Allergies are relatively common, presenting on the skin (hives, itching, swelling), or in the airways (sneezing, snuffles) and sometimes accompanied by gastrointestinal symptoms (cramps, diarrhoea). Chronic allergic disease (e.g., atopic eczema) sometimes deteriorates suddenly. Some people can also be severely allergic to something resulting in a life-threatening anaphylactic reaction (a severe allergic reaction). Many people with a history of anaphylaxis carry a lifesaving epinephrine autoinjector. There is some evidence that allergies and anaphylaxis may be occurring more frequently in recent decades (Lee et al., 2017).
Guidelines
Anaphylaxis
- Epinephrine should be used intramuscularly to treat anaphylaxis using the person’s prescribed autoinjector. **
- For a person with symptoms of anaphylaxis who has been treated by, but did not respond to, epinephrine within five to ten minutes, a second dose may be considered, if emergency medical services (EMS) have not arrived yet. *
Mild allergic reaction
- Using moisturisers in case of atopic eczema or dermatitis may relieve the symptoms. *
- Rinsing the eyes or nasal cavity with saline may relieve symptoms of hay fever. *
- If local regulations allow, a trained first aid provider may give common antiallergic medication (antihistamine or corticosteroid tablet) if the person does not have these with them. *
Good practice points
- The person should be asked about any known allergies and prescribed medication.
- If appropriate, the allergen should be removed (e.g., from the skin) or the person should be removed from the environment containing the allergen (e.g., a chemical).
- The first aid provider should help the person to get into a comfortable position and to take their prescribed medication if the person has this with them.
Anaphylaxis
- First aid providers should be trained in recognising the signs and symptoms of anaphylaxis.
- First aid providers should be familiar with the epinephrine autoinjector, so that they can help someone having an anaphylactic reaction self-administer their epinephrine, if local law permits.
- First aid providers may be permitted to use an epinephrine autoinjector if the person is unable to do so, provided that a doctor has prescribed the medication and local law permits.
- Epinephrine should only be given when symptoms of anaphylaxis are present. Inappropriate use of an epinephrine autoinjector (in a case of misdiagnosis, incorrect route of administration, inadvertent intravenous administration, or administration of an excessive dose of epinephrine) may result in adverse reactions.
- The epinephrine auto-injection may be administered through the person’s clothing if the clothes are not thick.
- First aid providers should access EMS when a severe allergic reaction (anaphylaxis) is suspected or recognised in a person.
- Unless the doctor’s prescription is different, for children between 15kg and 30kg bodyweight, an epinephrine dose of 0.15mg is recommended intramuscularly. For children over 30kg, epinephrine is recommended in a dose of 0.3mg, and for adults, the recommended dose is 0.5mg.
- First aid providers should be aware that anaphylactic reaction can be biphasic (symptoms recur after complete improvement) between 1 and 78 hours after the initial onset. Biphasic anaphylaxis is associated with initial presentation of anaphylaxis that is more severe or needs more than one dose of epinephrine. In these instances, the person should be observed in case of a second reaction.
Mild allergic reaction
- In case of an allergic reaction to the skin, advise the person not to rub the skin, as this may exacerbate the itch.
- In the case of hay fever, rinsing the eye or nose may offer some relief.
- The first aid provider should monitor the person closely, as a mild allergic reaction can develop into a severe allergic reaction.
Chain of survival behaviours
Prevent and prepare
- Prevention is of utmost importance. Anyone with a known allergy should avoid any contact with the allergen.
- Ensure a person with a known allergy carries an allergy card (describing their allergy) and their prescribed medication at all times, and that caregivers know where the medication can be found.
- Teach those with a known allergy, as well as their caregivers, to recognise the signs and symptoms of a severe allergic reaction, when and why to access EMS and how to use the epinephrine autoinjector.
- Consider food labelling at home and about.
- Be aware of the most common allergens causing anaphylaxis (foods, insect venoms, medication and latex).
Recognise
Unless the allergic reaction is the first one in the life of the person, the person usually knows they are allergic to a certain substance and may carry some antiallergic medicine with them. Ask the person if they have any known allergies.
You may notice the person has had contact with a common allergen.
