Mild to moderate reaction Cutaneous • urticaria • angioedema Gastrointestinal • tingling mouth • abdominal pain • vomiting* Other signs • face (eye, ear, nose) rubbing • sneezing • sudden onset of clear nasal discharge • conjunctival redness • irritability • clinging to caregiver

Severe reaction (anaphylaxis) Respiratory • swelling of tongue • swelling in throat (e.g. hoarseness, croakiness or difficulty vocalising) • wheeze, stridor or persistent cough • laboured or noisy breathing • low oxygen saturation • rapid respiratory rate for age • low respiratory rate may indicate impending respiratory arrest Cardiovascular • hypotension is a late sign in infants due to high peripheral vascular resistance and can represent a pre-arrest sign • collapse • pallor and floppiness • tachycardia – rapid resting heart rate for age may signal hypotension Behavioural changes • sudden drowsiness • unresponsiveness • loss of consciousness

* abdominal pain and vomiting are signs of anaphylaxis in insect sting or injected drug allergy