3.4.3 Allergic emergencies

Adrenaline / Epinephrine
  • Injection 1 in 1000 - 0.5ml, 1ml (£0.60 = 1ml amp)
  • Emerade® auto-injector 150 microgram dose, 300 microgram dose, 500 microgram dose (£28.94 = 500 microgram)
  • Epipen® auto-injector 300 microgram dose (£26.45)
  • Epipen® Junior auto-injector 150 microgram dose (£26.45)

Indications

  • Emergency treatment of acute anaphylaxis

Notes

  1. Prescribe by brand. Patient familiarity with one brand is important; instructions for use vary between preparations and patient training is required.
  2. Emerade April/May 2020: all 150, 300 and 500 microgram auto-injectors issued to patients are being recalled due to a failure of some auto-injectors to activate. See here for the 150 microgram, 300 microgram and 500 microgram auto-injectors. No stock of Emerade 150, 300 or 500 microgram auto-injectors is available in the UK until the issue is resolved.
  3. MHRA Drug Safety Update (October 2019): recent action taken to support safety - all adrenaline auto-injectors:
    1. Patients should continue to follow existing advice to carry 2 in-date pens with them at all times
    2. Different brands of adrenaline auto-injector are not used in exactly the same way so specific training and advice for patients and carers is required before using each of the devices

Angioedema

The NHS Commissioning Board (NHS CB) will commission the use of injected treatments for acute severe attacks in hereditary angioedema (all ages) (see NHS CB Commissioning Policy for more details).

NHS England (NHSE) will commission plasma-derived C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II (see NHSE Commissioning Policy for more details).

Berinert®

(Human C1-esterase Inhibitor)

  • Powder and solvent for solution for injection / infusion 500IU vial

Indications

  • Hereditary angioedema

Notes

  1. The administration of C1-esterase inhibitor, an endogenous complement blocker derived from human plasma (in fresh frozen plasma or in a partially purified form) can terminate acute attacks of hereditary angioedema but is not practical for long-term prophylaxis
Cinryze®

(Human C1-esterase inhibitor)

  • Powder and solvent for solution for injection 500IU vial

Indications

  • Hereditary angioedema
Ruconest®

(Conestat alfa)

  • Powder for solution for injection 2100U

Indications

  • Acute angioedema attacks in adults and adolescents with hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency
Firazyr®

(Icatibant)

  • Solution for injection in pre-filled syringe 30mg/3ml

Indications

  • Acute attacks of hereditary angioedema (HAE) in adults, adolescents and children aged 2 years and older, with C1-esterase-inhibitor deficiency
Lanadelumab
  • Solution for injection 300mg

Notes

  1. NICE TA606: Lanadelumab (Takhzyro) is recommended as an option for preventing recurrent attacks of hereditary angioedema in people aged 12 and older, only when the criteria of the NICE TA are met (October 2019)

 

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