ASCIA HP Checklist Anaphylaxis Pharmacists 2024120.74 KB 

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice. For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

There are two brands of adrenaline injectors, EpiPen^® and Anapen^®:

• EpiPen^® (300 mcg) and EpiPen^® Jr (150 mcg) are available in Australia on the PBS, and New Zealand (Pharmac listed since 1 February 2023).
• Anapen^® 500, Anapen^® 300 and Anapen^® 150 are available in Australia on the PBS.

Adrenaline injectors are prescribed as follows:

• 150 mcg devices for children weighing 7.5 to 20kg.
• 300 mcg devices for children weighing over 20kg and adults, including pregnant women.
• 500 mcg or 300 mcg devices for children weighing over 50kg and adults, including pregnant women.

1. Dispense prescribed adrenaline (epinephrine) injectors
   • Dispense prescribed injectors and check that the dose is appropriate (see above). 
   • Check that the patient has been prescirbed two devices, which are rebated by the PBS in Australia and New Zealand.
   • Remind the customer (patient and/or carer) to check and note the expiry date of their injector/s. 
   • Check that the patient has an ASCIA Action Plan for Anaphylaxis (RED) that should have been completed by their doctor or nurse practitioner.
   • Reinforce the need for the patient to always carry their adrenaline injector and ASCIA Action Plan.
   • Check that the patient’s asthma is well managed and refer them back to their doctor or nurse practitioner if further action is required. Patients at risk of severe allergic reactions (anaphylaxis) who have asthma that is not well controlled are at increased risk of fatal anaphylaxis.
2. Dispense non-prescribed adrenaline injectors
   • Dispense adrenaline injector/s to customers (patients/carers or organisations) for use in addition to prescribed devices or in first aid kits. Non-prescribed devices are not rebated by PBS or Pharmac.
   • Remind the customer to check and note the expiry date of their adrenaline injector/s.
   • Check that the customer has an ASCIA First Aid Plan for Anaphylaxis (ORANGE) that should be stored with the non-prescribed device/s. These plans are available at www.allergy.org.au/anaphylaxis
3. Provide adrenaline injector advice, education and training
   • Teach the customer how to use their prescribed or non-prescribed adrenaline injector/s using a trainer device. Trainer devices are available from the supplier or patient organisations (Allergy & Anaphylaxis Australia or Allergy New Zealand).
   • Educate the customer about correct storage of adrenaline injectors, away from excessive heat or cooling. 
   • Ensure the customer understands that adrenaline is the first line treatment for anaphylaxis and that antihistamines should not be used for the treatment for anaphylaxis. If antihistamines are used to treat mild to moderate allergic reactions, only non-sedating antihistamines should be used.
4. Be prepared for an anaphylaxis emergency
   • Train staff to recognise the signs and symptoms of anaphylaxis, how to position the patient, how to administer adrenaline injectors and to phone an ambulance immediately afterwards.
   • Display ASCIA Action First Aid Plans for Anaphylaxis to assist staff in recognising and responding to an anaphylaxis emergency.

For adrenaline injector supply updates check www.allergy.org.au/members/adrenaline-autoinjector-availability

© ASCIA 2024

Content updated March 2024

For more information go to www.allergy.org.au/hp/anaphylaxis

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

ASCIA PC Checklist Anaphylaxis121.93 KB

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice. For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

There are two brands of adrenaline injectors, EpiPen^® and Anapen^®:

• EpiPen^® (300 mcg) and EpiPen^® Jr (150 mcg) are available in Australia on the PBS, and New Zealand (Pharmac listed since 1 February 2023).
• Anapen^® 500, Anapen^® 300 and Anapen^® 150 are available in Australia on the PBS.

Adrenaline injectors are prescribed as follows:

• 150 mcg devices for children weighing 7.5 to 20kg.
• 300 mcg devices for children weighing over 20kg and adults, including pregnant women.
• 500 mcg or 300 mcg devices for children weighing over 50kg and adults, including pregnant women.

