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


  1. Resuscitation Council (UK) Guidelines. January 2008.Available at: Accessed on 03 June 2011.
  2. 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
  3. Muraro A, Roberts G, Clark A, et al. Allergy 2007;62:857–871.
  4. Korenblat P et al. Allergy Asthma Proc.1999;20(6):383-386.
  5. Kemp SF et al. World Allergy Org J 2008;1(7):S18-S26.