Buku Medicine

Adrenaline prescribing

From the 2016 BSACI Guidelines for adrenaline prescription (Please see website below for full guidelines)

Patients at risk of anaphylaxis that should be considered for long-term provision of an adrenaline auto-injector include those;

  • who have suffered a severe systemic reaction where the allergen cannot be easily avoided
  • who are allergic to high-risk allergens, for example nuts with other risk factors (such as asthma), even if the reaction was relatively mild
  • who had a reaction in response to trace amounts of allergen/trigger
  • who cannot easily avoid the allergen
  • with continuing risk of anaphylaxis (e.g. Food dependent, exercise-induced)
  • with idiopathic anaphylaxis
  • with significant co-factors (e.g. asthma in food allergy, raised baseline serum tryptase)

Adrenaline auto-injector dosing: Standard adult adrenaline autoinjectors are available in the form of JEXT or Epi-pen. A standard dose is 300mcg per injection. Some patients may require 500mcg based on weight and other risk factors. Currently, the only manufacturer for the high dose pens is Emerade, but supplies have been low for many months. All patients should have training in how to use these pens. Videos on the manufacturer websites can be used and “dummy pens” given through the local allergy unit for practice. Any patient being issued adrenaline autoinjectors should be referred to the Allergy Department for formal review.








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Type I/IgE mediated

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Vaccine allergies

The Green Book is a useful resource for information about vaccinations, dosage, contra-indications and allergy to vaccines.

There is helpful information about use of seasonal influenza vaccination in patients with egg allergy. There is also information about coronavirus vaccinations in patients with prior allergies, and management of patients who react to these vaccinations.