All schools in the UK will be allowed to buy spare adrenaline auto-injectors for use on children with serious allergies in emergencies, following a change in the law.

At present, children need a prescription to have one in school.

In the UK, 17% of fatal allergic reactions in school-aged children happen while at school.

From 1 October 2017, all primary and secondary schools will be able to order extra adrenaline auto-injectors, such as EpiPen, Jext or Emerade, from pharmacies, and store them for use in emergencies.

Children with severe allergies will be able to access the life-saving treatment if they need an extra dose, if their allocated device is not available, doesn’t work properly or is used incorrectly.

The spare devices can only be used on pupils at risk of anaphylaxis – a life-threatening allergic reaction – where consent from doctors and parents has already been obtained.

The Department of Health has issued new guidance for schools on how to use adrenaline auto-injectors.

It describes how to recognise the signs of a mild allergic reaction and the more serious anaphylaxis.

Anaphylaxis is a life threatening severe allergic reaction. It is a medical emergency and requires immediate treatment.

A severe allergic reaction can cause an anaphylactic shock and must be treated with an adrenaline pen.

What Causes an Anaphylactic Reaction?

In most allergic reactions the resulting chemicals are released locally into the tissues in a particular part of the body (skin, eyes etc.). This means the symptoms of the allergic reaction usually only occur in this area.

In anaphylaxis, the chemicals that cause the allergic symptoms (e.g. histamine) are released into the bloodstream. The symptoms of anaphylaxis usually occur within minutes of exposure to the trigger substance (allergen) but sometimes an hour or so later.

The most common causes of anaphylactic reactions include:

• certain foods (including peanuts, tree nuts or shellfish). However, all foods can potentially cause anaphylaxis
• insect stings
• drugs and contrast agents (used in some x-ray tests), particularly those given by injection

The Symptoms of Anaphylaxis

Any or all of the following symptoms may be present during an anaphylaxis reaction:

• Swelling of tongue and/or throat
• Difficulty in swallowing or speaking
• Vocal changes (hoarse voice)
• Wheeze or persistent cough or severe asthma
• Difficult or noisy breathing
• Stomach cramps or vomiting after an insect sting
• Dizziness / collapse / loss of consciousness (due to a drop-in blood pressure) (floppiness in babies) 

Treatment for Anaphylaxis

Steps you need to follow if someone is having an anaphylactic shock:

1. The first line treatment for severe symptoms is adrenaline (epinephrine) given by an injection into the upper outer muscle of the thigh. Adrenaline given in this way is a safe treatment and you should not hesitate to use it if required. It starts to work within minutes, reducing swelling, relieving wheeze and improving blood pressure. Adrenaline is life saving and must be used promptly in anaphylaxis. Delaying the giving of adrenaline    can result in deterioration and death. This is why using an adrenaline device is the first line treatment for anaphylaxis. IF IN DOUBT, GIVE ADRENALINE FIRST and then call for help.
2. Do not wait to see if the symptoms clear up – call an ambulance immediately. All patients receiving emergency adrenaline should be transported to hospital for further care. Dial 999 and inform the controller that the patient is suffering from anaphylaxis.
3. Adrenaline is a short-acting drug and the effects will wear off quite quickly. If there is no response to the initial injection, current recommendations are to give a further adrenaline dose after 5 minutes.

If you are suffering from an anaphylactic shock, you should use your adrenaline pen immediately. While waiting for the ambulance, it is better if you lie down as this helps to maintain your blood pressure and avoids injury if you faint. You may be more comfortable with your shoulders raised a bit if you feel wheezy or short of breath 

Name of drug

Adrenaline (also known as epinephrine)

Brand names: Emerade® ,EpiPen®, Jext®

(intramuscular injection for self-administration)

Why is it important to use the adrenaline?

Anaphylaxis is a severe allergic reaction, which may be life-threatening. It usually occurs straight after coming into contact with the trigger (also called the allergen); however, it can occur a few hours later. Different people have different triggers, such as foods (e.g. peanuts, eggs or seafood), medicines (e.g. penicillin) or animals (e.g. bee or wasp stings).