A mild allergic reaction will vary depending on what is causing it but may include:
- red, itchy eyes
- sneezing, snuffles or runny nose
- abdominal cramps, diarrhoea and vomiting
- itching, swelling or hives on the skin, including the face.
A severe allergic reaction (anaphylaxis) is likely to develop further to also include life-threatening conditions such as:
- difficulty breathing including shortness of breath, wheezing or asthma-like appearance
- airway narrowing, swelling of the tongue, throat and larynx, causing hoarseness, noisy breathing. Often, the first symptom occurring is difficulty swallowing.
- signs of shock including confusion or agitation, pale or ashen skin, which may lead to collapse and unresponsiveness.
The severity of anaphylaxis can differ from one person to another, and even in the same person from one episode to another. A mild allergic reaction may unpredictably progress to life-threatening anaphylaxis in minutes. Therefore, high alertness is required in treating a suspected anaphylactic reaction.
First aid steps
Severe allergic reaction (anaphylaxis)
- Access EMS as soon as you recognise the person is experiencing a severe allergic reaction.
- Help the person to lie down unless they are experiencing breathing difficulties. In that case, help them to sit down.
- If the person has an epinephrine autoinjector, help them to use it. The best place for injection is the middle of the outer side of the thigh. The injection can be administered through clothes if the clothes are not thick.
- If a person with symptoms of severe allergic reaction was treated with but did not respond to the first dose of epinephrine within five to ten minutes, a second dose may be considered.
- Keep monitoring the person’s responsiveness and breathing regularly until EMS is accessed.
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NOTE
Follow the usual rules for drug and medical device disposal after the autoinjector has been used.
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Local adaptation
If an epinephrine autoinjector is not available, access EMS (or equivalent) immediately. While waiting for medical assistance, alternative medicines can be used after medical advice such as antihistamines or corticosteroids.
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CAUTION
- First aid providers should be aware that use of epinephrine may have side effects, (some of which may also result from an anaphylactic reaction):
• faster (pounding) sometimes irregular heartbeat
• excitement, anxiety, or fear
• weakness or shakiness
• nausea and vomiting
• throbbing headache
• dizziness
• paleness
• sweating
A person being administered an epinephrine injection should lie down on their back for several minutes following the injection to minimise these side effects.
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Mild allergic reaction
- Ask the person about known allergies and any prescribed medication.
- If appropriate, remove the allergen (e.g. by rinsing from the skin) or remove the person from the environment containing the allergen.
- Help the person get into a comfortable position and to take their medication if they have it with them. If trained to do so, and the local regulations allow, offer the person common antiallergic medication or remedies.
- In case of an allergic reaction to the skin, advise the person not to rub the skin, as this may make it itch more.
- Monitor the person closely as a mild allergic reaction can develop into a severe allergic reaction.
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NOTE
- An antihistamine or corticosteroid medication may be given to the person.
- For hayfever, rinsing the eyes or nasal cavity with saline may relieve symptoms.
- In the case of hives, an anti-itch ointment might help. Advise the person to seek help from their doctor or pharmacist.
- In the case of eczema, applying moisturiser or using an anti-itch ointment may help.
- Advise the person that some antihistamines could cause drowsiness and diminish the reflexes needed for safe driving or working with a dangerous machine. This is more pronounced with the first generation of antihistamines. Even a small amount of alcohol may enhance these side effects.
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Access help
Anaphylaxis
- Anaphylaxis is a life-threatening condition requiring urgent medical attention. As soon as you suspect a severe allergic reaction, access EMS.
- Ensure you tell EMS if the person has received an epinephrine injection.
Mild allergic reaction
Advise the person to seek medical advice:
- In the case of hives: if the allergic reaction to the skin is very bothersome and does not improve over a couple of days.
- In the case of eczema: if it is the first time the allergic reaction occurs, or if the skin lesions are accompanied by signs of infection, such as fever or feeling unwell.
- In the case of hay fever: if it is the first time the allergic reaction occurs.
Recovery
- Ensure that a person who has a severe reaction or requires an epinephrine injection is monitored for the three days following a reaction, as a severe allergic reaction may recur.
- A person who has experienced a severe allergic reaction should keep an allergy card (explaining their allergy) with them at all times.
