Allergy Action Plan: Essential Medications to Carry and When to Use Them

Carrying the right medications for an allergic reaction isn’t just a good idea-it’s life-saving. If you or someone you care for has severe allergies, knowing exactly what to carry and when to use it can make the difference between a minor incident and a medical emergency. An allergy action plan isn’t a suggestion. It’s a medical directive, written by your doctor, that tells you exactly what to do when symptoms start. And at the heart of every serious plan? Epinephrine.

Epinephrine: The Only Medication That Can Stop an Anaphylactic Reaction

Epinephrine is not optional. It’s the first and only medication that reverses the dangerous drop in blood pressure, opens up swollen airways, and stops the body’s runaway allergic response. Antihistamines like Benadryl? They help with itching or hives-but they do nothing for breathing trouble or shock. If you wait to give epinephrine until you’re sure it’s "really bad," you’re risking death.

Every allergy action plan must list the correct epinephrine dose based on weight:

• 0.10 mg for children 7.5-13 kg (16.5-28.7 lbs)
• 0.15 mg for children 13-25 kg (28.7-55.1 lbs)
• 0.30 mg for anyone over 25 kg (55.1 lbs or more)

These doses are standardized by the American Academy of Pediatrics and the UK’s BSACI. Auto-injectors like EpiPen, Adrenaclick, or generic equivalents are the most common delivery method. Some newer options, like Neffy (an intranasal spray), are now FDA-approved and may be used as an alternative-but only if your doctor has approved it and trained you on how to use it properly.

Never keep epinephrine in a hot car, a sunlit drawer, or a backpack left outside. Heat and light can ruin it. Check the expiration date every three months. If it looks cloudy, brown, or has particles in it-replace it immediately. FARE’s 2023 survey found 32% of households had expired or damaged injectors. That’s not negligence-it’s preventable.

When to Use Epinephrine: The Rules Are Simple

You don’t need to wait for a checklist to be complete. If someone has a known allergen exposure and shows any sign of a serious reaction, give epinephrine right away.

Here’s what counts as a trigger for immediate use:

• Two or more body systems reacting at once (e.g., hives + vomiting + trouble breathing)
• Any breathing difficulty-wheezing, tight throat, hoarse voice
• Dizziness, fainting, pale skin, or weak pulse (signs of low blood pressure)
• In babies or toddlers: sudden hives, persistent cough, or unusual lethargy

Don’t wait for vomiting to happen before acting. Don’t hope the hives will go away on their own. If the person has a history of anaphylaxis or asthma, even mild symptoms after exposure should trigger epinephrine. Asthma increases the risk of a fatal reaction by 300%. That’s not a statistic-it’s a warning.

Studies show that giving epinephrine within five minutes of symptom onset reduces the chance of death by 94%. Delaying it-even by 10 minutes-can turn a treatable reaction into a fatal one. A 2021 study found that in school settings, antihistamines were often given first, delaying epinephrine by an average of 22 minutes. That’s 22 minutes too long.

What About Antihistamines? They Have a Role-But Not the One You Think

Antihistamines like diphenhydramine (Benadryl) or cetirizine (Zyrtec) are not replacements for epinephrine. They’re support players.

Use them only if:

• There’s a mild reaction-just hives or a runny nose-with no breathing or circulation problems
• You’ve already given epinephrine and are waiting for emergency help

The dose for diphenhydramine is 1 mg per kilogram of body weight, up to a maximum of 50 mg. But never give it before epinephrine. Never give it instead of epinephrine. And never assume it will stop a reaction from getting worse. It won’t.

Doctors in the UK and US agree: antihistamines don’t treat airway swelling or low blood pressure. They only ease itching and sneezing. Relying on them to "hold off" a reaction is dangerous. In fact, giving antihistamines first can make people feel falsely safe-delaying the one treatment that saves lives.

Other Medications That Belong in Your Allergy Kit

Depending on your history, your doctor might recommend additional items:

• Albuterol inhaler: If you have asthma or wheezing during reactions, this helps open airways. Use it after epinephrine if breathing is still tight.
• Corticosteroids (like prednisone): Sometimes prescribed to prevent a delayed or "biphasic" reaction-where symptoms come back hours later. These are taken orally, not injected, and are not for immediate use.

Never carry a steroid inhaler or nasal spray as your main defense. They don’t work fast enough. Epinephrine is the only thing that works within seconds.

What to Do After Giving Epinephrine

Calling 999 is not optional. Even if the person seems fine after the shot, they still need to go to the hospital.

Why? Because 1 in 5 people have a second wave of symptoms-called a biphasic reaction-up to 12 hours later. That’s why medical observation for 4 to 6 hours is standard. You can’t predict who it will happen to.

Also, you may need a second dose of epinephrine. If symptoms return or worsen after 5-10 minutes, give another injection. It’s safe. Multiple doses are common in severe cases. Don’t hesitate because you think you’ve "used it all up." You’re not running out of life-saving medicine-you’re running out of time.

Sharing Your Plan: Schools, Daycares, and Caregivers

An action plan is useless if no one else knows how to use it. If you have a child with allergies, give a copy to their school, after-school program, babysitter, and grandparents. Make sure the school nurse has a copy on file and that at least two staff members are trained to use the auto-injector.

Many schools in the UK and US now require individualized health plans for students with allergies. But here’s the problem: a 2023 study found only 38% of teachers could correctly identify anaphylaxis symptoms without a visual guide. That’s why FARE recommends including photos on the plan-like a picture of the child’s reaction or the auto-injector in use.

Even adults with allergies should carry a printed copy of their plan. Keep it in your wallet, phone case, or bag. Emergency responders don’t know your history. Your plan tells them what to do.

Digital Plans Are Here-But Paper Still Matters

FARE launched a mobile app in March 2024 that stores your action plan, alerts emergency contacts, and reminds you when your epinephrine expires. Over 142,000 people are using it. That’s great. But don’t rely on your phone alone. Batteries die. Phones get lost. In an emergency, you need something you can hand to someone without fumbling for a screen.

Keep a printed copy in your bag, your child’s backpack, and your car. Update it every year. If your weight changes, your dose might need adjusting. If your doctor changes your plan, get a new copy signed and dated.

Final Rule: When in Doubt, Inject

There’s no such thing as "overusing" epinephrine in a true emergency. The side effects-racing heart, shaking, feeling anxious-are temporary. The consequences of not using it? They’re permanent.

78% of fatal anaphylaxis cases involved delayed or missed epinephrine. That’s not because people didn’t care. It’s because they didn’t know when to act. Your allergy action plan removes that guesswork. It turns panic into action. It turns fear into safety.

Don’t wait for a near-death experience to get one. If you have allergies, ask your doctor for a written plan today. Carry your epinephrine. Know the signs. Use it fast. And never, ever wait for someone else to make the call.