On the Wednesday evening before Christmas, 14-year-old Emma Sloan tragically died from anaphylaxis on O'Connell Street in Dublin. She had been for a meal with her family at a Chinese buffet and had eaten satay sauce (which contains peanuts) by mistake. She had a known nut allergy but did not have her adrenaline auto-injector with her that evening. When she began to suffer an allergic reaction, her mother went into a nearby chemist to ask for an EpiPen. The pharmacy said they were unable to give out an adrenaline auto-injector without a prescription and advised the family to go to A&E. Emma died a few metres outside the chemist. RTÉ has reported that the Pharmaceutical Society of Ireland has launched an investigation.
Any report of an anaphylaxis death is incredibly sad to read. In this case, there is the added question mark of whether the pharmacy could and should have supplied the emergency adrenaline.
Could a similar tragedy occur in the UK?
It seems so. According to the EpiPen website, in the UK, EpiPens are "only available on prescription from your doctor". From what I've read (and I hasten to add I have no medical/pharmacy background), although adrenaline is a "POM" (prescription only medicine) an exemption exists allowing it to be "administered" in an anaphylaxis emergency. However, I am not clear if this means a UK pharmacist could "dispense" adrenaline in an anaphylaxis emergency.
The "orange cross" scheme in Scotland
In Scotland, whilst adrenaline auto-injectors are only available on prescription, Community Pharmacy Scotland (CPS) launched a campaign last summer in respect of anaphylaxis emergencies. The scheme has been backed by Lib Dem MP Jo Swinson, who suffered anaphylaxis and required an adrenaline injection in May 2013.
Under the scheme, wherever a Scottish pharmacy displays an orange anaphylaxis treatment cross, that pharmacy can provide "trained help in an anaphylaxis emergency".
I contacted CPS for further details and they have confirmed this means that participating pharmacies will each stock at least one adrenaline injection 300mcg per dose (adult) and at least one adrenaline injection 150mcg per dose (child). The producers of both Epipen and Jext have also provided the pharmacies with training and support materials.
CPS told me:
"Anaphylaxis is an issue with which community pharmacists are well placed to advise patients (even around correct use and expiry etc of pens), so we feel it was important to raise awareness for the pharmacies as well as the public. So far around 890 of our pharmacies have opted in and should be showing the orange cross within their pharmacy premises."
Until we get to the stage where adrenaline auto-injectors are held in public places (nurseries, schools, restaurants, shopping centres, railway stations etc) in the same way as some venues hold defibrillators, schemes such as the CPS orange cross scheme are a very welcome and reassuring step in the right direction.
Please England, Wales and Northern Ireland: can you follow suit?
Update: UK pharmacists' powers in life saving emergency
Please see extremely interesting comment from a pharmacist on the Nutmums facebook page (thank you, Kristeen).
Sources and further information
- Irish Independent, Mother's agony as teenage girl dies from peanut allergy on city street (20 December 2013).
- MailOnline, Teenager, 14, who had allergic reaction to peanuts at Chinese buffet died in the street after chemist refused to give her a life-saving adrenaline injection by Laura Lynott and Lizzie Parry (21 December 2013).
- RTÉ, Pharmaceutical Society of Ireland investigating death of teenager after peanut reaction (20 December 2013).
- Community Pharmacy Scotland, Anaphylaxis Campaign.
- BBC News, Allergy MP Jo Swinson backs anaphylaxis treatment scheme (9 August 2013).
- Herald Scotland, Swinson backs calls for allergy campaign to introduce help points in pharmacies (9 August 2013).
- The Scotsman, Pharmacies to offer allergic reaction treatment (9 August 2013).
(image courtesy of Community Pharmacy Scotland)