Who should have an EpiPen®?
Anyone at risk of an anaphylactic reaction should carry two EpiPen® (adrenaline) auto-injectors or EpiPen®Jr (adrenaline) auto-injectors with them at all times, as an immediate injection of adrenaline could be the difference between life and death.
According to the British Resuscitation Council guidelines, an auto-injector is an appropriate treatment for patients at increased risk of an idiopathic anaphylactic reaction, or for anyone at continued high risk of reaction e.g. to triggers such as insect venom and food-induced reactions (unless easy to avoid), but not usually for drug-induced reactions (unless difficult to avoid).
The draft NICE guidelines (published in July 2011) recommend that all patients admitted with a confirmed or suspected anaphylactic reaction should be prescribed an adrenaline auto-injector while awaiting specialist referral.
European guidelines provide the following absolute and relative indications for prescribing auto-injectors in children:
| Absolute indications | Relative indications |
|---|---|
| Previous cardiovascular or respiratory reaction to a food, insect sting or latex | Any reactions to small amounts of a food (e.g. airborne food allergen or contact only via skin) |
| Child with food allergy and co-existent asthma | History of only a previous mild reaction to peanut or a tree nut |
| Exercise induced anaphylaxis | Remoteness of home from medical facilities |
| Idiopathic anaphylaxis | Allergic reaction to food as a teenager |
Patients should carry TWO EpiPen® (adrenaline) auto-injectors at all times because:
- >35% of patients require more than one adrenaline dose
- as many as 20% of patients will go on to develop a biphasic anaphylactic response many hours later upon leaving medical care.