Anaphylaxis: Recognising & Responding to a Reaction

How does the NHS describe anaphylaxis?

• AA delayed allergic reaction that usually appears several days after eating the trigger food, most often as patches of eczema on the skin.
• BA long-term, chronic digestive condition caused by an ongoing intolerance to certain foods.
• CA minor, short-lived skin irritation caused by touching certain foods, such as citrus peel.
• DA life-threatening allergic reaction that can develop very quickly and can be triggered by food, medicine or an insect sting.✓

Answer: Anaphylaxis is a life-threatening allergic reaction that happens very quickly and can be caused by food, medicine or an insect sting. It is a medical emergency, not a skin-only problem or a digestive condition, so kitchen and front-of-house staff need to recognise it fast. Coeliac disease is the separate genetic condition triggered by gluten; anaphylaxis is an acute allergic emergency. Treating any suspected case as minor risks a fatal delay in calling for help.

A customer eating in your restaurant suddenly says their throat feels tight and you can see their lips visibly swelling. What should a member of staff do first?

• ACall 999 immediately and say a serious allergic reaction is suspected.✓
• BGive the customer a glass of water and wait to see if the swelling goes down.
• COffer the customer an antihistamine from the first-aid kit and monitor them.
• DAsk the kitchen to check the ingredients before doing anything else.

Answer: Throat and lip swelling are listed by the NHS as signs that mean you should call 999 immediately. Checking ingredients, giving water or waiting to see what happens all delay emergency care while the reaction can worsen within minutes. An over-the-counter antihistamine is not a substitute for calling an ambulance in a suspected anaphylactic reaction.

Which skin change is listed by the NHS as a possible sign of anaphylaxis?

• ASmall red spots appearing on the scalp and neck.
• BA rash that fades within seconds, leaving no mark.
• CA rash that is flat, dry and painless to the touch.
• DA rash that is swollen, raised or itchy.✓

Answer: The NHS lists a rash that is swollen, raised or itchy as a possible sign of anaphylaxis, alongside throat swelling and breathing difficulty. A flat, painless rash or one confined to the scalp is not the pattern described, and a mark that fades in seconds and leaves nothing behind is not how the NHS describes it either. Staff should treat any such rash alongside other symptoms as a warning sign, not something to dismiss.

A colleague with black skin collapses after eating and you notice their skin turning blue, grey or pale. Where does the NHS say this colour change may be easier to see?

• AOn the forehead, across the cheeks and on the tip of the nose.
• BOn the scalp and behind the ears.
• COn the back of the neck and the forearms.
• DOn the palms of their hands or the soles of their feet.✓

Answer: The NHS specifically notes that on brown or black skin, blue, grey or pale colouring may be easier to see on the palms of the hands or the soles of the feet. The scalp, ears, forehead, nose, neck and forearms are not the locations the NHS highlights for this sign on darker skin. Assuming the change cannot be seen on darker skin is dangerous misinformation that could delay staff recognising an emergency.

Which of these is listed by the NHS as a symptom of anaphylaxis?

• AImproved concentration and alertness.
• BA slow, steady pulse that stays completely normal.
• CWheezing, coughing or noisy breathing.✓
• DIncreased appetite and thirst.

Answer: Wheezing, coughing or noisy breathing is one of the symptoms the NHS lists for anaphylaxis, alongside feeling confused or faint. A normal steady pulse, a bigger appetite or sharper concentration are the opposite of what happens during a reaction, where breathing struggles and confusion are the concern. Staff should treat noisy or laboured breathing after eating as a warning sign, not something to wait out.

A diner who has just eaten a dish becomes confused and faint, with visible swelling around the lips. How should staff treat this combination of signs?

• AAs a possible anaphylactic reaction requiring an immediate call to 999.✓
• BAs low blood sugar that can be treated with a sugary drink.
• CAs a panic attack that only needs reassurance and no medical help.
• DAs simple tiredness that will pass if the diner sits quietly for a while.

Answer: Confusion, faintness and lip swelling together match the NHS list of anaphylaxis symptoms, so this combination should always be treated as a possible reaction and prompt an immediate 999 call. Tiredness, a panic attack and low blood sugar are all wrong explanations that would leave a genuine emergency untreated. Getting the diagnosis wrong here costs the minutes that matter most.

A customer having a suspected anaphylactic reaction has their own adrenaline auto-injector, such as an EpiPen. What does NHS guidance say should happen?

• AOnly use the auto-injector if the person is fully conscious, calm, and clearly asks for it themselves.
• BWait for the paramedics to arrive, and do not touch the auto-injector.
• CInject it at double the usual dose, ignoring the instructions printed on the device.
• DUse the adrenaline auto-injector immediately, following the instructions printed on the device.✓

Answer: The NHS advises using an adrenaline auto-injector straight away if the person has one, following the instructions included on the device itself. Waiting for paramedics before touching it, or requiring the person to be fully conscious and ask for it, both delay treatment the person urgently needs. Doubling the dose and ignoring the printed instructions is not what the device requires and could cause harm rather than help.

