|Face – customers may experience hives, itching, redness, or swelling of the face, lips or tongue|
Airway – customers may have trouble breathing, swallowing or speaking, or may experience nasal congestion or sneezing
Stomach – customers whose gastrointestinal systems are affected may experience stomach pain, vomiting or diarrhea
Total Body – customers having a “total body” reaction may experience hives, itching, swelling, weakness, dizziness, a sense of doom or even loss of consciousness
Symptoms can appear within minutes of exposure to an allergen or may take longer to develop in some cases. Additionally, symptoms can vary from one person to the next, and even from one reaction to another in the same person1. Because anaphylaxis is unpredictable, it should always be treated as an emergency situation.
The first-line medication used to treat anaphylactic reactions is epinephrine. In Canada, the EpiPen® brand of epinephrine auto-injectors is available. These devices contain a needle and a pre-measured dose of epinephrine, with the dosage based on a person’s weight. It is recommended that individuals with potentially life-threatening allergies carry epinephrine with them at all times.
Dealing with an emergency
According to the consensus guidelines contained in Anaphylaxis in Schools & Other Settings, allergic individuals should follow these five steps in the event of a life-threatening allergic reaction:
- Give epinephrine at the first sign of a reaction
- Call 9-1-1 or local emergency medical services
- Give a second dose of epinephrine as early as five minutes after the first dose if there is no improvement in symptoms
- Go to the nearest hospital right away (ideally by ambulance) and stay for possible treatment and observation
- Call an emergency contact person
Someone experiencing anaphylaxis may not be able to self-administer epinephrine. If this is the case, a family member or friend who is with them may be asked to help. If the person is alone, a manager may be asked to help3.
An undesignated or “stock” epinephrine auto-injector refers to a device which is not prescribed for a specific person. This medication may be used in an emergency to help someone who is experiencing an anaphylactic reaction but does not have his/her own epinephrine available, is experiencing a first-time reaction or needs a second dose. In Canada, epinephrine auto-injectors can be purchased without a prescription.
Some restaurants have taken a proactive approach by having epinephrine (e.g. EpiPen®) on hand in their establishments. Chris Christidis, owner of Ice ‘n Cake, decided to purchase two EpiPen® auto-injectors for his Toronto restaurant. He explained: “I thought it was important to take every precaution for my customers. The cost of these devices is a small price to pay for someone’s safety.” Similar initiative has been shown by La Cage aux Sports, the first restaurant chain in Quebec to have EpiPen® auto-injectors in each of its 51 locations.
By being aware and better prepared, your staff can create a safer and more enjoyable dining experience for people with food allergies. The efforts taken to accommodate the needs of the food-allergic diner will not go unnoticed!
EpiPen®, EpiPen® Jr are registered trademarks of Mylan, Inc. licensed exclusively to its wholly owned affiliate, Mylan Specialty, L.P.; sub-licensee, Pfizer Canada Inc. This article is supported by Pfizer Canada Inc.
- Anaphylaxis in Schools & Other Settings, 3rd Edition.
- Think F.A.S.T. concept developed by Anaphylaxis Canada.
- Allergen Training Basics for the Foodservice and Food Retail Industry.
Editor’s Note: A previous version of this article referenced Allerject brand epinephrine, which was voluntarily recalled across Canada and the United States. This article has been edited to reflect the recall. Please visit http://www.allerject.ca/Common/docs/en/Sanofi-Canada-Issues-Voluntary-Recall-of-Allerject.pdf for more information.
About the author:
Joni Huang has been involved with the development of anaphylaxis-related educational resources for nine years and has worked with different national organizations, including Anaphylaxis Canada and the Canadian Society of Allergy and Clinical Immunology.