1. Prescribed adrenaline (epinephrine) injectors

• Check that the prescribed adrenaline injector dose is appropriate (see above).
• Check that the prescription is for two devices, which are rebated by the Pharmaceutical Benefits Scheme (PBS) in Australia and Pharmac in New Zealand. If additional adrenaline injector/s are required, these can be purchased from pharmacies, and are not rebated by PBS or Pharmac.
• Check and note the expiry date of the injector/s you purchase. and consider subscribing to a reminder service.
• Ensure that an ASCIA Action Plan for Anaphylaxis (RED) has been completed by your doctor or nurse practitioner (available online at www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis).
• Remember to always carry an adrenaline injector and ASCIA Action Plan.
• Store adrenaline injectors away from excessive heat or cooling. For information go to www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-storage-expiry-and-disposal
• Check adrenaline injector updates at www.allergy.org.au/members/adrenaline-autoinjector-availability 

2. Anaphylaxis and adrenaline injector education and training

• It is important to understand that adrenaline is the first line treatment for anaphylaxis and that antihistamines should not be used for the treatment for anaphylaxis. If antihistamines are used to treat mild to moderate allergic reactions, only non-sedating antihistamines should be used.
• Complete free ASCIA online anaphylaxis training for community at https://anaphylaxis.ascia.org.au to learn how to recognise signs and symptoms of anaphylaxis, how to give an adrenaline injector and to know that you need to phone an ambulance immediately afterwards.
• Ensure that you know how to use an adrenaline injector/s using a trainer device. Trainer devices are available from the supplier or patient support organisations.
• For further information and support consider joining a patient/carer support organisation (Allergy & Anaphylaxis Australia  or Allergy New Zealand).

3. Other issues to consider

• Check that your asthma is well managed and see your doctor or nurse practitioner if further action is required. If you are at risk of severe allergic reactions (anaphylaxis) and have asthma that is not well controlled, you are at increased risk of fatal anaphylaxis.
• Translated ASCIA anaphylaxis information includes the ASCIA First Aid Plan for Anaphylaxis, adrenaline injector instructions and general information about anaphylaxis.
• If you have left an adrenaline injector at school, children’s education/care centre or office, ensure that you collect device before you leave for an extended time (such as school holidays, working or learning from home).

© ASCIA 2024

Content updated March 2024

For more information go to www.allergy.org.au/patients/about-allergy

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

Translations of anaphylaxis information

• 

  First Aid for Anaphylaxis | English

• 

  First Aid for Anaphylaxis | Other Languages

• 

  First Aid for Anaphylaxis | NZ - Maori, Samoan, Tongan

• 

  Anaphylaxis Patient Information | English

• 

  Anaphylaxis Patient Information | Other Languages

• 

  Anaphylaxis Patient Information | NZ - Maori, Samoan, Tongan

• 

  Anaphylaxis Fact Sheet for Parents | English

• 

  Anaphylaxis Fact Sheet for Parents | Other Languages

• 

  Anaphylaxis Fact Sheet for Parents | NZ - Maori, Samoan, Tongan

• 

  How to give an adrenaline injector | English

• 

  How to give EpiPen | Other Languages

• 

  How to give EpiPen | NZ - Maori, Samoan, Tongan

How to position a child or adult having a severe allergic reaction (anaphylaxis) - A short animated film developed by the National Allergy Council. 

How should a person having anaphylaxis be positioned?

ASCIA Action Plans for Anaphylaxis include the following infographics that show the correct and incorrect positioning of a person having a severe allergic reaction (anaphylaxis).

LAY PERSON FLAT - do NOT allow them to stand or walk

• If unconscious or pregnant, place in recovery position - on left side if pregnant         
• If breathing is difficult allow them to sit with legs outstretched
• Hold young children flat, not upright If unconscious, place in recovery position
• The person should NOT stand, walk, or be held upright, even if they appear to have recovered.

When a person has anaphylaxis their blood pressure can drop rapidly, which reduces blood flow to the heart:

• Laying the person flat will increase blood pressure and help blood flow to the heart.
• Standing or walking can make anaphylaxis worse by causing blood pressure to drop rapidly which reduces blood flow to the heart. 

Content updated April 2024