If someone is having a severe allergic reaction, lay them flat, give the adrenaline device, and call 000. If you are not sure whether it is anaphylaxis, give the adrenaline anyway. Adrenaline given when it was not needed does far less harm than adrenaline withheld when it was.
The step that matters most has nothing to do with the device
Lay the person flat. Do not let them stand or walk.
In anaphylaxis, blood pools away from the heart. Standing up — walking to the car, going to find help, sitting upright to breathe more easily — can be enough to stop the heart filling. It is why the instruction in ASCIA’s action plans is absolute rather than a suggestion: lay them flat, and do not let them stand or walk, even if they feel able to.
- Normally — lay them flat.
- If breathing is difficult — let them sit, with legs stretched out in front. Do not let them stand.
- If unconscious, or pregnant — use the recovery position. If pregnant, lie them on their left side.
- Young children — keep them flat, not upright.
Telling a mild reaction from anaphylaxis
Mild to moderate: swelling of the lips, face or eyes, hives or welts, tingling in the mouth. Stay with the person, find their adrenaline device, give an antihistamine if they have one, and call their emergency contact. For insect allergy, abdominal pain or vomiting is treated as anaphylaxis.
Any one of these is anaphylaxis:
- Difficult or noisy breathing
- Swelling of the tongue
- Swelling or tightness in the throat
- Wheeze or persistent cough
- Difficulty talking, or a hoarse voice
- Persistent dizziness or collapse
- Pale and floppy — in young children
Skin symptoms do not have to be present. ASCIA is explicit that sudden breathing difficulty in someone with a known allergy should be treated as anaphylaxis even with no skin symptoms at all — so do not wait for a rash to appear before acting.
How to give an EpiPen
- Form a fist around the EpiPen and pull off the blue safety release.
- Hold the leg still. Place the orange end against the outer mid-thigh. It can go straight through clothing.
- Push down hard until you hear or feel a click.
- Hold it there for 3 seconds, then remove it.
Blue to the sky, orange to the thigh. If you learned to hold it for ten seconds, that has changed — the current ASCIA action plan says three.
EpiPen 300 mcg is for adults and anyone over 20 kg. EpiPen Jr 150 mcg is for 7.5–20 kg.
How to give an Anapen
Anapen is a different device and the technique is not the same. If your workplace or service holds one, learn this one specifically — fumbling an unfamiliar device costs the minutes that matter.
- Pull off the black needle shield.
- Pull off the grey safety cap from the red button.
- Place the needle end firmly against the outer mid-thigh at 90 degrees. Clothing can stay on.
- Press the red button so it clicks, and hold for 3 seconds, then remove.
After the first dose
- Call 000 if you have not already.
- Give a second dose after 5 minutes if there is no response. Use a second device if one is available.
- Note the time each dose was given and tell the paramedics.
- Hospital, every time. Anyone who has had adrenaline needs at least four hours of observation — reactions can return after the adrenaline wears off.
If the person becomes unresponsive and is not breathing normally, start CPR — see the DRSABCD action plan.
Asthma puffer or adrenaline first?
Adrenaline. If someone with known asthma and a food, insect or medication allergy suddenly has trouble breathing — wheeze, persistent cough or a hoarse voice — give the adrenaline device first, then the asthma reliever. Even if there are no skin symptoms at all.
This catches people out because the breathing looks like an asthma attack. Treating it as asthma first has cost lives.
If you inject yourself by accident
It happens, usually by holding the wrong end. Phone the Poisons Information Centre on 13 11 26 — and keep following the action plan for the person having the reaction. They are the priority.
This is a summary of what is taught in class, not a substitute for training. Skills like this are assessed practically for a reason — reading about them is not the same as having done them. In a real emergency, call 000.
Learn it properly
Anaphylaxis response is taught in HLTAID011 first aid including CPR and HLTAID012 childcare first aid, which covers it in an education and care context. Best First Aid Training runs both at Parramatta, Penrith, Blacktown and Liverpool.
Source: Australasian Society of Clinical Immunology and Allergy, ASCIA Action Plan for Anaphylaxis (General), 2025. A person with a diagnosed allergy should always follow the individual action plan signed by their own doctor.
For stings specifically — getting the sting out, what a normal reaction looks like, and when it has tipped into anaphylaxis — see bee and wasp sting first aid.
