What to Include in a Peanut Allergy Emergency Action Plan for Your Child

While you can’t predict a food allergy reaction, you can plan for one. The best way is to create a written emergency action plan. This detailed document can prepare everyone in your child’s life for a possible peanut exposure.

“In an emergency, the goal is to reduce uncertainty and delay,” says David A. Hill, MD, PhD, a pediatric allergist, immunologist, and attending physician at Children’s Hospital of Philadelphia (CHOP). “An emergency action plan helps parents, teachers, school nurses, coaches, babysitters, and other caregivers recognize symptoms quickly and know exactly what to do.”

Important Information to Include in an Emergency Action Plan

Your child’s plan should be individualized and outline vital information caregivers should know. Here’s what you should consider including.

1. Basic Information About Your Child

• Their full name
• Their age and weight
• Whether they have a history of anaphylaxis (a severe allergic reaction that can be life-threatening)
• A list of symptoms they typically experience during mild and severe reactions
• Whether they have asthma (which puts them at higher risk of a severe reaction)
• Their emergency contacts
• Their doctor’s name and contact information
• A recent photo

It’s also important to list all of your child’s known allergies. “With peanut allergy being one of the most common culprits, the reaction may, of course, be triggered by peanut, but it can also be caused by other food allergens as well, such as milk, soy, egg, wheat, tree nuts, fish, shellfish, and sesame,” says Stanislaw J. Gabryszewski, MD, PhD, an attending physician in the division of allergy and immunology at CHOP.

2. Allergic Reaction Symptoms

As mentioned, your child’s emergency action plan should list both mild and severe symptoms that could occur.

• Itchy or runny nose
• Sneezing
• Itchy mouth
• A few hives (not widespread)
• Mild itch
• Mild nausea

“A child may have had only mild symptoms in the past, but still be at risk for a more serious reaction in the future,” Dr. Hill says.

• Shortness of breath
• Wheezing or a repetitive cough
• Pale or bluish skin
• Faintness or dizziness
• A weak pulse
• Trouble breathing or swallowing
• Tight or hoarse throat
• Swelling of the lips or tongue
• Many hives (widespread)
• Severe vomiting or diarrhea
• Anxiety or confusion
• A sense of doom or feeling like something bad is going to happen
• A combination of symptoms in two or more organs or systems can indicate anaphylaxis, even if the airway isn’t involved and blood pressure is normal.

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3. Step-by-Step Instructions for Symptoms

Your plan should provide straightforward instructions about what to do if your child experiences allergy symptoms. “A good emergency plan turns a frightening and confusing situation into a set of clear, rehearsed steps,” says Hill.

The instructions should depend on your child’s specific signs and symptoms. For instance, if they only have mild symptoms in just one area of the body, they may need an antihistamine or inhaler. Be sure to include which drug to give them and the dose.

4. Epinephrine Instructions

It’s extremely important that your child’s emergency plan stresses that epinephrine, whether it’s administered as an injection or a nasal spray, should be given right away if severe allergic symptoms occur.

“Remember that epinephrine is safe and effective, and when in doubt during a reaction that seems to meet the criteria for anaphylaxis, it is generally better to use epinephrine promptly rather than wait,” says Dr. Gabryszewski.

• When it’s appropriate to use epinephrine
• How to use epinephrine (including how long to wait before giving each additional dose)
• Where the medicine is stored
• How many doses of epinephrine are available
• Whether or not your child can self-administer the medication

Hill says to also include a note that a second dose of epinephrine may be needed if symptoms persist or come back before emergency help arrives. “Importantly, the plan should be simple enough that someone who is not medically trained can follow it during a stressful situation,” he says.

Parents and caregivers should practice injectable epinephrine administration with a trainer device and know where it’s kept, he says.

5. Post-Reaction Steps

After the event, medical professionals may need to monitor your child or provide additional treatments.

Most Important Tips for an Emergency Action Plan

Gabryszewski says you should complete an emergency action plan with the help of your child’s physician. Additionally, the plan should be well-understood by the family at the time it’s developed.

“Families should ensure that there is easy access to this plan and that they carry epinephrine at all times,” he adds.

Share your child’s action plan with:

• School and day-care personnel
• Babysitters
• Family members, neighbors, and friends
• Anyone who is around your child often

“The most important point is that the plan has to be practical. It should not just be a document that sits in a folder. It should be reviewed regularly, shared widely, and paired with ready access to epinephrine,” says Hill.

The Takeaway

• Peanut allergy reactions can be unpredictable, but an emergency action plan can help you and others care for your child if one occurs.
• Your child’s action plan should include basic personal information, emergency contacts, symptoms to look for, and step-by-step instructions for what to do if they have a reaction.
• Epinephrine can be lifesaving during a severe reaction; do not hesitate to use it.
• An emergency plan should be practical and easy to follow, as it’s designed to prepare caregivers and give them important instructions during a serious situation.