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Auto-injectors are primarily for self-use by patients who are at risk of an anaphylactic reaction. They should be prescribed on an individual basis by a allergy treatment specialist. Auto-injectors are relatively expensive with a limited shelf life compared with the cost of an ampoule of adrenaline, syringe, and needle. Anaphylactic reactions are uncommon, so auto-injectors purchased for the healthcare setting may not be used.

Another reason why we do not use auto-injectors, is that they come with standard length needle which may not be long enough to give intramuscular adrenaline for some patients. Giving the injection will allow the drug to be administered where that particular patient needs it.

Most healthcare staff likely to deal with anaphylactic reactions in the healthcare setting should have the skills to draw up adrenaline and give an intramuscular injection. This course is not designed to tell you how to administer adrenalin in this way because presumably, you will already know this. If you do not,  then you would only use an auto injector. In some areas, a local decision may be made where a healthcare setting opts to use auto-injectors instead of adrenaline ampoules. If there is no other form of adrenaline available, it would be appropriate for a healthcare professional to use an adrenaline auto-injector for the treatment of an anaphylactic reaction.

A question raised by the UK Resuscitation council recently clarified another difference. It was asked, "why does the guideline recommend giving repeat doses of intramuscular adrenaline every 5 minutes, when the manufacturers of adrenaline auto-injectors recommend a longer interval (10-15 minutes) between doses?" The answer they gave was that auto-injectors are recommended primarily to laypeople for self administration. Guidance for their use must allow a greater degree of safety in terms of dose and recommended dosing intervals.

There is little science on which to base a recommendation for the dosing interval. The recommendation of 5 minutes is pragmatic and based on the personal experience of those who use adrenaline in their regular practice. Waiting for 10-15 minutes for a response before giving a further dose may be excessive in a patient with life-threatening airway, breathing, or circulation problems caused by an anaphylactic reaction. Remember, as a healthcare professional you have more training and experience than a patient or non-professional, so you have more choices in what treatment should be administered and how it should be given.