Education considerations
Context considerations
- Programme designers should be mindful of local legislation and regulation which could affect what should be taught.
- Preparation, planning and training are needed, particularly in high-risk environments, to encourage quick action for anaphylaxis during an emergency.
- Some learners may work in environments (e.g., school, day-care) where they will have a different scope of practice to first aid providers. For example, they might have a responsibility to administer medication. They may also have access to epinephrine as part of their facility supplies or maybe reliant on individual users who have it on prescription from their doctor.
- Focus education on preparedness and prevention in remote contexts where access to medical supplies and EMS may be challenging. Likewise, people with a known allergy who are visiting remote places should take adequate supplies of antihistamine or epinephrine; tell others where they are going and when they expect to return, and research what allergens they need to be alert to and avoid.
Learner considerations
- Consider how you may differently prepare people (health care professionals, parents of young children, etc.) to help someone in case of a severe allergic reaction. Be aware in learning design that young people are susceptible to certain factors which may delay the recognition of an anaphylactic episode. They tend to have higher risk behaviour thus potentially leading them to disregard triggers of anaphylaxis. They also try to hide their allergy problems from others, avoid epinephrine autoinjectors, and seek medical care only at late stages of the reaction. The first experiences with alcohol may also act as a co-factor of severity.
- Schools might have their own policies and practices which school staff need to know about. Where these do not exist, learners who work in schools should be encouraged to develop safe and effective policies and protocols (Morris et al., 2011).
- A wider educational approach to this topic may be useful for caregivers of people with severe allergies, including practical considerations such as food labelling and psychological considerations such as how to cope with the anxiety of someone vulnerable to anaphylaxis (Brockow et al., 2015).
- Decision making about how to respond can be challenging for learners (deciding to give the injection, whether to repeat the dose and how to access help). Often, they need to acknowledge several symptoms to recognise the significance of the situation (Simons et al., 2009)
- Help learners to think through how they can help themselves if they are alone when they experience an allergic reaction or anaphylaxis.
- Help any learner with an epinephrine autoinjector to develop a personalised emergency action plan if they have not got one already.
Facilitation tips and tools
- It is valuable to emphasise the importance of a prescription of epinephrine autoinjector for those at risk, the key signs and symptoms which indicate a need for an auto-injection, administering epinephrine (having it available, when to use it and how to use it) as well as the importance of accessing medical care after administration (Simons et al., 2009).
- Use a training autoinjector to demonstrate their use to learners. If using a real autoinjector, ensure it does not contain any medication, and take care to mitigate risks of a learner coming in contact with a sharp needle. Do not use live medications for demonstrations.
- There are different types of auto-injectors, for instance, the needle is visible in some but not in others. First aid providers should know the main types and the principles of their function so use a variety of trainer examples in sessions (Ring et al., 2018).
- Emphasise the user should hold the device pressed down for about ten seconds to allow the entire dose to be administered.
- Delayed injection of epinephrine is associated with higher hospitalisation and mortality rates; while prompt administration of epinephrine is associated with better outcomes (Alvarez-Perea et al., 2017).
- First aid providers not trained in using an autoinjector may not be able to quickly learn how to use it properly. In an emergency, there may not be time to read the instructions for use. So, practise is essential.
- Reassure learners that epinephrine autoinjectors are safe to use in the event of someone having a severe allergic reaction.
Facilitation tools
- Beyond learning the first aid steps, focus on building learner confidence and ability by providing opportunities to practise decision making (possibly through a scenario or case-based learning) to encourage quick action (Litarowsky et al., 2004).
- Using a peer education approach, whereby learners are encouraged to teach their families and friends about this topic, could be beneficial to the wider community (Brockow et al, 2015).
- Regular practice and refreshing (small dose, high-frequency learning) could be helpful to maintain confidence/self-efficacy (Arkwright & Farragher, 2006).
Scientific foundation
Systematic reviews
Anaphylaxis
In 2015, the International Liaison Committee on Resuscitation (ILCOR) conducted a systematic review on the benefit of a second dose of epinephrine for severe anaphylaxis when signs and symptoms fail to respond to an initial dose. Based on very low-certainty evidence from nine observational studies, it was shown that resolution of symptoms improved when giving a second dose to people not responding to a first dose (Zideman et al., 2015; Singletary et al., 2015).
