Quick answer
Anaphylaxis is a severe, life-threatening allergic reaction. The first aid is: lay the person flat (never let them stand or walk), give adrenaline with their autoinjector (such as an EpiPen) into the outer mid-thigh, and call Triple Zero (000) straight away. If in doubt, give adrenaline — it is safe and acting early saves lives.
Emergency: if someone is having a severe allergic reaction, give adrenaline and call Triple Zero (000) immediately. This article is general information, not a substitute for the person's own ASCIA Action Plan or accredited first aid training.
Anaphylaxis can develop within minutes of exposure to an allergen such as food, an insect sting or a medication. Knowing how to recognise it and act quickly can save a life. This guide explains the signs of anaphylaxis, the first aid steps in order, how to use an adrenaline autoinjector, and how a medical ID helps responders act faster.
What is anaphylaxis?
Anaphylaxis is the most severe form of allergic reaction. It affects breathing and circulation and is a medical emergency. Common triggers include foods (such as peanuts, tree nuts, milk, egg, shellfish), insect stings, and some medications. The Australasian Society of Clinical Immunology and Allergy (ASCIA) sets the first aid guidance used across Australia, and the treatment is adrenaline given without delay.
Signs of anaphylaxis: mild to severe
A reaction can start with mild or moderate signs and progress quickly. Any one of the severe signs below means anaphylaxis — give adrenaline immediately.
| Mild to moderate | Severe (anaphylaxis) |
|---|---|
| Swelling of the lips, face or eyes | Difficult or noisy breathing |
| Hives or welts on the skin | Swelling of the tongue, or tightness in the throat |
| Tingling mouth | Difficulty talking or a hoarse voice |
| Abdominal pain or vomiting | Wheeze or persistent cough |
| (These can be early signs — watch closely) | Persistent dizziness or collapse; pale and floppy (young children) |
If in doubt, treat it as anaphylaxis. For a person known to have both asthma and severe allergy, if you cannot tell which is happening, give the adrenaline autoinjector first, then asthma reliever if needed.
Anaphylaxis first aid: step by step
Follow these steps in order. They mirror the ASCIA Action Plan for Anaphylaxis.
| Step | What you do |
|---|---|
| 1 | Lay the person flat. Do not allow them to stand or walk. If breathing is difficult, let them sit, but never stand. |
| 2 | Give adrenaline using their autoinjector (such as an EpiPen) into the outer mid-thigh. |
| 3 | Call Triple Zero (000), ask for an ambulance, and say "anaphylaxis". |
| 4 | Phone a family member or emergency contact. |
| 5 | Further adrenaline may be given if there is no improvement after 5 minutes and another autoinjector is available. |
How to use an EpiPen (adrenaline autoinjector)
An adrenaline autoinjector delivers a single, measured dose of adrenaline. The EpiPen is the most common in Australia; the steps below apply to it. Always follow the instructions printed on the person's own device.
| Step | What you do |
|---|---|
| 1 | Form a fist around the EpiPen and pull off the blue safety release. |
| 2 | Place the orange end against the outer mid-thigh (it can be given through clothing). |
| 3 | Push down hard until you hear a click, and hold in place for 3 seconds. |
| 4 | Remove the device, note the time, and keep it to hand to the ambulance crew. |
Adrenaline is safe to give. If you are unsure whether a reaction is anaphylaxis, giving adrenaline early does far more good than harm. Hesitating is the bigger risk.
After adrenaline: what happens next
Stay with the person and keep them lying flat until the ambulance arrives, even if they seem to improve. A second reaction (a biphasic reaction) can occur hours later, which is why everyone who has had anaphylaxis needs to be assessed in hospital. If their breathing stops and they become unresponsive, begin the DRSABCD action plan and start CPR if they are not breathing normally.
Anaphylaxis and medical IDs
For anyone with a severe allergy, a medical ID is one of the most useful things to wear. It tells a first responder about the allergy and that the person carries an adrenaline autoinjector — information that matters most when the person cannot speak. A medical ID can also carry a membership number for an online medical records service such as MedibandPlus.
