Which action will the nurse take first when treating a client who is having an anaphylactic reaction?

Anaphylaxis is a medical emergency that requires immediate treatment.

What to do

If someone has symptoms of anaphylaxis:

1. use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first
2. call 999 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis
3. remove any trigger if possible – for example, carefully remove any stinger stuck in the skin
4. lie the person down and raise their legs – unless they're having breathing difficulties and need to sit up to help them breathe. If they're pregnant lie them down on their left side
5. give another injection after 5 minutes if the symptoms do not improve and a second auto-injector is available

If you're having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Adrenaline auto-injectors

People with potentially serious allergies are often prescribed adrenaline auto-injectors to carry at all times. These can help stop an anaphylactic reaction becoming life threatening.

They should be used as soon as a serious reaction is suspected, either by the person experiencing anaphylaxis or someone helping them.

Make sure you're aware how to use your type of auto-injector correctly. And, carry 2 of them with you at all times.

There are 3 main types of adrenaline auto-injector, which are used in slightly different ways.

These are:

• EpiPen – find out how to use an EpiPen
• Jext – find out how to use Jext
• Emerade – find out how to use Emerade

Instructions are also included on the side of each injector if you forget how to use it or someone else needs to give you the injection.

Positioning and resuscitation

Someone experiencing anaphylaxis should be placed in the correct position:

• most people should lie flat with their legs raised
• if they're pregnant they should lie on their left side
• people having trouble breathing should sit up for a short time to help make breathing easier, and then lie down again when possible
• avoid a sudden change to an upright posture such as standing or sitting up – this can cause a dangerous fall in blood pressure

If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed immediately.

In hospital

You will need to go to hospital for observation – usually for 6-12 hours – as the symptoms can occasionally return during this period.

While in hospital:

• an oxygen mask may be used to help breathing
• fluids may be given directly into a vein to help increase blood pressure
• additional medicines such as antihistamines and steroids may be used to help relieve symptoms
• blood tests may be carried out to confirm anaphylaxis

You should be able to go home when the symptoms are under control and it's thought they will not return quickly. This will usually be after a few hours, but may be longer if the reaction was severe.

You may be asked to take antihistamines (an anti-allergy medicine) and steroid tablets for a few days after leaving hospital to help stop your symptoms returning.

You will also probably be asked to attend a follow-up appointment with an allergy specialist so you can be given advice about how you can avoid further episodes of anaphylaxis.

Adrenaline auto-injectors may be provided for emergency use between leaving hospital and attending the follow-up appointment.