Anaphylaxis First Aid: The 7 Mistakes That Cost Time in WA

By Britt Brennan, REACHAU | Updated 16 October 2026

Why mistakes matter when every second counts

When anaphylaxis begins, symptoms can escalate from mild to life-threatening in minutes. Anaphylaxis presentations have been increasing, especially among teenagers and young adults. Coronial reports across Australia often describe the same themes: delayed adrenaline, poor symptom recognition and uncertainty about what to do.

In my training sessions with schools, childcare centres, sport clubs, FIFO sites, workplaces and community groups, I see these patterns often. The good news is that these mistakes are preventable. Once you understand what slows people down, you can respond faster, more calmly and with far more confidence.

Here are the seven mistakes that cost time, and how to avoid them.

1. Hesitating to use the adrenaline device

The number one mistake is waiting too long.

People hesitate because they are unsure if it is really anaphylaxis, they worry about overdosing or they fear doing the wrong thing.

Adrenaline is the first-line treatment for anaphylaxis. If you are unsure whether a severe allergic reaction is anaphylaxis, follow the ASCIA Action Plan, which advises giving adrenaline. Delay carries real risk, and coronial findings have linked fatal outcomes to delayed adrenaline.

Adrenaline devices now include autoinjectors such as EpiPen, Anapen and Jext, as well as the intranasal spray neffy. Know which device the person carries and how it works. Check the current ASCIA guidance for details on each device.

2. Looking for skin symptoms and missing life-threatening signs

Anaphylaxis can occur without skin symptoms. No rash, no swelling, no hives.

Serious cases often involve breathing difficulty, sudden wheezing, throat tightness, a drop in blood pressure or collapse. Mistaking anaphylaxis for asthma has featured in coronial reviews. ASCIA guidance is clear: a sudden breathing problem after exposure to a likely allergen needs to be treated as possible anaphylaxis.

Breathing and circulation problems are the danger signs, not skin changes alone.

3. Using antihistamines instead of adrenaline

This mistake is common.

ASCIA states that antihistamines have no role in treating the breathing or circulation symptoms of anaphylaxis. They do not reverse airway swelling or low blood pressure, and they do not stop a reaction from progressing.

If someone gives an antihistamine and waits for a response, critical time is lost. Adrenaline is the treatment for life-threatening symptoms.

4. Sitting the person upright or letting them walk

This is one of the most dangerous mistakes.

During anaphylaxis, blood pressure can drop rapidly. If the person stands or walks, even briefly, they can collapse suddenly.

ASCIA recommends laying the person flat. If they are struggling to breathe, let them sit with legs stretched out in front, but do not let them stand or walk. Pregnant people should lie on their left side.

Correct positioning helps prevent sudden collapse.

5. Not calling an ambulance after giving adrenaline

Giving adrenaline is step one. Calling triple zero (000) is step two.

Symptoms can return, more doses may be needed and airway swelling can worsen. Paramedics can also manage biphasic reactions, which can occur hours later. Never assume someone is fine because they feel better after adrenaline.

Call 000 every time.

6. Failing to keep adrenaline devices accessible

Many emergencies escalate because the adrenaline device is locked away, forgotten, expired or simply missing.

Adrenaline devices should be readily accessible, stored according to their instructions and checked for expiry. People responsible for emergency care should know where the devices are kept and how to use them.

Seconds matter.

7. Not knowing the ASCIA Action Plan

An action plan is powerful only when people know how to use it.

During training, I often see people freeze because they have never practised with a trainer device or read the plan properly. A laminated sheet cannot save lives. Skill and confidence can.

Make your plan active, not passive.

Practise it before you need it

Reading about anaphylaxis helps. Holding a trainer device and doing it yourself helps more. Anaphylaxis response is part of HLTAID011 Provide First Aid, where you practise with trainer devices and work through realistic scenarios.

Final thoughts: these mistakes are preventable

Food reactions, venom reactions, medication-triggered anaphylaxis and exercise-related reactions all happen in Western Australia. The faster you recognise symptoms and respond, the better the chance of a good outcome.

You do not rise under pressure. You fall to the level of your training.

Frequently asked questions

Should I give adrenaline if I am not sure it is anaphylaxis?

If a severe allergic reaction is possible and you are unsure, the ASCIA Action Plan advises giving adrenaline. Then call 000. Delay carries real risk.

Can anaphylaxis happen without a rash or hives?

Yes. Serious cases can involve breathing difficulty, wheezing, throat tightness or collapse, with no skin symptoms at all.

Do antihistamines work for anaphylaxis?

No. ASCIA states antihistamines have no role in treating the breathing or circulation symptoms of anaphylaxis. Adrenaline is the treatment.

Do I still need an ambulance after giving adrenaline?

Yes. Always call 000. Symptoms can return, more doses may be needed and reactions can come back hours later.

How should the person be positioned?

Lay them flat. If they are struggling to breathe, let them sit with their legs stretched out in front. Pregnant people should lie on their left side. Do not let them stand or walk.