Food allergy and anaphylaxis advice (Food allergy and anaphylaxis management in children)
How to recognise, prevent and treat food allergy and severe allergic reactions (anaphylaxis) in children — including adrenaline auto-injectors, an action plan, and when to call 999.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- For a suspected severe reaction (anaphylaxis), give the adrenaline auto-injector FIRST and call 999 — do not wait; delay is the main danger.
- Children at risk should have TWO in-date adrenaline auto-injectors with them at all times, plus a written allergy action plan and trained carers.
- Lay the child flat (or sit up only if breathing is the main problem) and never stand them up suddenly; a second dose can be given after 5 minutes if there is no improvement.
- Avoiding the trigger and reading labels matters, but accidents happen — being prepared to treat a reaction is what keeps children safe.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
A confirmed diagnosis so the right foods are avoided and others are not cut out needlessly
Antihistamines alone are not suitable treatment for anaphylaxis — adrenaline is the first-line treatment and must not be delayed.
For anaphylaxis: give adrenaline into the outer thigh, call 999, lie the child flat (sit up only if breathing is the main problem), and give a second...
Two in-date adrenaline auto-injectors and a clear, written action plan shared with school and carers.
For anaphylaxis: give adrenaline into the outer thigh, call 999, lie the child flat (sit up only if breathing is...
Your child must be assessed in hospital and observed, because a delayed second (biphasic) reaction can happen...
Review what triggered the reaction, refresh the action plan and training, and make sure two in-date auto-injectors...
Some allergies (such as milk and egg) are outgrown, so plans are reviewed. Avoidance, label-reading and...
What is food allergy and anaphylaxis advice?
A food allergy is when the immune system reacts to a normally harmless food. Reactions range from mild (an itchy mouth, hives, tummy upset) to severe and life-threatening. Anaphylaxis is the most serious type: a rapid reaction that can affect breathing and circulation and is a medical emergency.
The common food triggers in children include peanuts, tree nuts, milk, egg, fish, shellfish, sesame, soya and wheat. Food allergy and anaphylaxis advice covers confirming the diagnosis, learning to avoid the trigger safely, recognising early and severe symptoms, and being ready to treat a serious reaction.
For any child at risk of anaphylaxis, the cornerstone is adrenaline. If a severe reaction is suspected, the first action is to use an adrenaline auto-injector straight away and call 999 — never wait to 'see how it goes'. Adrenaline is safe to give and works fast; the danger is in delaying it. The MHRA advises that two in-date auto-injectors should be available at all times, in case one fails or a second dose is needed before help arrives.
Good management means a written allergy action plan (such as the BSACI plans), two in-date auto-injectors carried at all times, training for parents, carers and school, and clear avoidance advice. Be cautious of unproven 'allergy' or 'intolerance' tests, which can mislead families about what is safe.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Mild reaction vs anaphylaxis (what to do)
| Feature | Mild reaction | Anaphylaxis |
|---|---|---|
| Typical signs | Itchy mouth, hives, mild swelling | Breathing trouble, tight throat, collapse |
| Breathing | Normal | Wheeze, hoarse voice, throat tightness |
| First action | Antihistamine, watch closely | Adrenaline auto-injector NOW |
| Call 999? | If it spreads or worsens | Always, straight away |
| Position | Comfortable | Lie flat; sit up only if breathing is the issue |
If you are ever unsure whether it is anaphylaxis, treat it as anaphylaxis: give adrenaline and call 999.
Preparing for your treatment
- Get the diagnosis confirmed by a clinician using the history and reliable tests, not unproven 'intolerance' tests.
- Make sure your child has two in-date adrenaline auto-injectors and that you, carers and school know how to use them.
- Ask for a written allergy action plan (such as a BSACI plan) and read it with everyone who looks after your child.
- Practise with a trainer auto-injector so the steps feel automatic in an emergency.
- Learn to read food labels, ask about ingredients when eating out, and avoid cross-contamination.
- Tell nursery, school, family and friends about the allergy and the plan, and provide spare auto-injectors where allowed.
- Check expiry dates regularly and reorder auto-injectors before they run out.
What happens
At a clinic appointment, the clinician takes a careful history of reactions and may arrange reliable tests (skin prick or specific IgE blood tests) to confirm the allergy and judge the risk. They explain which foods to avoid and how to do so safely, including labels and cross-contamination.
If your child is at risk of a severe reaction, you will be prescribed two adrenaline auto-injectors and shown exactly how and when to use them, usually with a trainer device to practise. You will be given a written action plan that lists the allergens, the symptoms of mild and severe reactions, and the steps to take, including using adrenaline and calling 999.
You will learn the key emergency drill: recognise severe symptoms, give adrenaline into the outer thigh first, call 999, lay the child flat (or let them sit up if breathing is the main problem), and give a second auto-injector after 5 minutes if there is no improvement. You will also learn how to manage milder reactions and when they need escalating.
The plan is then reviewed over time, as some allergies are outgrown and auto-injectors and prescriptions need renewing.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Antihistamines alone are not suitable treatment for anaphylaxis — adrenaline is the first-line treatment and must not be delayed.
