Sudden widespread rash, difficulty breathing, or dizziness — treat as anaphylactic shock; call 120 immediately and explain the situation clearly.

15. Sudden widespread rash, difficulty breathing, or dizziness — treat as anaphylactic shock; call 120 immediately and explain the situation clearly.

Cost: No cost involved. However, people with known severe allergies must purchase epinephrine auto-injectors themselves; these are prescription-only medications.

In plain terms: If someone suddenly develops a full-body rash along with trouble breathing or dizziness, treat it as anaphylactic shock. Call 120 right away and clearly state “suspected anaphylactic shock” so emergency responders can bring epinephrine with them. Epinephrine is the first-line treatment; antihistamines and steroids act too slowly to be effective in such cases. Individuals who have experienced this before should consult a doctor for an epinephrine auto-injector and learn how to administer it to the outer midsection of the thigh — this can be done even through clothing.

Benefit: Epinephrine is the recommended first-line treatment for all grades of anaphylactic shock (Grade 2 and above); clinical guidelines strongly endorse its use. Antihistamines and steroids are much slower-acting and cannot replace epinephrine in emergency situations.

Evidence grade: B (guidelines strongly recommend it, though the underlying evidence base is relatively weak).

Sources: et al. (2022). Clinical Practice Guidelines for Anaphylactic Shock Emergency Care (2020). Frontiers in Pharmacology: "Epinephrine is the first-line medicine in GRADE II to IV anaphylaxis" "Intramuscular epinephrine should be injected in the mid-anterolateral thigh", upper limit of intramuscular injection in adults: 0.5 mg, under 14 years of age: 0.3 mg, repeat every 5–15 minutes if no response. <https://doi.org/10.3389/fphar.2022.845689>; Muraro A, et al. (2022). EAACI guidelines: Anaphylaxis (2021 update). Allergy. <https://doi.org/10.1111/all.15032>

Notes: The EAACI allergy guidelines themselves note that “most evidence in this field remains at a low level.” They still classify epinephrine as a strongly recommended treatment because its benefits far outweigh the risks, rather than because of large-scale clinical trials. In China, epinephrine is a prescription medication and is not readily available to the general public. The best immediate action is to call 120 and clearly describe “suspected anaphylactic shock” so emergency teams can bring epinephrine along. Those with a history of severe allergic reactions should consult a doctor for an epinephrine auto-injector and learn how to inject it into the outer midsection of the thigh — this can be done through clothing as well.