INTRODUCTION
At Amiry & Gilbride, we provide an adrenaline pen supply service for schools.
17% of fatal allergic reactions happen at school. Since October 1, 2017, all schools are able to buy and store spare adrenaline auto-injector pens for children with severe allergies.
All primary and secondary schools can order auto-injectors from their local pharmacy. Devices such as EpiPen, Emerade and Jext can be stored in case of emergencies.
As a result, children will be able to access the life-saving treatment they need in the event that their device can’t be located, is misused, doesn’t work properly, or they require an additional dose.
The Department of Health has issued new guidance on using auto-injectors in schools.
The guidance includes information on recognising the signs of mild allergic reactions or anaphylaxis, which causes life-threatening symptoms and happens very quickly.
Anaphylaxis caused by a severe allergic reaction is a medical emergency requiring immediate treatment.
Anaphylactic shock must be treated with an adrenaline pen.
Schools storing auto-injectors can only use them on pupils at risk of anaphylaxis with the consent of doctors and parents.
SYMPTOMS OF ANAPHYLAXIS
During an anaphylactic reaction, any or all of the following symptoms may be present:
Vomiting or stomach cramps following an insect sting
Limpness or floppiness in babies and children
Swelling of the tongue and/or throat
Vocal changes, e.g. voice sounds hoarse
Difficulty in speaking or swallowing or tightness in the throat
Breathing is noisy or difficult
Persistent cough, wheezing or severe asthma
Feeling faint or dizzy, collapse or loss of consciousness (as the result of a drop in blood pressure)
Pale, grey or blue skin, lips, tongue, palms of the hands or soles of the feet
WHAT CAN TRIGGER AN ANAPHYLACTIC REACTION?
Most allergic reactions are localised to the tissues in a particular part of the body, for example, the skin or eyes. As a result, the reaction only occurs in that area.
In anaphylaxis, the chemicals that cause the reaction are released into the bloodstream. In response, the immune system overreacts, causing blood pressure to drop and airways to narrow. As a result, symptoms usually occur within minutes of exposure to the trigger but can take an hour or so to develop.
The most common triggers for an anaphylactic reaction include:
Foods, including shellfish, tree nuts, and groundnuts. However, any food can potentially cause anaphylaxis
Drugs including antibiotics and NSAIDs, particularly injectable drugs
Insect stings
TREATMENT FOR ANAPHYLAXIS
Follow these steps if someone is experiencing anaphylactic shock:
1. The first line of treatment for severe symptoms of anaphylaxis is adrenaline (epinephrine). An auto-injector device must be injected into the upper outer thigh muscle. Adrenaline administered this way is a safe treatment and should be used immediately if required. Adrenaline is life-saving and works within minutes to reduce swelling, improve blood pressure and relieve wheezing. Delays in giving adrenaline can result in deterioration or death. IF IN DOUBT, USE ADRENALINE FIRST. Then, call for help.
2. Call an ambulance immediately. Dial 999 and explain that the patient is suffering from anaphylactic shock. Don’t wait for symptoms to clear up. If emergency adrenaline has been given, the patient should be taken to hospital for follow-up care.
3. Adrenaline is a short-acting drug; its effects wear off quickly. If there’s no response to the initial injection, the current recommendation is to give another dose after 5 minutes.
If you’re suffering from anaphylactic shock, you must use your adrenaline pen immediately. Lie down while waiting for the ambulance, as this helps to maintain blood pressure and avoids injury if you faint. Raising your shoulders slightly can help you feel more comfortable if you feel wheezy or short of breath.
WHY IS IT IMPORTANT TO USE ADRENALINE?
Anaphylaxis can be life-threatening. It’s a severe allergic reaction that occurs immediately after coming into contact with an allergen, also called the trigger. However, the reaction can also happen a few hours later, so vigilance is required. Triggers differ for different people, but common allergens include foods like peanuts and shellfish, medicines like penicillin, and bee or wasp stings.
By using an adrenaline auto-injector at the first signs of an anaphylactic reaction, you may be able to prevent a full-blown reaction as you wait for an ambulance.
NAME OF DRUG
Adrenaline or epinephrine
Brand names: EpiPen®, Jext®, Emerade®
Intramuscular injection for self-administration
WHAT IS ADRENALINE AVAILABLE AS?
