Anaphylaxis in Aesthetic Practice
Anaphylaxis in Aesthetic Practice: The First Five Minutes
Clinical Practice · Patient Safety · Emergency Care
9 September 2026 · Dr Philippe Hamida-Pisal and Dr Jihyun Byun
Most aesthetic practitioners will go an entire career without seeing one. That is precisely the problem. Anaphylaxis in aesthetic practice is rare enough that nobody rehearses it, and fast enough that there is no time to look anything up when it happens.
It does not arrive politely. It arrives fifteen minutes into a routine appointment, on an ordinary Tuesday, in a patient who was completely well when they walked through the door.
This article sets out what the first five minutes actually look like, based on current Resuscitation Council UK guidance. It is a summary for practitioners who already work clinically. It is not a substitute for hands-on training, and it does not replace your own clinic protocols.
What actually triggers it in an aesthetic clinic
The injectables themselves are not the usual culprits. The higher-risk exposures in an aesthetic setting are:
- Hyaluronidase. Derived from bovine or ovine sources, and the single agent most associated with hypersensitivity reactions in aesthetic practice. The uncomfortable irony is that you are most likely to reach for it in an emergency — a suspected vascular occlusion — which is the worst possible moment to meet a second emergency.
- Local anaesthetics, particularly with preservatives.
- Chlorhexidine skin preparation, a well-documented and frequently missed trigger.
- Latex, still present in some gloves and packaging.
Knowing which of these sits in your treatment room, and whether your patient has reacted to any of them before, is part of your consent process — not an afterthought.
Recognising it, and not confusing it with a faint
A vasovagal episode after an injection is far more common than anaphylaxis, and the two are mistaken for each other constantly.
A faint is pale, clammy, bradycardic, and improves quickly when the patient is laid flat with their legs raised. It does not involve the airway.
Anaphylaxis is a sudden-onset, rapidly progressing Airway, Breathing or Circulation problem, usually — but not always — with skin changes. Look for swelling of the tongue or throat, a hoarse voice, stridor, wheeze, difficulty breathing, a rising heart rate with a falling blood pressure, or a patient who suddenly feels a “sense of impending doom”.
Skin changes alone are not anaphylaxis. Absent skin changes do not rule it out. Up to one in five cases have no rash at all.
The first five minutes
Call for help immediately. Dial 999 and say the word “anaphylaxis”. Do not wait to see whether things settle. If you are working alone, put the phone on speaker and keep your hands free.
Remove the trigger if you can — stop the injection, stop the infusion. Do not delay adrenaline to hunt for a cause.
Position the patient, and keep them there. This is the step most likely to be got wrong, and it kills people. Lying flat, with or without leg elevation, for anyone with low blood pressure. Semi-recumbent if they are struggling to breathe. On their left side if they are pregnant, to avoid aortocaval compression. Under no circumstances let them stand up, walk, or sit up suddenly — fatality can occur within minutes of a sudden posture change, even in someone who appears to be improving.
Give intramuscular adrenaline. Now.
Adult and child over 12: 500 micrograms IM — that is 0.5 mL of 1 mg/mL (1:1000) adrenaline, into the anterolateral aspect of the middle third of the thigh, using a green (21G) or blue (23G) needle to be certain you are in muscle and not fat.
Through clothing is acceptable. Hesitation is not. There is no meaningful harm from giving IM adrenaline to someone who turns out not to have anaphylaxis, and enormous harm in withholding it from someone who does.
Repeat after five minutes if there is no improvement.
If there is still no improvement after two doses, you are dealing with refractory anaphylaxis. Escalate — this needs expert help and, in hospital, an intravenous adrenaline infusion. Your job is to keep giving IM adrenaline every five minutes and keep the patient alive until the ambulance arrives.
Afterwards — the part people forget
Nobody who has had anaphylaxis in your clinic goes home in a taxi twenty minutes later because they feel better. Biphasic reactions are real.
Current guidance risk-stratifies the observation period: a fast-track two hours only where a single dose resolved everything within thirty minutes and the patient has their own auto-injectors; a minimum of six hours if two doses were needed or there is a history of a biphasic reaction; and at least twelve hours after a severe reaction, one needing more than two doses, or where severe asthma was involved.
That observation happens in hospital, not on your couch.
Then: document everything, contemporaneously. Time of onset, time of each adrenaline dose, observations, who you called. Report via the Yellow Card scheme. Refer to allergy services — the patient needs to know what did this to them before anyone injects them again.
What your clinic needs to have, today
Go and check, rather than assuming:
- In-date adrenaline 1:1000 ampoules, or auto-injectors, and enough for repeat dosing — one is not enough
- Green and blue needles, and syringes you can draw up under pressure
- A written anaphylaxis protocol where people can actually see it
- A named person who calls 999, so that in the moment nobody assumes someone else has done it
- Everyone in the building, including reception, knowing where the kit is
The thing that no amount of reading fixes
You have just read the protocol. Now imagine performing it while a patient’s airway is closing, with a colleague panicking beside you, on the one day it actually happens.
Knowing the dose and being able to deliver it under pressure are different skills, and only one of them is trained by reading. That is the entire argument for putting your hands on the kit — an EpiPen trainer, an AED, a manikin — until the sequence runs without conscious thought.
That is what our CPD certified First Aid and Basic Life Support course for healthcare and aesthetic practitioners is built to do. Pre-study pack and online MCQ in your own time, then a practical day at 22 Harley Street with a maximum of six delegates, so everyone gets real repetitions rather than watching a demonstration from the back of the room.
It is a CPD certified course, not a regulated First Aid at Work qualification — we are clear about that, because the distinction matters.
Dr Philippe Hamida-Pisal and Dr Jihyun Byun
PHP Training Academy, 22 Harley Street, London. Clinical guidance in this article follows the Resuscitation Council UK Emergency Treatment of Anaphylaxis guidelines. It is written for qualified practitioners and is not a substitute for training or for your own clinic’s protocols.
Frequently asked questions
What dose of adrenaline is given for anaphylaxis in an adult?
500 micrograms intramuscularly — 0.5 mL of 1 mg/mL (1:1000) adrenaline — into the anterolateral aspect of the middle third of the thigh, repeated after five minutes if there is no improvement.
Can anaphylaxis happen after dermal filler?
Reactions to hyaluronic acid fillers themselves are uncommon. The greater risk in aesthetic practice comes from hyaluronidase, local anaesthetics, chlorhexidine skin preparation and latex.
How do I tell anaphylaxis apart from a vasovagal faint?
A faint is pale, clammy and bradycardic, and improves rapidly when the patient lies flat. Anaphylaxis involves a sudden Airway, Breathing or Circulation problem. If you are unsure, treat as anaphylaxis.
How long must a patient be observed after anaphylaxis?
Between two and twelve hours depending on severity and how many adrenaline doses were needed — and in hospital, not in your clinic.
Do aesthetic practitioners need basic life support training?
It is expected as part of safe practice, and indemnity providers and accreditation bodies routinely ask for evidence of current training. Our course is CPD certified and designed specifically for aesthetic and healthcare practitioners.
