop into anaphylaxis. Closely watch your child any time that they have an allergic reaction, and treat every allergic reaction seriously.
How to know if my child has anaphylaxis?
When the symptoms of an allergic reaction are severe, and involve more than one organ system, the reaction is classified as anaphylaxis. Anaphylaxis can be life-threatening.
These severe allergic reaction symptoms may indicate that your child has anaphylaxis:
Difficulty breathing/shortness of breath
Swelling of the throat
Tightness of the throat
Swelling of the tongue
Difficulty swallowing
Hives that spread to many areas of the body
Persistent, significant coughing
Wheezing/noisy breathing
Change in voice or cry
Difficulty vocalizing
Pale appearance
Diarrhea
Repeated vomiting
Dizziness
Fainting/collapse
Drop in blood pressure
Rapid heartbeat
Loss of consciousness
Feeling floppy (only in babies and younger children)
Remember: severe symptoms that affect at least two organ systems = anaphylaxis.
Anaphylaxis symptoms will usually emerge within seconds to minutes after someone is exposed to their allergen (after they eat a food, get stung by an insect, or take medicine that they are allergic to). However, symptoms may also appear an hour or two after exposure.
Treating Anaphylaxis: Give Epinephrine Immediately
An epinephrine injection is the only medicine that can stop anaphylaxis. It can quickly reverse the life-threatening anaphylaxis symptoms and save your child's life.
Epinephrine is given with an auto-injector (also called an Epi-pen).
When your child develops anaphylaxis, they will need immediate emergency attention. Give epinephrine immediately, and call 911.
It’s crucial that your child receives epinephrine as soon as possible.
If you think your child has anaphylaxis (even if you have some doubts), inject epinephrine.
Follow this rule: If your child shows severe allergic reaction symptoms, use the Epi-Pen right away!
Learn when and how to give epinephrine from Nationwide Children’s Hospital. (If you need to give epinephrine immediately, skip to 2:52.)
YouTube video: How To Use an EpiPen
Only Epinephrine Can Stop Anaphylaxis
Antihistamines like Benadryl and Zyrtec cannot stop anaphylaxis. Never use any other medicine in place of epinephrine.
If you do not have epinephrine, call 911 right away. Let the 911 operator know that your child is having an anaphylactic reaction and that they need epinephrine promptly. Ask for an ambulance with epinephrine.
How to give your baby or young toddler epinephrine (under 2 years of age)
Lay baby flat in your arms.
Don’t hold them upright, and don’t let them stand or walk.
If baby is vomiting, or has fainted, lay them on their side.
If baby has difficulty breathing, sit them up.
Pop off the cap of the Epi-pen, and make a fist as you hold it.
Don’t place your thumb on either end!
Hold baby and their leg still.
Find the big muscle in the outer thigh.
This is the best place to inject an Epi-pen.
Use the Epi-pen by pushing the needle end down on the middle of baby’s outer thigh, into the thigh muscle.
This is about halfway between the hip and knee, on the side of the leg that faces out.
You can inject the Epi-pen through clothing.
Listen for the click.
Hold the Epi-pen down on their thigh for 10 seconds, then release.
Massage the injection site for 10 seconds.
Keep track of the exact time you used the Epi-pen.
How to give your older toddler or older child epinephrine
Have your child sit or lie down on their back.
If they’ve fainted or are vomiting, lay them on their side.
If you have a toddler, you can have them sit in your lap.
Make sure your child will stay still during the injection process.
Pop off the cap of the Epi-pen, and make a fist as you hold it.
Don’t place your thumb on either end!
Hold your child’s leg still.
Find the big muscle in the outer thigh.
This is the best place to inject an Epi-pen.
Use the Epi-pen by pushing the needle end down on the middle of your child’s outer thigh, into the thigh muscle.
This is about halfway between the hip and knee, on the side of the leg that faces out.
You can inject the Epi-pen through clothing.
Listen for the click.
Hold the Epi-pen down on their thigh for 10 seconds, then release.
Massage the injection site for 10 seconds.
Keep track of the exact time you used the Epi-pen.
Different epinephrine brands may have slightly different instructions for injection. Familiarize your family with the exact instructions included with the auto-injector. You can also ask your doctor if you have any questions, or practice with a training Epi-pen (that doesn’t contain epinephrine and that is only for practice.)
What to do after giving epinephrine?
After giving epinephrine, urgently call 911.
Let the emergency operator know your child is having an anaphylactic reaction.
Ask for an ambulance with epinephrine.
Stay with your child and monitor their symptoms until they’re under the care of the EMS team.
Keep your child lying on their back (or on their side, if they are vomiting or have fainted).
If you’ve just given an Epi-pen and your child’s anaphylaxis gets worse, or doesn’t improve within 5 minutes, give them a second Epi-pen injection.
Make sure to have two or more Epi-pens ready at all times in case your child would need a second dose.
Once the EMS team arrives, tell them the exact time you injected the Epi-pen, and give them the used Epi-pen.
After giving epinephrine, keep in mind that anaphylaxis could also potentially return after 4-24 hours. This is known as a biphasic reaction.
If this happens, your child will need a second dose of epinephrine.
This is another reason why it’s vital to have at least two Epi-pens ready for your child at all times.
Planning For Possible Anaphylaxis
The number one way to plan for possible anaphylaxis is to have a current prescription for an Epi-pen, and have at least two Epi-pens on hand at all times. So, talk to your doctor if your child has a food, insect sting, or medicine allergy and doesn’t yet have an epinephrine prescription.
Making sure your child avoids foods, insects or medicine they are allergic to is the only way to prevent anaphylaxis from starting in the first place. But emergencies can occur, so it's vital to have two Epi-pens on hand at all times.
Also, make sure all of your child’s caregivers know how to recognize anaphylaxis, and how to inject an Epi-pen whenever anaphylaxis develops. Always make sure your child’s school, daycare, and any other place your child receives care outside the home has two Epi-pens on hand in case of an emergency.
An anaphylaxis emergency action plan, like this sample one from the American Academy of Pediatrics (AAP), can help you make sure your child’s caregivers are prepared. Ask your pediatrician or allergist to develop a personalized action plan for your child.
Anaphylaxis, Food Allergies, and Babies
A recent study indicates that babies are the age group least likely to develop anaphylaxis, so it's very safe to feed them common allergy-causing foods.
Some key results of this study, conducted by Dr. Jonathan Spergel and others, include:
Infants under 1 year of age were least likely to develop a severe allergic reaction (including anaphylaxis), compared to toddlers, young children, older children, and teens.
Infants were least likely to experience severe cardiovascular or respiratory symptoms from an allergic reaction.
Infants were also least likely to have food allergy reactions that required an Epi-pen injection.
When infants under 1 do have allergic reactions, the reactions tend to be mild.
Food allergies did not cause any deaths in children under the age of 1.
Since it's very rare for babies to experience anaphylaxis, it's safest to start feeding baby top 9 allergenic foods (including peanut, tree nuts, egg, and milk) before your baby turns 1.
In fact, feeding your baby foods like these early and often may help prevent them from developing allergies to these foods later in life --- saving them and your family from a lifetime of worry about possible anaphylaxis.
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These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.