By using the adrenaline auto-injector as soon as your child has signs of an anaphylactic reaction, you may be able to prevent a full-blown reaction, while you wait for an ambulance.

What is adrenaline available as?

• Emerade 150 micrograms: delivers 150 micrograms of adrenaline
• Emerade 300 micrograms: delivers 300 micrograms of adrenaline
• Emerade 500 micrograms: delivers 350 micrograms of adrenaline
• EpiPen Auto-injector 0.3 mg (yellow label): delivers 300 micrograms of adrenaline
• EpiPen Jr Auto-injector 0.15 mg (white label with yellow stripe): delivers 150 micrograms of adrenaline
• Jext 300 micrograms: delivers 300 micrograms of adrenaline
• Jext 150 micrograms: delivers 150 micrograms of adrenaline

How should I give it?

There are three different types of adrenaline auto-injector – Emerade, EpiPen and Jext. These are used in different ways. You MUST follow the instructions provided with your auto-injector. If you follow the wrong instructions, you risk injecting the adrenaline into your own thumb. The auto-injector must only be used in the thigh. Never inject it anywhere else on the body, as this could do harm.

Giving adrenaline auto-injector in the thigh

Detailed information on how to use adrenaline auto-injectors can be found on the manufacturers’ websites:

Emerade – www.emerade-bausch.co.uk

EpiPen – www.epipen.co.uk

Jext (Lifeline) – www.jext.co.uk

Keep your autoinjectors in date but remember that even an out of date pen is better than nothing.

After giving adrenaline

You must take your child to hospital after using the autoinjector, even if they seem well. Take the auto-injector with you, where it can be safely disposed of.

When should the medicine start working?

The medicine should start working immediately. If your child’s symptoms have not improved 5 minutes after using the auto-injector, give another dose of adrenaline using a new pen. Keep the child in the recovery position or lying down till help arrives.

Even if you are not sure the first injection worked properly, you must wait at least 5 minutes before giving another injection. Otherwise you risk giving too much.

What if my child is sick (vomits)?

You do not need to give another dose of adrenaline, as it will still work.

What if I give too much?

You are unlikely to do harm if you give an extra dose of adrenaline by mistake. If you are concerned, discuss this with your doctor when you get to the hospital.

Are there any side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Your child may get any (or none) of the following side-effects after using the adrenaline auto-injector but they usually do not last for long:

• feeling sick or being sick (vomit)
• fast or irregular heart rate (feeling that the heart is racing or fluttery)
• cold hands and feet
• difficulty breathing
• feeling anxious, shaky, restless, weak or dizzy
• headache
• sweating
• difficulty passing urine (doing a wee)
• the skin where the adrenaline was injected may go pale or feel sore

Is there anything else I need to know about this medicine?

The auto-injector must only be used in the thigh. Never inject it anywhere else on the body, as this could do harm.

Make sure you know how to use the auto-injector correctly, otherwise it may not work. Remember that EpiPen, Jext and Emerade are used in different ways, so make sure you know how to use the one your child has.

Make sure that your child has their auto-injector with them at all times.

Make sure that anyone who looks after your child knows what to do and how to use the auto-injector if your child has an anaphylactic reaction. You may need to make special arrangements with your child’s school or nursery.

If someone accidentally injects the adrenaline into their hands or fingers, the blood flow to this area may stop (the skin will go pale). Take the person to hospital straight away.

Make sure that you always have at least two auto-injectors. Order a new prescription as soon as you have used one.

Make sure that the auto-injector you carry with you is still within its ‘use by’ date. Give old pens to your pharmacist to dispose of.

Where I should keep this medicine?

There are differences between each brand – check the manufacturers’ website for detailed information on how to store your child’s auto-injectors.

Keep the auto-injectors out of the reach and sight of other children.

Keep the auto-injectors in the box they came in, to protect the contents from light.

If you have EpiPen or Jext auto-injectors, check, from time to time, that the liquid in the glass container is clear and colourless. If it is pink or brown, or has bits in it, order a new prescription and throw the old auto-injector away.

At Dears Pharmacy we are committed to supporting schools to purchase adrenaline pens. We stock all three brands and they are available at £47.95 each including advice and support from our team of pharmacists. 

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