GPs - Key decisions on prescribing adrenaline
Who needs adrenaline?
Allergic reactions vary in severity. Many allergy doctors believe it would be reasonable to prescribe injectable adrenaline together with oral antihistamine for anyone who has had an allergic reaction that:
- Was severe (laryngeal oedema, respiratory or hypotensive symptoms)
- Or was associated with respiratory symptoms (even mild)
- Or occurred on exposure to only a trace amount of allergen
- Or occurred in someone who has asthma that requires regular inhaled corticosteroid therapy
The decision to prescribe adrenaline should be part of an approach that includes a thorough assessment of the patient. This can ideally be done at a specialist allergy clinic or by a doctor who has had training in allergy management.
When and how to use adrenaline
The varied and unpredictable course of severe allergic reactions makes it difficult to define when adrenaline is best administered. The UK Resuscitation Council recommends giving adrenaline as soon as there is stridor, respiratory distress, wheeze or clinical signs or shock. Urgent transfer to hospital is vital. Visit www.resus.org.uk/pages/reaction.pdf
How many devices to prescribe
There is no consensus among experts about how many devices to prescribe for each person. Some advise that patients should have one device at each site that they regularly attend (e.g. home, school). Others advise there should be two devices in each location in case one is broken or misfires. Regular training and re-training should help avoid problems. A second dose may be needed even if the first is given early enough. Therefore it may be safest to prescribe at least two devices so that a spare is available if the first misfires or the reaction is slow to respond before the emergency services arrive. This would certainly be appropriate if the patient is going to a remote location where prompt medical attention is unavailable.
