Managing anaphylaxis in the COVID-19 vaccination setting

Helen Davis, Director, North West Medicines Information CentrePublished Last updated See all updates

Advice on managing anaphylaxis in the vaccination setting with specific reference to COVID-19 vaccines.

Anaphylaxis in the vaccination setting for all vaccines

Recognising and managing anaphylaxis

The Green book provides details on the distinguishing features of an anaphylactic reaction compared to other potential reactions.

Anaphylaxis is likely when all of the following three criteria are met:

  • sudden onset and rapid progression of symptoms
  • life-threatening airway and/or breathing and/or circulation problems
  • skin and/or mucosal changes (flushing, urticaria, angioedema)

The Resuscitation Council UK in their 2021 guidance advises, particularly in community settings, dial 999 urgently for ambulance support and clearly state “ANAPHYLAXIS”. They also advise that all clinical staff should be able to recognise anaphylaxis, call for help and start treatment.

The Resuscitation Council UK recommend that an anaphylaxis pack should be immediately available in each location where vaccines are being given, and should not be stored in a locked cupboard or trolley. Staff should check packs regularly to ensure the contents are within their expiry dates.

The key management options for anaphylaxis are intramuscular adrenaline and oxygen. Note that antihistamines and steroids are no longer recommended for the immediate management of anaphylaxis in vaccination settings.

Management of severe anaphylaxis in children

The Resuscitation Council UK produced further guidance, for use in vaccination clinics where children will be vaccinated, on the management of paediatric cardiac arrest caused by severe anaphylaxis.  The first priority is to treat anaphylaxis with intramuscular adrenaline and oxygen, as for adults, along with a call to emergency services (999). If cardiorespiratory arrest occurs start cardiopulmonary resuscitation (CPR) immediately using the highest level of PPE available to the rescuer. Bag-valve-mask ventilation, is preferable to using a face mask, which is in turn preferable to mouth-to-mouth or mouth-to-mouth-and-nose from a rescuer safety perspective.

Use of oxygen

Additional information from the Resuscitation Council states that although oxygen is advised in  guidance for vaccination settings, it has not been needed for routine immunisations in the community, based on a local risk assessment. The immediate availability of oxygen is not an absolute requirement for vaccination settings.

See also Medical gases

Change history

  1. Added reference to guidance on managing severe anaphylaxis in children in the vaccination centre setting
  1. Clarifying use of oxygen in the community setting
  1. Published