2.5 Adverse & Allergic Reactions, First Aid Kits & Treatment-Room Emergencies

1. Adverse Reactions Versus Allergic Reactions

An adverse reaction is any unwanted response to a service or product. The exam separates two mechanisms:

An immediate (Type I) allergic reaction such as urticaria (hives), angioedema (swelling of lips, eyelids or tongue) or anaphylaxis can occur within minutes of exposure, for example to latex gloves or a botanical ingredient. Anaphylaxis is life-threatening.

Signs and symptoms to watch for during a service:

• redness or heat beyond what the service normally causes;
• itching, burning or stinging that gets worse rather than settling;
• swelling, especially around the eyes and lips;
• hives or raised welts;
• blistering, weeping or "frosting" (whitening) of the skin;
• watery, red or painful eyes after tinting or lash work; and
• trouble breathing, wheezing, throat tightness, dizziness, or a pale, clammy appearance.

2. Correct Action When a Reaction Occurs

1. Stop the service immediately and tell the client calmly what you are doing.
2. Remove the product. Rinse with cool water or cool, wet compresses. For a lash adhesive or tint reaction, remove the product only if doing so will not cause more irritation. Follow the manufacturer's removal instructions.
3. Do not layer on other products. Avoid "fixing" it with an acid, a strong botanical or a heavy occlusive over a burn. A cool compress soothes safely.
4. Assess severity. For localized, mild redness, cool and calm the skin and monitor it. For blistering, spreading rash, eye involvement or symptoms that persist, refer the client to a physician. Estheticians do not diagnose or treat medical conditions.
5. Call 911 for any sign of anaphylaxis: hives with breathing difficulty, swelling of the tongue or throat, wheezing, faintness or confusion. If the client carries an epinephrine auto-injector, help them use it according to its instructions while you wait for emergency services.
6. Document the date, product (with batch number if possible), service, symptoms, actions taken and your referral on the client record. Keep a note of the product so you can avoid it in future.
7. Report product problems. Under the federal Modernization of Cosmetics Regulation Act of 2022, the company responsible for a cosmetic must report serious adverse events to the FDA. Practitioners and consumers may also report reactions to the FDA voluntarily.

Prevention is the best correct action: a thorough intake form, asking about allergies and past reactions, patch tests when directions recommend them (Minnesota requires you to offer one), and matching products to the client's skin condition (see sections 2.4 and 6.1).

3. The First Aid Kit

Minnesota requires every salon to keep a readily accessible first aid kit meeting National Standard ANSI Z308.1-2015 or the most recent version (Minn. R. 2105.0370, item A). Homebound permit holders carry one when working outside a licensed nursing home (Minn. R. 2105.0410, subp. 3).

ANSI Z308.1 defines Class A kits for common workplace injuries and Class B kits for higher-risk settings. A Class A kit includes items such as:

• adhesive bandages, sterile pads and adhesive tape;
• antiseptic and antibiotic application packets;
• a burn dressing and burn treatment;
• a cold pack;
• eye coverings and an eye or skin wash;
• medical exam gloves and hand sanitizer;
• a breathing barrier for rescue breaths;
• a triangular bandage and a roller bandage;
• scissors; and
• a first aid guide.

Restock after every use. For blood exposures, the kit supplies gloves, antiseptic and sterile bandages, matching steps A–C of Minn. R. 2105.0375, subp. 5 (see section 2.3).

4. Treatment-Room Emergencies

Chemical burn from a peel or other exfoliant. Signs include intense burning, patchy redness or sudden white frosting. Stop immediately. Remove the product and flood the area with cool water, or use the neutralizer if the manufacturer's protocol provides one, and keep rinsing. Never apply steam, heat or heavy occlusives over a fresh chemical burn. Refer the client for medical care if blistering or frosting occurred.

Chemical splash to the eye (tint, remover, disinfectant). Flush immediately with clean, lukewarm water or an eyewash, holding the eyelids open. Flow from the inner corner outward so the other eye is not contaminated, and keep flushing for at least 15 minutes. Remove contact lenses if possible and seek medical care. Check the product's SDS Section 4 for specific first aid.

Thermal burn (overheated wax or a hot towel). Remove the source. Cool the area under cool running water (not ice) for about 10 to 20 minutes. Cover it loosely with a sterile, non-stick dressing, and do not break blisters. Seek medical care for large, blistered or facial burns. Remember that clients with reduced sensation may not feel the heat.

Fainting (vasovagal syncope). Warning signs are pallor, sweating, lightheadedness, nausea or yawning, which can be triggered by anxiety, extraction discomfort, hunger or sitting up quickly. Stop the service, keep the client lying flat and raise the legs about 12 inches if there is no injury, loosen tight clothing, and apply a cool compress. Never give food or drink to someone not fully alert. Call 911 if the client does not recover promptly or has chest pain, breathing trouble or a seizure. Afterward, have the client sit up slowly.

Seizure. Protect the head, clear the area of equipment, never put anything in the mouth, time the seizure, and call 911 if it lasts more than a few minutes or the client is injured.

Scenario: Ten minutes after a brow tint, a client's eyelids begin to swell and she feels itchy on her neck. The esthetician removes the tint, applies cool compresses, and watches closely. When the client says her throat feels tight, the esthetician calls 911 at once. Throat tightness with spreading hives suggests anaphylaxis. Afterward the esthetician documents the product, batch, timing and actions, and notes the allergy on the record.