Anaphylaxis

About anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction.

Anaphylaxis happens when your child reacts to something in the environment called an allergen. Allergens might be found in food, insect stings or bites, and medicines.

Allergens cause your child’s immune system to release histamine and other substances into their body. This leads to allergy symptoms, which might include anaphylaxis.

Not all children and teenagers with allergies have anaphylaxis. Mild to moderate allergic reactions are much more common than anaphylaxis.

Anaphylaxis requires urgent medical attention. If your child is having an anaphylactic reaction, first lay your child flat or keep them sitting. Don’t let your child stand or walk around. Next use an adrenaline injector like EpiPen or Anapen if one is available. Then call an ambulance – phone 000.

Symptoms of anaphylaxis

If your child is having a severe allergic reaction, they might have one or more of the following signs or symptoms:

difficult or noisy breathing
tongue swelling
throat swelling or tightness
difficulty talking or a hoarse voice
a wheeze or persistent cough
persistent dizziness or fainting
paleness and floppiness (in young children)
severe stomach pain, vomiting or diarrhoea.

Sometimes an anaphylactic reaction might seem like a mild reaction at first but will quickly get worse. So if your child has allergies, it’s important to watch your child closely whenever they have an allergic reaction. Monitor your child until all signs of the reaction have settled.

Anaphylaxis usually happens within minutes of your child being exposed to the allergen. But sometimes it can happen up to 1-2 hours later.

Assessment and diagnosis of anaphylaxis

If you think your child is at risk of anaphylaxis, getting a diagnosis is important. This means a doctor will need to identify what’s causing your child to have an allergic reaction.

To start the process of allergy diagnosis, you can talk to your GP. They can order some tests or refer you to an allergy and immunology specialist or paediatrician, who can assess your child.

When your child has a confirmed diagnosis of allergies, you can prepare yourself to respond to all kinds of allergic reactions, including anaphylaxis.

Most children with food allergies to egg, cow’s milk, wheat or soy bean outgrow their allergies by the time they’re in primary or secondary school. This is true even if your child has had a previous severe allergic reaction to these allergens. Peanut, tree nut, fish and shellfish allergies are more likely to be lifelong.

Treatment for anaphylaxis

Adrenaline is used to treat anaphylaxis. It works very quickly to reverse the symptoms of anaphylaxis.

If your child is at risk of anaphylaxis, they’re likely to be prescribed an adrenaline injector – for example, EpiPen or Anapen.

If your child is prescribed an adrenaline injector, it’s important that both you and your child learn how and when to use it. Your child’s ability to use it will depend on their age and development. You and/or your child should carry the adrenaline injector at all times. You can also teach family, friends, teachers and carers how to use the adrenaline injector.

Your doctor should also give your child an ASCIA (Australasian Society of Clinical Immunology and Allergy) anaphylaxis action plan.

If you think your child is having a severe allergic reaction, it’s safer to give the adrenaline injector than to wait and see whether your child’s symptoms get worse. Not giving the adrenaline injector can be more harmful than giving it, even if it’s not needed.

Managing anaphylaxis

There’s no effective cure for allergies yet, although researchers are working on it. It might help to know that many children outgrow their allergies. And you can take some steps to make it easier to live with your child’s anaphylaxis in the meantime.

Avoid the allergen
It’s very important for your child to avoid the allergen that causes anaphylaxis. This can be challenging, but there are important things you can do to help your child.

Here’s what you can do if your child has a food allergy:

Read and make sure you understand all food labels. Be aware that some allergenic foods have different names. For example, cow’s milk protein might be called ‘whey’ or ‘casein’. By law the 10 most common allergens need to be plainly stated on food labels – cow’s milk, soy, egg, wheat, peanuts, tree nuts, sesame, fish, shellfish and lupin.
Be careful when you eat out. Ask what ingredients each dish includes, how it was prepared, whether it has touched any other foods, and whether there’s any risk of cross-contamination. Most restaurants will be happy to tell you, but they might not know about the ingredients in some foods like sauces.
Avoid foods and cutlery that could have been in contact with the allergen. This includes buffets and bain-maries (food warmers). Even tiny amounts of the allergen can cause your child to have a severe reaction.
Teach your child not to share food. This might depend on your child’s age and ability to understand.

Here’s what to do if your child has an allergy to insect stings or bites:

Make sure your child wears shoes when they’re outdoors. Don’t let them walk barefoot on grass.
Avoid dressing your child in bright colours.
Avoid wearing perfumes.
Dress your child in long-sleeved shirts and long pants when you can.
Teach your child not to drink from open soft drink cans outdoors.
Teach your child not to disturb insects like bees or wasps.

If your child has an allergy to a medicine, let your doctor, pharmacist or dentist know before your child has any treatments or takes any medicines.

Let people know about the allergy and its management
It’s important that family, carers, babysitters, early childhood educators and teachers know that your child has a severe allergy. It’s a good idea for them to know how and when to use your child’s EpiPen or Anapen. They should also have a copy of your child’s anaphylaxis action plan.

Wear a medical bracelet
This lets people know about your child’s particular allergy. This can be important if your child has an allergic reaction and there are no people around who know about their allergy.

Discuss allergen immunotherapy with an allergist
You can talk with your allergist or immunologist about immunotherapy, also called desensitisation. Immunotherapy isn’t currently available for food allergies, but it can be used to treat a severe allergy to insect stings or bites, house dust mites and grass pollen.

Allergen immunotherapy involves a specialist regularly giving your child increasing doses of the allergen. This helps your child to tolerate the allergen better and reduces their symptoms. This form of treatment takes 5 years or longer to complete, but it’s usually very effective. For more information on allergies and allergy testing, treatment and management, see our articles on allergies, non-food allergies and food allergies.