Anaphylaxis Update – New devices and standards

GP Connect Clinical Feature by By Sandra Vale, National Allergy Strategy Manager and Dr Katie Frith, Paediatric Clinical Immunology/Allergy Specialist

In 2020, the Australian Commission on Safety and Quality in Health Care released an Acute Anaphylaxis Clinical Care Standard which has provided a nationally standardised definition for anaphylaxis. The Standard also provides clear guidance on how to manage anaphylaxis and provide appropriate discharge information, regardless of whether the anaphylaxis occurred in a hospital or community setting.

The Anaphylaxis HealthPathway has also been updated to be consistent with the Acute Anaphylaxis Clinical Care Standard and to include updated information about adrenaline injectors.

The Standard contains six quality statements describing key components of care:

  1. Prompt recognition of anaphylaxis
  2. Immediate injection of intramuscular adrenaline – intramuscular adrenaline administered before any other treatment.
  3. Correct patient positioning – patient is laid flat or allowed to sit with legs extended if breathing is difficult and not allowed to stand or walk
  4. Access to a personal adrenaline injector in all healthcare settings
  5. Observation time following anaphylaxis – clinical observation for at least four hours after the last dose of adrenaline or overnight as appropriate in line with the ASCIA guidelines.
  6. Discharge management and documentation –allergen avoidance advice, ASCIA Action Plan, referral, prescription for an adrenaline injector (where risk of re-exposure exists).

The Standard and the Anaphylaxis HealthPathway aim to ensure that anaphylaxis is managed promptly and appropriately and that the patient receives an ASCIA Action Plan, appropriate referral and prescription for an adrenaline injector.

A re-designed Anapen adrenaline injector was approved by the TGA and PBS listed for use in Australia last year. Anapen is available in three doses – 150 micrograms, 300 micrograms and 500 micrograms. EpiPen continues to be available on the PBS in two doses 150 micrograms and 300 micrograms. The availability of a second adrenaline injector brand in Australia is important to help ensure a continued supply of life-saving adrenaline, particularly if one brand has stock shortages; to provide choice of brand and dose (particularly for people over 50kg who may prefer a 500 microgram dose device); and to encourage suppliers to provide devices with longer shelf lives.

Key points when prescribing an adrenaline injector:

  • When writing the authority prescription, it is really important to tick ‘no substitution’. This will ensure the patient receives the brand of device chosen during the consultation. EpiPen and Anapen are activated differently so it is important that the patient receives the device they are expecting, have been taught how to use and is consistent with the ASCIA Action Plan you have provided them.
  • Teach the patient (and/or carer) how to use the device prescribed using trainer devices. Ask them to show you how to administer the prescribed device using the trainer. Encourage them to get a trainer device to have at home so that they can practice regularly.
  • Provide the patient with an ASCIA Action Plan specific for the adrenaline injector brand prescribed. This is an emergency response plan that provides information on when and how to administer the adrenaline injector.

Both EpiPen and Anapen contain adrenaline and both devices are autoinjectors, which provide effective emergency treatment of anaphylaxis. They have different mechanisms for activation and a summary of their features is outlined here

Further information is available at:

Source: Adapted from Vale S, Smith J, Loh R. Safe use of adrenaline autoinjectors. Aust Prescr 2012;35:568.