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Home Formulary 3.0 Respiratory System 3.4 Antihistamines, hyposensitisation and allergic emergencies 3.4.3 Allergic emergencies

3.4.3 Allergic emergencies

3.4.3.1 Patient Use

ChoiceDrugDosage
Ensure patient is trained on use of device prescribed
Formulary choices

EpiPen® Auto-injector 0.3mg

(delivering a single dose of adrenaline 300 micrograms)

Dose: (adrenaline for self-administration) 300 micrograms, then 300 micrograms after 5 minutes as required
Or

Jext® 300 micrograms adrenaline autojector

(delivering a single dose of adrenaline 300 micrograms)

Dose: (adrenaline for self-administration)
300 micrograms, then 300 micrograms after 5 minutes as required

3.4.3.2 Healthcare Professional Use

ChoiceDrugDosage
Formulary choiceAdrenaline 1 in 1000 (1mg/mL) injection (1ml ampoules)Dose: Intramuscularly, 500 micrograms (0.5ml), using adrenaline 1 in 1000 (1mg/ml) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, to be injected preferably into the anterolateral aspect of the middle third of the thigh.

Prescribing Notes

  • Refer to the Resuscitation Council UK for the Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers.
  • The Resuscitation Council do not recommend the use of auto-jectors by healthcare professionals for a number of reasons. Adults should receive 500 micrograms of adrenaline for the management of anaphylaxis. It is good practice to keep adrenaline 1mg in 1ml ampoule(s) for intramuscular use for the treatment of anaphylaxis in an ‘anaphylaxis pack’.
  • Adrenaline should be given immediately for an acute anaphylactic reaction (laryngeal oedema, bronchospasm and hypotension).
  • Patients with known severe allergy should carry, and receive instruction for the use of, prefilled syringes (EpiPen®/Jext®) for self-administration. Adults should usually be prescribed two devices.
  • Adrenaline for self-administration should be prescribed by brand name to ensure that the patient gets the device that they have been taught to use.
  • MHRA Adrenaline auto-injectors (AAIs): new guidance and resources for safe use (June 2023) provides updated advice on body positioning.

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