ASCIA Anaphylaxis Updates 2026: New Action Plans, EpiPen Use & Training for Schools

By SKLD Training — 2026-03-05

ASCIA has released updated Anaphylaxis Action Plans and guidelines for 2026, including revised infographics, clearer escalation triggers, and recognition of new adrenaline delivery options. This guide explains what changed, how it affects schools, childcare centres, and hospitality venues, and what first aid training staff need to meet their compliance obligations.

What the 2026 ASCIA Updates Mean for First Aiders in Australia

If you manage anaphylaxis action plans for a school, childcare centre, or food-service venue, the 2026 ASCIA updates matter to you now. The Australasian Society of Clinical Immunology and Allergy (ASCIA) has refreshed its action plans, tightened its escalation guidance, and formally acknowledged new adrenaline delivery devices that may appear alongside traditional EpiPens in your setting.

The short version: the core first aid sequence has not changed — adrenaline first, call 000, lay the person flat, monitor. But the visual presentation of the action plans is clearer, the trigger criteria for giving adrenaline have been sharpened, and a TGA-approved intranasal adrenaline spray is now a recognised alternative device that some individuals may be prescribed in addition to, or instead of, an auto-injector.

Knowing these changes keeps your team legally current, operationally prepared, and genuinely safer.

Book Now: SKLD Training — check available dates

What Is ASCIA and Why Do Their Guidelines Drive Australian Practice?

ASCIA — the Australasian Society of Clinical Immunology and Allergy — is the peak professional body for clinical immunologists and allergists in Australia and New Zealand. Their anaphylaxis action plans and training resources are the accepted standard across Australian schools, childcare services, healthcare settings, and food businesses.

ASCIA action plans are the documents prescribed by allergists to individual patients. They are the plans that schools and childcare centres are legally required to implement when a child with a documented allergy is enrolled. They are also the basis for all anaphylaxis training delivered through nationally recognised first aid qualifications including HLTAID011 and HLTAID012.

When ASCIA updates their guidance, those updates flow through to:

Individual patient action plans — families receive updated plans from their allergist or immunologist
School and childcare policies — services must reflect current ASCIA guidance in their anaphylaxis management procedures
First aid training content — RTOs update course materials to align with current ASCIA guidelines
Workplace procedures — hospitality, food service, and events venues that hold emergency adrenaline must follow current administration guidance

(ASCIA Anaphylaxis e-Training — allergy.org.au)

Summary of the 2026 ASCIA Action Plan Updates

The 2026 revisions to the ASCIA Anaphylaxis Action Plans include several key changes that first aiders, educators, and compliance managers should understand:

What Changed	Previous Version	2026 Version
Action plan infographics	Two-column format with symptom lists	Cleaner visual flow with colour-coded severity bands; easier to read under stress
Adrenaline trigger criteria	Broad descriptions of severe reaction signs	More explicit decision points — particularly around single severe symptom (e.g. difficulty breathing alone) being sufficient to give adrenaline
Device options	Auto-injectors only (EpiPen, Anapen)	Recognises intranasal adrenaline spray (Neffy) as a TGA-approved option; instructions differ from auto-injector
Positioning guidance	Lay flat — sit up if breathing difficult	Reinforced: do NOT allow the person to stand or walk at any time, even if they feel better
Second dose timing	Second auto-injector after 5 minutes if no improvement	Consistent: second dose at 5 minutes — applies to both auto-injector and intranasal device
Language around mild reactions	Antihistamines mentioned in mild reaction guidance	Reinforced that antihistamines do NOT treat anaphylaxis and must NOT delay adrenaline

Source: ASCIA Action Plans for Anaphylaxis — allergy.org.au

The New Device: Intranasal Adrenaline (Neffy) — What First Aiders Need to Know

One of the most significant practical changes in 2026 is the formal recognition of intranasal epinephrine (adrenaline administered as a nasal spray) as a TGA-approved emergency option for anaphylaxis. The brand name is Neffy.

