Anaphylaxis is a life-threatening allergic reaction that can happen anytime, anywhere – even in people not previously diagnosed with an allergy. Allergies represent the most common chronic disease in Europe, and are particularly prevalent in children.1 Exposure to certain foods, environmental substances like pollen, household materials like latex, or numerous other common allergens could lead to a fatality within minutes.2 Deaths that result from a sudden, unexpected episode of anaphylactic shock are particularly tragic considering that, according to the World Health Organization, the timely administration of adrenaline is potentially lifesaving.3 The WHO recommends intramuscular adrenaline as an essential, first-line treatment for anaphylaxis.4

Adrenaline is the WHO’s recommended first-line treatment for anaphylaxis, but emergency access to adrenaline auto-injectors remains restricted across much of Europe.

The key challenge is that adrenaline auto-injectors (AAIs) – the form of adrenaline used in emergency situations – are not equally accessible across Europe. In many Member States, it is impossible to obtain an AAI to hold for emergency use in places like schools or restaurants, where people are at a higher risk for anaphylaxis. Further limiting the life-saving potential of AAIs, it is often illegal for a non-healthcare professional to administer the treatment, even in a life-or-death situation and when the person has received training. Numerous studies conclude that the benefits of expanding access to AAIs in public places and allowing their use by non-healthcare professionals clearly outweighs the risks.5

The EU and Member States consider the reduction of inequity in healthcare access and outcomes as one of the most important public health challenges. The EU can make meaningful progress toward this objective and help prevent unnecessary allergy deaths by adopting these measures.6

Recommendations

Raise awareness about food allergies, anaphylaxis, and management of allergic reactions.

Awareness campaigns should be launched at both pan-European and national levels to improve understand on the risks of allergic reactions, the proper response in the cases of anaphylaxis, and the potentially life-saving effect of timely treatment.

Allow for emergency medicines, such as AAIs, to be made available in public places where risk of allergic reaction could be higher.

Organisations such as schools, offices, restaurants, and sports venues should be permitted to keep emergency medicines such as AAIs on hand without the need for a prescription designated to a particular person. This change is in line with the EU 4 Health program’s stated goals, which include enhancing the availability and accessibility of medicinal products and medical devices. The decision to acquire AAIs for emergency use can remain voluntary and be left up to the organisation.

While Ireland and Portugal have recently adopted policies in line with those in the US, UK, and Australia, laws in most Member States still forbid acquisition of AAIs for public places.

Create and promote EU-wide, evidence-based guidelines for allergy management and response to anaphylaxis, including recommendations around the emergency administration of AAIs.

European-level guidance covering diagnosis, treatment, management, and prevention of allergies is essential. This guidance should include a harmonized framework for the acquisition, storage, and procedures for administration of AAIs in public places.

Currently, only a few Member States have such guidelines, and they are varied and fragmented between countries.

1 The European Academy of Allergy and Clinical Immunology
2 American College of Allergy, Asthma and Immunology
3 European Medicines Agency
4 World Allergy Organization Journal
5 UK Government
6 European Parliamentary Research Service