ASCIA Adrenaline (Epinephrine) Injector Prescribing Guidelines and Frequently Asked Questions (FAQ) have been updated, and are now available on the ASCIA website:

Adrenaline Injectors FAQ Updated Februry 2022

ASCIA Guidelines - Adrenaline (Epinephrine) Injector Prescription Updated February 2022

ASCIA Guidelines Summary - Adrenaline (Epinephrine) Injector Prescription New February 2022 

The main updates include links to several publications (see below) that support ASCIA adrenaline injector dose recommendations for EpiPen^® and Anapen^® and the use of a 500 microgram device (Anapen^® 500), which:

• Provides doctors with  choice of dose for doctors, as some may prefer to prescribe a higher dose (500 microgram device) for people over 50kg.
• May potentially reduce the need for further doses of adrenaline in older adolescents and adults weighing over 50kg. 

The Guidelines and FAQ also include other reasons why it is important to have more than one brand of adrenaline injector available.

Publications 

ASCIA adrenaline injector dose recommendations are based on expert consensus and standard practice by ASCIA members, which vary to the product information. These doses are consistent with the Acute Anaphylaxis Clinical Care Standard for Australia, Australian Prescriber Anaphylaxis wallchart, Australian Immunisation Handbook and international recommendations from the World Allergy Organisation (WAO), Canada and the UK.

https://www.safetyandquality.gov.au/standards/clinical-care-standards/acute-anaphylaxis-clinical-care-standard

https://www.nps.org.au/australian-prescriber/articles/anaphylaxis-emergency-management-for-health-professionals

https://immunisationhandbook.health.gov.au/resources/handbook-tables/doses-of-intramuscular-11000-adrenaline-for-anaphylaxis 

https://www.worldallergyorganizationjournal.org/article/S1939-4551(20)30375-6/fulltext

https://www.resuscitationjournal.com/article/S0300-9572(21)00150-7/fulltext

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-2-vaccine-safety/page-4-early-vaccine-reactions-including-anaphylaxis.html#shr-pg0

https://onlinelibrary.wiley.com/doi/full/10.1111/cea.14055

Other changes in the ASCIA Adrenaline Injectors FAQ are as follows:

• Some of the FAQs have been reordered and expanded, to address the most common questions that we have received, including FAQs 1 and 2.
• FAQ 8 includes ‘Students and children may be prescribed EpiPen^® or Anapen^® devices, and schools and CEC services need to accept both devices. Therefore, staff in schools and CEC services should be trained on both device brands.’
• FAQs 9 and 10 clarify that there are three steps to give EpiPen^® and four steps to give Anapen^®.
• FAQ 13 includes ‘There is no evidence that injecting the second dose of adrenaline into the same thigh is a problem. The most important thing is to give another dose of adrenaline (after 5 minutes) if symptoms persist, and phone an ambulance.’

Other changes in the ASCIA Adrenaline Injector Prescription Guidelines are as follows:

• Addition of ‘These guidelines should be used in conjunction with clinical judgement, with consideration of issues that include training on a new device and preference of device from the patient or their carer.’
• Inclusion of ‘It is important to specify brand and tick box on PBS prescription to ensure that brand is not substituted’ on the first and last page and ‘Ensure correct ASCIA Action Plan is provided for the brand of prescribed device’.
• A reordering of the dose recommendations to be on page 2, in a more prominent location than in the previous version.
• Colour coding of the prescription guide recommendations to make them easier to follow.
• Replacement of the definitions with a link to clinical definitions in the ASCIA Guidelines for Acute Management of Anaphylaxis.

This news item was issued on 13 January 2022 and updated on 28 February 2022 by the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body for clinical immunology and allergy in Australia and New Zealand.