This is why every parent, pupil and staff member needs to know the signs:

Two numbers should change how we all think about severe allergic reactions.

Up to 30% of anaphylaxis cases have no obvious trigger at all.

Up to 20% of anaphylaxis reactions in schools happen in children with no previously known allergy.

In other words, you cannot rely on a list. The child who reacts may not be the child with the Individual Healthcare plan and the Epipen. They may be someone no one thought could have a reaction.

I have had a serious idiopathic anaphylactic reaction myself and ended up requiring emergency treatment in St Georges. It came out of nowhere and was frightening and dangerous. I have no history of allergy, let alone anaphylaxis and there was no obvious trigger whatsoever.

This is exactly why the Department for Education now expects every school to hold spare adrenaline auto-injectors, and why allergy awareness training under Benedict’s Law applies to all staff, not just first aiders.

What anaphylaxis actually is

Anaphylaxis is a severe allergic reaction that affects the whole body. The immune system overreacts to something harmless – a food, a sting, a medicine, or something never formally identified – and floods the body with chemicals that swell the airway and cause blood pressure to drop. This substantial drop in blood pressure is why it is often referred to as Anaphylactic Shock.

It can develop within minutes. It is potentially life-threatening. But it is also very survivable: most people recover completely when the reaction is spotted early and adrenaline is given quickly.

Delay in giving Adrenaline is the single biggest risk factor for a death from anaphylaxis.

Only around 20-30 people die from anaphylaxis in the UK each year. That is a small number set against the number of people who have reactions – and the difference between the two is almost always the speed of spotting something is wrong and giving Adrenaline immediately.

“But they have never reacted before”

This is the sentence that costs time, and it is worth unpicking properly.

Up to 30% of anaphylaxis cases have no identifiable trigger. Doctors call this idiopathic anaphylaxis. Someone can have a full-blown reaction with no allergy diagnosis, no known allergen, and nothing obvious to blame. If you are waiting to work out why it is happening before you act, you are waiting too long.

A previous mild reaction tells you very little. Someone who has only ever had an itchy mouth could react differently with subsequent exposure. Severity depends on how much of the allergen they were exposed to, whether the person is unwell, tired, stressed, exercising, or has poorly controlled asthma. None of that is predictable in advance.

Allergy tests do not predict severity either. A low or even negative test result does not rule out a serious reaction.

Why schools in particular need to be ready

Children spend around a fifth of their waking hours at school, and roughly one in five serious food-allergic reactions happens while a child is there. Most classrooms will have at least one child with a food allergy.

And, crucially, up to 20% of anaphylaxis reactions in schools happen in children with no pre-existing diagnosis. That figure is the reason the DfE’s statutory guidance expects schools to stock spare devices — a spare adrenaline auto-injector can be used on any child showing signs of anaphylaxis, including a child nobody knew was allergic.

From September 2026, under Benedict’s Law, maintained schools, academies and pupil referral units in England must:

• Have and publish a whole-school allergy safety policy
• Provide allergy awareness training for all staff – not only first aiders
• Hold spare adrenaline auto-injectors on site
• Maintain Individual Healthcare Plans for pupils with diagnosed allergies
• Record and review allergy incidents and near misses

Benedict’s Law is named for Benedict Blythe, who died aged five after an allergic reaction at school.

The signs – and why they are so easy to miss

Early anaphylaxis rarely looks dramatic. It often starts as:

• Itchy or tingling lips, mouth or tongue
• Swollen lips, face or eyelids
• Hives or a raised, itchy rash
• Tummy pain or vomiting
• A child who says they feel odd, frightened, or “wrong”

It becomes an emergency when you see any of these:

• Airway – swollen throat or tongue, difficulty swallowing, a hoarse or croaky voice, noisy breathing
• Breathing – wheeze, persistent cough, struggling for breath, exhaustion from the effort of breathing
• Circulation – pale clammy skin, dizziness, floppiness, collapse, loss of consciousness

Three things people commonly get wrong

You do not need a rash. Around 10–20% of anaphylaxis happens with no rash, hives or facial swelling whatsoever. Waiting for a visible sign is dangerous.

Vomiting is not “just a bug”. Tummy pain, vomiting and diarrhoea are common early signs of a food-triggered reaction and often come before any breathing problem. If a child with a known food allergy vomits, treat it as possible anaphylaxis.

A cough and a wheeze may not be asthma. In children, anaphylaxis most often shows up as a breathing problem, and reaching for the blue inhaler first delays the adrenaline that is actually needed. If there is any chance a reaction is involved, give adrenaline.

What to do

1. Stop the trigger if you can – stop them eating, remove the sting if visible
2. Give adrenaline immediately. An autoinjector into the outer mid-thigh, through clothing if necessary. If a nasal spray (EURneffy/neffy) has been prescribed, spray it into one nostril
3. Call 999 and say the word “anaphylaxis.” Put the phone on speaker so your hands are free
4. Lie them down, with their legs raised if possible. If they are struggling to breathe, let them sit up with their legs out straight. If pregnant, lie them on their left side
5. Do not let them stand up or walk anywhere – not to the office, not to the first aid room, not to fetch their own Epipen. Standing up suddenly during a reaction can cause a fatal collapse. Bring the adrenaline to the person
6. No improvement after 5 minutes? Give a second dose, ideally in the opposite thigh (with a nasal spray, use the same nostril)
7. Stay with them. Be ready to start CPR if they stop responding and are not breathing normally

If you are not sure whether it is anaphylaxis, give the adrenaline anyway. Adrenaline given unnecessarily is very unlikely to cause harm. Adrenaline given too late is the most important correlation with a poor outcome and fatality following anaphylaxis. There is no scenario in which hesitating is the safer choice.

