Adrenaline (epinephrine) autoinjectors (e.g EpiPen®) are approved for use in Australia and New Zealand for the emergency treatment of anaphylaxis, the most severe form of allergic reaction.
ASCIA cannot dictate policy regarding the use of adrenaline autoinjectors for general use that are not prescribed for an individual. Advice from the local education and/or health authorities should be sought regarding authorisation to include adrenaline autoinjectors for general use in first aid kits and whether these can be administered in an emergency.
Having an adrenaline autoinjector for general use (e.g. in first aid kits) should be considered as being additional to the prescribed adrenaline autoinjectors for individuals. They should NOT be a substitute for individuals at high risk of anaphylaxis having their own prescribed adrenaline autoinjector/s.
Adrenaline autoinjectors for general use are most likely to be used when:
- An individual who is known to be at risk of anaphylaxis does not have their own device immediately accessible or the device is out of date; or
- A second dose of adrenaline is required before an ambulance has arrived; or
- An individual's device has misfired or accidentally been discharged; or
- A previously diagnosed individual with mild allergy who was not prescribed an adrenaline autoinjector has their first episode of anaphylaxis; or less commonly
- An undiagnosed individual is having a first episode of anaphylaxis and was not previously known to be at risk (e.g. a child having their first reaction at school). This is dependent on (a) local policies that allow administration under those circumstances, and (b) education of caregivers about the recognition of anaphylaxis and training in adrenaline autoinjector administration.
Using another person's adrenaline autoinjector device
ASCIA does not have published information or guidelines on using another person's adrenaline autoinjector in an anaphylaxis emergency. It is unlikely that these can be developed whilst there is still inconsistency in the regulations regarding giving non-prescribed adrenaline autoinjectors in Australia and New Zealand.
- The following is general advice, not an official ASCIA Guideline:
- If another individual's adrenaline autoinjector is used in an anaphylaxis emergency, when there is no adrenaline autoinjector for general use available, it would be essential that the device is immediately replaced by the institution, purchasing the same brand of adrenaline autoinjector at a local pharmacy.
- If the individual whose adrenaline autoinjector has been used has anaphylaxis before their adrenaline autoinjector is replaced, they should be taken immediately to hospital by ambulance. If the individual is not insured for the ambulance cost, this expense should be covered by the institution.
- Adrenaline autoinjectors are available from pharmacies without a prescription at full price.
- In Australia, the Pharmaceutical Benefits Scheme (PBS) listing for adrenaline autoinjectors allows for authority prescriptions of a maximum quantity of 2 adrenaline autoinjectors (EpiPen) for children or adults (no repeats). They are available at a subsidised cost when prescribed by doctors for individuals considered to be at high risk of anaphylaxis.
- In New Zealand adrenaline autoinjectors are not currently subsidised by Pharmac.
- All adrenaline autoinjectors, whether they are prescribed or for general use, can only be used once and should be replaced by the expiry date, or immediately after they are used.
- It is reasonable for a person without specific first aid training in anaphylaxis to administer an adrenaline autoinjector in an emergency if there is no other person nearby who has had basic training in the use of an adrenaline autoinjector.
- The person administering first aid should have reasonable grounds for believing that the individual is having an acute allergic reaction. Symptoms and signs of anaphylaxis are shown on the ASCIA Action Plan for Anaphylaxis (general), which should be stored with an adrenaline autoinjector for general use.
- Instructions for giving an adrenaline autoinjector are shown on the barrel of the device, package insert and the device specific (EpiPen) ASCIA Action Plan for Anaphylaxis.
- If a person is in doubt, an adrenaline autoinjector should be given, as outlined on the ASCIA Action Plan for Anaphylaxis.
- An adrenaline autoinjector should be administered into the outer mid-thigh, as shown in the diagrams on the barrel of the device, the package insert, and the ASCIA Action Plan for Anaphylaxis.
- An ambulance should be called immediately after giving an adrenaline autoinjector to take the individual to hospital, so they can remain under observation until symptoms have resolved.
- A copy of the device specific (EpiPen) ASCIA Action Plan for Anaphylaxis (general) should always be kept with an adrenaline autoinjector for general use, and in the first aid kit if that is where it is stored.
- There are no absolute contraindications (factors which make it unwise to give treatment) for use of an adrenaline autoinjector in an individual who is experiencing anaphylaxis.
- Transient (temporary) side effects of adrenaline such as increased heart rate, trembling and paleness are to be expected.
- There are no published reports of death or serious injury resulting from use of adrenaline autoinjectors.
- No serious or permanent harm is likely to occur from mistakenly administering adrenaline using an adrenaline autoinjector, to an individual who is not experiencing anaphylaxis.
ASCIA website www.allergy.org.au – Anaphylaxis Resources section includes:
- Frequently asked questions and answers (FAQ) about adrenaline autoinjectors
- ASCIA Action Plans for Anaphylaxis
- ASCIA First Aid for Anaphylaxis (including translations)
- How to use EpiPen video and translated instruction sheets
- ASCIA anaphylaxis e-training for health professionals
- ASCIA anaphylaxis e-training for schools and childcare services
Patient information and support is available from the following national patient support groups for Australia and New Zealand:
Allergy & Anaphylaxis Australia www.allergyfacts.org.au
Allergy New Zealand www.allergy.org.nz
© ASCIA 2017
ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand
Postal address: PO Box 450 Balgowlah NSW Australia 2093
This document has been developed and peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.
The development of this document is not funded by any commercial sources and is not influenced by commercial organisations.