- Relying on avoidance without auto-injectors is not safe for a child at risk of severe reactions.
- Unproven 'intolerance' tests are not an appropriate basis for diagnosis or for cutting out foods.
- An expired or single auto-injector is not adequate — two in-date devices should always be available.
Delay or rearrange if…
- Do not delay adrenaline in a suspected severe reaction — this section is about clinic assessment, not emergencies.
- Routine assessment may wait if a child is acutely unwell and needs stabilising first.
- Skin prick testing may be delayed if antihistamines cannot be stopped (a blood test can be used instead).
- Reintroducing a food at home should wait until a clinician has advised it is safe.
Alternatives to discuss
- Strict avoidance with an action plan and auto-injectors as the foundation of care
- A specific IgE blood test where skin prick testing is unsuitable
- A supervised oral food challenge to confirm or exclude allergy under medical supervision
- Oral immunotherapy for selected children under specialist care (not a cure, with risks)
- Specialist allergy referral for severe, multiple or uncertain allergies
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- A confirmed diagnosis so the right foods are avoided and others are not cut out needlessly
- A clear, written plan so everyone knows what to do in a reaction
- The ability to treat anaphylaxis immediately with adrenaline, which saves lives
- Confidence for parents, carers and schools through training and practice
- Fewer accidental reactions through label-reading and avoidance
- Regular review so the plan and auto-injectors stay current as your child grows
Risks & complications
- Anxiety for the family about accidental exposure and emergencies
- Practical limits around food, parties, eating out and travel
- Accidental reactions despite careful avoidance
- Out-of-date or forgotten auto-injectors if not regularly checked
- A reaction being under-treated because adrenaline was delayed or not given
- Confusion if carers are not trained or the plan is unclear
- Unnecessary food restriction if based on unreliable testing
- A life-threatening reaction (anaphylaxis) that progresses despite treatment — which is why early adrenaline and 999 matter
- A second (biphasic) reaction hours after the first, which is why medical assessment after anaphylaxis is essential
The single most dangerous thing in food allergy is delaying adrenaline in anaphylaxis. Adrenaline is safe and works fast; hesitation costs time. Make sure two in-date auto-injectors are always with your child, that carers are trained, and that the action plan is clear. After any use of adrenaline, your child must be seen urgently because a second reaction can occur. If a severe reaction is suspected, give adrenaline first and call 999.
Published figures to discuss
How severe a future reaction will be cannot be reliably predicted from tests, and reaction severity varies with the amount eaten, the food, exercise, illness and how well any asthma is controlled. Because of this uncertainty, fixed percentages for individual children would be misleading and are not quoted here. The safe approach is to assume any child at risk could have a severe reaction and to be fully prepared.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Anaphylaxis | Uncommon but potentially life-threatening | Breathing difficulty, throat/tongue swelling, collapse or widespread symptoms after food exposure need adrenaline and emergency help. | Guide sourcesClinical context |
| False-positive sensitisation | Common interpretive issue | Positive IgE or skin tests must match a convincing history; otherwise children can be put on unnecessary avoidance diets. | Guide sourcesClinical context |
| Accidental exposure | Recognised | Written allergy plans, school/nursery training, label reading and in-date adrenaline auto-injectors reduce risk. | MHRA — Adrenaline auto-injectors: updated advicegov.ukSource-linked context |
| Nutritional deficiency from avoidance | Recognised | Milk, egg, wheat or multiple exclusions should involve dietetic advice, especially in infants and toddlers. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Food allergy is managed long-term rather than cured. After a reaction, recovery depends on its severity; after anaphylaxis, your child needs urgent medical assessment and a period of observation.
- Feeling shaken or anxious after a reaction or after using adrenaline
- Needing a period of hospital observation after anaphylaxis
- Tiredness for a short time after a significant reaction
- Re-checking and restocking auto-injectors and updating the plan
Aftercare
- Always carry two in-date adrenaline auto-injectors and check expiry dates regularly.
- After any use of adrenaline, call 999 and ensure your child is assessed in hospital.
- Keep the written action plan up to date and shared with school, family and carers.
- Practise with a trainer device so the steps stay automatic.
- Read labels carefully, ask about ingredients when eating out, and avoid cross-contamination.
- Reorder auto-injectors well before they expire so there is never a gap.
- Attend reviews, as some allergies are outgrown and the plan may change.
- Two in-date adrenaline auto-injectors with your child at all times
- Written allergy action plan (copies at home and school)
- Trainer auto-injector for practice
- Carers and school trained to recognise and treat a reaction
- Reaction history and confirmed allergen list
- Expiry-date reminders set for auto-injectors
- 999 drill understood by everyone who looks after your child
⚠ Get urgent help if…
- Difficulty or noisy breathing, wheeze, persistent cough, a hoarse voice or the throat feeling tight — give adrenaline NOW and call 999
- Swelling of the tongue, lips, mouth or throat — give adrenaline and call 999
- Suddenly pale, floppy, drowsy, going blue-grey, or collapse — give adrenaline and call 999
- Widespread hives with any breathing, swelling or tummy symptoms after a food — treat as anaphylaxis: adrenaline and 999
- No improvement 5 minutes after the first auto-injector — give the second and ensure 999 is on the way
- A non-blanching rash, a child who will not wake, or a seizure — call 999
- If you are ever unsure whether it is anaphylaxis — treat it as anaphylaxis: adrenaline first, then 999
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Good management means your child can live a full life with their allergy: the trigger is avoided as far as possible, mild reactions are handled calmly, and everyone is ready to treat a severe reaction fast. The aim is safety and confidence, not fear.
