Adrenaline auto injector prescription guideline

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Objectives

The document provides clear guidance on the prescription of adrenaline auto injectors for children.

Scope

The guidance should be used by healthcare professionals that are involved in potential prescription of adrenaline auto injectors to children.

Introduction

The prescription of an adrenaline injector should only be considered

  • As part of a full allergy assessment including identification of triggers, education on avoidance, assessment of risk and the provision of an allergic reaction management plan or whilst a full assessment is awaited if risk deemed considerable
  • Where adequate training in appropriate usage as been given
  • Where follow-up has been arranged and where rationale for prescription can be reviewed and/or training re-enforced

The prescription of an adrenaline autoinjector should be on the basis of a risk assessment which indicates a significant risk of anaphylaxis. There are currently no agreed national guidelines for the prescription of adrenaline autoinjectors in the UK but various local and international guidelines exist. This guideline represents guidance on the basis of current practice in the RHSC, Glasgow

Recommendations

Adrenaline auto injector prescription is recommended if

  • History of previous anaphylaxis*
  • History of generalized allergic reaction** with nuts (or skin prick test result / RAST test result indicates high risk of reaction and therefore challenge deemed inappropriate) and co-existent asthma requiring regular preventer therapy
  • History of generalized allergic reaction to stinging insect
  • History of idiopathic or exercise induced anaphylaxis
  • History of cardiovascular or respiratory reaction to latex

Adrenaline auto injector prescription may be considered on an individual basis if

  • History of generalized allergic reaction and one or more of the following additional risk factors
    •  co-existent asthma requiring regular preventer therapy
    • generalized reaction to trace amounts of foodstuff
    • limited access to emergency medical care
    • adolescents
Definitions

*Anaphylaxis is a rapidly evolving generalised multi-system allergic reaction characterized by one or more symptoms or signs of respiratory and/or cardiovascular involvement and involvement of other systems such as the skin and/or the gastrointestinal tract.

**A generalized allergic reaction characterized by one or more symptoms or signs of skin and/or gastrointestinal tract involvement without respiratory and/or cardiovascular involvement.

Weight based prescription of adrenaline auto-injector

0-10 kg: Please discuss with allergy clinic consultant if adrenaline prescription considered

10-30kg: Epipen or Anapen junior

30kg: up Epipen or Anapen

Families should be given a prescription for 2 devices only unless a risk assessment indicates an exceptional need for more devices.

Editorial Information

Last reviewed: 13 October 2016

Next review: 11 October 2018

Author(s): C Doherty

Approved By: Area Drugs & Therapeutics Committee