Severe Allergic Reactions (Anaphylaxis)

For any emergency situation, call 9-1-1

Delaying the use of the auto-injector can be fatal, while using it when it is not absolutely necessary will not have serious consequences for a healthy person.

  • Epinephrine auto-injector is the only medication to be used in case of anaphylaxis.
  • Asthma medications (Ventolin® bronchodilators) or antihistamines (e. g. Benadryl®) are not recommended during an anaphylactic reaction.

Since April 4, 2013, in the absence of a first responder or ambulance technician, anyone may administer the auto-injector to an individual with signs of a severe anaphylactic-type allergic reaction. For more information on these regulations, follow this link.

Click here for the PDF version (in French)

  1. Administer a dose of epinephrine using the auto-injector if a severe symptom OR a combination of mild symptoms affecting more than one system of the body appear (see symptom description in the table below).
    (Detailed instructions for the auto-injectors EpiPen® and Auvi-Q®).
  2. Call 911.
  3. In case of discomfort or dizziness, lay the person on their back, lift their legs and keep them elevated. In case of nausea, vomiting or breathing difficulties, allow the person to sit or lie on their side.
  4. Administer a second dose of epinephrine as quickly as 5 minutes after the first dose if symptoms do not improve.
  5. Have the person immediately transported to the hospital by ambulance.
Nose and eyes (upper respiratory system)Nose: sneezing, discharge, itching
Eyes: itching, discharge
SkinA few hives, slight itching (mouth, etc.)
Digestive systemModerate nausea, discomfort
LungsShortness of breath, wheezing, persistent cough
HeartPallor, bluish skin, weakness, weak pulse, dizziness, fainting
ThroatTightness, hoarse voice, difficulty breathing, difficulty swallowing
MouthMarked swelling of the tongue and/or lips
SkinSevere hives on the body, widespread redness, swelling of the eyelids and/or the rest of the face
Digestive systemRepeated vomiting, severe diarrhea
OtherFeeling of impending doom, anxiety, confusion
  • “Mild” symptoms may indicate the beginning of an anaphylaxis reaction.
  • If the person has only one mild symptom, keep him or her under observation as the situation could deteriorate quickly.
  • If the person has several mild symptoms in the same system (such as nose and eyes, i. e. the upper respiratory system, see table above), keep them under observation as the situation could deteriorate rapidly.
  • If another mild symptom appears in a 2nd system, use the epinephrine auto-injector immediately.
  • Although it is necessary to use the auto-injector in the presence of a single severe symptom, if the person has a combination of mild symptoms in more than one system, do not wait for symptoms to worsen before injecting epinephrine.
  • Assessing the general condition of the person who is experiencing symptoms described as “mild” can help indicate the course of action.
  • Severe anaphylactic-type reactions are unpredictable. Symptoms and their progression can vary significantly from one episode to another and from one person to the next.
  • In the presence of a person with a history of anaphylactic-type allergic reactions, epinephrine should be administered with an auto-injector at the first signs of an allergic reaction, when contact with an allergen has occurred or is suspected (even when consumed up to 12 hours before the reaction). If different indications have been provided by the attending physician in his or her Emergency plan, these take precedence over the rest.
  • If a person not known to have allergies is presenting with severe anaphylactic-type allergic reaction symptoms, and a causative agent can be identified, epinephrine should be administered without delay.
  • People with asthma who also have a history of anaphylaxis are at greater risk of experiencing serious respiratory problems during an anaphylactic reaction. If you suspect an anaphylactic reaction based on the criteria described in the table above, epinephrine should be administered without hesitation.f
  • The person who has received epinephrine must be taken to the hospital immediately, as adjunctive treatment may be indicated and a second reaction (biphasic reaction) may occur within a few hours of the first. Close medical surveillance is necessary.
  • Although some side effects may occur after an epinephrine injection (pallor, palpitations, tremors, dizziness, weakness, headache, nervousness, anxiety, cardiac arrhythmia), the benefits of this drug far outweigh the side effects.
Anaphylaxis is a rapid, generalized and often unpredictable allergic reaction (affecting several systems/organ systems) which can lead to death within minutes in the absence of an epinephrine injection.
  • Anaphylactic reaction is not the same as anaphylactic shock. A drop in blood pressure is associated with anaphylactic shock.
  • In general, anaphylactic reactions occur within minutes of exposure to the trigger, usually within the first two hours. These reactions rarely occur several hours following exposure.
  • The faster the onset of symptoms, the more intense the reaction is likely to be. It is important to respond quickly.
  • The risk of a biphasic reaction is higher if there has been a delay in administering the appropriate treatment.
Other symptoms of anaphylaxis: In addition to the main symptoms described in the table above, some others are also reported occasionally and include : metallic taste in the mouth; redness or heat on the skin; changes in crying in young children; itching of the external auditory canals and nose; nasal congestion; rapid pulse; cold sweats; loss of consciousness; chest pain and low blood pressure.