Avoidance and planning greatly reduce risk, but they cannot guarantee a reaction will never happen, which is exactly why adrenaline auto-injectors and an action plan are essential. No test can perfectly predict how severe a future reaction will be. Treatments like oral immunotherapy are available for some children under specialist care but are not a cure and carry their own risks.
Some childhood food allergies, particularly to milk and egg, are commonly outgrown, while peanut, tree nut, fish and shellfish allergies more often persist into adulthood. Because this changes, the diagnosis, action plan and need for auto-injectors should be reviewed regularly, and any reintroduction should be supervised by a clinician rather than tried at home.
Related tests, treatments or support
Food allergy and anaphylaxis advice overlaps closely with allergy testing and management, and with asthma and eczema care, which often occur together. Poorly controlled asthma increases the risk of a severe food-allergy reaction, so keeping asthma well managed is part of staying safe.
Follow-up & long-term care
Children with food allergy should have regular review to update the action plan, check auto-injector technique and expiry, and reassess whether the allergy persists. After any anaphylaxis, follow-up with an allergy service is important. You should know who to contact, how to renew auto-injectors, and exactly when to seek emergency help.
- Keep two in-date adrenaline auto-injectors with your child at all times
- Replace auto-injectors before they expire and check them regularly
- Refresh training and the action plan at least yearly and after any reaction
- Keep school, family and carers updated and equipped
- Attend reviews to reassess the allergy and the plan
- Keep any asthma well controlled, as it affects reaction severity
Repeat, follow-on and what comes next
- Action plans and auto-injectors are reviewed and renewed regularly.
- Some allergies are outgrown, so reassessment over time is normal.
- After any reaction, the plan and training should be refreshed.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Two in-date adrenaline auto-injectors and a clear, written action plan shared with school and carers.
- Training and regular practice so the emergency drill is automatic.
- A named contact, prescription-renewal route and reminders before auto-injectors expire.
- Urgent hospital assessment after any anaphylaxis, with replacement devices arranged.
- Planned review to reassess the allergy and keep the plan up to date.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether care is with a GP or a specialist allergy clinic
- Tests used to confirm the allergy and judge risk (skin prick, specific IgE)
- Adrenaline auto-injectors (two are advised) and replacements as they expire
- Training sessions and written action plans
- Any supervised food challenge or immunotherapy under specialist care
- Follow-up reviews and repeat testing over time
- Who carries out and interprets the assessment and their allergy expertise
- Whether two adrenaline auto-injectors and training are included
- Whether a written action plan is provided and shared with school
- Cost of any tests, food challenges or immunotherapy
- How auto-injector prescriptions and renewals are handled
- What happens after a reaction and how urgent review is arranged
- Cancellation policy and how care links with your NHS GP
On the NHS? Diagnosis, allergy action plans and adrenaline auto-injectors are provided on the NHS when clinically needed; some families use private allergy clinics for a faster appointment, but emergency care for a severe reaction is always via 999.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being clearly told to give adrenaline first and call 999 in a severe reaction.
- Being prescribed only one auto-injector, or no clear action plan.
- No training or trainer device for parents, carers and school.
- Diagnosis or food avoidance based on unproven tests.
- Not being told that hospital assessment is needed after any anaphylaxis.
Marketing red flags
- Claims to 'cure' food allergy quickly or with supplements.
- Unproven allergy or intolerance testing sold to the public.
- Downplaying the need for adrenaline auto-injectors or an action plan.
- Promoting antihistamines as adequate treatment for severe reactions.
- Selling broad elimination diets without clinical or nutritional oversight.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is my child at risk of anaphylaxis, and exactly when should I use the auto-injector?
- Can you show me how to use the auto-injector and give me a trainer device?
- Can I have a written allergy action plan to share with school and carers?
- Which foods must we avoid, and how do we handle labels, eating out and cross-contamination?
- How many auto-injectors should my child carry, and how do I renew them?
- What should I do after a reaction, and why does my child need hospital assessment?
- Might my child outgrow this, and when should they be reviewed or retested?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
When should I use the adrenaline auto-injector?
Why does my child need two auto-injectors?
What position should my child be in during anaphylaxis?
Do I still need to call 999 if the adrenaline works?
Can a food allergy be cured?
Are 'intolerance' tests a good way to find food allergies?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Anaphylaxis Anaphylaxis UK — Information and support BSACI — Paediatric allergy action plans Allergy UK — Adrenaline auto-injectors factsheet NICE CG116 — Food allergy in under 19s: assessment and diagnosis MHRA — Adrenaline auto-injectors: updated advice
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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