Antihistamines are not a treatment for anaphylaxis. Piriton may settle an itch, but it does nothing for a swelling airway or a dropping blood pressure – and fetching it wastes minutes that matter.

It isn’t over when they look better

Everyone treated for anaphylaxis must go to hospital, even if they seem completely fine. Symptoms can come back after apparent recovery – usually within about 8 hours, occasionally up to 72 hours later. This is called a biphasic reaction, and it is why observation matters.

Afterwards, the person should be referred to a specialist allergy clinic, prescribed two adrenaline devices to carry at all times, trained in how to use them, and given a written allergy action plan.

Two devices is not belt-and-braces. Around one in ten reactions needs a second dose, and devices can misfire, expire or be in the wrong bag.

A short checklist for pupils and parents

• Make sure two in-date devices go everywhere your child goes
• Check expiry dates every school term
• Make sure the school has a current Individual Healthcare Plan and a written action plan
• Teach your child to tell an adult straight away and, above all, not to walk anywhere if they feel unwell
• Ask what training the school’s staff have had, and when they last practised
• Talk to grandparents, clubs, sports coaches and friends’ parents too – not just school
• An anaphylactic reaction can affect anyone of any age.

A short checklist for school staff

• Know where the spare adrenaline devices are kept, and check they are unlocked, in date and within five minutes of anywhere they might be needed (stored at 15–25°C, never in a locked cupboard or a hot car)
• Make sure every member of staff can recognise a reaction – lunchtime supervisors, sports coaches, office staff, supply teachers
• Run an anaphylaxis drill at least annually, ideally each term
• Remember a spare device can be used on any child showing signs of anaphylaxis, whether or not they have a diagnosis
• Record every incident and near miss, and review what happened

The message in one line

You will not always know which child is allergic, and you will not always know what caused it. If someone has signs of a severe allergic reaction, give adrenaline, call 999, and keep them lying down.

Get properly trained

Our First Aid for Anaphylaxis and Acute Allergic Reaction online course covers recognition, adrenaline devices and the emergency response. For schools, nurseries and parent groups, email emma@firstaidforlife.org.uk to arrange practical training with hands-on trainer devices, so everyone knows what to do before they need to know it.

Further reading from First Aid for Life

• 13 Myths, Facts and Controversies about Anaphylaxis
• Anaphylaxis and Adrenaline Auto-Injectors: a guide
• Neffy – the New Needle-Free Treatment for Anaphylaxis
• Resuscitation Council UK 2025 Update and Summary of Key Changes

References

8. Resuscitation Council UK. 2025 Resuscitation Guidelines: First Aid Guidelines. December 2025. https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/first-aid-guidelines
9. Resuscitation Council UK. Emergency Treatment of Anaphylaxis: Guidelines for Healthcare Providers. May 2021. https://www.resus.org.uk/library/additional-guidance/guidance-anaphylaxis/emergency-treatment-anaphylactic-reactions
10. Department for Education. Allergy Safety in Schools: statutory guidance. 6 July 2026.
11. Allergy UK. Benedict’s Law. https://www.allergyuk.org/information-and-support/at-school/for-schools/benedicts-law/
12. Allergy UK / Anaphylaxis UK / BSACI. Model Policy for Allergy at School. https://www.allergyuk.org/resources/model-policy-for-allergy-at-school/
13. Anaphylaxis UK. Allergy information for schools. https://www.anaphylaxis.org.uk/
14. National Institute for Health and Care Excellence. Anaphylaxis: assessment and referral after emergency treatment. NICE guideline CG134. 2011, updated 2020.
15. Anagnostou K, Turner PJ. Myths, facts and controversies in the diagnosis and management of anaphylaxis. https://pmc.ncbi.nlm.nih.gov/articles/PMC6317446/
16. British Society for Allergy and Clinical Immunology (BSACI). Allergy Action Plans. https://www.bsaci.org/professional-resources/resources/paediatric-allergy-action-plans/
17. Medicines and Healthcare products Regulatory Agency (MHRA). Adrenaline nasal spray approved for anaphylaxis in the UK. 18 July 2025. https://www.gov.uk/government/news/mhra-approves-adrenaline-nasal-spray-the-first-needle-free-emergency-treatment-for-anaphylaxis-in-the-uk
18. Benedict Blythe Foundation. https://www.benedictblythefoundation.org/

About us

First Aid for Life provide award-winning first aid training tailored to your needs. Please visit our site and learn more about our practical and online courses. It is vital to keep your skills current and refreshed. We are currently providing essential training for individuals and groups across the UK. In addition, we have a great range of online courses. These are ideal as refreshers for regulated qualifications or as Appointed Person qualifications. You can attend a fully regulated Practical or online first aid course to understand what to do in a medical emergency. Visit firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses.

First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken on this information.

Author: Emma Hammett