Anyone at risk of an anaphylactic reaction should carry a EpiPen® or EpiPen® Jr with them at all times 1, as an immediate injection of adrenaline could be the difference between life and death.
NICE guidelines recommend that all patients admitted with a confirmed or suspected anaphylactic reaction should be prescribed an adrenaline auto-injector while awaiting specialist referral. 2
European guidelines provide the following absolute and relative indications for prescribing adrenaline auto-injectors in children 3:
|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 tree nut|
|Exercise induced anaphylaxis||Remoteness of home from medical facilities|
|Idiopathic anaphylaxis||Allergic reaction to food as a teenager|
Patients may need to carry TWO EpiPens® with them because:
- >35% of patients may require more than one adrenaline dose 4
- As many as 20% of patients will go on to develop a biphasic anaphylactic response many hours later. 5
- Resuscitation Council (UK) Guidelines. January 2008.Available at: http://www.resus.org.uk/pages/reaction.pdf Accessed on 03 June 2011.
- NICE clinical guideline 134. Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode. Issued December 2011
- Muraro A, Roberts G, Clark A, et al. Allergy 2007;62:857–871.
- Korenblat P et al. Allergy Asthma Proc.1999;20(6):383-386.
- Kemp SF et al. World Allergy Org J 2008;1(7):S18-S26.