Patients don’t have a choice when it comes to allergies and the risk of anaphylaxis, but now you have a choice of treatment.
Anaphylaxis is an acute, potentially lethal reaction, usually resulting from exposure to an allergen. Australia’s rates of hospitalisations for all-cause anaphylaxis1 and fatal anaphylaxis are rising steadily; even higher than that seen in the UK, Europe and US2.
The Australasian Society of Clinical Immunology and Allergy (ASCIA) defines anaphylaxis as:
“Any acute onset illness with typical skin features (urticarial rash or erythema/flushing, and/or angioedema), plus involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms; or
Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if typical skin features are not present.”3
Risk of occurrence
Anaphylaxis is highly likely when any one of the following two criteria are fulfilled3:
Acute onset of an illness (minutes to several hours) with simultaneous involvement of the skin, mucosal tissue, or both (e.g. generalized hives, pruritus or flushing, swollen lips-tongue-uvula), and at least one of the following:
- Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
- Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g. hypotonia [collapse], syncope, incontinence).
- Severe gastrointestinal symptoms (e.g. severe crampy abdominal pain, repetitive vomiting), especially after exposure to non-food allergens.
Acute onset of hypotension or bronchospasm or laryngeal involvement after exposure to a known or highly probable allergen for that patient (minutes to several hours), even in the absence of typical skin involvement.
Anaphylaxis may be preceded by mild to moderate allergy reactions. The onset of a reaction may occur rapidly (within 30 minutes) or may be delayed several hours3.
Mild to moderate reactions:
- Swelling of lips, face, eyes
- Hives or welts
- Tingling mouth
- Abdominal pain, vomiting
Anaphylaxis – Indicated by any one of the following signs:
- Difficult/noisy breathing
- Swelling of tongue
- Swelling/tightness in throat
- Difficulty talking and/or hoarse voice
- Wheeze or persistent cough (usually sudden)
- Persistent dizziness or collapse
- Pale and floppy (young children)
- Abdominal pain, vomiting (for insect stings or injected drug (medication) allergy)
Risk factors for fatal anaphylaxis by trigger
Factors associated with the risk of anaphylaxis by trigger include4;
- Food: Adolescent and young adult age group (10–35 years), active asthma, peanut trigger, ingestion of food not prepared at home
- Insect venom: Adult age group (35–85 years), being male (likely to be related to increased risk of exposure)
- Medication: Older adult age group (55–85 years), antibiotic or anaesthetic trigger, cardiovascular and respiratory comorbidities, concurrent medications
Adrenaline is the first line treatment for anaphylaxis and acts to reduce airway mucosal oedema, induce bronchodilation, induce vasoconstriction and increase strength of cardiac contraction3.
An immediate step upon an anaphylaxis attack is location and injection of adrenaline whether via an auto-injector or ampoule/syringe3.
Anapen® adrenaline (epenephrine) – PBS listed 1 September 2021
Anapen® Adrenaline Auto-injectors – imagery supplied by Arrotex Pharmaceuticals. NOTE: Packaging and product images are for illustrative purposes and should be used as a guide only.
Anapen® Junior 150 , Anapen® 300, and Anapen® 500 – Listed on the Pharmaceutical Benefits Scheme 1st September 2021.
Anapen® benefits include:
- A new dose of 500 mcg for adults weighing over 60kg.
- Front and back safety covers reduce the risk of accidental discharge.
ASCIA resources include a number of materials specific to Anapen® including specific action plans:
a Red Action Plan for Anaphylaxis and an orange First Aid Plan for Anaphylaxis3.
For more information, please contact your Arrotex Representative or Customer Service on 1800 276 839.
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE DISPENSING.
FULL PRODUCT INFORMATION IS AVAILABLE FROM ARROTEX MEDICAL INFORMATION ON 1800 195 055.
MINIMUM PRODUCT INFORMATION: Anapen® Junior 150 Adrenaline (epinephrine) 150 microgram / 0.3 mL solution for injection auto-injector; Anapen® 300 Adrenaline (epinephrine) 300 microgram / 0.3mL solution for injection auto-injector; Anapen® 500 Adrenaline (epinephrine) 500 microgram / 0.3 mL solution for injection auto-injector. INDICATIONS: For the emergency treatment of anaphylaxis (acute severe allergic reactions) due to insect stings, drugs or other allergens. CONTRAINDICATIONS: Patients with known hypersensitivity to adrenaline (epinephrine) or to any of the excipients. There are no absolute contraindications for use in allergic emergency situations. PRECAUTIONS: Asthma, Ventricular arrhythmias, cardiac dilatation, Parkinsonism, cardiac arrhythmias or tachycardia, hyperthyroidism, cardiovascular disease, phaeochromocytoma, high intraocular pressure, severe renal impairment, prostatic adenoma, hypercalcemia, hypokalaemia, diabetes, or in elderly. Sulfite allergy. Accidental injection into hands or feet. Accidental intravascular injection. USE IN PREGNANCY: Category A. Use with caution in pregnant women whose maternal blood pressure is in excess of 130/80. INTERACTIONS: CNS medicines, alpha and beta adrenergic blocking agents, general anaesthetics, hypoglycaemic agents. ADVERSE EFFECTS: The occurrence of undesirable effects depends on the sensitivity of the individual patient and the dose applied. Refer to the Full PI. DOSAGE: Single intramuscular injection into anterolateral aspect of the thigh, not to the buttock. The patient should always carry 2 units of auto-injectors in case the first administration fails or if one dose is not sufficient. Effective dose range 5-10 micrograms per kilogram of bodyweight but higher doses may be necessary in some cases. In case of a second injection needed it is recommended to inject in the opposite thigh. ADULTS:<60kg 300 micrograms.>60kg 300 to 500 micrograms, depending on clinical judgement. CHILDREN: – Anapen® 500 micrograms is not recommended for use in children. 150 micrograms (Anapen® Junior) or 300 micrograms (Anapen®), depending on the body weight of the child and the discretion of the doctor. Children and adolescents>30kg: Anapen® 300mcg. Refer to the full PI for further information.
References: 1. Turner, P. et al. (2020). The Journal of Allergy and Clinical Immunology: In Practice, [online] 8(4), pp.1169–1176. 2. Mullins, R.J. et al. (2016). Clinical & Experimental Allergy, [online] 46(8), pp.1099–1110. 3. ASCIA (2016). ASCIA Guidelines – Acute management of anaphylaxis. [online] Australasian Society of Clinical Immunology and Allergy (ASCIA). [Accessed 08 Jul. 2021]. 4. Liew WK, Williamson E, Tang ML. J Allergy Clin Immunol 2009;123:434–42. 5. Data on file. 6. Australian Approved Product Information for Anapen® March 2021. 7. Australian Approved Consumer Information for Anapen®. 8. Australian Approved Product Information for EpiPen® October 2019. 9. Australian Approved Product for Adrenaline Mylan October 2019.
Anapen® is a trademark used under licence. Arrotex Pharmaceuticals, Cremorne VIC, ABN 30 605 552 234. Arrow, APO and APOTEX are trademarks used under licence. All other brand or product names mentioned are trademarks of their respective holders. ©Copyright 2021. All rights reserved. PRESCRIPTION-001071. Date of preparation: July 2021.