An emergency action plan puts the most important information in one place, so anyone around you knows exactly what to do during a reaction. Below is a simple template you can copy, fill in, and print. Keep one copy with your epinephrine, and give copies to your school, workplace, and caregivers.
Peanut allergy emergency action plan
Person’s name: ________________________________
Date of birth: ____________ Allergy to: Peanuts (and: ________________________)
Emergency contacts:
- Name / relationship: ________________________ Phone: ______________
- Name / relationship: ________________________ Phone: ______________
Allergist / doctor: ____________________________ Phone: ______________
Medications I carry:
- Epinephrine auto-injector (brand / dose): ____________________ Expires: __________
- Antihistamine (name / dose): ____________________________
If a reaction happens
Mild symptoms (a few hives, itchy mouth, mild stomach upset, runny nose): give antihistamine if directed by my doctor, and watch closely for any worsening.
Severe symptoms — if ANY of these appear, give epinephrine immediately:
- Trouble breathing, wheezing, or throat tightness
- Swelling of the lips, tongue, or throat
- Widespread hives, repetitive vomiting, or stomach pain
- Dizziness, faintness, pale or bluish skin, or collapse
Emergency steps
- Give epinephrine into the outer thigh without delay.
- Call your local emergency number and say “anaphylaxis.”
- Lie the person down, legs raised (sit up if breathing is hard; on side if vomiting).
- Give a second dose after 5–15 minutes if symptoms don’t improve.
- Go to the emergency room even if symptoms ease — reactions can return.
Notes / special instructions: ____________________________________________
Doctor’s signature: ____________________ Date: __________
How to use this plan
Copy the section above into a document, fill in your details, and print it. Post a copy where your epinephrine is stored, and share it with anyone responsible for your care. At work, pair it with a shared-kitchen allergy sign; for travel, keep a copy with your flight documents.
For official, clinician-designed templates, FARE and the Allergy & Asthma Network publish free downloadable forms — see the Resources page.