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April 24, 2013
Don't be shocked by anaphylaxis; Train workers to respond to life-threatening reactions

Many people suffer from allergies. An unfortunate minority have allergies so severe that their reaction is a life-threatening condition called "anaphylaxis."

Individuals who know they have a life-threatening allergy will usually avoid exposure and carry epinephrine injection devices, commonly called EpiPens, that interrupt the reaction. However, many people don't know they have a potentially deadly allergy until they experience their first life-threatening reaction.

To respond effectively to anaphylactic shock in the workplace, workers need to know the signs and symptoms of anaphylactic shock and what they should do.

Background on anaphylaxis

Who needs to be trained? No specific Cal/OSHA standard requires training for anaphylaxis, but anaphylaxis is included in most first-aid training. Several Cal/OSHA standards require first-aid training for workers.

Why train workers to respond to anaphylaxis? Even prompt emergency medical assistance can sometimes arrive too late to help anaphylaxis victims. Workers who respond appropriately could save a coworker's, customer's, or client's life.

Basics of anaphylaxis

Instructions to Trainer: Nationwide Children's Hospital has created an informative 4-minute video on using an EpiPen that should be included in this session. It features children but also applies to adults.

One in five Americans is allergic to something—a food product, drug, chemical, insect bite, or plant pollen. Allergies occur when our bodies overreact to proteins in our environment. Symptoms range from runny noses to life-threatening reactions involving the heart and lungs. These life-threatening allergic reactions are called "anaphylaxis."

Practice tip

The American Academy of Allergy, Asthma and Immunology has created a wallet card listing symptoms and treatment for anaphylaxis.


Some substances are more likely to provoke an allergic reaction. If it is a chemical in your workplace, the safety data sheet (SDS) will list it as a sensitizer, or potential allergen; some of these chemicals can cause anaphylaxis.

Your workplace may contain many substances that could cause an anaphylactic reaction that will not have SDSs, including:

  • Foods. The U.S. Food and Drug Administration requires food labels to list the eight most common food allergens: dairy, egg, wheat, soy, seafood, fish, tree nuts, and peanuts.

  • Indoor/outdoor allergens. The most common indoor/outdoor allergens are animal dander, pollen, mold, and dust mites.

  • Drugs. Common allergenic drugs include penicillin drugs, anticonvulsants, insulin, iodine contrast dyes, and sulfa drugs.

  • Insect bites and stings. Biting insects, like flies or mosquitoes, can cause mild allergic reactions, but stinging insects are far more likely to cause anaphylaxis. These insects include bees (honeybees and bumblebees), wasps (yellow jackets, paper wasps, and hornets), and stinging ants like fire ants.

Recognizing anaphylaxis

One of the most dangerous things about an anaphylactic reaction is that victims may not know they have this kind of allergy until they suffer a life-threatening reaction. In fact, they may not have had a previous problem with the allergen.

People who have never been allergic to shellfish can suddenly begin reacting to it in adulthood; nurses who have worked in patient care for decades might develop life-threatening allergies to latex after years of exposure. So it's important to recognize the symptoms of anaphylaxis and react, even if you're not sure what's causing the reaction.

An allergy may cause a localized reaction (for example, swelling at the site of a sting), but anaphylaxis is a systemic reaction and affects multiple areas of the body. Symptoms of anaphylaxis include:

  • Sudden hives, in different places on the body;

  • Wheezing, hoarseness, or difficulty breathing or speaking;

  • Itchy skin or eyes;

  • Skin rash;

  • Swelling of the lips, tongue, or face;

  • Dizziness;

  • Abdominal pain or cramping, nausea, vomiting, or diarrhea;

  • Confusion, light-headedness, or fainting; and

  • Racing pulse or palpitations (a sensation of being able to feel your heart beat).

In as many as 90 percent of cases, hives or skin rash and swelling in and around the mouth are present. These two symptoms, plus either respiratory difficulties or blood pressure problems (light-headedness, dizziness, fainting), are considered sure signs of anaphylaxis. But don't hesitate: If you see more than one of the symptoms above and think a person might be experiencing anaphylaxis, treat for anaphylaxis.

Anaphylaxis can reoccur anywhere from 1 to 72 hours after it initially occurs, even without further exposure to the allergen. For this reason, most people who know they have an anaphylactic allergy carry two doses of epinephrine.

Treating anaphylaxis

If you suspect someone is suffering anaphylaxis:

  • Use the EpiPen (as demonstrated in the video included in this training). You cannot hurt someone—even a person who is not, in fact, suffering anaphylaxis&$8212by giving them a standard dose of epinephrine.

  • Call 911. Because the reaction may become worse, or reoccur, it's vital to call 911 and get medical assistance.


Because the substances that can cause anaphylaxis are so common, it's important to recognize this life-threatening condition. When you know how to recognize and respond to the symptoms of anaphylaxis, you may be able to save the life of a coworker, customer, or client, or even a family member.

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