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3.4.3 Allergic emergencies

Patient Use

ChoiceDrugDosage
Ensure patient is trained on use of device prescribed
Formulary choicesEpiPen® Auto-injector 0.3mg (delivering a single dose of adrenaline 300 micrograms)Dose: (adrenaline for self-administration)
300 micrograms repeated after 5 minutes as necessary
Or
Emerade® 300micrograms adrenaline autojector; 500 micrograms adrenaline autojectorDose: (adrenaline for self-administration)

Emerade 300micrograms: Adult (body-weight 31Kg and above) - 300micrograms, then 300 micrograms after 5 minutes as required, on the basis of a dose of 10micrograms/Kg, 500 micrograms may be more appropriate for some patients, depending on clinical judgement.

Emerade 500micrograms: Adult (body weight 60Kg and above) – 500 micrograms, then 500 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 repeated after 5 minutes as necessary

Healthcare Professional Use

ChoiceDrugDosage
Formulary choiceAdrenaline 1 in 1000 (1mg/mL) injectionDose:
Intramuscularly, 0.5mL repeated if necessary at 5 minute intervals according to blood pressure, pulse and respiratory function

Prescribing Notes

  • The Resuscitation Council do not recommend the use of auto-jectors by health care professionals for a number of reasons. Adults should receive 500 micrograms of adrenaline for the management of anaphylaxis.
  • Adrenaline should be given immediately for an acute anaphylactic reaction (laryngeal oedema, bronchospasm and hypotension).
  • Chlorphenamine injection is a useful adjunctive treatment given after adrenaline injection and continued for 24 to 48 hours to prevent relapse.
  • Hydrocortisone injection is of secondary value in the initial management of anaphylactic shock because the onset of action is delayed for several hours, but should be given to prevent further deterioration in severely affected patients.
  • Patients with known severe allergy should carry and receive instruction for the use of prefilled syringes (e.g. EpiPen®/Jext®) for self-administration. Patients should usually be prescribed two devices (four in children).
  • 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.