This does not replace the EpiPen as the standard device — auto-injectors remain the primary recommended treatment. However, you may increasingly encounter individuals whose allergist has prescribed intranasal adrenaline as part of their action plan, particularly in cases where the individual is needle-phobic, has certain comorbidities, or where the prescribing clinician has judged it appropriate.

Key points for first aiders regarding intranasal adrenaline:

Always follow the individual's action plan. The plan will specify which device to use and in what order. Do not substitute one device for another unless the plan instructs it.
The technique is different from an auto-injector. Intranasal adrenaline is administered into one nostril with a single press. The person should be upright or slightly reclined (not lying completely flat) during administration — then laid flat immediately after.
Absorption may be slower in severe reactions with nasal congestion. ASCIA guidance acknowledges this limitation and why auto-injectors remain the primary option for most individuals.
A second dose at 5 minutes applies equally. If there is no improvement after 5 minutes and a second dose is available, administer it to the same nostril.
Call 000 immediately after the first dose — regardless of which device is used.

Never delay calling 000 or giving adrenaline while trying to decide which device to use. Follow the action plan. Act immediately.

How to Administer an EpiPen: Step-by-Step for 2026

The EpiPen auto-injector technique has not changed in 2026. Every staff member who may be required to administer an EpiPen should be able to perform these steps without hesitation:

Retrieve the EpiPen from its known, accessible location. Do not waste time searching. EpiPens should be stored in a clearly labelled, unlocked location accessible to all relevant staff.
Remove the EpiPen from the carrier tube. Grip it firmly in your dominant hand with the orange tip pointing down.
Pull off the blue safety cap with your other hand — pull straight, not at an angle. Do not place fingers over the orange tip at any point.
Position the orange tip against the outer mid-thigh — can be given through clothing. Use the outer thigh only, not the inner thigh or buttocks.
Push down firmly and hold until you hear or feel a click, then continue holding for 3 seconds. The needle deploys automatically on the click.
Remove the EpiPen and massage the injection site firmly for 10 seconds.
Note the time. Write it down or tell someone to remember — paramedics will ask.
Call 000 immediately if not already done. Inform the operator that adrenaline has been given and the time.
Lay the person flat — do not allow them to stand or walk. If breathing is very difficult, allow a semi-reclined position but not sitting upright or standing.
If no improvement after 5 minutes and a second auto-injector is available, administer it in the same way. Do not wait longer than 5 minutes.
Remain with the person until paramedics arrive. Continue monitoring and be prepared to begin CPR if they become unresponsive and stop breathing.

Practising with a training EpiPen device (no needle, spring-loaded, identical feel to the real device) is essential. Physical practice — not reading a list of steps — is what builds the muscle memory that functions under stress.

Implications for Schools and Early Childhood Settings in Queensland

Queensland schools and approved early childhood education and care (ECEC) services have specific regulatory obligations around anaphylaxis management. The 2026 ASCIA updates have direct implications for these settings:

Action plans must reflect current ASCIA versions. If a child's action plan predates the 2026 update, families should be advised to obtain an updated plan from their allergist. Services should not continue operating from outdated plans indefinitely.
Staff training must cover the devices that appear in action plans. If a child in your care has been prescribed intranasal adrenaline, at least one trained staff member must understand how to use it. HLTAID012 training delivered by a current RTO should now address this.
Positioning guidance must be updated in drills. The reinforced "do not stand or walk" instruction should be practised explicitly in onsite drills — not just described theoretically.
Early childhood leaders should review their anaphylaxis policies against the current ASCIA framework to ensure language aligns. The Sector publication covering the 2026 early childhood implications highlights this as a priority action for directors and nominated supervisors.

Gold Coast ECEC services across Southport, Robina, Coomera, Burleigh Heads, and Helensvale often serve large enrolments with multiple children carrying anaphylaxis action plans. Regular training — not just initial induction — is essential for maintaining team response readiness.

