Anaphylaxis action plan

Nut-allergic Ruth Holroyd who, on two previous occasions just survived serious reactions without using her Epipen describes how she did use her pen this winter for the first time and suggests an ‘allergy action plan’ to help others through a similar experience.

On a cold, icy, snowy afternoon in February this year I used my EpiPen for the first time ever, whilst in the grip of a terrifying anaphylactic attack.

I had been out for lunch with a friend and had what I felt should be a safe meal: smoked salmon and scrambled eggs with brown bread and salad. (I didn’t eat the brown bread!) During the meal I did experience a slight tingling in my mouth and throat. I foolishly ignored these early symptoms and carried on eating the food until I’d finished everything but the bread. It was delicious and I thoroughly enjoyed it, all washed down with a large glass of red wine.

I felt fine, full and satisfied after such a lovely meal. I usually avoid eggs, suspecting that I have a mild intolerance to them, but today I was being naughty. During the short five minute walk back to my house I began to feel a little short of breath. A few puffs and the inhaler didn’t seem to be working. The attack then took hold and advanced very quickly. I realised my face, lips and throat were swelling and my nose was streaming.

I have honestly always been terrified about using my EpiPen, imagining in my head, the huge needle, the pain and something going wrong. In the throes of a full-on anaphylactic attack, I was beginning to panic and not behaving in a rational way.

What did I do?
The first thing I did was take some antihistamines. Then I phoned my husband, who on hearing my strangled struggling voice, ordered me to get off the phone, use the EpiPen and then call 999.

I was terrified and shaking with shock. On top of all the other unpleasant side effects of this dreadful affliction (the itching, the swelling, the feeling of impending doom) my throat was hurting. I could not swallow or speak properly. I felt that I was spiralling out of control. Luckily I did administer the EpiPen immediately. I am amazed to say that it didn’t hurt at all and I was able to do it easily.

I would like to thank a lady I met at a wedding last year. Her job was to visit schools and educate members of staff in how to use an EpiPen safely and effectively. She explained to me the key things you should and should not do and was horrified that I had never used mine before – despite having numerous anaphylactic attacks.

I did check the instructions just to make sure I was doing it correctly. The important thing to remember is that once the cap is removed the EpiPen is ready to use.

Grip the pen in your fist near the base above where the needle will come out – and ‘stab’ yourself – see the action plan for full instructions. Then massage the area when you remove the needle.

I think I was vaguely aware that the pen had clicked into action but I felt nothing except the punch of my hand hitting my thigh. When I removed the pen there was a tiny pin prick and it didn’t bleed. The needle was actually much smaller than I had imagined it would be.

Phone 999 and stay calm
Quickly I phoned 999. By now I was crying and very upset. I was all on my own at home in the middle of nowhere and beginning to feel very out of control and frightened.

I could hardly speak when I got through to the operator and could not communicate my name and address and what was wrong. The operator was a godsend and stayed on the line keeping me calm and updating the ambulance with my condition, assuring me that she had found my location using my phone number. She also made sure that the paramedics could get into the house, asking me to put the door on the latch and try to stay calm until they arrived.

I only have praise for the paramedics. They were very professional and immediately took control of the situation, which helped me to calm down a lot. They gave me another dose of adrenalin and I think some more antihistamines via an injection – although I’m not quite sure what went on. Before I knew what was happening I was on my way to my local hospital in the ambulance.

I stayed in the hospital for about three hours under observation where they also gave me steroids to ease the symptoms. Within an hour of the first adrenalin that I administered I was in the hospital and beginning to feel the symptoms easing and my breathing finally heading back towards normal.

What caused it? I was very anxious about the cause of this latest attack. Having checked with the pub where I ate, they insisted the meal contained no nuts (although I have numerous intolerances I only have a serious allergy to all nuts) and the menu for lunch contained no dishes with nuts in the ingredients. The nuts they do use are kept in sealed containers in the kitchen – so it is unlikely that I consumed nuts. They even produced packaging to prove that the salmon and bread did not contain nuts. So what did I react to? It seems I have developed a new allergy. My doctor thought the most likely offender was the eggs. If they are cooked quickly and contain any raw egg anaphylaxis can occur.

Both my EpiPens had expired. I had not realised this in the heat of the moment, but the ambulance staff did notice.

They said I did the right thing by using them in the emergency – but that I should really be more aware of their expiry date – and renew them accordingly.

I would urge you all to check the expiry dates on your EpiPens now. Once you have your new pens, you can go to to enrol online for the expiry alert service. After registering you can edit your profile, request an EpiPen trainer and update your EpiPen expiry dates online. You can also register by post by completing and returning the tear off form attached to the instructions that come with your EpiPen.

Every anaphylaxis sufferer should also join the Anaphylaxis Campaign. They provide an alert service by post to flag any products that have been recalled due to incorrect labelling and possible contamination with allergenic food types.

Do you wear a medical bracelet or necklace? I have a MedicAlert necklace but had got out of the habit of wearing it. Two organisations which supply these in the UK are MedicAlert and SOS Talisman: (0800 581 420); 0141 639 7090. I now make sure I wear mine every day. All medics are trained to recognise these and they will then have instant life saving information about you if you can’t tell them yourself.

Write an Action Plan - please feel free to base it on mine.

Finally, I would urge everyone to write an action plan. I didn’t have one and clearly when I look back on this attack I did everything in the wrong order and panicked under the pressure. I have now written one, and a copy is now stored in my EpiPen pouch.

Give a copy of your action plan to someone responsible at your place of work and keep another copy with your EpiPen.

Make sure all your family, friends and colleagues know where you keep your EpiPen and how to administer it in case of emergency.

Include emergency numbers in your action plan and explain in lay persons’s terms exactly what needs to done and when.

Practise with a trainer pen You can also get a free trainer pen to practise with and to demonstrate the technique. I would recommend that all allergy sufferers do this as you can then practise and demonstrate how to use your EpiPen safely with no worry of activating your real pen by mistake.

I hope that sharing my experience I will allay some of your fears. I am quite alarmed to think that as a 36-year-old woman I could be so frightened of using an EpiPen. I always felt that I didn’t want to make a fuss and that I might get better naturally.

So I urge you all to use your EpiPen fast if you think you might be having an anaphylactic attack. You won’t harm yourself if it is just a mild attack, but, if it is serious one, you will increase your chances of recovering – and, possibly, save your own or a friend’s life.

Meanwhile, please do check in with me on my new allergy blog at

First published in 2009

If you found this article interesting, you will find many more articles on anaphylaxis here, and reports of research into anaphylaxis here.
You can also find articles on peanut and tree-nut allergy here, cow's milk allergies here, egg allergy here, histamine intolerance hereand articles on a wide range of other allergic and intolerance reactions to a wide range of other foods here.

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