ASCIA* guidelines for prescribing an adrenaline autoinjector


History of anaphylaxis (if patient is considered to be at continuing risk)


A rapidly-evolving, generalised multisystem allergic reaction.

Characterised by one or more symptoms or signs of respiratory and/or cardiovascular involvement and involvement of other systems such as the skin and/or gastrointestinal tract.

Respiratory symptoms

  • Difficult/noisy breathing
  • Swelling of tongue
  • Swelling/tightness in throat
  • Difficulty talking and/or hoarse voice
  • Wheeze or persistent cough

Cardiovascular symptoms

  • Loss of consciousness
  • Collapse
  • Pale and floppy (in young children)
  • Hypotension


History of a generalised allergic reaction AND one or more risk factors

Generalised allergic reaction

Characterised by one or more symptoms or signs of skin and/or gastrointestinal tract involvement without respiratory and/or cardiovascular involvement.

Skin symptoms

  • Generalised pruritus
  • Urticaria/angioedema
  • Erythema

Gastrointestinal symptoms

  • Abdominal pain
  • Vomiting
  • Loose stools

Risk factors

  • Asthma (current or past history)
  • Age (children over 5 years, adolescents and young adults)
  • Specific allergic triggers:
    peanut/nut allergy
    — stinging insect allergy in adults (bees, wasps, jumper ants)
  • Comorbidity (e.g. ischaemic heart disease)
  • Geographical remoteness from emergency medical care


  • Asthma with no history of anaphylaxis or generalised allergic reactions
  • Elevated specific IgE only (positive RAST and/or skin test) without a history of clinical reactions
  • Family (rather than personal) history of anaphylaxis or allergy
  • Local reactions to insect stings – in adults and children
  • Generalised skin rash (only) to bee or wasp stings – in children
  • Resolved food allergy

* Abbreviated from ASCIA (the Australasian Society of Clinical Immunology and Allergy) guidelines for adrenaline autoinjector prescription