The MHRA's updated advice for healthcare professionals to prescribe two auto-injectors, which patients at risk of anaphylaxis should carry at all times, comes after a European review identified uncertainties about the site of drug delivery and the speed of adrenaline action within the body.
It is particularly important for patients who also have allergic asthma to carry two auto-injectors at all times because they are at increased risk of a severe anaphylactic reaction.
Prescribers should consider needle length when choosing a suitable auto-injector and must ensure the patient or carer thoroughly understands how and when to use the device they have been prescribed as technique varies between devices. Currently available auto-injectors in the UK are Emerade, EpiPen and Jext.
Patients and carers should be encouraged to obtain and practise administration of these auto-injectors using a trainer device, available for free via the manufacturers' websites.
When prescribed adrenaline auto-injectors, patients should be advised to use the device at the first signs of a severe allergic reaction and then immediately take the following actions:
- Call 999, ask for an ambulance and state 'anaphylaxis', even if symptoms are improving
- Lie flat with legs raised to maintain blood flow (if they have breathing difficulties, they may need to sit up)
- Seek help immediately and if at all possible make sure someone stays with them while waiting for the ambulance
- If they do not start to feel better, they should use the second auto-injector 5–15 minutes after the first one.
Patients must check the expiry date of their auto-injectors and obtain replacements before the devices expire. Manufacturer websites provide expiry alert services to which patients can sign up.
These instructions are summarised in an updated advice sheet for prescribers to give to patients and carers.