General Overview

The incidence of true anaphylaxis is rare. Most allergic reactions can be managed with over-the-counter anti-histamines. Epinephrine has been given mistakenly to patients for mild allergic reactions, hyperventilation syndrome and panic attacks.

Treatment for Allergic Reactions and Anaphylaxis

  1. Remove the allergen or the patient from the offending environment.
  2. Administer oral antihistamines (e.g. diphenhydramine 50mg PO every 4-6 hours).
  3. If patient shows signs and symptoms of anaphylaxis (Swollen face, lips and tongue; difficulty swallowing; systemic hives; respiratory distress; inability to speak in more than one or two word clusters; signs and symptoms of shock) administer epinephrine .3ml/1:1000 SQ or IM.
  4. If reaction reoccurs or the epinephrine is ineffective, continue to administer epinephrine.

Evacuation Guidelines for Allergic Reactions and Anaphylaxis

Evacuate Rapidly:

  • Any patient who continues to show respiratory compromise or signs and symptoms of shock after treatment with epinephrine and antihistamines.


  • Any patient who has received epinephrine.  Continue to provide anti-histamines during evacuation.


Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <>

“Position Statement 26:The Use of Epinephrine in the Treatment of Anaphylaxis.” American Academy of Allergy Asthma & Immunology.  28 Dec. 2004.  <>;

Schimelpfenig, Tod and Linda Lindsey.  “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 11.

Specific Protocols for Wilderness EMS Allergic Reactions.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <>;

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Allergic Reactions and Anaphylaxis.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 28.

Wilderness Field Protocols Protocol 1 Anaphylaxis.  2001.  Wilderness Medical Associates.  2 Dec. 2004 <>;

Wilkerson, James A.  “Allergies.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 20.

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