Patient handout

Anaphylaxis (acute resuscitation)

PRODUCTION

1. Your condition

This handout is for anaphylaxis (acute resuscitation). Your care team identified this based on: urticaria + angioedema after exposure (sampson 2006 niaid criteria).

Other reasons your team may use this plan: stridor / throat tightness (wao 2020 airway criterion); acute dyspnea / wheeze (eaaci 2014 respiratory criterion); hypotension after trigger exposure (sampson 2006 circulatory criterion).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
epinephrine	Adult 0.3-0.5 mg (0.3-0.5 mL of 1:1000); pediatric 0.01 mg/kg (max 0.3 mg) per AAAAI/ACAAI 2020	IM lateral thigh (vastus lateralis) per Simons JACI 2011	Repeat q5-15 min PRN until response (WAO 2020)	Only mortality-reducing intervention; IM lateral thigh > deltoid > SC; never delay for steroids/antihistamines (Resus Council UK 2021, JTF 2023, GA²LEN 2024)

Plan: Acute anaphylaxis bundle — epi-first per WAO 2020

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — No reaction — stable / trigger avoidance (WAO 2020)

If you have:

No symptoms after exposure or distance from known trigger (WAO 2020)
No skin, breathing, GI, or circulatory symptoms (Sampson 2006)

Do this:

Carry TWO epinephrine auto-injectors at all times (AAAAI/ACAAI 2020)
Avoid known triggers; read food labels; communicate allergy at restaurants and clinics (EAACI 2014)
Wear medical-alert identification (WAO 2020)
Keep allergist follow-up appointments (NICE 2020)
Keep asthma controller therapy current if applicable (Pumphrey 2000)

YELLOW — Mild reaction — skin or mild GI only (Sampson 2006 Grade 1-2)

If you have:

Hives / itching only (Sampson 2006 Grade 1)
Mild lip / face swelling without breathing change (WAO 2020)
Mild abdominal cramps / one episode of vomiting (Sampson 2006)
No throat tightness, no breathing difficulty, no dizziness (WAO 2020)

Do this:

Take an antihistamine (cetirizine 10 mg or diphenhydramine 25-50 mg) per AAAAI/ACAAI 2020
Watch closely for ANY of: throat tightness, voice change, hard time breathing, dizziness, fainting, severe abdominal pain, repeated vomiting (WAO 2020)
Have epinephrine ready in your hand (AAAAI/ACAAI 2020)
Call provider OR go to ED if any new symptom develops (NICE 2020)

Call your provider if:

Symptoms not resolving within 1 hour (NICE 2020)
Any new chest, throat, or breathing symptom (WAO 2020)
Reaction worsening despite antihistamine (AAAAI/ACAAI 2020)

RED — Anaphylaxis — give epinephrine NOW, then call 911 (AAAAI/ACAAI 2020)

If you have:

ANY of: trouble breathing, wheeze, throat tightness, voice hoarse / muffled (Sampson 2006 criterion 1)
Hives PLUS any breathing or stomach symptom after a trigger (Sampson 2006 criterion 2)
Lightheaded, faint, or pale / clammy (WAO 2020 circulatory)
Repetitive vomiting + skin symptoms (Sampson 2006)
Sudden collapse after exposure (WAO 2020)
Past severe reaction + any symptom now after re-exposure (AAAAI/ACAAI 2020)

Do this:

INJECT epinephrine auto-injector into the OUTER MIDDLE THIGH right now (through clothing if needed). Hold for 3 seconds. (Simons JACI 2011)
CALL 911 / emergency services immediately, even if you feel better — biphasic reaction can occur 1-72 hours later. (AAAAI/ACAAI 2020)
Lie flat with legs raised (or left side if pregnant or vomiting). Do NOT stand up suddenly. (WAO 2020)
Use second epinephrine auto-injector after 5-15 min if symptoms persist or return. (AAAAI/ACAAI 2020)
Use rescue inhaler (albuterol 4-8 puffs) for wheeze AFTER giving epinephrine, not instead. (WAO 2020)
Bring used auto-injectors to the hospital. (NICE 2020)

Call your provider if:

Always call 911 — anaphylaxis requires hospital observation even if symptoms resolve quickly (NICE 2020)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Persistent hypotension, airway oedema, or bronchospasm despite >=2 IM epinephrine doses (5-15 min apart) plus 1-2 L crystalloid (AAAAI/ACAAI 2020)(life-threatening)
Stridor, voice change, tongue/laryngeal swelling progressing despite IM epi (WAO 2020)(life-threatening)
Recurrence of anaphylaxis features 1-72 h after initial resolution (typical 4-12 h) per AAAAI/ACAAI 2020
Refractory hypotension in patient on beta-blocker or ACE-inhibitor despite epi + IVF (AAAAI/ACAAI 2020)
Anaphylaxis in pregnant patient (any trimester) per Simons JACI 2011
PEA / asystole during anaphylactic shock (AHA 2024)(life-threatening)

5. Follow-up

2x epi auto-injectors + written action plan + allergist referral 4-6 weeks; medical-alert bracelet; venom immunotherapy referral if hymenoptera (AAAAI/ACAAI 2020; EAACI 2014)

6. Sources

Guideline: Resuscitation Council UK 2021 Adult Advanced Life Support + JTF/AAAAI/ACAAI Anaphylaxis Practice Parameter Update (Shaker JACI 2020; reaffirmed 2023) + 2024 GA²LEN consensus on anaphylaxis definition (Cardona JACI 2025) + WAO 2020 Anaphylaxis Guidance (Cardona WAO J 2020) + EAACI 2021 + 2024 AHA focused update on cardiac arrest from anaphylaxis