With MedibandPlus, that membership number lets first responders access a secure profile that stores the wearer's allergies, medications and next-of-kin contact. It does not assess or diagnose anything — it simply makes the wearer's own information available when they cannot speak, so the right care reaches them sooner.
Part of the Mediband family. Designed in Australia since 2004.
Related reading: asthma first aid, seizure first aid, the full DRSABCD first aid action plan, the recovery position, and checking for a response with COWS. When you are ready, you can start a MedibandPlus membership.
Position matters as much as the adrenaline
There is one instruction in Australian guidance that is broken more often than any other in anaphylaxis, usually with the best of intentions: lay the person flat, and do not let them stand or walk.
ANZCOR states it plainly: “Lay the victim flat; do not stand or walk. If breathing is difficult, allow to sit (if able).”
That matters because the instinct in a frightening situation is to get the person up and moving — to the car, to the door, to somewhere that feels like help. Australian guidance is explicit that you should not, even if they say they feel well enough and want to.
- Flat is the default. On their back, on the floor, wherever they are.
- If breathing is difficult, let them sit — sitting up can be easier for the chest — but do not let them get up.
- If they are unresponsive but breathing normally, use the recovery position.
- If they need to be moved at all, keep them horizontal.
The adrenaline doses
Adrenaline autoinjectors come in two strengths, and the right one depends on age. ANZCOR gives the intramuscular doses into the outer thigh as:
- Children under 5 years: 0.15 mg
- Children 5 years and over, and adults: 0.3 mg
The device is designed to work through clothing, so do not waste time undressing anyone.
A second dose
If severe symptoms persist and there is no improvement 5 minutes after the first injection, ANZCOR supports giving a second dose — noting that the certainty of evidence behind this is very low, so it is a reasonable step rather than a guaranteed one. Many people who carry an autoinjector carry two for exactly this reason.
Call the ambulance immediately after the first dose, not after the second. And if the person also has asthma and is wheezing, Australian guidance supports giving their asthma reliever medication as well — see asthma first aid. Adrenaline first, then the reliever.
Finally, remove the trigger if you safely can — stop the food, remove the sting, stop the infusion. Do not go hunting for what caused it while the person is deteriorating.
Keep the used autoinjector
Once it has been fired, put the used device somewhere safe and hand it to the paramedics. It tells them the strength that was given and, together with your account of the timing, when it went in — two things that shape what happens next and that nobody will reliably remember under pressure. Note the time of each dose if you can.
Anaphylaxis first aid FAQs
How do you treat anaphylaxis?
Lay the person flat (never let them stand or walk), give adrenaline with their autoinjector into the outer mid-thigh, and call Triple Zero (000). Phone an emergency contact, and give a second dose after 5 minutes if there is no improvement and another autoinjector is available.
What are the signs of anaphylaxis?
Severe signs include difficult or noisy breathing, swelling of the tongue or throat, difficulty talking or a hoarse voice, wheeze or persistent cough, and persistent dizziness or collapse. Any one of these means anaphylaxis — give adrenaline immediately.
Can giving adrenaline cause harm if it is not anaphylaxis?
Adrenaline given with an autoinjector is safe. If you are unsure whether a reaction is anaphylaxis, it is safer to give it than to wait. Acting early saves lives.
Why does someone need hospital if they feel better after adrenaline?
A second reaction can occur hours after the first, so everyone who has had anaphylaxis should be assessed in hospital even if they appear to recover.
Sources
- ASCIA — Australasian Society of Clinical Immunology and Allergy — Action Plan for Anaphylaxis and first aid.
- ANZCOR Guideline 9.2.7 — First aid management of anaphylaxis — recognition, adrenaline autoinjector use, positioning and when to give a second dose.
- healthdirect — Anaphylaxis — symptoms, triggers and what happens at hospital afterwards.
- Triple Zero (000) — when and how to call Australia’s emergency number, and what the call taker will ask you.
Disclaimer: This article is general first aid information, not medical advice or a substitute for the person's own ASCIA Action Plan or accredited first aid training. In an emergency, always call Triple Zero (000). MedibandPlus stores and provides access to a member's own medical information; it does not monitor, assess or diagnose any condition.
