What is Anaphylaxis?

Anaphylaxis is a rapid, generalized and often unpredictable allergic reaction which affects several organ systems. If left untreated, this type of reaction can lead to death within minutes. The recommended treatment is an epinephrine injection.

A person presenting with either 2 mild symptoms in 2 organ systems or only 1 severe symptom requires immediate use of the epinephrine auto-injector.

Nose and eyes (upper respiratory system) Nose: sneezing, discharge, itching
Eyes: itching, discharge
Skin A few hives, slight itching (mouth, etc.)
Digestive system Moderate nausea, discomfort
Lungs Shortness of breath, wheezing, persistent cough
Heart Pallor, bluish skin, weakness, weak pulse, dizziness, fainting
Throat Tightness, hoarse voice, difficulty breathing, difficulty swallowing
Mouth Marked swelling of the tongue and/or lips
Skin Severe hives on the body, widespread redness, swelling of the eyelids and/or the rest of the face
Digestive system Repeated vomiting, severe diarrhea
Other Feeling of impending doom, anxiety, confusion

Administering epinephrine

  1. Administer a dose of epinephrine using an auto-injector if a severe symptom occurs OR a combination of mild symptoms affecting more than one body system (see description of symptoms in the table above). Detailed auto-injector instructions: EpiPen®AllerjectTM autoinjector, EmeradeTM auto-injector.
  2. Call 911.
  3. If unwell or dizzy, lay the person on their back, lift their legs and keep them elevated. If experiencing nausea, vomiting, or difficulty breathing, encourage the person to sit or lie on their side.
  4. Administer a second dose of epinephrine as soon as 5 minutes after the first dose is injected if symptoms do not improve.
  5. Immediately have the person transported to hospital by ambulance.

What about mild symptoms?

Mild symptoms may indicate the beginning of an anaphylactic reaction.

If only one mild symptom is observed, the individual should be watched closely, as the situation can deteriorate quickly.

When several mild symptoms are observed within the same organ system, continue to observe the individual, as the situation can deteriorate quickly. (For example, if symptoms are only  in the upper respiratory system (nose and eyes) continue observation). 

Any additional symptoms in other organ systems necessitate the immediate use of an epinephrine auto-injector.

Although it is necessary to use the auto-injector for a single, severe symptom, if the person has a combination of mild symptoms in more than one system, do not wait for the appearance of a severe symptom to administer epinephrine.

In some situations, assessing the general condition of the person experiencing supposedly mild symptoms can help determine the right course of action.

Considerations based on individual needs

Severe anaphylactic-type reactions are unpredictable. Symptoms and their progression can vary significantly from one reaction to another and from one person to the next.

Individuals with a known history of anaphylaxis should administer epinephrine with an auto-injector at the first sign of an allergic reaction, following contact with a suspected allergen. (even when consumed up to 12 hours before the reaction). If specific and different indications have been provided by the attending physician in the Emergency Plan, follow the physician’s recommendations.

Individuals without known allergies should administer epinephrine promptly if a causative agent can be identified and symptoms of a severe allergic reaction are observed.

Asthmatic individuals with diagnosed risk for anaphylaxis are known to be at greater risk of experiencing serious respiratory problems during an anaphylactic reaction.

Anytime an anaphylactic reaction is suspected, epinephrine should be administered without hesitation. Please refer to the above table for detailed description of possible symptoms.