On Alert for Anaphylaxis


Marcie was in the lunchroom eating with co-workers when she used a knife that had come into contact with shrimp. She felt her throat begin to constrict, making it hard to breathe. She alerted her co-workers who immediately called 911. Marcie is one of many who experience life-threatening anaphylactic reactions at work each year.

What is anaphylaxis?

Anaphylaxis is an allergic reaction that can develop quickly, affecting many different body organs and systems. Allergic reactions can be mild, affecting only the skin, to severe, affecting the airways and/or heart, resulting in death.

Signs and symptoms of anaphylaxis

If you are having an anaphylactic reaction, you may experience a few or all of these signs and symptoms:

Flushed or pale skin
Other skin changes, such as hives, itching, or rash
Swelling of the eyelids, and itchy, watery eyes
Itchy or swollen tongue or throat
Constriction (a blocking) of the airways, causing wheezing or breathing troubles
Rapid or weak pulse
Rapid heart rate
Dizziness or fainting
Nausea, vomiting, or diarrhea
A feeling of impending doom

Symptoms usually occur within minutes of exposure, but there can be a delay of 30 minutes or more. There can be an equally serious second reaction one to eight hours after the initial reaction.


Triggers commonly include:

Certain medications
Certain foods such as peanuts and shellfish
Insect venom from bites or stings
Certain chemicals (for example diisocyanates which are used in polyurethanes and memory foam)

What workplaces can do

Have trained first aid personnel onsite, including cardio pulmonary resuscitation (CPR).
Educate employees about the dangers of anaphylaxis, how to recognize and respond to the signs of anaphylaxis, and how best to avoid known allergens.
Promote basic principles of allergen control including handwashing, cleaning and disinfecting work surfaces, and properly handling and/or preparing food.
Know which employees have the potential for anaphylactic reactions.
Ask employees who have an auto-injector if they would like to keep an extra one at work and make its storage location known.
Store epinephrine in the container provided, keeping it away from light and extreme temperatures.
Epinephrine auto-injectors expire (about 18 months). Check the expiry date and be sure there is always a current injector available.
Replace the epinephrine auto-injector immediately after use.

If you have been prescribed an epinephrine auto-injector, inform your workplace. Wear a medic alert bracelet or necklace that states your allergy and the location of your auto-injector, or carry your auto-injector with you at all times.

During a reaction, it may not be possible for you to inject yourself. Make sure immediate co-workers know how to recognize signs of a reaction, where the auto-injector is located, and how to use it. Co-workers should also know how to call for first aid personnel or for outside emergency responders.

When in doubt, inject.

If a worker indicates that they are having a severe allergic reaction, or if you suspect a person is having a severe reaction, administer the epinephrine auto-injector. No harm will be caused to a person by providing a single injection if it turns out they are not having an allergic reaction.

Resources and information on administering first aid appropriate for anaphylaxis:

First Aid - Using an Epinephrine Auto-injector fact sheet, CCOHS
Food Allergy Canada (formerly Anaphylaxis Canada)
Anaphylaxis, World Allergy Organization
Food Allergies in Schools, CDC/NIOSH (Center for Disease Control and Prevention)