Another review on the recognition of anaphylaxis concluded, based on observational studies and case studies, that first aid providers have difficulties recognising signs and symptoms (Markenson, 2010).
The update of the existing systematic reviews was explored via two scoping reviews (Carlson et al., 2019), concerning the second dose of epinephrine for anaphylaxis and recognition of anaphylaxis by first aid providers. Both concluded there was not sufficient information to alter the existing ILCOR treatment recommendations or to pursue a new systematic review.
A recent comprehensive systematic review of the topic (Shaker et al., 2020) summarises current knowledge. It underlines that due to human anaphylaxis being a potentially fatal, acute condition, ethical considerations make double-blind studies almost impossible. This limits the availability of evidence. Some highlights here are either confirming our former knowledge or updating certain points:
- The lifetime prevalence of anaphylaxis has been estimated at 1.6% to 5.1%, and recent studies demonstrated the rate of biphasic reactions closer to 4% to 5%.
- While diagnostic criteria for anaphylaxis (National Institute of Allergy and Infectious Diseases, 2006) are very sensitive and quite specific, fulfilling these is not a prerequisite for epinephrine administration in a person experiencing an acute allergic reaction.
- US, European, and international anaphylaxis guidelines recommend intramuscular epinephrine in the front and outer sides (anterolateral) of the thigh rather than subcutaneous epinephrine in the upper muscle of the shoulder (deltoid) for the treatment of anaphylaxis. This is based on a limited number of studies in volunteers (not in anaphylaxis) that demonstrated that when administered intramuscularly into the thigh, epinephrine works rapidly and reaches maximal efficacy within ten minutes of injection, though no proof exists that subcutaneous delivery is not effective.
- Epinephrine administered intramuscularly (in a dose of 0.01 mg/kg of a 1:1000 [1 mg/mL] solution to a maximum of 0.5 mg in adults and 0.3 mg in children) into the n the front and outer sides (anterolateral) of the thigh is the first-line treatment for anaphylaxis. The availability of newer auto-injector dose formulations (0.1 mg for infants) allows greater epinephrine dosing accuracy. However, a 0.15-mg intramuscular dose is also widely prescribed for infants at risk for anaphylaxis. Particularly in settings where a 0.1-mg autoinjector dose is not available, the speed and precision gained from a 0.15-mg auto-injector dose compared with having caregivers draw up doses using a syringe method may justify trade-offs in dosing accuracy, especially in infants weighing more than 7.5 kg. Depending on the response to the initial injection, the dose can be repeated every 5 to 15 minutes.
- Biphasic anaphylaxis is a well-recognised potential complication of anaphylaxis and has been defined as recurrent anaphylaxis after complete improvement. This has been reported to occur between 1 and 78 hours after the onset of the initial anaphylactic reaction, and this must be clinically differentiated from a reaction that does not fully respond to initial treatment and persists or quickly returns.
- Biphasic anaphylaxis is associated with a more severe initial presentation of anaphylaxis or repeated epinephrine doses (i.e., more than one dose of epinephrine) required with the initial presentation (very low certainty evidence). A person presenting with severe anaphylaxis or requiring more aggressive treatment (e.g., more than one dose of epinephrine) should be considered for longer observation time for a potential biphasic reaction following complete resolution of signs and symptoms. Certainty rating of evidence: very low.
Shaker et al. (2020) provide some additional good practice statements for anaphylaxis:
- Administer epinephrine as the first-line treatment for anaphylaxis and biphasic anaphylaxis.
- Do not delay the administration of epinephrine for anaphylaxis, as doing so may be associated with higher morbidity and mortality.
- After recognition and treatment of anaphylaxis, the person should be kept under observation in a setting capable of managing anaphylaxis until symptoms have fully resolved.
Allergic reaction
The Centre for Evidence-Based Practice (CEBaP) developed four evidence summaries for eczema or hives and hay fever.
Use of moisturisers in atopic eczema or dermatitis
CEBaP found moderate-certainty evidence from one Cochrane systematic review showing that using moisturisers resulted in a statistically significantly increased number of people experiencing good improvement and a statistically significant decrease in disease severity and itch in people with a flare of atopic eczema or dermatitis. Any adverse event or a statistically significant change in their quality of life, could not be demonstrated.
