The emergency treatment of anaphylaxis using adrenaline injections
Concern raised over the emergency treatment of anaphylaxis using adrenaline injections, after the MHRA issues a patient-level recall of Emerade auto-injector pens
Emerade auto-injector recall
Some concern has been raised over the emergency treatment of anaphylaxis using adrenaline injections, after the MHRA issued a patient-level recall of Emerade auto-injector pens on 9th May, for both the 300 or 500 microgram formulations. This is because it has been found that some pens may rarely fail to activate if they are dropped, meaning a dose of adrenaline would not be delivered. Premature activation has also been detected in some pens after they have been dropped, meaning that the dose is delivered too early. New prescriptions should be issued for patients who carry emerade pens for alternative injector devices.
What are the options?
Alternative injector devices include other auto injector-pen brands such as EpiPen or Jext, or adrenaline ampoules. It is important that staff are familiar with how to use alternative pens as different brands have different instructions. The MHRA released some useful guidance in April on the correct use of auto-injectors, including an infographic and a 2 minute video.
For information on how to treat anaphylaxis via adrenaline injections, please see below.
How to administer Adrenaline (IM) 1mg/1ml (1:1000) injection for treating a patient with symptoms of anaphylaxis
Adrenaline is used for treating patients with symptoms of anaphylaxis and should be administered intramuscularly into the middle of the thigh muscle.
It is most commonly available as an auto-injector device (e.g. Epi-Pen) or as ampoules.
Autoinjectors may be in doses less than 500micrograms, but these can be used for adults.
Ampoules will require syringes and 23G hypodermic needles for administration.
In their Anaphylaxis Algorithm, the Resuscitation Council UK advise:
Use adrenaline at 1 mg/mL (1:1000) concentration:
Adult and child > 12 years: 500 micrograms IM (0.5 mL)
Child 6-12 years: 300 micrograms IM (0.3 mL)
Child 6 months to 6 years: 150 micrograms IM (0.15 mL)
Child <6 months: 100-150 micrograms IM (0.1-0.15 mL)
The above doses are for IM injection only, given by experienced specialists in an appropriate setting.
Patients must be treated promptly, and repeated doses are often required.
The BNF recommends administration every 5 minutes, if required, to control symptoms.
A longer interval of up to 15 minutes may administered depending on the presentation of the patient, according to the manufacturers of auto-injectors.
All patients with symptoms of anaphylaxis should be taken by ambulance to an A&E hospital for further treatment even if their symptoms appear to improve.