One Epipen? No, surely, it should be two.

The prescription of auto injector pens (Epipen, Jext, Emerade etc) for those who are thought to be at risk of anaphylactic shock is now fairly standard – although, all too often, this  is accompanied by little if any serious advice on how to use them.*  However, advice from MHRA (the government’s Medicines and Healthcare Products Regulatory Agency), the EMA (European Medicines Agency) and the Anaphylaxis Campaign suggest that those at risk of anaphylaxis should be prescribed with, and always carry, two injector pens not just one. Why?

• You might need two doses of adrenaline to control the attack
• The pen might misfire or, in your or helper’s anxiety to use it, they may use it incorrectly
• The emergency services may be delayed

One can therefore understand the confusion and, indeed, shock at the BSACI (British Society for Allergy and Clinical Immunology)’s recent suggestion  that only one autoinjector is  needed for self administration and that two should only be prescribed in specific circumstances – ‘including obesity, remoteness from medical help, a previous life-threatening reaction or if two doses were required (as distinct from given) in a short time period for previous reactions, or other assessment of risk’. (See the Executive summary for the above.)

The Anaphylaxis Campaign has already issued a statement reiterating that ‘their  position has always been that all patients prescribed adrenaline should have two AAIs on their person at all times’.  Meanwhile Angela Waters (mum of a child with life threatening allergies) has started a Change.org petition calling on the BSACI to change their advice. She already has nearly 40,000 signatures.

As Angela Waters points out, apart from the chance of the pen not working or being misused:
‘Ambulances services in the UK are over stretched with many taking over 20 minutes to arrive in an emergency ( regular reports of up to 40 minutes ) and it has been known for them to arrive without the required medication . We also have written confirmation from the head of ambulance services that 999 Anaphylaxis calls are now triaged, with many calls not being treated as a code red response.’ (In other words they may not be treated as an emergency which needs to be dealt with immediately – which, of course, they absolutely are. Time is vital and failure to give an appropriate dose of adrenaline within minutes could lead to a fatality.)

If you wish to support her petition you can do so at Change.org –  We ask the BSACI to change their recommendation of one adrenaline auto injector pen

* Because GPs often know and understand little about allergy, they also know little about auto-injectors and, although they prescribe them, have little idea how to use them. The pens are, however, very simple to use and all the manufacturers proved dummy pens so that you can experiment and practice. This is a VERY good idea. The last thing you want to have to do in the panic which naturally accompanies an anaphylactic attack (whether it is yourself of someone else) is to have to read instructions to find out what to do. Having practised using the pen a few times before makes it very much less likely that you will mess up if you need to use it earnest.