August 2023

Allergy and anaphylaxis emergencies continue to rise – make sure you’re prepared.

Admissions to hospital for severe allergic and anaphylactic reactions have more than doubled in the last 20 years according to recently released figures from NHS digital. Food-related anaphylaxis and other adverse reactions, have risen even sharper, going from just under 2,000 admissions twenty years ago (1,971 admissions) to over 5,000 last year (5,013 admissions, a 154% increase). This continues a worrying trend of rising attendance and admission for allergy and anaphylaxis which has been seen since at least the turn of the Millennium (“In the 20 years to 2012 there was a 615% increase in the rate of hospital admissions for anaphylaxis in the UK” (Turner PJ, 2015)).

The Medicines and Healthcare Regulatory Agency (MHRA) recently issued updated guidance on how to recognise and respond to the signs of anaphylaxis, including the use of adrenaline auto-injectors (AAI’s).

What is anaphylaxis?

  • An allergic reaction is an abnormal reaction by the immune system to a normally harmless “trigger” (or allergen) entering the body that it wrongly perceives as a threat. 
    It produces an “allergy” antibody which causes the release of chemicals including histamine.
  • Anaphylaxis is a severe allergic reaction affecting the whole body and is life-threatening.
    Allergies and anaphylaxis can occur in adults and children of all ages.
    Reactions usually begin within minutes and progress rapidly; however, they can occur up to 2-3 hours after exposure.


How to help someone having an anaphylactic emergency

1. Use the AAI without delay

  • If there are any signs of anaphylaxis, use the AAI immediately.
  • Signs may include swelling of the throat or tongue, wheezing or breathing difficulty, dizziness, tiredness and confusion.
  • There may also be signs normally associated with a milder reaction (such as red itchy skin or hives)
  • If in doubt, use it.

2. Immediately dial 999

  • Say anaphylaxis (“ana-fill-axis”).

3. If they are not already lying down, then help them to do so.

  • Lie them down flat and raise their legs (if they’re pregnant, lie them on their left side). This will assist blood flow to the heart and vital organs.
  • Keep them lying down even if they feel better.

4. Use the second AAI if the casualty hasn’t improved after 5 minutes.

  • They should carry two AAIs at all times.

What are Adrenaline Auto-Injectors (AAI’s)?
Adrenaline auto-injectors are licensed medicinal products that deliver a medicine called adrenaline by means of an auto-injector device for the emergency treatment of anaphylaxis, a life-threatening severe allergic reaction. 
Adrenaline auto-injectors are intended for self-administration by the patient, or administration by a carer, colleague or bystander.
People at risk of anaphylaxis should always carry two auto-injectors, regularly check they haven’t expired and ensure they know how to use the brand prescribed to them.
In the UK, there are currently only three brands licensed for use; Epipen, Jext and Emerade (although Emerade was subject to a full product recall early this year, with future production on hold), all available in two different dosages (150 mcg and 300 mcg), dependant on the age of the patient.


Who can use them?
UK medicines legislation prevents the administering of many medicines by injection by anyone other than certain medical professionals, or by those who have been prescribed a medicine.
Adrenaline is one of a group of prescription only medicines known as “Schedule 19 medicinal products” (as they are listed in Schedule 19 of the Human Medicines Regulations 2012), which allows the “administration of a prescription only medicine specified in Schedule 19 where this is for the purpose of saving life in an emergency”.
AAI’s should only be used for the person they have been prescribed to (unless in schools, see below, or by medical organisations who have supplied spare devices for use by their staff).
This means that anyone, in an emergency, can administer an AAI to someone having an anaphylactic emergency. They don’t need any prior knowledge or formal training to use – instructions are printed on the side of the device.


What about schools?
“1 in 30 children live with an allergy – an average of one for every classroom.” (Allergy UK – Statistics and figures 2021).
Where schools have staff and pupils that are known to be at risk of severe allergic / anaphylactic reactions, they should be known to the school (along with their “triggers”) to reduce the risk of them suffering a reaction. Additionally, the school (especially nursery or primary schools) may hold one or two AAI’s prescribed to the individuals for use in an emergency at school. These AAI’s may only be used for the person that they have been prescribed to.
From 1st October 2017, the Human Medicines (Amendment) Regulations 2017 has allowed all schools to purchase their own “spare” Adrenaline Auto-injectors without a prescription. Guidance released by the Department of Health provides information to schools on not only how to respond to an emergency, but also how to access, store, care and dispose of spare AAI’s. These spare AAI’s are there to support staff and pupils with known severe reactions, in the event they don’t their AAI with them, or delay in reaching it would be potentially life-threatening.
Spare AAI’s in schools are not supplied for a named pupil (not prescribed to an individual), and can be used on anyone having a severe reaction.
“20% of anaphylaxis at school occurs in children with no prior history of allergy” (The management of the allergic child at school: EAACI/GA2LEN Task force 2010).
Subsequent clarification released this year also supported that a school’s spare AAI can be used on someone who experiences an anaphylactic emergency for the first time (i.e. not formally diagnosed), and not just those who have previously been diagnosed and prescribed adrenaline.


What about other venues, sports or youth groups?
Sadly, this exemption to the Human Medicines Regulations doesn’t extend outside of education / schools, so other groups or venues can’t, at this time, hold spare AAI’s.
However, people with severe allergic and anaphylactic reactions still use these venues and attend these groups. There should be an awareness of anyone with a severe allergy (to reduce the risk of a reaction), and where they carry their own AAI staff and volunteers should know where it is still and be aware of what to do in an emergency.


How can Act Fast Clinical help?
Adrenaline can be given by anyone, and AAI’s don’t require any training to be used – instructions are printed on the side. However, many people are understandably still very nervous about using an AAI, and to avoid delay in an emergency, to have some knowledge and familiarisation with how to administer one, can be a real lifesaver.

Although anaphylaxis is covered in our (and others) Full Paediatric First Aid course, there is no guarantee that the nearest person to someone having a reaction will be the trained First Aider. Act Fast Clinical offers short, one-hour sessions on how to recognise and manage allergic and anaphylactic reactions, along with the opportunity to handle and practice with training AAI devices. This allows more of your team to have the training and knowledge available in case of an emergency.

As part of our schools’ medication and first aid audit, we also include reviewing school’s policies and arrangements for medications (including AAI’s), making sure that they follow best practice and meet your needs.

Get in touch to find out more.