Doctor talking to a patient

Adrenaline Auto-Injectors (AAIs) Safety Campaign

AAIs Save Lives

View the above video with Welsh subtitles.

Adrenaline auto-injectors (AAIs) (product names Epipen or Jext) deliver adrenaline by means of an auto-injector device for the emergency treatment of anaphylaxis, a life-threatening severe allergic reaction.

AAIs are intended for self-administration by a patient, or administration by a carer, and should be always carried by patients considered to be at risk of anaphylaxis, so the medicine is available for immediate use before the arrival of the emergency services. Death from anaphylaxis can occur within a very short period and therefore swift intervention by the administration of AAIs can be lifesaving. AAIs are critical medicines, their effectiveness being of utmost importance.

The background to our campaign

In October 2019, the Commission on Human Medicines (CHM) endorsed the formation of an AAI expert working group (AAI EWG) to examine a range of issues to support the effective and safe use of AAIs for the emergency treatment of anaphylaxis.

One of the agreed actions for the group was to improve communication channels and develop a communication campaign so that patients, healthcare professionals and the wider public can be better informed and therefore equipped to understand the importance of AAIs as a potential life-saving medicine.

View the full Public Assessment Report: Recommendations to support the effective and safe use of adrenaline auto-injectors.

What is anaphylaxis?

A serious life-threatening allergic reaction which usually occurs within a few seconds or minutes of exposure to allergic substances. This involves hives (a raised red rash), swelling and sudden drop in the blood pressure and sometimes shock. It is more common in females.

The main cause is exposure to an allergic substance, which may include:

  • foods such as nuts, cows’ milk, eggs, fish, shellfish or sesame seeds
  • insect stings such as wasp and bee stings
  • medicines such as antibiotics or non-steroidal anti-inflammatory drugs (NSAIDs)
  • anaesthetics
  • latex (a type of rubber found in some rubber gloves and condoms)
  • aerobic exercise can also trigger anaphylaxis in some people
  • sometimes it is not known what caused an anaphylactic reaction

Symptoms of anaphylaxis can happen very quickly they include:

  • swelling of the throat and tongue
  • difficulty breathing or breathing very fast
  • difficulty swallowing, tightness in the throat or a hoarse voice
  • wheezing, coughing or noisy breathing.
  • feeling tired or confused
  • feeling faint, dizzy, or fainting
  • skin that feels cold to the touch
  • blue, grey, or pale skin, lips, or tongue – in brown or black skin, this may be easier to see on the palms of the hands or soles of the feet.
  • there may also be a rash that is swollen, raised or itchy (hives)

Things you can do to help prevent anaphylaxis: avoid the food, medicine, or thing that you are allergic to – for example, if you have a food allergy, check food labels carefully and tell staff at restaurants and cafes about your allergy.

What to do in an emergency

Call 999 if:

  • your lips, mouth, throat, or tongue suddenly become swollen
  • you are breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
  • your throat feels tight, or you are struggling to swallow
  • your skin, tongue or lips turn blue, grey, or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
  • you suddenly become very confused, drowsy, or dizzy
  • someone faints and cannot be woken up
  • a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
  • You or the person who is unwell may also have a rash that is swollen, raised or itchy (hives)

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

What to do if you have anaphylaxis and you have been prescribed an AAI

AAIs are intended for self-administration by the patient or for administration by the patient’s carer. AAIs should always be carried by the patient considered to be at risk of anaphylaxis.

An AAI should be administered early, at the first signs of anaphylaxis, in line with clear evidence that this improves patient outcome.

This requires the patient and carer to be confident in recognising the early signs of anaphylaxis and in distinguishing a severe, life-threatening allergic reaction from one that is less severe and does not require adrenaline.

Making this distinction can be challenging, given the wide range of signs and symptoms of anaphylaxis. If there is doubt about the severity of an episode, an AAI should be administered without delay as the risks of delay outweigh the potential risks from unnecessary administration of adrenaline.

  • use your AAI without delay, instructions are included on the side of the injector.
  • immediately dial 999 for medical help and say that you think you are having an anaphylactic (‘ana-fill-axis) reaction.
  • if you are not already laying down then do so, raise your legs, and if you are struggling to breathe, raise your shoulders or sit up slowly (if you are pregnant, lie on your left side)
  • if an insect has stung you, try to remove the sting if it is still in the skin
  • if your symptoms have not improved after 5 minutes, use your second AAI
  • do not stand or walk at any time, stay lying down even if you feel better
  • always carry two AAIs with you
  • check your AAI’s expiry dates regularly and get new ones before they expire
  • practice how to use your AAI by using a trainer injector (an injector that has no needle or medicine in it) – you can order one online from the company that makes your AAI.
  • teach friends, family, colleagues, or carers how and when to use your AAI
  • use your AAI if you think you may have anaphylaxis, even if your symptoms are mild.
  • wear medical alert jewellery such as a bracelet with information about your allergy – this tells other people about your allergy in case of an emergency
  • do not leave your AAI anywhere too hot or cold such as in the fridge or outside in the sun.