Clear New AAI Guidance – Always Carry Two!

When our daughter Natasha was very little and first diagnosed with allergies, our GP gave us a prescription for two junior Epi-Pen adrenaline auto-injector pens (AAIs) and those prescriptions continued for all of her life. The reason for this we were told was that if an AAI was faulty and didn’t fire the adrenaline, to mitigate the danger we would have another one. We were however, never told that two AAIs can be injected if a serious allergic reaction requires it.

I always therefore thought that it was common practice to carry two AAIs.  Since launching Natasha’s Foundation in 2019, we have been surprised to find out that GPs in the UK sometimes prescribe just one AAI and at other times two to allergic patients. Guidance given has suggested that only one AAI is effective as a first aid treatment and whether one or two AAIs are prescribed, seems to have been a decision based solely on the individual GPs discretion. 

In the UK this inconsistency in prescribing AAIs is due to poor allergy training, a general lack of compliance and the follow-up of patients.  It’s a travesty that there has been such lack of knowledge of allergy in both primary and secondary care and a general lack of proper guidance. So we are really pleased that updated and clear advice from The National Institute for Health and Care Excellence (NICE) says healthcare professionals when discharging patients from hospital should now prescribe those people with severe allergies two AAIs and patients should always carry two devices with them.

NICE updated its guidance on ‘Anaphylaxis: Assessment and Referral After Emergency Treatment’ in August 2020 in response to the inquest into Shante Turay-Thomas, who died in north London just 18 years old, from anaphylaxis after eating hazelnut. At the time of her death in September 2018 Shante had only one AAI available at this crucial time.  The Coroner found that she had not been properly advised that the reason for carrying two AAIs was that in the event of a severe food allergy,  a second dose of adrenaline can be a life preserving measure whilst waiting for emergency medical treatment.  Furthermore, Shante had not been properly trained in administering her injector pen and the dosage of the pen prescribed was inadequate to maintain her until the paramedics arrived.

Following Shante’s inquest in January this year, the coroner warned that action is needed to ensure that people with severe food allergies are aware that two AAIs must be carried at all times and they must be properly trained in how to use them. This would help to prevent further, avoidable deaths from severe food allergies. The new NICE guidance states that people should be offered a prescription for two further AAIs before being discharged from hospital and advised to carry them with them at all times.

Our daughter Natasha died from anaphylaxis in July 2016 and the two Epi-Pens her father administered her with, did not help her. Her anaphylaxis was fast and severe and the hospitalisation she so desperately needed was impossible on a BA plane flying above France.  But it is important to be clear, the early administration of adrenaline from an AAI generally improves outcome of anaphylaxis and it should be seen as a first-aid measure combined with calling for emergency services and getting to hospital as soon as possible.