• The number of AAI prescribed should be discussed with each patient and their carers.
  • One AAI is usually sufficient. The need for two injections of adrenaline to treat an allergic reaction is uncommon and often implies either poorly controlled allergies/asthma OR incorrect/inappropriate use. Any child needing two doses of adrenaline for a single reaction should receive urgent medical attention and then be referred to a clinician with expertise in managing children’s allergies for review
  • Patients and their carers should be trained to use the particular auto-injector that they have been prescribed—technique varies between injectors.
  • People with allergies and their carers should obtain and practice using a trainer device (available for free from the manufacturers’ websites)
  • All patients who use their AAI should call an ambulance and seek immediate medical attention to ensure that the reaction is settling.
  • Patients with AAI who have asthma should be seen regularly by their GP and ensure that their symptoms are well controlled.
  • We recommend that a review of competence in use of the device and understanding of the indications of the use of adrenaline auto-injectors occurs at the time of each prescription and repeat prescription. Incorrect use of auto-injectors may lead to serious needlestick injuries.  Trainer devices should be available to all families for regular practice.


  • Legislation now allows (but does not demand) schools to purchase from their own funds AAI which can be used in an emergency for children suffering an anaphylactic reaction.
  • Use of these auto-injectors are only allowed if there is explicit consent from the child’s parents and doctor.
  • These auto-injectors should not replace, but rather supplement personal auto-injectors.
  • The NWPAN will always support children at risk of anaphylaxis and provide training for parents and carers, as well as advice for nurseries/schools and colleges.
  • Decisions regarding generic auto-injectors will be left to individual schools. NWPAN healthcare professionals will support any reasonable requests to support training needs of school nurses in order to cascade best practice.