Use this quick-reference guide to recognise, treat and hand over Allergic Reactions & Anaphylaxis on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Recognize
Skin + airway or BP
Hives may be absent
Stridor · hoarse voice
✅ Treat
Epinephrine first
Lateral thigh
Remove the trigger
📌 Position
Hypotensive → flat, legs up
Breathless → sitting up
✅ After
Symptoms can return
Always needs evaluation
📚 Allergic Reactions & Anaphylaxis — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
An allergic reaction becomes anaphylaxis when it involves more than one body system or threatens the airway, breathing or circulation. Epinephrine is the first-line treatment, and a delay in giving it is the most common fatal mistake.
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Key points
Understand these first
Anaphylaxis: skin or mucosal signs plus breathing trouble or low blood pressure — or two systems after exposure.
Hives are not required — up to one in five cases has no skin signs.
Epinephrine by auto-injector into the lateral thigh is first-line; antihistamines do not reverse airway swelling or shock.
Lay the patient flat with legs raised if hypotensive; let a breathing-distressed patient sit up.
Symptoms can return hours later (biphasic reaction), so every patient given epinephrine needs evaluation.
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Treatment priorities
What to do, in order
Give epinephrine early for anaphylaxis; a repeat dose may be needed if symptoms persist.
Remove the trigger if possible (stinger scraped away, infusion stopped).
Watch for sudden collapse when a hypotensive patient stands or sits up.
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Red flags — report now
Escalate immediately
Hoarseness, stridor or throat tightness
Swelling of the tongue or lips
Hypotension or fainting after exposure
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Patient teaching
What patients must know
Hives alone with normal breathing and blood pressure is a mild allergic reaction, not anaphylaxis — monitor closely, because it can progress.
❓ Allergic Reactions & Anaphylaxis: NREMT FAQs
What are the priority actions for Allergic Reactions & Anaphylaxis in the field?
Give epinephrine early for anaphylaxis; a repeat dose may be needed if symptoms persist. Remove the trigger if possible (stinger scraped away, infusion stopped). Watch for sudden collapse when a hypotensive patient stands or sits up.
What findings in Allergic Reactions & Anaphylaxis change your plan or your transport decision?
Hoarseness, stridor or throat tightness. Swelling of the tongue or lips. Hypotension or fainting after exposure.
What do I need to know about Allergic Reactions & Anaphylaxis for the NREMT?
Anaphylaxis: skin or mucosal signs plus breathing trouble or low blood pressure — or two systems after exposure. Hives are not required — up to one in five cases has no skin signs. Epinephrine by auto-injector into the lateral thigh is first-line; antihistamines do not reverse airway swelling or shock. Lay the patient flat with legs raised if hypotensive; let a breathing-distressed patient sit up.
What should the crew communicate or document for Allergic Reactions & Anaphylaxis?
Hives alone with normal breathing and blood pressure is a mild allergic reaction, not anaphylaxis — monitor closely, because it can progress.
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Quick Tip
Anaphylaxis: skin or mucosal signs plus breathing trouble or low blood pressure — or two systems after exposure.