Allergic reactions can range from mild symptoms such as itching or a small area of hives to a rapidly developing medical emergency.
Anaphylaxis is a severe allergic reaction that can affect breathing, circulation, or several body systems and can become life-threatening very quickly.
Children with known severe allergies may have an emergency action plan and prescribed adrenaline — also called epinephrine — in an auto-injector. However, anaphylaxis can sometimes be the first obvious sign that a child has a serious allergy.
Parents, caregivers, teachers, and other adults responsible for children should know how to recognise the warning signs and understand that suspected anaphylaxis requires immediate action.
What Can Trigger an Allergic Reaction?
Children can be allergic to many different substances.
Common triggers include certain foods, medicines, insect stings, and latex.
Food allergens can include:
▪ Peanuts
▪ Tree nuts
▪ Milk
▪ Eggs
▪ Wheat
▪ Soy
▪ Fish
▪ Shellfish
▪ Sesame
Any food or other substance can potentially trigger an allergic reaction in a susceptible child.
What Does a Mild Allergic Reaction Look Like?
Milder reactions may involve:
▪ Itching
▪ A limited area of hives
▪ Mild skin redness
▪ Watery or itchy eyes
▪ Sneezing
Follow the child’s individual allergy plan and medical advice.
Parents should continue observing the child because allergic reactions can sometimes progress.
Do not assume that a reaction will remain mild simply because it started with skin symptoms.
What Is Anaphylaxis?
Anaphylaxis is a severe systemic allergic reaction requiring immediate treatment.
Symptoms can develop rapidly.
Possible warning signs include difficulty or noisy breathing, wheezing, throat tightness, tongue swelling, difficulty speaking, persistent coughing, dizziness, collapse, or loss of consciousness.
A child may become pale, floppy, confused, or unusually distressed.
Gastrointestinal symptoms such as repeated vomiting or severe abdominal symptoms may occur, particularly with food-triggered reactions.
Anaphylaxis Can Occur Without Hives
One dangerous misconception is that anaphylaxis always causes a rash.
It does not.
A child can experience severe breathing or circulatory symptoms without developing obvious hives or skin redness.
Do not wait for a rash before responding to serious allergic symptoms.
The child’s breathing, responsiveness, and overall condition are more important than whether their skin looks normal.
Use Adrenaline/Epinephrine Promptly
Adrenaline, also known as epinephrine, is the first-line emergency treatment for anaphylaxis.
If a child has a prescribed auto-injector and their emergency plan indicates anaphylaxis, use it promptly according to the device instructions and plan.
Do not delay adrenaline while waiting to see whether an antihistamine will work.
Antihistamines may help certain mild allergic symptoms but do not replace adrenaline for anaphylaxis.
After giving adrenaline, call emergency medical services.
How Is an Auto-Injector Used?
Different adrenaline auto-injector brands may operate differently.
Parents and caregivers should learn how to use the specific device prescribed for the child.
Follow the manufacturer’s instructions and the child’s medical emergency plan.
Schools, relatives, babysitters, and other regular caregivers should also know where the auto-injector is kept and how to use it.
Check expiry dates regularly and replace expired devices.
Positioning a Child During Anaphylaxis
A child experiencing anaphylaxis can deteriorate rapidly.
Follow the child’s emergency action plan and emergency medical instructions regarding positioning.
In general, avoid suddenly allowing a child with suspected anaphylaxis to stand or walk around, particularly if they are dizzy or faint.
A child with severe breathing difficulty may need a position that helps them breathe more comfortably.
If unconscious and breathing, appropriate recovery positioning may be required.
If they stop breathing normally, begin CPR according to recognised training.
What if One Dose Does Not Work?
Some children require more than one dose of adrenaline.
If symptoms persist or return, follow the child’s emergency plan, device instructions, and emergency service guidance regarding additional doses.
This is another reason children at risk may be advised to carry more than one auto-injector.
Do not delay contacting emergency services while waiting to see whether the first dose completely resolves symptoms.
Call Emergency Services
Anaphylaxis requires emergency medical assessment even if the child appears much better after adrenaline.
Symptoms can sometimes return after initial improvement.
Tell emergency professionals:
▪ What triggered the reaction if known
▪ When symptoms started
▪ When adrenaline was given
▪ How many doses were administered
▪ Any other medicines given
Send the used auto-injector with the child if emergency professionals request it.
First-Time Allergic Reactions
A child may experience a significant allergic reaction without previously being diagnosed with an allergy.
If symptoms suggest anaphylaxis, treat the situation as an emergency.
Do not wait for confirmation of the allergen.
After recovery, the child may be referred for specialist allergy assessment to identify possible triggers and develop a future management plan.
Food Allergies and Schools
Children with significant food allergies need clear communication between families and schools.
Provide the school with current medical information, prescribed emergency medication, and the child’s action plan according to school procedures.
Children should gradually learn to manage their allergies as they become developmentally ready.
This may include learning to ask about ingredients, avoid sharing food, recognise early symptoms, and tell an adult immediately when they feel unwell.
Avoiding Cross-Contact
For children with food allergies, even small amounts of an allergen may sometimes cause a reaction.
Cross-contact can occur when an allergen is unintentionally transferred between foods through utensils, preparation surfaces, hands, or shared equipment.
Families should follow the child’s individual allergy advice regarding avoidance and food preparation.
Read ingredient labels carefully and recheck familiar products because formulations can change.
Insect-Sting Allergies
Some children develop severe reactions to insect stings.
Children with a known risk should follow their specialist’s avoidance and emergency advice.
If a sting is followed by breathing difficulty, throat or tongue swelling, collapse, severe dizziness, or other signs of anaphylaxis, use prescribed adrenaline when available and call emergency services immediately.
Medication Allergies
If a child develops an allergic reaction after taking medicine, stop giving further doses until appropriate medical advice is obtained unless a healthcare professional instructs otherwise.
Serious symptoms require emergency care.
Make sure confirmed medication allergies are recorded with relevant healthcare providers.
Teach older children the name of any medicine they must avoid.
Have an Allergy Emergency Plan
Children at risk of anaphylaxis should have an individual plan created with their healthcare professional.
Parents should make sure that appropriate caregivers understand:
▪ The child’s allergens
▪ Early warning signs
▪ Signs of anaphylaxis
▪ Where medication is stored
▪ How to use the auto-injector
▪ When to call emergency services
Plans and medication should be reviewed periodically as children grow.
Help Children Manage Their Own Allergies
As children mature, they can gradually take more responsibility.
Teach them not to eat unidentified food, to ask questions when necessary, and to tell an adult immediately if they think they have been exposed to an allergen.
Older children and teenagers should understand why they need to carry prescribed emergency medication consistently.
They should also know that embarrassment about using an auto-injector should never delay treatment during an emergency.
Frequently Asked Questions
What is the difference between an allergic reaction and anaphylaxis?
Allergic reactions vary in severity. Anaphylaxis is a severe systemic reaction that can affect breathing or circulation and requires immediate emergency treatment.
Does anaphylaxis always cause hives?
No. Severe anaphylaxis can occur without a rash or hives.
Should I give an antihistamine instead of adrenaline?
No. Antihistamines do not replace adrenaline/epinephrine as the first-line treatment for anaphylaxis.
Should I call emergency services after using an adrenaline auto-injector?
Yes. Suspected anaphylaxis requires emergency medical assessment even if symptoms improve after adrenaline.
Can anaphylaxis happen the first time a child appears to have an allergy?
Yes. A severe allergic reaction can sometimes occur without a previous allergy diagnosis. Treat serious symptoms as an emergency.