A customer having a severe allergic reaction is struggling to breathe and is not pregnant. How does the NHS say they should be positioned while waiting for the ambulance?

• ALying flat with legs raised, the position used when breathing is not the problem.
• BStanding them up and walking them to a quiet room away from other customers.
• CLying on their left side, the position the NHS gives for someone who is pregnant.
• DLying down with their shoulders raised, or sitting up slowly.✓

Answer: For someone struggling to breathe, the NHS advises lying down with the shoulders raised or sitting up slowly, rather than the flat, legs-raised position used when breathing is not the problem. Standing and walking the person anywhere is unsafe and directly against NHS guidance, which says never to let someone stand or walk during a reaction. The left-side position is reserved for someone who is pregnant, not this scenario.

A pregnant employee begins showing signs of anaphylaxis after accidentally eating a food she is allergic to. Besides calling 999, which position does the NHS recommend for her?

• ALying on her left side, as the NHS specifically advises during pregnancy.✓
• BLying flat on her back, with her legs raised straight up.
• CLying on her right side, with her head lower than her feet.
• DSitting bolt upright with her knees pulled tightly to her chest.

Answer: The NHS specifically advises that a pregnant person having an anaphylactic reaction should lie on their left side. Lying flat with legs raised is the general position for someone who is not pregnant, and sitting with knees pulled in or lying on the right side with the head lowered are not positions the NHS describes at all. Getting the side wrong matters, so staff should learn this exception specifically.

A member of staff is stung by a wasp while clearing an outdoor table and starts to show signs of anaphylaxis. If the sting is still in the skin, what does NHS guidance say to do?

• ALeave the sting exactly where it is until paramedics arrive.
• BTry to remove the sting from the skin if it is still there.✓
• CApply ice directly to the sting and take no other action.
• DSqueeze the area to push the sting deeper in.

Answer: The NHS says that if someone having an anaphylactic reaction has been stung by an insect, staff should try to remove the sting if it is still in the skin. Leaving it in place is not what the guidance recommends, and squeezing the area risks pushing more venom in rather than removing the sting. Applying ice and doing nothing else ignores the far more urgent steps of calling 999 and using an auto-injector.

A person having an anaphylactic reaction has used one adrenaline auto-injector but shows no improvement. What does the NHS say should happen if 5 minutes pass with no change?

• AA second adrenaline auto-injector should be used straight away.✓
• BStaff should wait a further 20 minutes before considering more treatment.
• COral antihistamine tablets should be given instead of any further injection.
• DThe same, already-used auto-injector should be pressed against the skin again.

Answer: The NHS is specific that if symptoms have not improved after 5 minutes, a second adrenaline auto-injector should be used. Antihistamine tablets are not the recommended step, and waiting another 20 minutes ignores the 5-minute timeframe the guidance gives. Pressing the same, already-discharged device against the leg again will not deliver any further dose, so a fresh injector is needed.

A customer's breathing improves noticeably about a minute after their adrenaline auto-injector is used, and they say they feel fine and want to walk to the toilet. What should staff do?

• ACancel the 999 call since the auto-injector appears to have worked.
• BLet them walk to the toilet, since their breathing has clearly improved.
• CAllow them to stand for a few minutes under staff supervision.
• DInsist the customer does not stand or walk, and continue to wait for the ambulance.✓

Answer: NHS guidance is explicit that a person should never stand or walk during a suspected anaphylactic reaction, even if they feel better, because symptoms can return quickly. Letting the customer walk, or even stand briefly with supervision, goes directly against this instruction. The 999 call should never be cancelled on the strength of an early improvement, since the ambulance and further treatment are still needed.

According to the NHS, how quickly do the symptoms of anaphylaxis usually develop after contact with a trigger?

• AUsually within minutes of contact with the allergen.✓
• BTypically after a full 24 to 48 hours have already passed by.
• CAfter several days of repeated, ongoing exposure to the same trigger substance.
• DUsually not until several hours have passed after contact.

Answer: The NHS states that anaphylaxis symptoms usually start within minutes of coming into contact with something a person is allergic to. A delay of hours, days, or the need for repeated exposure does not match this fast-acting pattern, which is why staff cannot assume a reaction is unrelated to food eaten shortly beforehand. This speed is exactly why an immediate 999 call matters so much.

Besides food and medicines, which trigger does the NHS list as a possible cause of anaphylaxis?

• AExtreme heat, such as prolonged sunburn.
• BInsect stings, such as from a wasp or bee.✓
• CLoud noise or bright flashing lights.
• DDrinking cold water too quickly.

Answer: The NHS lists insect stings, such as wasp and bee stings, alongside food and medicines as possible causes of anaphylaxis. Loud noise, bright lights, sunburn and cold water are not among the causes the NHS gives, so staff should not treat those as anaphylaxis triggers. Knowing the real triggers helps staff take a sudden reaction outdoors, such as after a sting, just as seriously as a reaction to food.