Cooling the skin for itching or wheals (eczema, hives)
CEBaP identified very low-certainty evidence from four randomised controlled trials. It was shown that cooling the skin to temperatures less than 22°C resulted in a statistically significant decrease in itch intensity, size and flare size, compared to not lowering the skin temperature or maintaining a skin temperature of 32 °C, (in three studies). However, a statistically significant decrease in itch intensity or wheal size when cooling the skin to 28 °C compared to maintaining skin temperature of 32 °C; or a statistically significant decrease in wheal diameter when cooling the skin to 22 °C, compared to not lowering the skin temperature, could not be demonstrated in two studies. A statistically significantly decreased risk of itch resolution or reduction when cooling the skin to 10 °C, compared to heating the skin to 45 °C, could not be demonstrated in one study.
Use of antihistamines in cold urticaria (hives)
First-generation H1-antihistamines
There is limited evidence neither in favour of first-generation oral H1-antihistamines nor placebo. A statistically significant increase in the rate of complete response, using first-generation H1-antihistamines, compared to placebo, could not be demonstrated. However, it was shown that first-generation H1-antihistamines were associated with a statistically significant increased occurrence of adverse events, compared to placebo. Evidence is of low certainty.
Second-generation H1-antihistamines
There is limited evidence in favour of second-generation oral H1-antihistamines. It was shown that second-generation H1-antihistamines resulted in a statistically significant increase in the rate of complete response, compared to placebo. However, it was shown that second-generation H1-antihistamines were associated with a statistically significant increased occurrence of adverse events, compared to placebo. Evidence is of low certainty.
H2-antihistamines
No relevant studies comparing oral H2-antihistamines to placebo could be identified.
Use of antihistamines in eczema
CEBaP identified low-certainty evidence from two systematic reviews for the use of antihistamines in eczema.
Oral H1-antihistamines compared to placebo
No relevant studies comparing oral H1-antihistamines to placebo could be identified.
Oral H1-antihistamines and topical treatment compared to placebo and topical treatment There is limited evidence neither in favour of combining topical treatment with H1-antihistamines nor combining it with placebo. A statistically significant change in the rate of response, overall response rate, physician-assessed number of people for whom treatment helped itching or reported pruritus, could not be demonstrated when using the combination of topical treatment and oral H1-antihistamines compared to the combination of placebo with topical treatment. It was, however, shown that Fexofenadine resulted in a statistically significant increased reported change in pruritus, compared to placebo. Also, it was shown that Acrivastine resulted in a statistically significant increase in the physician-assessed number of people for whom treatment helped itching, compared to placebo. A statistically significant increased occurrence of adverse events, using the combination of topical treatment and oral H1-antihistamines compared to the combination of placebo with topical treatment, could not be demonstrated.
Nasal rinsing for hay fever
CEBaP identified low-certainty evidence from one Cochrane systematic review on nasal rinsing for hay fever. There is limited evidence in favour of nasal irrigation with saline. It was shown that nasal irrigation with saline, compared to no irrigation, resulted in a statistically significant decrease in disease severity scores within four weeks and between four weeks and six months. A statistically significant increase in health-related quality of life within four weeks or between four weeks and six months could not be demonstrated.
Eye rinsing for hay fever
CEBaP identified very low-certainty evidence from one non-randomised controlled trial on eye rinsing for hay fever. There is limited evidence in favour of eye rinsing. It was shown that eye rinsing resulted in a statistically significant change in overall improvement, compared to no eye rinsing. A statistically significant change in clearness, redness and comfort, when eye rinsing, compared to no eye rinsing, could not be demonstrated.
Non-systematic reviews
Autoinjectors
Sicherer and Simons (2017) state that while epinephrine autoinjectors are usually prescribed for people with a history of anaphylaxis, they may also be prescribed for some people at high risk without a history of anaphylaxis. Epinephrine autoinjectors are best prescribed in the context of a written, personalised anaphylaxis emergency action plan, developed by the doctor with input from the family. It is important to teach people and caregivers how to recognise anaphylaxis symptoms; when, why, and how to use an epinephrine autoinjector; and the rationale for accessing EMS. Morris et al (2011) support this with a call to schools to develop safe and effective policies and protocols in order to support the school community to respond effectively in the event of someone having an allergic reaction.