Book Now: SKLD Training — onsite anaphylaxis and first aid training for Gold Coast schools and childcare

Implications for Hospitality, Food Service, and Events Venues

Anaphylaxis in food-service and events settings is a significant and growing compliance concern. The 2026 updates are relevant to hospitality operators for the following reasons:

Food allergy emergency preparedness. A patron with a known food allergy can experience anaphylaxis from cross-contamination or mislabelled ingredients. Venues with trained staff and accessible emergency adrenaline (where management has elected to hold it) are better positioned to manage these events.
Staff must know the current action plan format. If a patron presents their personal ASCIA action plan to staff (which some individuals carry), staff should be able to read and follow it. The updated 2026 format should be familiar.
Hospitality staff completing HLTAID011 receive anaphylaxis response training as part of the course. This training should now reflect 2026 ASCIA guidance including the updated escalation triggers and new device awareness.
Surfers Paradise, Broadbeach, and the Gold Coast hospitality strip represent high-traffic food service environments where anaphylaxis incidents are a realistic risk. Regular team first aid refreshers are prudent practice.

Recognising Anaphylaxis: Mild to Severe Progression

One area the 2026 ASCIA updates sharpen is the decision point for giving adrenaline. Understanding the difference between a mild allergic reaction and anaphylaxis remains the most critical clinical skill for first aiders:

Mild to Moderate Allergic Reaction	Anaphylaxis (Severe) — Give Adrenaline
Swelling of face, lips, eyes	Difficult or noisy breathing
Hives, welts, redness	Swollen tongue
Tingling or itching in mouth	Stridor — high-pitched sound on breathing
Abdominal pain or vomiting	Wheeze or tight chest (in someone with known allergy)
Runny nose	Persistent dizziness, collapse, or loss of consciousness
Mild skin rash	Pallor, limpness (young children)

Key 2026 clarification: a single severe symptom — such as difficulty breathing alone, even without other signs — is sufficient to give adrenaline. Do not wait for multiple signs to develop simultaneously.

Antihistamines treat mild allergic reactions only. They do not treat anaphylaxis. Administering an antihistamine when anaphylaxis is present wastes critical time. When in doubt — give adrenaline, call 000.

Training Requirements: What Courses Cover Anaphylaxis Management

The following table summarises the nationally recognised first aid qualifications that include anaphylaxis management, and how the 2026 ASCIA updates apply to each:

Qualification	Unit Code	Anaphylaxis Coverage	ASCIA Alignment	Who Needs It
Provide First Aid	HLTAID011	Anaphylaxis recognition, EpiPen use, ASCIA action plan basics	Updated to reflect 2026 guidance	Most workplaces, hospitality, events
Provide First Aid in an Education and Care Setting	HLTAID012	Full anaphylaxis management including child-specific action plans, auto-injector and new device awareness	Updated to reflect 2026 ASCIA action plan format and new devices	Schools, childcare, OSHC, family day care
Anaphylaxis Management (VIC course, accepted nationally)	22578VIC	Dedicated anaphylaxis management — deepest coverage of ASCIA plans, devices, and sector-specific requirements	Specifically aligned to ASCIA guidelines	Education and care settings requiring dedicated anaphylaxis unit
ASCIA Anaphylaxis e-Training	Online (not nationally recognised unit)	Comprehensive ASCIA guideline content, action plan literacy, device instructions	Direct from ASCIA — most current	All school and childcare staff; complements RTO qualifications

(HLTAID012 — training.gov.au) (HLTAID011 — training.gov.au)

