#AlwaysCarryTwo – The value of carrying two adrenaline auto-injectors



The #alwayscarrytwo petition highlights the need for everyone at risk of anaphylaxis to carry at least two adrenaline auto-injectors (AAIs) at all times.

Adrenaline is the front-line treatment for anaphylaxis. It stabilises symptoms until the patient can get medical treatment from a doctor. Early adrenaline administration is associated with a decreased risk of hospitalisation. Patients who receive a dose of adrenaline prior to arriving at hospital are less likely to be admitted.

Guidelines recommend the prescription of at least one adrenaline auto-injector (AAI) for patients at risk of anaphylaxis. Although not all guidelines recommend more than one AAI, a second dose is needed for 16-36% of patients with anaphylaxis. The petition looks to change the UK BSACI guidelines which don’t recommend prescribing 2 AAIs in all cases.


  • A recent study published in the Journal of Allergy and Clinical Immunology: In Practice looked at 448 caregivers and 505 patients in the US at risk of anaphylaxis.
    • It found that although 80% of respondents said they do not carry 2 AAIs, half have required 2 doses of adrenaline during a previous reaction.
    • 64% of those surveyed were told in training to keep 1 AAI on them and 1 in another location. The second dose usually was kept at home. Only 27% were advised to keep 2 on them at all times.


  • A further study shows that:
    • though the majority of people (89%) who were given a prescription for an AAI had it filled, almost half (45%) said they didn’t have their pen with them during their most severe allergic reaction.
    • 78% said they had been hospitalised for their allergy at some point in their lifetime.
    • 21% said they didn’t know how to use their AAI.

These studies underline the importance of keeping two AAIs on you at all times and the importance of adequate training in order to prevent tragedy.

Proper training would help patients understand the importance of having a second device on them at all times.

Some anaphylactic reactions are so severe that one device is not enough. The first dose may not relieve symptoms, or it may not relieve them for long enough for the patient to reach the emergency department.

Learn more and sign the #alwayscarrytwo petition here: 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


Source: https://www.sciencedirect.com/science/article/pii/S2213219818300461


Disclaimer: The information provided is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Allergy Lifestyle Limited (t/a) Allergy Lifestyle) uses reasonable endeavours to check the accuracy of information provided however no warranty is given that they are error-free. Always seek the advice of an allergy specialist and follow your anaphylaxis emergency care plan.

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