Adrenaline auto-injector advice for patients

After every use, an ambulance should be called even if symptoms are improving, the individual should lie down with legs raised and, if at all possible, should not be left alone.

Post-publication note - July 2023

The information in this article has been superseded by the June 2023 Drug Safety Update. MHRA guidance and Summary of Product Characteristics and Patient Information Leaflets should be used for the most up to date advice. In June 2023, we launched a new toolkit of resources health and social care professionals to support the safe and effective use of adrenaline auto-injectors. The resources are freely available for download from the MHRA’s guidance page on adrenaline auto-injectors (AAIs).

15 August 2017: This advice has been updated. See Drug Safety Update volume 11 issue 1, August 2017: 3.

Article date: May 2014

Anaphylaxis is a life-threatening systemic allergic reaction. It can be triggered by a broad range of allergens. The most common allergens are certain foods, drugs, and venom (including wasp and bee stings).

An intramuscular injection of adrenaline in the outer thigh is the treatment of choice for someone having an anaphylactic reaction.[footnote 1] Because the onset of anaphylaxis can be very fast, the individual should use an adrenaline auto-injector at the first signs of a severe reaction, then call for emergency medical help. Signs of a severe reaction include:

  • swelling in the throat (altered voice, difficulty swallowing or breathing)
  • wheezing
  • dizziness, feeling faint, tiredness (symptoms of low blood pressure)

If in doubt about severity, or if previous reactions have been severe, the individual should use an adrenaline auto-injector. If the individual does not feel better after the first injection, the second auto-injector should be used 5 to 15 minutes after the first.

Adrenaline auto-injectors currently licensed for use in the UK are Emerade, EpiPen, and Jext. Each is available in a 150 microgram and 300 microgram dose. Emerade is also available in a 500 microgram dose.

The MHRA has recently conducted a review of all adrenaline auto-injectors approved in the UK. Strengthened warnings, have been included in the product information as a result.

Advice for healthcare professionals:

  • Ensure that people with allergies and their carers have been trained to use the particular auto-injector that they have been prescribed. Injection technique varies between injectors.
  • Encourage people with allergies and their carers to obtain and practise using a trainer device (available for free from the manufacturers’ websites).

Advice to give to people with allergies and their carers:

  • Carry two adrenaline auto-injectors at all times. This is particularly important for people who also have allergic asthma as they are at increased risk of a severe anaphylactic reaction.
  • Use the adrenaline auto-injector at the first signs of a severe allergic reaction. 
  • Take the following actions immediately after every use of an adrenaline auto-injector:

    1. Call 999, ask for an ambulance and state “anaphylaxis”, even if symptoms are improving.
    2. Lie flat with the legs raised in order to maintain blood flow. If you have breathing difficulties sit up to make breathing easier.
    3. Seek help immediately after using the auto-injector and if at all possible stay with the person while waiting for the ambulance.
    4. If the person does not start to feel better, the second auto-injector should be used 5 to 15 minutes after the first
  • Check the expiry date of the adrenaline auto-injectors and obtain replacements before they expire. Expired injectors will be less effective.

Article citation: Drug Safety Update volume 7 issue 10, May 2014: A3.

  1. Resuscitation Council (UK): Emergency treatment of anaphylactic reactions. January 2008. Annotated with links to NICE guidance July 2012. 

Published 11 December 2014