Severe allergic reaction

1. If the person has an adrenaline auto-injector (for example an EpiPen), help them use it straight away, or use it yourself. Follow the instructions printed on the device. The injection goes into the outer part of the thigh.
2. Call for an ambulance, or ask someone to while you help. Say that you think it is anaphylaxis.
3. Lay the person down and raise their legs. If breathing is difficult, let them sit up instead. If they are pregnant, lay them on their left side.
4. Keep them in that position. Do not let them stand or walk, even if they start to feel better.
5. If there is no improvement after about 5 minutes and there is a second auto-injector, use it.
6. Keep watching their breathing and how they respond until the ambulance arrives. If they stop responding and are not breathing normally, start CPR, as in the hands-only CPR guide.
7. Stay with them. Tell the ambulance team what you think caused the reaction and whether an auto-injector was used.

Adrenaline auto-injectors are not easy to get in India, so many people who are at risk will not have one. If there is none, do not wait: call for an ambulance and keep the person lying down.

What not to do:

• Do not let the person stand or walk, even if they feel better.
• Do not wait to see whether it passes before calling for help or using the auto-injector.
• Do not give tablets, medicines or drinks to someone who is struggling to breathe.
• Do not put a pillow under the head of someone who is having trouble breathing.

Anaphylaxis usually starts within minutes of contact with the trigger. Common triggers are foods such as nuts, milk, eggs, fish and sesame, insect stings, some medicines such as certain antibiotics and painkillers, and latex. Sometimes no cause is found.

Signs of a severe reaction:

• swelling of the lips, mouth, tongue or throat, a tight throat or trouble swallowing
• fast, difficult or noisy breathing, wheezing or coughing
• feeling faint, dizzy, confused or agitated, or collapsing
• pale, blue or grey skin, lips or tongue, or cold skin
• a child who is limp, floppy or not responding as usual

An itchy, raised rash, watery eyes, swelling of the face or hands, tummy pain or vomiting can be signs of a milder reaction. Watch closely, and treat it as anaphylaxis if any of the signs above appear.

Everyone who has had anaphylaxis needs to be seen in hospital, even if the auto-injector has worked, because symptoms can come back after they first improve. People are usually watched for several hours.

• Avoid known triggers, and check food labels carefully.
• Ask your doctor for an emergency plan. If you are prescribed auto-injectors, carry two with you at all times, check their expiry dates and keep them away from heat and the fridge.
• Practise with a trainer injector, which has no needle or medicine, and teach family, friends and carers when and how to use yours.
• Use the injector if you think it is anaphylaxis, even if the symptoms seem mild.