Simons et al. (2009) report a study of survivors of anaphylaxis in a community using a survey. In this study more than half the responders reported problems in using the autoinjector. Such problems included knowing when to use it, how to decide whether to give a second dose, and knowing how to use it. The authors conclude that there is a need for greater guidance to those with prescribed autoinjectors on when and how to use it, the signs and symptoms of anaphylaxis and recovery actions.
Ring et al. (2018) conducted a selective literature search between 2007 and 2014. The authors stress that several epinephrine autoinjector types are available, being different in dose, shelf life, length of the needle, and usage technique. Their use needs to be learned and practised, meaning that they are not simply interchangeable.
Incidence of anaphylaxis
Lee et al. (2017) in the framework of the Rochester Epidemiology Project performed a population-based incidence study in Olmsted County, Minnesota, from 2001 through 2010. This showed a 4.3% increase per year in the incidence rate of anaphylaxis.
Recognising anaphylaxis
Sampson (2006) state that anaphylaxis is highly likely when any one of the following three criteria are fulfilled:
- Acute onset of an illness (minutes to several hours) with the involvement of the skin, mucosal tissue, or both (e.g., generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of the following:
a. Breathing difficulties (wheezing, high pitched wheezing, hypoxia).
b. Reduced blood pressure or associated symptoms (e.g. feeling faint, fainting, or becoming unresponsive).
- Two or more of the following that occurs rapidly after exposure to a likely allergen for that patient (minutes to several hours):
a. Involvement of the skin-mucosal tissue (e.g., generalized hives, itch-flush, swollen lips-tongue-uvula).
b. Breathing difficulties (wheezing, high pitched wheezing, hypoxia).
c. Reduced blood pressure or associated symptoms (e.g. feeling faint, fainting, or becoming unresponsive).
d. Persistent gastrointestinal symptoms (e.g., crampy abdominal pain, vomiting).
- Reduced blood pressure after exposure to a known allergen for that person (minutes to several hours):
a. Babies and children: low blood pressure (age specific).
b. Adults: blood pressure of less than 90 mm Hg.
Managing anaphylaxis
A narrative review by Alvarez-Perea et al., (2017) reports that delayed injection of epinephrine is associated with higher hospitalisation and mortality rates. In contrast, prompt pre-hospital administration of epinephrine is associated with better outcomes. The review also suggests that after administration of epinephrine, people with anaphylaxis should not let be in an upright position but should be placed on their back with their lower limbs elevated and if possible, supplemental oxygen should be given.
The review also states that adolescents are at greater risk of anaphylaxis owing to the intrinsic characteristics of this age group. Adolescents tend to have higher risk behaviour thus potentially leading them to disregard triggers of anaphylaxis. They also try to hide their allergy problems from others, avoid epinephrine autoinjectors, and seek medical care only at late stages of the reaction. These factors may delay the recognition of an episode of anaphylaxis. Management of anaphylaxis in adolescents presenting at the emergency department may be hampered by misinformation (e.g., lessening of symptoms, hiding triggers). The first experiences with alcohol may worsen the severity of anaphylaxis.
References
Systematic reviews
Carlson, J. N., Bendall, J., Zideman, D., Singletary, E. (2019). Recognition of Anaphylaxis by First Aid Providers Scoping Review and Task Force Insights, Brussels, Belgium: International Liaison Committee on Resuscitation, First Aid Task Force, December 28. Available from http://ilcor.org
Carlson, J. N., Djarv, T., Woodin, J. A., et al. (2019). Second Dose of Epinephrine for Anaphylaxis Scoping Review and Task Force Insights, Brussels, Belgium: International Liaison Committee on Resuscitation, First Aid Task Force, December 17. Available from http://ilcor.org
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Eczema/hives – Antihistamines. Available from https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Eczema/hives – Cooling. Available from https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Eczema/hives – Emollients. Available from https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Hay fever – Irrigation. Available from https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Markenson, D., Ferguson, J. D., Chameides, L., Cassan, P., Chung, K. L., Epstein, J. L., … & Ratcliff, N. (2010). Part 13: first aid: 2010 American Heart Association and American Red Cross International Consensus on first aid science with treatment recommendations. Circulation, 122(16_suppl_2), S582-S605. DOI https://doi.or/10.1161/CIRCULATIONAHA.110.971168
Shaker, M. S., Wallace, D. V., Golden, D. B., Oppenheimer, J., Bernstein, J. A., Campbell, R. C., … & Lang, D. M. (2020). Anaphylaxis–a 2020 Practice Parameter Update, Systematic Review and GRADE Analysis. Journal of Allergy and Clinical Immunology.
