Adrenaline auto-injector (AAI) prescribing for children in UK primary care has increased dramatically since 2000.1 As these young patients grow older, an increasing number of adults will require AAIs to mitigate their risk of an anaphylactic reaction.
Current National Institute for Health and Care Excellence (NICE) guidance advises that adults and children aged >12 years should receive 500 μg adrenaline intramuscularly at the onset of suspected anaphylaxis, with doses of 300 μg and 150 μg advised for children aged 6–12 years and <6 years respectively.2
A recent audit of AAI prescribing I undertook while working at a West London surgery found 100% adherence to these doses for patients aged <6 years, but adherence fell to 62% in children aged 6–12 years and to just 3% in patients aged >12 years.
The current lack of a 500 μg AAI in the popular ‘EpiPen’ range may be a factor in the underdosing of adults at risk of anaphylaxis (96% of AAIs prescribed were from this range). Five-hundred microgram AAIs are available as part of the local formulary at a similar price to ‘EpiPen’ products but appear to be seldom prescribed despite this.
Care should also be taken to ensure that the dose of AAI prescribed is increased appropriately as young patients turn 6 and 12 to avoid the potential for undertreatment of life-threatening anaphylactic reactions.
- © British Journal of General Practice 2017