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 October 2021:
    1. 300 microgram and 500 microgram: Following satisfactory implementation of corrective actions, the MHRA has agreed that the 300 microgram and 500 microgram strengths of Emerade adrenaline auto-injectors can be re-supplied to the market
    2. 150 microgram: Emerade 150 microgram auto-injectors will not be returning to market at this time, further details of re-supply will be provided at a later date
    3. the Epipen brand of adrenaline auto-injector in a strength of 300 microgram continues to be a suitable alternative to the Emerade 500 microgram adrenaline auto-injector; this has been confirmed by measurement of adrenaline blood levels following administration (MHRA Drug Safety Update, November 2021).
  3. MHRA Drug Safety Update (November 2021): Adrenaline auto-injectors: reminder for prescribers to support safe and effective use
    1. for each adrenaline auto-injector, follow advice in the Summary of Product Characteristics to prescribe appropriate doses for individual patients (see section on dosing considerations)
    2. remind patients to follow existing advice to carry 2 in-date adrenaline auto-injectors with them at all times and to replace them before they expire
    3. provide patients and their caregivers with training and advice specific to their prescribed adrenaline auto-injector; encourage them to order a trainer device from the manufacturer to ensure they are familiar with using their auto-injector

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
Berotralstat
  • Capsules 150mg

Notes

  1. NICE TA738: Berotralstat (Orladeyo) is recommended as an option for preventing recurrent attacks of hereditary angioedema in people 12 years and older (October 2021), only if:
    1. they have at least 2 attacks per month, and
    2. it is stopped if the number of attacks per month does not reduce by at least 50% after 3 months
    3. It is only recommended if the company provides berotralstat according to the commercial arrangement
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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