A number of different brands of AAIs are available in different doses, depending on the manufacturer.
Advice as to which brand to purchase, and which dose, can be found here. Schools may wish to purchase the brand most commonly prescribed to its pupils.
No. Schools should decide themselves whether they would like to purchase “spare” AAI(s) for emergency use.
Yes, this change covers all the devolved nations in the UK; the responsible departments have produced their own guidance documents, accessible via this link.
A number of different brands of AAIs are currently available in the UK, in different doses:
- Emerade: 150, 300 and 500 microgram doses available
- Epipen: 150 and 300 microgram doses available. Epipen Junior delivers a 150 microgram dose
- Jext: 150 and 300 microgram doses available
Schools may wish to purchase the brand of AAI most commonly prescribed to its pupils, to reduce confusion and assist with training. The decision as to how many devices and which brands to purchase will depend on local circumstances, and is left to the discretion of the school. Schools may wish to seek appropriate medical advice when deciding which AAI device(s) are most appropriate.
When healthcare professionals prescribe AAIs, this is done according to each child’s individual weight:
- 7.5–25 kg: 150 microgram (0.15mg) dose. Emerade 150 is not recommend in children under 15kg.
- More than 25 kg: 300 microgram (0.3mg) dose.
Emerade also market a 500 microgram dose which is recommended for people over 60kg, although many specialist centres will recommend Emerade 500 for anyone over 45kg.
However, in the context of supplying schools with AAIs for emergency use (rather than for individuals), schools may wish to use the following guidance from the Department of Health:
|For children age under 6 years:||For children age 6-12 years:||For teenagers age 12+ years:|
|• Epipen Junior (0.15 mg)|
• Emerade 150 microgram
• Jext 150 microgram
|• Epipen (0.3 milligram)|
• Emerade 300 microgram
• Jext 300 microgram
|• Epipen (0.3 milligram)
• Emerade 300 microgram
• Emerade 500 microgram
• Jext 300 microgram
NB: These age-based dose recommendations are consistent with the UK Resuscitation Council guideline for the management of anaphylaxis by healthcare professionals.
The needle length varies from device to device. Healthcare professionals have the option of prescribing a larger or smaller dose following clinical assessment of each individual patient. For more information, see the MHRA review of adrenaline auto-injector devices.
Severe anaphylaxis is an extremely time-critical situation: delays in administering adrenaline have been associated with fatal outcomes.
All AAI devices – including those belonging to a younger child (older children should keep their AAI(s) with them), and any spare AAI– must be kept in a safe and suitably central locationg. school office or staffroom which is access at all times, but in which the AAIs are out of the reach and sight of children. They must not be locked away in a cupboard or an office where access is restricted.
AAIs must be accessible and available for use at all times, and not located more than 5 minutes away from where they may be needed. In larger schools, it may be prudent to locate a kit near the central dining area and another near the playground; more than one kit may be needed.
“Spare” AAIs can be obtained, without prescription, from a pharmacy in small quantities on an occasional, and not-for-profit basis. The school will need to give the pharmacy a written request signed by the principal or head teacher stating:
- the name of the school for which the product is required;
- the purpose for which that product is required, and
- the total quantity required.
A template letter which can be used for this purpose can be accessed here. A healthcare professional does not need to sign this letter.
Pharmacies are not required to provide AAIs free of charge, the school must pay for them as a retail item. Unfortunately, there are no funds held centrally or by local authorities to cover the cost.
The school’s “spare” AAI(s) should only be used on pupils known to be at risk of anaphylaxis, and for whom both medical authorisation and written parental consent for use of the spare AAI has been provided. This includes children who have not been prescribed their own AAI, so long as the school has medical authorisation and parent/guardian consent.
The British Society for Allergy and Clinical Immunology (BSACI) has produced a range of Allergy Plans which can be used for this purpose, and can be downloaded here. All children with a diagnosis of food allergy and at risk of anaphylaxis should have a written Allergy Management Plan.
The school’s spare AAI(s) can be administered to a pupil whose own prescribed AAI cannot be given correctly without delay.
If a pupil has anaphylaxis but does not have the necessary approvals in place for them to receive the “spare” AAI:
- Immediately call 999 and seek advice
- If spare AAIs are available, tell this to the call handler/emergency medical dispatcher, as they can authorise use of the spare AAI if appropriate.
Any member of staff may volunteer to take on this role. In most schools, a number of staff members should be trained to administer AAIs, to avoid any delay in treatment and ensure cover when staff are on leave.
Staff should have appropriate training and support, relevant to their level of responsibility. This is a legal requirement.
Further information on staff training can be found here.
No. The legislation only allows for the “spare” AAI(s) to be used in registered pupils, in whom both medical authorisation and parent/guardian consent have been obtained.
If an adult has anaphylaxis whilst on school premises, immediately call 999: if “spare” AAIs are available, tell this to the call handler/emergency medical dispatcher, as they can authorise use of the “spare” AAI if appropriate.