Seasonal Allergy Emergency

Seasonal Allergy Emergency Overview

Some allergies can trigger anaphylaxis, a severe, life-threatening allergic reaction that usually involves several parts of the body and is a medical emergency. Common triggers include certain foods, medications and insect stings, and symptoms usually start within minutes of exposure (FDA). Pollen allergies (hay fever) themselves rarely cause anaphylaxis; see life-threatening vs. seasonal allergies.

Symptoms of a seasonal allergy emergency, a severe allergic reaction (anaphylaxis)

• difficult or noisy breathing
• swelling of the tongue
• swelling or tightness of the throat
• difficulty talking or a hoarse voice
• wheeze or persistent cough
• persistent dizziness or collapse
• paleness and floppiness in young children
• abdominal pain and vomiting.
• Loss of consciousness

Milder allergic symptoms that can appear before a severe allergic reaction include:

• swelling of your lips, face and eyes
• hives
• tingling mouth

What should be done at this moment?

If you are with someone who is having an allergic reaction and shows signs of shock, act fast. Look for pale, cool and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and loss of consciousness. Do the following immediately:

1. Use an epinephrine auto-injector (or epinephrine nasal spray), if available, right away. Inject into the middle of the outer thigh; it can go through clothing (MedlinePlus).
2. Call 911 or emergency medical help.
3. Lie the person down flat – unless they are unconscious, pregnant or having breathing difficulties.
4. Check the person’s pulse and breathing and If the person’s     breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed immediately.
5. If symptoms continue or come back and a second device is available, a second dose may be given as directed by the person’s doctor or the device instructions (MedlinePlus).

Positioning

• most people should lie flat
• pregnant women should lie on their left side to avoid putting too much pressure on the large vein that leads to the heart
• people having trouble breathing should sit up to help make breathing easier
• people who are unconscious should be placed in the recovery position to ensure the airway remains open and clear – place them on their side, making sure they are supported by one leg and one arm, and open their airway by lifting their chin
• avoid a sudden change to an upright posture such as standing or sitting up – this can cause a dangerous fall in blood pressure

Adrenaline auto-injectors for seasonal allergy emergencies

People with potentially serious allergies are often prescribed adrenaline auto-injectors to carry at all times. These can help stop an anaphylactic reaction becoming life threatening.

Epinephrine (adrenaline) is the first-line treatment for anaphylaxis and the only life-saving treatment for it (FDA).

Adrenaline acts fast and rapidly treats most dangerous symptoms of anaphylaxis, including throat swelling, difficulty breathing and low blood pressure. It also helps alleviate itching, rash, swelling, gastrointestinal and genitourinary symptoms. It works most effectively if it is given within the first few minutes of a severe allergic reaction. either by the person experiencing anaphylaxis or someone helping them.

Learn how to use your specific device, and always carry 2, because one dose may not be enough (MedlinePlus).

In the U.S., several epinephrine products are available, and they are used in slightly different ways.

These are:

• EpiPen and generic epinephrine auto-injectors

• Auvi-Q

• neffy, a needle-free epinephrine nasal spray approved by the FDA in 2024 for people who weigh at least 30 kg (about 66 lb) (FDA)

Instructions are also included on the side of each injector if you forget how to use it or someone else needs to give you the injection.

Below we describe the EpiPen, one of the most widely used auto-injectors. Always follow the instructions for your own device.

EpiPen

What is EpiPen

EpiPen® is an adrenaline auto-injector (AAI) used for self-administration of adrenaline for the emergency treatment of severe allergic reactions (anaphylaxis).

• Delivers the correct dose of adrenaline quickly.
• Has needle protection which deploys immediately after administration.
• Familiar jab administration and 3 second hold time during injection, making it quick to administer in an emergency.

How to use it

1. Remove the blue safety cap

Grasp the EpiPen^® in dominant hand and remove the blue safety cap.

2. Position the orange tip

Hold the EpiPen® with the orange tip pointing toward the outer thigh.

3. Jab the orange tip

Jab the EpiPen® firmly into outer thigh at a right angle. Hold firmly for 3 seconds, before removing and safely discarding.

4. Dial 911

Dial 911, ask for an ambulance and say ‘anaphylaxis’.

