The Pharmaceutical Journal
Vol 270 No 7242 p427
29 March 2003

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DTB advocates prescription of injectable adrenaline for children

A child with an allergy who has had a previous severe allergic reaction should be prescribed injectable adrenaline as a precaution, according to the Drug and Therapeutics Bulletin (2003;41:21).

The bulletin points out that there is little published evidence to support such recommendations but adds that it would also advocate prescription of injectable adrenaline for a child:

• who had respiratory symptoms in a previous allergic reaction

• who has had any allergic reaction and has asthma requiring regular inhaled corticosteroid therapy

• who has had an allergic reaction on exposure to only a trace ammount of allergen

The bulletin describes the prefilled devices Anapen and EpiPen, which are both available as preparations containing either 300µg or 150µg of adrenaline. It points out that the doses recommended by the British National Formulary (according to age) cannot be delivered using these devices.

It cites advice given by the UK Resuscitation Council that children who, according to their age, need 120µg should be prescribed a device delivering 150µg and that those who need either 250µg or 500µg should be prescribed 300µg.

In terms of the number of devices required, the bulletin says that a second dose is unlikely to be needed but adds that there are occasions when it might be wise to have two devices available, for example, if the patient is going to a remote location where prompt medical attention is unavailable.

It concludes that the role of injectable adrenaline should not be considered in isolation and that allergen avoidance should be the mainstay of management.

In the same issue of the DTB, the management of lower urinary tract symptoms in men is reviewed, as well as the reasons behind the withdrawal of Schering Health Care's advertisement for Yasmin (drospirenone/ethinylestradiol).