Preparing Your Team: An Anaphylaxis Compliance Checklist for 2026

Audit all current action plans. Identify any plans that predate the 2026 ASCIA revisions. Notify families to obtain updated plans from their allergist or immunologist.
Check device inventory. Confirm that EpiPens (and any prescribed intranasal adrenaline) are in date, correctly stored, and known to all relevant staff. Emergency EpiPens held by the service should also be checked.
Update your policies and procedures. Ensure your anaphylaxis management procedure references the 2026 ASCIA action plan format and includes guidance on intranasal adrenaline if relevant.
Schedule first aid refresher training. Staff holding HLTAID011 or HLTAID012 who trained before 2025 may not have received 2026 ASCIA update content. A refresher or onsite update session is advisable.
Run a response drill. A timed drill — from trigger to adrenaline administration to 000 call — reveals gaps that written procedures do not. Southport, Helensvale, Coomera, and Burleigh Heads childcare services should consider annual drills as minimum practice.
Confirm training currency for all staff. HLTAID011 renews every 3 years; HLTAID012 renews every 3 years with annual CPR. Check that no certificates have lapsed in your team.
Ensure new staff receive onboarding training, not just an introduction to where the EpiPen is stored. Physical practice with a trainer device is the minimum standard.

Book Now: SKLD Training — group and onsite first aid training for Gold Coast schools and businesses

Frequently Asked Questions

What has changed in the ASCIA Anaphylaxis Action Plan for 2026?

The 2026 ASCIA updates include redesigned infographics for easier reading under stress, clearer escalation criteria (a single severe symptom such as breathing difficulty is sufficient to give adrenaline), formal recognition of intranasal adrenaline spray (Neffy) as a TGA-approved device, and reinforced guidance that the person must not stand or walk at any point — even if they feel better after adrenaline. The core sequence remains unchanged: adrenaline first, call 000, lay flat, monitor, repeat dose at 5 minutes if needed. (ASCIA e-Training — allergy.org.au)

What is intranasal epinephrine and is it replacing the EpiPen?

Intranasal epinephrine (adrenaline delivered as a nasal spray, brand name Neffy) is a TGA-approved alternative device for anaphylaxis management. It is not replacing the EpiPen as the standard device — auto-injectors remain the primary option. However, some individuals may be prescribed intranasal adrenaline as part of their action plan, particularly those who are needle-phobic or for whom an allergist has judged it appropriate. First aiders should always follow the individual's action plan and be familiar with the correct technique for whichever device is prescribed.

Do QLD schools need to update their anaphylaxis policies following the 2026 changes?

Yes. Schools and ECEC services in Queensland are expected to implement the current ASCIA action plan format and ensure their anaphylaxis management procedures reflect current guidance. Services that hold emergency adrenaline or manage children with individual action plans should review their policies against the 2026 ASCIA materials and update accordingly. Training should reflect the current ASCIA content.

Does HLTAID012 cover the 2026 ASCIA anaphylaxis updates?

HLTAID012 (Provide First Aid in an Education and Care Setting) includes anaphylaxis management aligned to current ASCIA guidelines. RTOs are expected to deliver course content that reflects current guidance. If your HLTAID012 was completed before 2025, a refresher or update session through a current RTO is advisable to ensure your knowledge is aligned with the 2026 ASCIA materials. Check current course dates with SKLD Training.

Can first aiders administer adrenaline in Queensland without a prescription?

In Queensland, lay first aiders are generally permitted to administer an adrenaline auto-injector in a life-threatening anaphylaxis emergency, following the individual's documented action plan. This includes administering the person's own prescribed device, or an emergency adrenaline device held by the service under relevant state health provisions. Always follow the individual's action plan and call 000 immediately. Confirm the current QLD legislative position with your employer and the Queensland Health authority.

How often does anaphylaxis first aid training need to be renewed?

HLTAID011 is renewed every 3 years. HLTAID012 is renewed every 3 years with the CPR component renewed annually. ASCIA recommends their free anaphylaxis e-training be completed annually or biennially by school and childcare staff. Given the 2026 updates, any staff member who has not trained recently should complete a refresher regardless of their certificate expiry date. Enquire about group training with SKLD Training.

Training and assessment delivered on behalf of Allens Training Pty Ltd RTO 90909.