Site of injection

Inject only into the middle of the outer thigh. Never inject into the buttocks, hands, feet or a vein (MedlinePlus).

Advantages of EpiPen

• Viewing window

The EpiPen® must be replaced in line with the expiry date. In addition, check the EpiPen® regularly to make sure the solution is clear and colorless. If the solution becomes discolored or contains particles it should be replaced.

• Needle cover

This keeps the needle covered before and after use.

Types of EpiPen

1. EpiPen® (0.3 mg) and EpiPen Jr® (0.15 mg) are prescribed based on body weight.
2. Your doctor will choose the right strength for you or your child; check the product instructions for weight ranges.

Side effects and precautions

• Potential side effects include an increase in heart rate, a stronger or irregular heartbeat, sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, nervousness, or anxiety. However, these side effects usually disappear quickly, especially if the patient rests.
• It should be used with caution in patients with high blood pressure and thyroid conditions (as side effects can last longer) and in pregnancy. Blood sugar may increase in patients with diabetes and symptoms can temporarily get worse in patients with Parkinson’s disease.
• Use epinephrine only as prescribed. Only a healthcare provider should give more than 2 doses for a single episode (MedlinePlus).
• Even if your symptoms improve after an epinephrine injection, you should go to the emergency department to make sure symptoms do not return when the effects of the injection wear off.
• If you have had a severe allergy attack or any signs and symptoms of anaphylaxis in the past, make an appointment to see your doctor. Evaluation, diagnosis and long-term management of anaphylaxis are complicated, so you will probably need to see a doctor who specializes in allergies and immunology.

Other kinds of self-administered treatments related to seasonal allergy emergencies

Antihistamines

Antihistamines relieve milder allergy symptoms such as hay fever, hives and itching. They do not treat anaphylaxis and should never be used instead of epinephrine in a severe reaction.

Most antihistamines can be bought from pharmacies and shops, but some are only available on prescription.

Types of antihistamines

They are divided into 2 main groups:

• antihistamines that make you feel sleepy, such as chlorpheniramine, hydroxyzine and promethazine

•       non-drowsy antihistamines that are less likely to make you feel sleepy – such as cetirizine, fexofenadine and loratadine

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays.

Which type is best?

There is not much evidence to suggest any particular antihistamine is better than any other at relieving allergy symptoms.

Some people find certain types work well for them and others do not. You may need to try several types to find one that works for you.

Non-drowsy antihistamines are generally the best option, as they are less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

How to take antihistamines

Take your medicine as advised by the pharmacist or doctor, or as described in the leaflet that comes with it.

Before taking an antihistamine, you should know:

• how to take it – including whether it needs to be taken with water or food, or how to use it correctly (if eyedrops or a nasal spray)
• how much to take (the dose) – this can vary depending on things such as your age and weight
• when to take it – including how many times a day you can take it and when to take it (some types should be taken before bedtime)
• how long to take it for – some types can be used for a long time, but some are only recommended for a few days
• what to do if you miss a dose or take too much (overdose)

The advice varies depending on the exact medicine you are taking. If you are not sure how to take your medicine, ask a pharmacist.

Side effects of antihistamines

Like all medicines, antihistamines can cause side effects.

Side effects of antihistamines that make you drowsy can include:

• sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines
• dry mouth
• blurred vision
• difficulty peeing

Side effects of non-drowsy antihistamines can include:

• headache
• dry mouth
• feeling sick
• drowsiness – although this is less common than with older types of antihistamines

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This article is for general education and is not medical advice. Talk with your doctor or pharmacist about your symptoms and before starting, stopping, or combining any medicine.

Allergy Emergency FAQs

What is the first thing to do in anaphylaxis?

Use epinephrine right away, then call 911 (MedlinePlus).

Can antihistamines stop anaphylaxis?

No. Epinephrine is the only life-saving treatment for anaphylaxis (FDA).

Should I still go to the ER if I feel better?

Yes. Get emergency treatment immediately after using epinephrine (MedlinePlus).

Is there an epinephrine option without a needle?

Yes. The FDA approved neffy nasal spray in 2024 for people who weigh at least 30 kg (FDA).

Sources

Looking for more treatment options? Find a full list of other seasonal allergy treatment options here.