Carry Two Adrenaline Auto-injectors

When I think about living with allergies and anaphylaxis one thing that really resonates with me is just how vital having access to adrenaline pens are if you're at risk of anaphylaxis. Adrenaline is the life-saving drug that helps to reverse the effects of anaphylaxis within the body. I am very fortunate to live within the UK where thanks to the NHS we have access to free healthcare and do not have to pay the cost of the medication itself, whilst in England many people need to pay a prescription charge I am very fortunate to live in Scotland where prescribed medication is entirely free. I find myself thinking about those living at risk of anaphylaxis and requiring an adrenaline pen in the USA where unfortunately people are charged for the medication itself and whilst some insurance companies do cover part or all of the cost of adrenaline pens lots of people affected by anaphylaxis in some way are subjected to having to pay hundreds of dollars for adrenaline pens. Whilst we do not face this battle in the UK many people are facing their own issues.

Most guidance available suggests that a person at risk of anaphylaxis should be prescribed, have access to and carry with them 2 adrenaline auto-injectors:

MHRA (Medicines and Healthcare products Regulatory Agency):
"It is recommended that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times" (Medicines and Healthcare products Regulatory Agency cited in Gov.uk, 2017)
"If you do not start to feel better, use the second auto-injector 5-15 minutes after the first one" (Medicines and Healthcare products Regulatory Agency cited in Gov.uk, 2017)

European Medicines Agency:
"It is likely that your doctor will recommend that you carry 2 injectors, in case a second dose is needed while you wait for emergency treatment" (European Medicines Agency, 2015)
"It is recommended that healthcare professionals prescribe 2 auto-injectors, which patients should carry at all times" (European Medicines Agency, 2015)

Epi Pen UK:
"Anyone at risk of an anaphylactic reaction should carry an adrenaline auto-injector with them at all times, as an immediate injection of adrenaline could be the difference between life and death" (Resuscitation Council (UK) Guidelines, 2008 cited in Epipen UK, 2017)
"People who have been prescribed an adrenaline auto-injector because of the risk of anaphylaxis should carry two with them at all times for emergency, on-the-spot use" (Drug Safety Update Volume 7 Issue 10, 2013 cited in Epipen UK, 2017)
"35% of patients may require more than one adrenaline dose" (Korenblat P et al. Allergy Asthma Proceedings, 1999 cited in Epipen UK 2017)
"It is vital that at risk patients carry 2 Epipen at all times. A second dose can be given after about 5 to 15 minutes if necessary" (Drug Safety Update Volume 7 Issue 10, 2013 cited in Epipen 2017)

However, guidance from the BSACI (British Society for Allergy and Clinical Immunology) only recommends one unless: the person is obese, the person lives in a rural location, the person has had a prior reaction which proved life-threatening or if the person required more than one lot of adrenaline in a short timespan:

"A recent MHRA drug safety update (2014) recommended that people who have been prescribed an AAI should carry two; however, normally only one auto-injector is required for self-administration during a reaction. For children, two should usually be prescribed one each for school and for home. Exceptions, when two pens may be required in one kit, that is giving the option of administering two doses, include obesity, remoteness from medical help, a previous life-threatening reaction or if two doses were required (as distinct from given) in a short time period for previous reactions, or other assessment of risk." (British Society for Allergy and Clinical Immunology, 2016)

This guidance means that a lot of people would fit into the category of not requiring having more than one pen at hand. This guidance not only means that people who have never had a reaction before but are at risk for an anaphylactic reaction would most likely only be supplied one adrenaline auto-injector but people who have suffered anaphylaxis before would also only be supplied with one if they don't fit into the categories mentioned above. 

As a result of these new guidelines many people throughout the UK are facing issues with only being prescribed one adrenaline auto-injector. This reduction in access to adrenaline auto-injectors has a high probability of allergies and the potential of anaphylaxis resulting in an increased level of anxiety, a reduction of independence and added stress. What happens if the only adrenaline auto-injector a person has is faulty? What happens if the auto-injector is used incorrectly? What happens if an ambulance doesn't reach the person within 5-15 minutes when a second pen is usually recommended to be used? Many reasons exist past obesity, rural location and severity of reaction where a second pen should be supplied to people. Adrenaline is a life-saving medication and reducing people's access to this life-saving drug could potentially result in fatalities that could otherwise have been avoided.

The Campaign For The Right To Carry 2 Adrenaline Auto-injectors was founded to try ensure that everyone has access to at least 2 auto-injectors no matter their weight, their location, the severity of a previous reaction or having a previous anaphylactic reaction. They set up a petition 3 years ago in response to the BSACI guidelines. The aim of the petition to encourage the BSACI to alter their guidelines surrounding access to adrenaline auto-injectors. This campaign has received immense support in the past 3 years from all over the UK and has even had celebrity support too. In the 3 years since the petition was set up it has gained over a whopping 49,300 signatures! This is a fantastic result thus far and it continues to be shared far and wide with new signatures being added on a regular basis. They are working extremely hard behind the scenes to promote their campaign to not only those living with anaphylaxis but members of the general public too. Many may not understand why the BSACI's guidelines are so anxiety-provoking however many people who's lives are influenced by allergies and anaphylaxis state that the guidelines are causing added stress and anxiety that doesn't exist as much as when 2 adrenaline auto-injectors are accessible. Many people live in fear of when they're next adrenaline auto-injector prescription is due that their GP/consultant will only prescribe one pen to have to hand.

For more information on the Campaign For The Right To Carry 2 Adrenaline Auto-injectors please visit:
Facebook: https://www.facebook.com/campaign42AAI/

Please also considering signing the petition to encourage the BSACI to alter their guidelines:
https://www.change.org/p/this-petition-supports-the-alwayscarrytwo-campaign-we-ask-the-bsaci-to-reverse-its-recommendation-that-the-majority-of-patients-require-one-aai-back-to-two

References

BSCAI (2016) Adrenaline Auto-injector (Accessed on: 6th December 2017) Available at <http://www.bsaci.org/Guidelines/adrenaline-auto-injector>
Epipen UK (2017) Epipen (Accessed on: 6th December 2017) Available at <http://www.epipen.co.uk/hcp/epipen/>
European Medicines Agency (2015) Adrenaline auto-injectors (Accessed on: 6th December 2017) Available at <http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Adrenaline_auto_injectors/human_referral_000367.jsp&mid=WC0b01ac05805c516f>
Gov. UK (2017) Adrenaline auto-injectors: updated after European review (Accessed on: 6th December 2017) Available at: <https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review>