Anaphylaxis in children
Know what to do
If you or your child has an allergy, it’s really important to recognise the signs of anaphylaxis. Reactions can come on quickly and unexpectedly, and when emotions are high, it can be hard to think clearly. Having a simple way to remember what to do can make all the difference.
Identifying anaphylaxis
The way I explain it to parents is to think about where the reaction is happening – in front of the teeth or behind the teeth.
In front of the teeth (antihistamine)
Anything you can see in front of the teeth usually means the reaction is on the outside and affecting the skin or soft tissues:
- Lip swelling
- Eye or eyelid swelling
- Hives or widespread rash
These symptoms need an antihistamine, close observation, and reassurance. They are uncomfortable and distressing, but on their own, they are not anaphylaxis.
Behind the teeth
(EpiPen auto-injector or EURNeffy intranasal)
A reaction behind the teeth suggests that the reaction is now inside the body and affecting the airway or circulation.
- Tongue swelling
- Difficulty breathing or noisy breathing
- Wheeze or persistent cough
- Becoming drowsy, floppy, or hard to rouse
That is anaphylaxis, and it needs:
- Adrenaline immediately – either via an adrenaline auto-injector (e.g. EpiPen / Jext) or the intranasal adrenaline spray (EURNeffy) if this has been prescribed
- Call 999
Important reminders
- If you’re unsure whether to give adrenaline (auto-injector or EURNeffy intranasal adrenaline), always give it and call 999.
- You will never be wrong for giving adrenaline. It is safe, and giving it early saves lives. Waiting too long is far more dangerous.
- If symptoms are not improving 5–10 minutes after giving the first dose of adrenaline, give a second dose of the auto-injector or EURNeffy intranasal adrenaline.
- Swelling of the tongue
- Breathing difficulties or wheezing
- Sudden tiredness, floppiness, or collapse
Teach children, carers, schools, and friends this simple rule:
Front of the teeth – antihistamine.
Behind the teeth – adrenaline and 999.
When in doubt: administer adrenaline and call 999.
Note: Some children may now be prescribed intranasal adrenaline (EURNeffy) as an alternative to an EpiPen adrenaline auto-injector. It delivers adrenaline as a nasal spray, which can be easier to use for some families. If your child has been prescribed EURNeffy, make sure all carers and schools are trained in how and when to use it.
Seeking support with diagnosing and managing allergies, or considering desensitisation therapy?
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