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
Emerade 150 micrograms: 150 micrograms of adrenaline
Emerade 300 micrograms: 300 micrograms of adrenaline
Emerade 500 micrograms: 350 micrograms of adrenaline
HOW SHOULD I GIVE ADRENALINE?
There are three different adrenaline auto-injector devices – EpiPen, Jext and Emerade. The auto-injector must only be used in the thigh. Injecting anywhere else in the body could do harm.
Different devices are used differently, so you MUST follow the instructions provided. If you follow the wrong instructions, you may risk injecting adrenaline into your own thumb.
Remember: keep your auto-injector pens in date. However, an out-of-date pen is still better than nothing in the event of an anaphylactic reaction.
Detailed instructions on using an auto-injector in the thigh can be found on the manufacturers’ website:
EpiPen: www.epipen.co.uk
Jext (Lifeline): www.jext.co.uk
Emerade: www.emerade-bausch.co.uk
AFTER GIVING ADRENALINE
Even if your child seems better after using an auto-injector, you must take them to hospital for follow-up care. Take the auto-injector with you for safe disposal.
WHEN WILL THE ADRENALINE START WORKING?
After using the auto-injector, the adrenaline should start working immediately. If your child’s symptoms haven’t improved after 5 minutes, use a new pen to give your child another dose. Place your child in the recovery position, and keep them lying down until help arrives.
Even if you’re not sure the first injection worked properly, you must wait 5 minutes before giving a second dose. Otherwise, you run the risk of giving your child too much adrenaline.
WHAT IF MY CHILD VOMITS?
The adrenaline still works, so there’s no need to give another dose.
WHAT IF I GIVE TOO MUCH?
You’re unlikely to harm your child if you give them an extra dose by mistake. However, discuss any concerns you may have with the doctor when you get to hospital.
ARE THERE ANY SIDE EFFECTS?
Using adrenaline will make your child feel better if they suffer anaphylactic shock. However, it’s a good idea to be aware of its side effects.
Your child may experience one or more of the following side effects after using their auto-injector. Fortunately, these usually don’t last long.
Cold hands and feet
Difficulty breathing
Headache
Sweating
Feeling anxious, restless, dizzy, shaky or weak
Feeling that the heart rate is racing, fluttery or irregular
Feeling sick or vomiting
Difficulty passing urine (doing a wee)
The skin where the auto-injector was used may look pale or feel sore
WHAT SHOULD I KNOW ABOUT USING ADRENALINE?
Make sure your child always has their auto-injector with them.
An auto-injector must only be used in the thigh. It could harm the body if used anywhere else.
Make sure you’ve read the manufacturer’s instructions and know how the pen works. If you don’t use it correctly, it may not work. EpiPen, Jext, and Emerade are all used differently, so ensure you know which device your child uses.
Make sure that anyone who looks after your child knows what to do if your child has an anaphylactic reaction. Discuss your child’s auto-injector use with their nursery or school and agree on a treatment protocol.
Adrenaline accidentally injected into the hands or fingers can stop blood flow to the area. If this happens, the skin will become pale. Take the person to hospital immediately for treatment.
Make sure you always have two auto-injectors. As soon as you use one, order a new prescription.
Ensure the auto-injector you carry with you is within its ‘use by’ date. Give your old pens to your pharmacist to dispose of safely.
Avoid allergen triggers wherever possible; for example, always scrutinise food labelling and tell restaurant and cafe staff about your child’s allergy.
Use a trainer auto-injector to practise giving adrenaline – the manufacturer of your child’s device should supply one.
WHERE SHOULD I KEEP AN AUTO-INJECTOR?
Different brands have different instructions for storing their devices. Check with the manufacturer’s website about how best to store your child’s auto-injector.
Always keep auto-injectors in the box they came in, to protect the contents from light.
Users of Jext and EpiPen injectors should check their devices regularly. The liquid in the glass container should be clear and colourless. If the liquid has turned pink or brown or has bits in it, order a new auto-injector and ask your pharmacist to dispose of the old one.
Never leave an auto-injector anywhere too hot or too cold, such as in direct sunlight or the fridge.
Always keep auto-injectors in a safe place, out of the sight and reach of other children.
At Amiry & Gilbride Pharmacy, we’re committed to supporting schools in purchasing adrenaline pens. We stock all three brands, and they’re available at £47.95 each, including advice and support from our team of pharmacists.
AVAILABILITY
Select your preferred pharmacy to visit their page and enquire about this service. Or pop into your local pharmacy when it suits you.
