Anaphylaxis

02

M.A.M.I.  —  Clinical Resources

Anaphylaxis

Protocol AN-01  ·  Reviewed 13 July 2026  ·  Next review July 2027

Adrenaline is the only treatment for anaphylaxis.

Antihistamines do not treat the breathing or cardiovascular symptoms of anaphylaxis, and must never delay adrenaline. There is no time to wait and see — symptoms can worsen within minutes. This protocol is written for practitioners in a clinical setting, where the likely trigger is an injected or applied product.

The three non-negotiables

In this order. Without hesitation.

  1. 01Lay them flatNever allow them to stand or walk. Not even if they seem to have recovered.
  2. 02Give adrenalineIntramuscular, into the outer mid-thigh. Immediately.
  3. 03Call 000Say the word "anaphylaxis".

If in doubt, give adrenaline.

01

Recognise

Watch for any one severe sign

Mild to moderate
  • Swelling of the lips, face or eyes
  • Hives or welts
  • Tingling of the mouth
  • Abdominal pain or vomiting
Anaphylaxis — act immediately
  • 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)

In drug and insect allergy, severe abdominal pain and vomiting are themselves signs of anaphylaxis.

Anaphylaxis can occur without any skin symptoms at all. The absence of a rash does not exclude it. Mild to moderate signs do not always come first.

02

Act

Position · Adrenaline · Ambulance

Flat, not upright

Legs may be raised. Never standing, never walking.

Outer mid-thigh

Intramuscular. Through clothing if necessary.

Call 000

Do not delay adrenaline to make the call.

  1. Lay them flat

    Do not allow them to stand or walk. If breathing is difficult, they may sit with legs outstretched — but never stand. If unconscious, vomiting, or pregnant, place in the recovery position; on the left side if pregnant.

  2. Give adrenaline immediately

    Intramuscular injection into the outer mid-thigh. Do not wait to see whether symptoms settle, and do not give an antihistamine instead.

  3. Call 000

    State clearly that this is anaphylaxis. Adrenaline comes first — delegate the call if you are alone with the patient.

  4. Remove the trigger

    Stop any infusion, injection or application. Do not attempt to remove an injected product from the tissue.

  5. Give oxygen

    If available, and if you are trained to do so.

  6. Repeat adrenaline after 5 minutes

    If there is no response to the first dose, give a second dose after five minutes. Further doses may be required.

  7. Start CPR if unresponsive or not breathing normally

    Either sign is enough. Follow the ANZCOR Basic Life Support flowchart. Do not wait for both.

  8. Asthma and allergy together

    If someone with known asthma and allergy has sudden breathing difficulty, give the adrenaline device first, then the asthma reliever.

Adult adrenaline dose

Preparation
Adrenaline 1:1,000
Dose
0.01 mg/kg, to a maximum of 0.5 mg per dose
Route
Intramuscular, outer mid-thigh (vastus lateralis)
Repeat
After 5 minutes if there is no response
Devices
An adrenaline autoinjector delivers a single fixed dose. Know which devices your clinic stocks, and how each one is given.

Paediatric dosing is weight-based and is not reproduced here. Use the current ASCIA adrenaline dose document: allergy.org.au — Acute Management of Anaphylaxis

The error that kills

Never let them stand up

Fatality can occur within minutes if a patient with anaphylaxis stands or walks — before or after adrenaline is given, and even if they appear to have fully recovered. Standing impairs blood returning to the heart and can cause sudden, catastrophic hypotension.

They must not walk to the toilet. They must not be showered. Transfer them on a stretcher, trolley or wheelchair with legs outstretched — to the ambulance, to the emergency department, to the treatment room.

Do not allow standing or walking until the patient is haemodynamically stable: a minimum of one hour after one dose of adrenaline, and four hours if more than one dose was given.

03

Do and do not

The errors that cause harm

Do
  • Give adrenaline first, and early. It is safe.
  • Lay the patient flat and keep them flat.
  • Call 000 and say "anaphylaxis".
  • Give a second dose after five minutes if there is no response.
  • Start CPR if the patient is unresponsive or not breathing normally.
  • Transfer on a stretcher, trolley or wheelchair.
  • Observe for a biphasic reaction — symptoms can return.
Do not
  • Do not let the patient stand, walk, or sit upright in a chair.
  • Do not give an antihistamine instead of adrenaline, or before it. Antihistamines do not treat anaphylaxis.
  • Do not wait to see whether symptoms improve on their own.
  • Do not withhold adrenaline because there is no rash. Anaphylaxis can occur without skin symptoms.
  • Do not withhold adrenaline in pregnancy.
  • Do not discharge the patient early, or unaccompanied.

Pregnancy

Management is the same. Adrenaline is first line and must not be withheld. Position on the left side.

Difficulty breathing

The patient may sit with legs outstretched. They must still never stand or walk.

Device misfire

If a device is accidentally injected or activated, use another device if one is available.

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 for Anaphylaxis, or nationally accredited first aid certification (HLTAID011 Provide First Aid). Reading this document does not confer competence in the recognition or management of anaphylaxis.

The ASCIA Action Plan

An ASCIA Action Plan for Anaphylaxis is a patient-specific medical document, completed and signed by the treating prescriber. It is not reproduced here. Obtain the current plans, the adrenaline dose tables and the device instructions directly from ASCIA: allergy.org.au

Sources

  • ASCIA Guidelines — Acute Management of Anaphylaxis (2026).
  • ASCIA First Aid Plan for Anaphylaxis (2026).
  • ANZCOR Guideline 9.2.7 — First Aid Management of Anaphylaxis.
  • ANZCOR Guideline 8 — Cardiopulmonary Resuscitation, Basic Life Support flowchart.

Where this document differs from the current ASCIA guidelines, the ASCIA guidelines prevail. ASCIA describes its guidelines as living documents, revised as required. 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.

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