Self-treatment should be an option to all individuals who have had anaphylaxis in the past with ongoing risk of further attacks. For incapacitated subjects and children, relatives, friends or teachers should be taught how to give adrenaline. The golden rules are:
- teach individual comprehensively how to use adrenaline device
- carry adrenaline at all times
- label adrenaline pack so bystander can follow simple instructions to give adrenaline
- ensure adequate supply of adrenaline to cover time for ambulance to arrive at scene
There are several devices that can be carried by the sufferer:
- Min-I-Jet Adrenaline: a 1ml disposable, prefilled syringe with short needle for subcutaneous use. The concentration of adrenaline is 1 in 1000, so the patient has to measure the dose
- adrenaline auto-injectors are authorised for the emergency treatment of severe acute allergic reactions (anaphylaxis) triggered by allergens in foods, medicines, insect stings or bites, and other allergens, as well as for exercise-induced or idiopathic anaphylaxis. Adrenaline auto-injectors available in the UK are:
- in addition to advice in the Summary of Product Characteristics and Patient Information Leaflet, each brand of adrenaline auto-injector has educational materials available for healthcare professionals and patients. People with allergies and their carers can also use manufacturers’ websites to order trainer devices and to sign up for expiry alert services.
- each brand of adrenaline auto-injector is available in more than one strength (corresponding to the dose delivered by the device). Broadly, the lower strength is suitable for younger children and the higher strengths suitable for older children and adults.
- only one brand of adrenaline auto-injector (Emerade) is available in a 500 microgram strength, with the other 2 brands being available in a maximum strength of 300 microgram. The labelled strength of adrenaline auto-injectors reflects the dose of adrenaline dispensed by the device in a single injection. However, the amount of adrenaline reaching the bloodstream in a particular time window can differ according to patient-specific and device-specific factors
- evidence found that in healthy people, adrenaline auto-injectors of the same strength but with shorter needles and potentially higher propulsive force (EpiPen and Jext 300 micrograms) delivered more of the adrenaline dose to the bloodstream in the first 30 minutes than did the Emerade 300 microgram auto-injector (2)
- as such, the Epipen or Jext brands of 300 microgram adrenaline auto-injector are both suitable alternatives to the Emerade 500 microgram adrenaline auto-injector
- Advice for healthcare professionals (2):
- Emerade 300 microgram and 500 microgram adrenaline auto-injectors have been re-supplied to the market following the implementation of corrective actions to resolve the issue that caused some devices to fail to activate and deliver adrenaline
- for each adrenaline auto-injector, follow advice in the Summary of Product Characteristics to prescribe appropriate doses for individual patients (see section on dosing considerations)
- remind patients to follow existing advice to carry 2 in-date adrenaline auto-injectors with them at all times and to replace them before they expire
- provide patients and their caregivers with training and advice specific to their prescribed adrenaline auto-injector; encourage them to order a trainer device from the manufacturer to ensure they are familiar with using their auto-injector
- suspected adverse drug reactions or defective medicines should be reported to the Yellow Card scheme
- Further information for prescribers and patients on adrenaline blood level data is included in the MHRA summary (2) and in the Summary of Product Characteristics for each medicine
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