An allergic reaction occurs when a person’s immune system treats a protein (an allergen) as harmful. Some children with food allergy are at risk of having a severe allergic reaction. A severe allergic reaction is very serious. It is also called anaphylaxis (an-nah-fil-axe-is). It often happens quickly and can cause death if not treated.

Symptoms of a severe allergic reaction (anaphylaxis)

Symptoms of a severe allergic reaction, called anaphylaxis, can start within minutes of eating or being exposed to an allergen. In some cases, the reaction can take up to several hours.

Symptoms can vary from person to person. The same person can have different symptoms each time they have a severe allergic reaction. An anaphylactic reaction can take place without hives, so look out for any of the signs of a severe allergic reaction. Symptoms of a severe allergic reaction can include any of the following:

• Skin: hives, swelling (face, lips, tongue), itching, warmth, redness, rash
• Respiratory (breathing): coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing
• Gastrointestinal (stomach): nausea, pain or cramps, vomiting, diarrhea
• Cardiovascular (heart): paler than normal skin colour/blue colour, weak pulse, passing out, dizziness or lightheadedness, shock
• Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, a metallic taste

Responding to a severe allergic reaction

A severe allergic reaction can be life threatening. It is important to respond quickly and follow these emergency steps:

1. Give epinephrine auto-injector (e.g. EpiPen® or Allerject™) at the first sign of a known or suspected severe allergic reaction
2. Call 9-1-1 or your local emergency service. Tell them someone is having a severe allergic reaction
3. Give a second dose of epinephrine as early as 5 minutes after the first dose if there is no improvement in their symptoms
4. Go to the nearest hospital immediately (by ambulance if possible) even if symptoms are mild or have stopped. The reaction could get worse or come back, even after proper treatment. Stay in the hospital for observation for as long as the emergency department physician suggests (generally about 4 to 6 hours)
5. Call emergency contact person (e.g. parent, guardian)

Other Important Information About EpiPen®

1. EpiPen® products expire on the last day of the month indicated on the product packaging. For example, if the product is marked as expiring in January, it remains valid (not expired) until January 31
2. You are advised to have more than one auto-injector with different expiry dates to avoid only having an expired auto-injector
3. If you are experiencing an anaphylactic reaction and only have an expired auto-injector, use the expired product and immediately contact 9-1-1
4. Whether the product is expired or not, go to the nearest hospital as soon as possible after using the product, as instructed in the product labelling

Managing Food Allergies

Food can be an allergen for many people. Whether you or someone in your care has a food allergy, making food choices can be challenging. See our Food Allergies – Resources to learn about healthy food choices for you and your family while managing food allergies.

Our HealthLinkBC Files provide information on recognizing and responding to severe food allergies in children and teens. You will also find tips on how to help your child stay safe:

• HealthLink BC File #100a Severe Allergic Reactions to Food: Children and Teens
• HealthLinkBC File #100c Allergy Safe Child Care Facilities

For information and resources to reduce a baby’s risk of developing food allergy, see:

• Reducing Risk of Food Allergy in Your Baby

For information about food allergies and adults living in care facilities, see:

• HealthLinkBC File #100b Allergy Safe Adult Care Facilities

Useful Websites

BC Government

The BC Government provides safety planning resources for severe allergic reactions in schools. Learn about promoting awareness, developing policies and creating safety plans in schools.

• Anaphylaxis

Food Allergy Canada

Food Allergy Canada provides allergy information to educate, support and advocate for the needs of people living with food allergy. They support and take part in research related to food allergy and anaphylaxis. For more information on responding to a severe allergic reaction see:

• Allergy Aware
• Food Allergy Canada: Anaphylaxis
• Food Allergy Canada: Anaphylaxis Emergency Plan
• Food Allergy Canada: Emergency Treatment of Anaphylaxis
• Living Confidently with Food AllergyNewly diagnosed Support Centre
• Think F.A.S.T...
• Why Risk It

Health Canada, Government of Canada

Health Canada provides information on how to avoid allergic reactions and staying prepared. For resources on common allergens see:

• Common Food Allergens, Government of Canada
• Tips for Avoiding Common Allergens in Food, Government of Canada

Canadian Society of Allergy and Clinical Immunology

The Canadian Society of Allergy and Clinical Immunology supports allergy and clinical immunology research. The Society provides information about common allergies that affect students in schools. You will find sample policies and emergency plans to help individuals, schools and organizations develop effective management strategies:

• Anaphylaxis in Schools and Other Settings

Last Reviewed: December 21, 2018

The information provided in the Severe Allergic Reaction Health Feature is adapted from the Anaphylaxis in Schools and Other Settings, Copyright 2005-2016 Canadian Society of Allergy and Clinical Immunology.

Information about EpiPen® is adapted from Information Update - Shortage of EpiPen (0.3 mg) and EpiPen Jr (0.15 mg) auto-injectors in Canada, Government of Canada, accessed December 12, 2018.