Medication Allergy
M.A.M.I. — Clinical Resources
Medication Allergy
Most reactions to a medication are mild. The task is to identify the one that is not.
In a cosmetic practice the medication is almost always something we have injected or applied ourselves — which means the exposure is ongoing, the onset is fast, and we are the only people in the room. This protocol covers recognition, immediate management, and what must happen afterwards.
Where it comes from
The agents in this room
Local anaesthetics
True IgE-mediated allergy is rare. Most reactions are vasovagal, or to adrenaline or preservatives in the preparation — but it must not be assumed.
Antibiotics
Beta-lactams most commonly. Ask about prior reactions before every prescription, and record what actually happened.
Hyaluronidase
An animal-derived protein. Anaphylaxis is recognised, and it is usually given under time pressure.
Chlorhexidine
A well-recognised cause of procedural anaphylaxis, and easily missed — it is a skin prep, not a drug anyone remembers giving.
Latex
Gloves, tourniquets, vial stoppers. Ask, and have a latex-free pathway.
Topical agents
Topical anaesthetics, antiseptics and adhesives. Contact dermatitis is common; systemic reaction is not, but is possible.
Recognise
One severe sign is enough
- Swelling of the lips, face or eyes
- Hives or welts
- Tingling of the mouth
- Abdominal pain, or vomiting
- Difficult or noisy breathing
- Wheeze, or persistent cough
- Swelling of the tongue
- Swelling or tightness in the throat
- Difficulty talking, or a hoarse voice
- Persistent dizziness, or collapse
- Pale and floppy (young children)
Anaphylaxis can occur with no skin symptoms at all. The absence of a rash does not exclude it, and mild signs do not reliably come first.
Abdominal pain and vomiting following a medication are classed as mild to moderate. But severe, persistent abdominal pain or vomiting can be a sign of anaphylaxis of any cause — treat it as such if there is any doubt.
Mild to moderate reaction
Stop · Stay · Watch
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Stop the medication
Cease the injection, infusion or application immediately. Remove any remaining product from the skin.
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Stay with the patient
Do not leave them alone, and do not move them to a waiting area. A mild reaction can become anaphylaxis within minutes.
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Watch for any severe sign
Breathing, voice, throat, dizziness. Re-check continuously rather than once.
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An antihistamine may be given
An oral antihistamine may relieve hives or itch. It does not prevent progression to anaphylaxis, it does not treat anaphylaxis, and giving it must never create a false sense of security.
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Do not discharge early
Observe. Do not let the patient drive themselves home. Ensure they are not alone afterwards, and that they know what to look for.
Escalation
Any one severe sign is anaphylaxis
Do not wait for a second sign, and do not wait to see whether it settles. Lay the patient flat, give adrenaline intramuscularly into the outer mid-thigh, and call 000.
Never allow them to stand or walk — before or after adrenaline, and even if they appear to recover.
Anaphylaxis protocolAfterwards
The part that is usually skipped
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Document what actually happened
The agent, the dose, the route, the time from exposure to onset, the exact signs, what was given, and the response. "Allergic to lignocaine" recorded without detail is close to useless, and may wrongly follow the patient for life.
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Record the allergy
In the patient's clinical record, and encourage them to have it added to their My Health Record and to wear medical identification.
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Refer for formal assessment
Refer to a clinical immunologist or allergist. Many patients carry a drug allergy label that formal testing does not confirm — and the label itself causes harm by forcing inferior alternatives.
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Do not re-challenge
Not in this clinic, and not to test the diagnosis. Re-exposure is for a specialist setting with resuscitation facilities.
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Ensure the patient has a plan
Where anaphylaxis has occurred, the patient's prescriber should provide the relevant ASCIA Action Plan and, where indicated, an adrenaline device.
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Review the incident
Review the clinic's response, restock what was used, and check the expiry dates on every adrenaline device in the building.
Practice point
Hyaluronidase deserves separate thought
Hyaluronidase is an animal-derived protein and anaphylaxis to it is recognised. It is also, almost by definition, given in a hurry — in the management of suspected vascular occlusion, often in large or repeated doses, into a patient who is already distressed and in whom flushing, pain and anxiety are expected.
That is precisely the situation in which the early signs of anaphylaxis are attributed to the emergency being treated. Adrenaline and a means of calling for help should be immediately to hand whenever hyaluronidase is used — not in a cupboard, not in another room.
Do and do not
The errors that cause harm
- Take an allergy history before every procedure, every time.
- Stop the agent at the first sign of a reaction.
- Stay in the room.
- Treat any single severe sign as anaphylaxis.
- Keep adrenaline within reach, in date, and known to every staff member.
- Document the reaction in detail.
- Refer for formal allergy assessment.
- Do not treat an antihistamine as a substitute for adrenaline, or let it delay adrenaline.
- Do not assume a reaction is vasovagal because it looks like one.
- Do not wait for a rash before considering anaphylaxis.
- Do not send the patient to the waiting room to "see how they go".
- Do not re-challenge the patient with the agent.
- Do not record an allergy without recording what happened.
Scope and limitations
This protocol is an educational resource for practitioners. It is a guide only. It does not replace clinical judgement, your clinic's own emergency procedures, an individual patient's ASCIA Action Plan, or nationally accredited first aid certification (HLTAID011 Provide First Aid). Reading this document does not confer competence in the recognition or management of allergic reactions.
ASCIA plans
The ASCIA Action Plan for Drug (Medication) Allergy is a patient-specific medical document completed and signed by the treating prescriber. It is not reproduced here. Obtain the current plans directly from ASCIA: allergy.org.au
Sources
- ASCIA Guidelines — Acute Management of Anaphylaxis (2026).
- ASCIA Action Plan for Drug (Medication) Allergy (2026).
- ANZCOR Guideline 9.2.7 — First Aid Management of Anaphylaxis.
Where this document differs from the current ASCIA guidelines, the ASCIA guidelines prevail. Confirm the current version at allergy.org.au before relying on this page.
Clinical review. Reviewed by Dr Larissa Miller, Cosmetic Physician, on 13 July 2026. Next scheduled review July 2027. Protocols are reviewed at least annually and after any incident.