Emma Hammett A qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience Anaphylaxis is an extremely severe allergic reaction. Reactions usually begin within minutes and progress rapidly, however, they can occur up to 2-3 hours after exposure and exercise can also initiate symptoms a while after exposure to an
Anaphylaxis is an
extremely severe allergic reaction. Reactions usually begin within minutes and
progress rapidly, however, they can occur up to 2-3 hours after exposure and
exercise can also initiate symptoms a while after exposure to an allergen.
Common allergens include food and insect stings.
In the UK, 5–8% of children have a food allergy.
Anaphylaxis can proceed rapidly and failure to administer adrenaline promptly
has been associated with fatalities.
Many children at
risk of anaphylaxis are prescribed adrenaline auto-injectors
(AAI) by their doctor. These devices should be swiftly accessible to them at all
times. AAIs deliver a potentially life-saving dose of adrenaline in the event
of a severe allergic reaction (anaphylaxis).
Why does anaphylaxis occur
How to treat someone experiencing an anaphylactic reaction
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In extreme cases,
the allergic reaction can progress within minutes into a life-threatening reaction. The
treatment of anaphylaxis is to give adrenaline, (usually using an
autoinjector) by injection into the outer muscle of the mid-thigh.
the symptoms and stops it from becoming worse. Other “allergy” medicines, such
as antihistamines can help with mild symptoms but are not effective
for severe reactions (anaphylaxis) as they only reduce the histamine release
and take up to 30 minutes to work – which may be too late.
adrenaline can be lifesaving, but you may need more than one dose.
reactions require more than a single dose of adrenaline. It is therefore vital
to always dial 999 and request an ambulance whenever anaphylaxis has
occurred – even if there has been a good response to the adrenaline
occasionally been reported manufacturing faults which have resulted in the
adrenaline autoinjector device failing to deliver the necessary dose, there are
also issues with human mistakes. It is therefore recommended that anyone prescribed
an adrenaline autoinjector, has immediate access to two at all times.
A second adrenaline
auto-injector can be given 5 minutes after the first.
Adrenaline can be
safely given by non-healthcare workers as an injection into the muscle using an adrenaline auto-injector (AAI). Current brands
available in the UK are EpiPen®, Emerade®, Jext®. School staff should ideally
have received appropriate training to be confident administering the medication.
adrenaline FIRST in someone with known food
allergy who has sudden-onset breathing difficulties (before other
medicines such as asthma inhalers) – even if there are no skin symptoms.
Delays in giving adrenaline are a common finding in fatal reactions. – advice
IF IN DOUBT, give adrenaline. It is much
better to give it early, or unnecessarily than too late!
For non-life-threatening reactions or localised swelling that does not impair breathing, then they can be given an antihistamine, such as Piriton. Antihistamine tablets or elixir will take around 15 minutes to take effect.
If you have the latest version of the Epipen, you no longer need to hold for 10 seconds – just 2 will suffice. However, holding for longer will do no harm and there is such a problem with supply that people are unsure which version they have!
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Different makes of adrenaline auto-injectors
- Emerade: 150, 300 and 500 microgram
doses available and the 500mcg dose has a longer needle, to allow for
deeper fat penetration for larger children.
- Epipen: 150 and 300 microgram
doses available. Epipen Junior delivers a 150 microgram dose
- Jext: 150 and 300 microgram
issues causing worrying problems
The high-profile death of Natasha Ednan-Laperouse
and others who have died from anaphylaxis, has raised the importance of prompt
access to emergency medication.
However, there have been major distribution
problems with all three drug companies manufacturing the auto-injectors.
As a result, many pharmacies have been advised only
to fulfil two auto-injectors – even if more have been prescribed – causing
problems for parents, pupils, GPs and schools, all desperately trying to fulfil
all requirements with a reduced supply.
Unfortunately, many parents are resorting to buying
auto-injectors online where they cannot be sure of the quality or source of
Additionally, pharmaceutical companies have also
been advising use of their auto-injectors beyond their expiry dates. Previous
advice has been the adrenaline deteriorates becomes less potent beyond their
expiry date. Manufacturers have issued occasional guidance resulting from these
supply issues, indicating that certain doses of autoinjectors can be used up to
3 months after the stated expiry date.
Before using the adrenaline auto-injector, it is
vital to check in the viewing window that the solution remains clear and
colourless. Keep up to date with the latest drug company and Allergy UK
In response to the shortages, the Anaphylaxis
Campaign have issued the following advice;
you are prescribed an alternative AAI device, ensure that you know how to use
it and train others that may need to use it in an emergency.
carry two adrenaline auto-injectors with you at all times.
you have registered the expiry date of your devices on the relevant
manufacturers websites to give you ample warning when a new prescription is
you gain a replacement device prior to disposing of any out of date devices.
make sure you have a trainer device which can be ordered from the
manufacturer’s websites for free
Written by Emma Hammett RGN – Founder and CEO of
First Aid for Life.
First Aid for Life is the leading provider of first
aid training for schools, parents, child carers and health workers and our team
of highly experienced medical, health and emergency services professionals will
tailor the training to your needs. We incorporate anaphylaxis training in all
our first aid courses and can provide specialist annual refreshers as needed.
We always train using all devices.
It is strongly advised that you attend a First Aid
course to understand what to do in a medical emergency. First Aid for Life run
specific courses covering in detail how to help someone having an asthma
Please visit www.firstaidforlife.org.uk, firstname.lastname@example.org or tel: 0208 675 4036 for more information about
our courses. First Aid for life provides this information for guidance and it
is not in any way a substitute for medical advice. First Aid for Life is not
responsible or liable for any diagnosis made, or actions taken based on this