Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department has considered locating anaphylaxis kits in (a) schools, (b) supermarkets and (c) other public places.

Since October 2017, the Human Medicines (Amendment) Regulations 2017 have allowed all schools to buy adrenaline auto-injectors (AAIs) without a prescription, for emergency use on children who are at risk of anaphylaxis but whose own device is not available or not working. The Department has published non-statutory guidance to accompany this legislative change, which is available at the following link:

https://www.gov.uk/government/publications/using-emergency-adrenaline-auto-injectors-in-schools

This guidance advises schools on the recognition and management of an allergic reaction and anaphylaxis, and outlines when and how an AAI should be administered for pupils. The guidance makes clear that any AAIs held by a school should be considered a spare device and not a replacement for a pupil’s own AAIs. It also states that children at risk of anaphylaxis should have their own prescribed AAIs at school for use in an emergency, and that they should always carry two devices.

There are many implications that would need to be given careful consideration if anaphylaxis kits were to be located in supermarkets and other public places. For example, we would need to consider the impacts on supplies of AAIs for patients to whom they are prescribed. There are currently only two suppliers of AAIs and, whilst there is close monitoring of continuity of supply at current levels, a significant increase in demand for AAIs would require close collaboration with suppliers.

There are other technical and practical challenges. It is not uncommon for AAIs to reach the market with around 15 months or less to expiry, and so establishments holding spare AAIs would need to conduct regular checks on their expiry dates and replace them quite frequently.

The susceptibility of adrenaline to deterioration at high temperature, and of the delivery mechanism to be impaired at very low temperature, make a temperature-controlled environment necessary. AAIs could, therefore, not be placed in direct sunlight or in an outside environment susceptible to freezing.

AAIs are marketed with different adrenaline doses and needle lengths. Individual prescriptions take into account age and body weight.

The administration of AAIs is not intuitive for an untrained individual. There are different brands of AAIs and they are not considered generic equivalents of each other. There are device-specific characteristics, including needle length, dose and propulsion, that affect the delivery of adrenaline into the circulation. Certain brands have different instructions for use, according to the device mechanism. Each has a different mode of operation and requires specific training in use.

There is also concern for the security of AAIs in public places against malicious tampering and theft with criminal intent.