Prescribing Adrenaline

Adrenaline (epinephrine) is the emergency treatment for a serious allergic reaction. If it’s given quickly, it can treat the features of anaphylaxis by acting on adrenoceptors.

  • As an alpha-receptor agonist, it reverses vasodilatation and reduces oedema.
  • As a beta-receptor, it dilates the airways, increases the force of myocardial contraction, and suppresses further histamine and leukotriene release.

Who Needs to be Prescribed Adrenaline?

Allergic reactions vary in severity. In its 2016 guidelines, the British Society of Allergy and Clinical Immunology (BSACI) suggests that people who should be considered for long-term provision of an adrenaline auto-injector include those:

…who have suffered an anaphylactic reaction where the cause is unknown (idiopathic anaphylaxis)

…who have suffered an anaphylactic reaction where the known allergic trigger cannot easily be avoided

…who are allergic to high-risk allergic triggers, for example nuts, with other risk factors also present, such as asthma, even if the reaction was relatively mild

…who had a reaction in response to trace amounts of the allergic trigger

…where an anaphylactic reaction triggered by food is only likely to occur if that food is eaten around the time of physical exercise (known as Food-Dependant Exercise-Induced Anaphylaxis or FDEIA).

…where other significant risk factors are present (such as asthma in someone with a food allergy).

Posters for Healthcare Professionals

For our Anaphylaxis Awareness Week 2023 we designed five posters on the recent guidance issued by the BSACI titled Adrenaline Auto-Injector Prescription for Patients at Risk of Anaphylaxis: BSACI Guidance for Primary Care. Our posters aim to support busy healthcare professionals by focusing on the key points of different aspects of the guidance to enable effective management of serious allergies in primary care across the UK.

Download and share these posters with colleagues and display them in your place of work.

What adrenaline auto-injectors should be prescribed?

The adrenaline auto-injectors available in the UK are:

EpiPen

EpiPen® is currently available in two doses:

Adult: 0.3mg of adrenaline 1:1000

Junior: 0.15 mg of adrenaline 1:2000

Junior is suitable for children weighing 7.5kg – 25kg  (1 stone 3lbs – 3 stone 13lbs).

The 0.3mg dose is indicated for children larger than 25kg and all adults.

Jext

Jext® is available in two doses:

Adult: 300 mcg of adrenaline 1:1000

Junior: 150 mcg of adrenaline 1:1000

Junior is suitable for children weighing 15kg – 30kg (2.4 – 4.5 stone).

The 300 mcg dose is indicated for children larger than 30kg and all adults.

Emerade

Emerade® is available in 3 doses:

Adult: 500 mcg of adrenaline 1:1000

Adult: 300 mcg of adrenaline 1:1000

Junior: 150 mcg of adrenaline 1:1000

Junior is suitable for children weighing 15kg -30kg  (2.4 – 4.5 stone).

The 300 mcg dose is indicated for children and adults over 30kg. The indicated dose for individuals over 60kg bodyweight is 300 or 500 mcg, depending on clinical judgement.

Prescribing Devices

In its 2023 guidance, The UK’s Medicines and Healthcare products Regulatory Agency (MHRA), recommends prescribing two adrenaline auto-injectors, and patients should carry these at all times.

Training patients to use their auto-injectors

The MHRA also recommend that professionals:
  • right_arrow_orange_icon Ensure that people with allergies and their carers have been trained to use the particular auto-injector that they have been prescribed, as technique varies between injectors.
  • right_arrow_orange_icon Encourage people with allergies and their carers to obtain and practice using a trainer device. These are available for free from the manufacturers’ websites.
  • right_arrow_orange_icon For further details see the MHRA guidance.

How & When to Use Adrenaline

Because the course of serious allergic reactions is varied and unpredictable, it is difficult to define when adrenaline is best administered. The UK Resuscitation Council recommends giving adrenaline as soon as there is stridor (noisy breathing), respiratory distress, wheezing or clinical signs of shock. Urgent transfer to hospital is vital.

Adverse Effects of Adrenaline & Drug Interactions

Unwanted effects are rare when appropriate doses of adrenaline are given. However, prescribers should consider all co-existing medical conditions and check for potential interactions. For example, beta-blockers and ACE inhibitors may hinder treatment.

When prescribing medicines for people with food allergies, check the ingredients and excipients to ensure the food allergens they react to are not present.

Replacing Adrenaline Auto-Injectors

Adrenaline injectors have expiry dates and may be less effective after that date. Therefore, it is helpful to do a regular audit of prescribed adrenaline to identify patients whose last prescription was more than two years ago. The MHRA have also produced an infographic to give to patients, and manufacturers have an expiry alert service.

AllergyWise for Healthcare Professionals

AllergyWise is our series of e-learning courses, providing an easy way to learn about anaphylaxis and how to manage serious allergies.

We have two courses available for healthcare professionals covering topics such as early recognition of symptoms, emergency treatment, using auto-injectors, and patient management.

  • AllergyWise for Care Workers.
  • AllergyWise for Healthcare professionals aimed at  school nurses, health visitors and other healthcare professionals working in a community setting.

A brighter future for people living with serious allergies