In May 2023, important information was shared about the changes that schools will have to make with the way they manage Adrenaline Auto-Injector (AAI) devices. We share all you need to know about managing AAIs correctly and informing parents with children who are at risk of anaphylaxis.

What can cause Anaphylaxis in children?

Anaphylaxis in children is an allergic reaction. These reactions can be life-threatening and can occur quickly. It happens when a child is exposed to one of the 14 common allergens. The reaction is often within minutes of exposure but can be delayed and display symptoms can show up to 3 hours afterwards.

How common are allergies in children?

Around 8% of UK children are thought to have a foodallergy. There are 14 known allergens, the four most common triggers for anaphylaxis are:

• Foods (such as peanuts, nuts, milk or dairy products, egg, wheat, seafood, sesame and soy). It is worth noting that wheat allergies and Coeliac Disease are not the same, Coeliac Disease attacks the intestinal walls when gluten is eaten.
• Insect stings.
• Medication (like penicillin and antibiotics).
• Latex (used in rubber gloves, plasters, and balloons).

What types of AAI are there?

There are three main brands of Adrenaline Auto-Injectors (AAIs) in the UK: EpiPen, Emerade and Jext. These contain a fixed dose and single shot of adrenaline which are easy to use. Children with severe allergies will be prescribed an AAI and should always carry TWO devices at all times. The reason for two being more than one dose may be required or the device may be used incorrectly or misfire.

There has been a change within the use of Emerade AAIs from May 2023.

What changes have been made to AAIs in schools?

From the 9^th May 2023, Emerade 300 and 500 microgram adrenaline pens have been recalled. The Medicines and Healthcare products Regulatory Agency instructs any patients or schools who use the Emerade 300 or 500 pens to contact their GP to obtain one of the other brands (including schools who have Emerade 300 or 500 as their spare AAI pen).

It is important to ensure you, as a school or if you are advising parents, to keep hold of the Emerade 300 or 500 until replacement pens are given. The EpiPen or Jext pens may work differently than the Emerade pen, it is vital the child, parents and school are aware of any differences in function.

So, why have the Emerade 300 and 500 pens been recalled? It is mainly a precautionary measure. Some of the brand’s pens may fail to activate or activate too early if they have been dropped. Meaning in an emergency, the correct dosage may not be administered.

Can schools keep a spare EpiPen?

Since October 2017, schools can obtain spare AAI devices without needing a prescription, although this is not mandatory. These spare AAIs can only be used on pupils with medical authorisation and written parental consent to use during anaphylaxis. The school’s spare AAI can ultimately only be used if a child’s own pen is broken, out-of-date or is used incorrectly.

Schools should be aware of the pupils with severe (and mild) allergies and have the location of their prescribed AAI pen shared on their medical pupil profile. The location of the school’s spare AAI pen should be known to all staff. As well as whole-school training on how and when to administer an AAI device during a severe allergic reaction.

Some pupils with food allergies may not be prescribed AAI, but can still be at risk of anaphylaxis. These children, with known allergies, can use the spare AAI if:

• The child’s IHCP identifies the child as a risk of anaphylaxis.
• A healthcare professional has authorised the use of a spare AAI in an emergency.
• The child’s parent or guardian has consented to the spare AAI to be administered in an emergency.

Next steps.

Parents of children with severe allergies should have been made aware of the recall of Emerade 300 or 500. It is useful to remind all parents of the changes to increase awareness of how to correctly administer AAIs across their work places or even for children’s sports teams outside of school. 

1. Share this article with your parents via your school newsletter or social media platform. 
2. Audit the current AAI devices you have in your school, if you have a spare AAI device. Any that are Emerade should be immediately returned to a local pharmacy once replacement AAIs have been received. 
3. Monitor current AAI devices expiry dates.
4. Deliver a recap short training session for all staff on how to use EpiPens or Jext devices.

How Medical Tracker can help.

• Monitor and track expiring medication and staff first aid qualifications. 
• Record all uses of AAI devices (including near-miss mild allergy attacks). 
• Send parent consent forms digitally for the use of spare AAIs in school time. 
• Share life-saving information about anaphylaxis triggers and AAI device locations across your staff force.