The chief aim of this page is to help people with allergies – particularly those who are newly diagnosed – to get to grips with the most important issues surrounding allergy, so that they can stay out of harm and treat any allergic reaction should it occur.
Setting up a care plan
Research has provided strong evidence showing that the risks from allergy will be reduced if you follow a written care plan. A care plan will help you recognise when an allergic reaction has started and show you how to treat it. Your allergy clinic or GP may help you set this up, or the Anaphylaxis Campaign helpline can offer guidance (telephone 01252 542029 or email us).
The British Society for Allergy and Clinical Immunology (BSACI) has also created a guide to writing a care plan to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training or equipment apart from access to an adrenaline auto-injector (AAI). For more information read about allergy action plans.
Care plans in settings such as schools should be reviewed every year.
The importance of adrenaline
Adrenaline is an important drug that is used in a number of emergency medical situations. It is the first line treatment for severe allergic reactions (anaphylaxis) and is available on prescription in a pre-loaded injection device (known as an adrenaline auto-injector or AAI).
At the BSACI 2020 Conference, hosted digitally in October, we collaborated on an awareness-raising video with pharmaceutical company Mylan to highlight the importance of carrying two adrenaline auto-injectors at all times, ensuring these are valid and in date, and understanding the correct way to use to the device.
Carrying your medication
If you have been prescribed treatments for your allergy — such as injectable adrenaline — the golden rule is clear: carry it everywhere at all times, with no exceptions. It’s important to make sure others are aware of what to do when a reaction occurs, such as relatives, close friends and colleagues.
About adrenaline injectors
There are three adrenaline auto injectors (AAIs) available on prescription in the U.K. The manufacturers of all three offer trainer devices so people can learn how to use them.
EpiPen® has a spring-loaded concealed needle. The built-in needle protection keeps the needle covered during and after use. Visit www.epipen.co.uk.
Jext® has a locking needle shield which engages after use, designed to protect against needle injury. Visit www.jext.co.uk.
Emerade® has a needle guard to protect against needle stick injury. Visit www.emerade-bausch.co.uk.
How many injectors should I carry?
The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) has advised that anyone who is at risk of suffering anaphylaxis should always have two adrenaline injector devices immediately available for use. Their report said: “It is acknowledged that in some cases, a single injection is not sufficient to achieve a response for a number of reasons, including severity of attack as well as the possibility that a dose has not been effectively administered; a second injection may therefore be needed”. The Anaphylaxis Campaign supports this view.
In cases where the risk of anaphylaxis is thought to be low, there is a difference of opinion among members of the medical community. While some doctors agree that two injectors must always be immediately available, in line with the MHRA report, others believe it is sufficient to have one device available, arguing that one injection is likely to be enough to treat the symptoms until emergency medical help arrives.
This is a matter that you should discuss thoroughly with your allergist.
Checking your device
Your adrenaline auto-injector devices should be checked regularly to ensure the liquid is clear and colourless. If it appears discoloured or contains particles, the device should be replaced. If you have just received a new device and this device looks defective, please return immediately and report using the MHRA’s Yellow Card Scheme https://yellowcard.mhra.gov.uk/
If you have asthma as well as allergies, your asthma should be well controlled. Poorly-controlled asthma will raise the chances of any allergic reaction being severe. If your asthma needs more treatment than usual, you should take extreme care to avoid those foods or substances that might cause a reaction. You will also need to discuss your asthma with your GP.
If you or your child carries adrenaline, there are key messages you must remember:
- Have your adrenaline with you at all times, no exceptions.
- Check the expiry date regularly. An out-of-date injector may offer some protection, but this will be limited. Sign up to the expiry alert service via the manufacturers website to give you ample warning when a new prescription is required.
- Get a health professional to show you how to use your injector. If you haven’t already been shown how, go back to the doctor who prescribed it and ask for a demonstration. Ask the practice nurse at your local GP surgery or the school nurse. Our AllergyWise online training courses can also help or alternatively, visit the manufacturers website to watch demonstration videos.
- Get hold of a “trainer” pen and practice regularly. See the links above relating to individual adrenaline injectors.
- If you suspect a reaction is serious or becoming serious, use your injector immediately. Dial 999 or get someone else to do it. Whoever telephones must tell the operator the patient is suffering from anaphylaxis and must ask for a paramedic ambulance. You will need to get to hospital because the symptoms can return and you may need further treatment.
- Remember that children who have been prescribed Jext or Emerade adrenaline injectors need to go on to the higher dose when they weigh 30kg or 4 stone 9 lbs. This is likely to be somewhere between 5-11 years old. Infants and children who have been prescribed EpiPen will be prescribed the Junior version if they weigh between 7.5kg and 25kg. The higher dose EpiPen is suitable for adults and children weighing over 25kg.
For more information and advice please call our helpline on 01252 542029 or email our helpline team.
Wear a MedicAlert ID
If you experience a reaction, you may not be able to speak for yourself. Wearing a MedicAlert ID bracelet or necklace means you can point to it, highlighting your allergy and that you’re carrying an adrenaline auto-injector. If you are in any other emergency, such as an accident, it will also allow the hospital to know that you are allergic to any medications and/or natural rubber latex. You can save £10 with code ANA10
This article has been reviewed by Sue Clarke, who is nurse adviser to the Anaphylaxis Campaign.
All the information we produce is evidence based or follows expert opinion and is checked by our clinical and research reviewers. If you wish to know the sources we used in producing any of our information products, please let us know, and we will gladly supply details. Call our helpline (01252 542029) or email email@example.com.
Publication date: August 2019
Review date: August 2022