Anaphylaxis — what to do in the next 10 minutes

Within minutes of eating something, being stung, or taking a medicine — two or more of these mean anaphylaxis:

Skin

Sudden hives or red blotches, intense itching, swelling of the lips, face, eyelids or tongue.

Breathing

Wheezing, noisy or crowing breath, throat tightness, hoarse voice, cannot finish a sentence.

Circulation

Feeling faint, dizzy, pale, sweating, or collapsing.

Stomach

Sudden cramps, vomiting or diarrhoea alongside any of the above.

If the person is a known allergy patient and has just met their trigger, even ONE of these is enough. Do not wait for it to get worse to be sure — by the time you are sure, the airway has closed.

1. 1Pull the pen out of its tube. Remove the safety cap by pulling it straight off.
2. 2Do not touch the tip that the needle comes out of — if you press it against your thumb, the needle fires into your thumb.
3. 3Press that tip firmly into the outer middle of the thigh, at a right angle — the side of the leg, halfway between hip and knee.
4. 4Push it through the clothes — the manufacturers say to do exactly this if needed. Jeans, salwar, sari, school uniform are all fine; do not waste time undressing anyone. What you must avoid is a thick seam, a pocket, or anything inside the pocket — a phone, keys, coins — and thick belts or hard zips.
5. 5Hold it firmly in place while you count. An EpiPen needs 3 seconds, an Emerade 5, a Jext 10 — the pen itself says which. If you are not sure, count to 10: holding longer does no harm. Then remove it and rub the spot briefly.
6. 6If there is a second pen and there is no improvement after 5–10 minutes, give it in the OTHER thigh.

• Waiting. 'Let's give an antihistamine first and see' is the commonest fatal decision. Adrenaline first, everything else after.
• Injecting into the arm or buttock. Those muscles absorb too slowly. Outer thigh only.
• Undressing the person first. The needle goes through clothes.
• Standing them up or walking them to the car because they look weak — this can cause cardiac arrest. Keep them flat and let the ambulance come.
• Going home after they improve. The reaction can come back hours later. Everyone who gets adrenaline must be seen in hospital.

• Loosen anything tight — dupatta, tie, belt, top button.
• Give nothing by mouth. No water, no food, no tablets — they may choke on it.
• Stay with them and keep watching their breathing.
• If they stop breathing and have no pulse, start hands-only CPR — push hard and fast in the centre of the chest until help arrives.