Allergic reactions, anaphylaxis and asthma attacks

Food allergies and asthma are common among teenagers, and both can become life-threatening quickly. If a friend carries an adrenaline pen or a blue inhaler, knowing how to help them could save their life.

Recognising anaphylaxis

• Anaphylaxis is a severe allergic reaction that can follow foods such as nuts, insect stings or medicines.
• Milder signs (St John Ambulance) include a red, itchy rash or raised skin (hives), often around the face and neck, itchy watery eyes, rapid swelling, and stomach pain, vomiting or diarrhoea.
• NHS emergency signs: swelling of the lips, mouth, throat or tongue; fast breathing or struggling to breathe; a tight throat or trouble swallowing; pale, grey or blue skin, lips or tongue; sudden confusion, drowsiness or dizziness; fainting.
• Anaphylaxis needs hospital treatment immediately, even if symptoms seem to improve.

What to do in anaphylaxis

• Use their adrenaline auto-injector straight away if they have one, or help them use it. Follow the instructions printed on the side, as different brands work differently.
• Call 998 and say you think it is anaphylaxis.
• Lay them down with their legs raised. If they are struggling to breathe, help them sit up instead.
• The NHS stresses: do not let them stand or walk at any time, even if they feel better.
• If there is no improvement after 5 minutes, use a second auto-injector if available (NHS); St John Ambulance says doses can be repeated at five-minute intervals.
• If they become unresponsive and stop breathing normally, start CPR (lesson fa-03).

How an EpiPen is used (one common brand)

• Grip the pen firmly around the middle in your fist, orange tip pointing down, with your thumb nearest the blue cap. Never put your thumb, fingers or hand over either end.
• Pull off the blue safety cap with your other hand.
• Hold the pen a few inches (about 10 cm) from the outer thigh, then jab the orange tip firmly into the outer thigh until you hear a click.
• Hold it in place for a count of three seconds, then remove it.
• It may not go through thick clothing such as denim; remove clothing if possible, or avoid seams.
• Call 998 if not already done, and give the used pen to the ambulance crew.

Recognising an asthma attack

• Asthma + Lung UK signs: cough, breathlessness, wheezing or a tight chest getting quickly worse.
• The reliever inhaler (usually blue) is not helping as much as usual, or is needed more often.
• The person finds it hard to walk or talk.
• Not everyone has every sign; take worsening breathing seriously.

What to do in an asthma attack

• Help them sit up straight and stay calm, and reassure them.
• They take one puff of their blue reliever inhaler every 30 to 60 seconds, up to 10 puffs (Asthma + Lung UK). Use a spacer if they have one.
• Call 998 if they feel worse at any point, do not feel better after 10 puffs, or have no inhaler with them (Asthma + Lung UK). St John Ambulance adds: call if it is their first attack.
• If the ambulance has not arrived after 10 minutes and they are not improving, repeat the puffs.
• If they recover without an ambulance, they still need an urgent same-day appointment with their doctor or asthma nurse.
• People on a MART or AIR inhaler plan follow their own plan, which uses a different schedule.