Singletary, E. M., Zideman, D. A., De Buck, E. D., Chang, W. T., Jensen, J. L., Swain, J. M., … & Hood, N. A. (2015). Part 9: first aid: 2015 international consensus on first aid science with treatment recommendations. Circulation, 132 (16_suppl_1), S269-S311.
DOI https://doi.org/10.1161/CIR.0000000000000278
Singletary, E. M., Zideman, D. A., Bendall, J. C., Berry, D. C., Borra, V., Carlson, J. N., … & Douma, M. J. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation, 142(16_suppl_1), S284-S334. DOI https://doi.org/10.1161/CIR.0000000000000897
Singletary, E.M., Zideman, D.A., Bendall, J.C., Berry, D.C., Borra, V., Carlson, J.N., Cassan, P., … Lee, C.C. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation. Nov;156:A240-A282. DOI https://doi.org/10.1016/j.resuscitation.2020.09.016
Zideman, D. A., De Buck, E. D., Singletary, E. M., Cassan, P., Chalkias, A. F., Evans, T. R., … & Vandekerckhove, P. G. (2015). European resuscitation council guidelines for resuscitation 2015 section 9. first aid. Resuscitation, 95, 278-287.
Non-systematic reviews
Lee, S., Hess, E. P., Lohse, C., Gilani, W., Chamberlain, A. M., & Campbell, R. L. (2017). Trends, characteristics, and incidence of anaphylaxis in 2001-2010: a population-based study. Journal of Allergy and Clinical Immunology, 139(1), 182-188.
Litarowsky, J. A., Murphy, S. O., & Canham, D. L. (2004). Evaluation of an anaphylaxis training program for unlicensed assistive personnel. The Journal of School Nursing, 20(5), 279-284.
Full text article
Ring, J., Klimek, L., & Worm, M. (2018). Adrenaline in the acute treatment of anaphylaxis. Deutsches Ärzteblatt International, 115(31-32), 528.
Sampson, H. A., Muñoz-Furlong, A., Campbell, R. L., Adkinson, N. F., Jr., Bock, S. A., Branum, A., et al. (2006). Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Journal of Allergy and Clinical Immunology, 117(2), 391–397.
DOI http://doi.org/10.1016/j.jaci.2005.12.1303
Sicherer, S. H., & Simons, F. E. R. (2017). Epinephrine for first-aid management of anaphylaxis. Pediatrics, 139(3).
Education references
Alvarez-Perea, A., Tanno, L. K., & Baeza, M. L. (2017). How to manage anaphylaxis in primary care. Clinical and Translational Allergy, 7(1), 1-10.
Arkwright, P. D., & Farragher, A. J. (2006). Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Pediatric allergy and immunology, 17(3), 227-229. Available from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-3038.2006.00392.x
Brockow, K., Schallmayer, S., Beyer, K., Biedermann, T., Fischer, J., Gebert, N., … & Lange, L. (2015). Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis. Allergy, 70(2), 227-235.
Morris, P., Baker, D., Belot, C., & Edwards, A. (2011). Preparedness for students and staff with anaphylaxis. Journal of School Health, 81(8), 471-476. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1746-1561.2011.00616.x
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Explore the guidelines
Published: 15 February 2021
First aid
Explore the first aid recommendations for more than 50 common illnesses and injuries. You’ll also find techniques for first aid providers and educators on topics such as assessing the scene and good hand hygiene.
First aid education
Choose from a selection of some common first aid education contexts and modalities. There are also some education strategy essentials to provide the theory behind our education approach.
About the guidelines
Here you can find out about the process for developing these Guidelines, and access some tools to help you implement them locally.