Abstract
Intramuscular epinephrine is the first-line treatment for patients with anaphylaxis. The 2012 World Allergy Organization anaphylaxis guidelines recommend the mid-anterolateral thigh as the preferred site of injection.1 The deltoid muscle and the subcutaneous route are not recommended because studies in adults have shown that mean plasma epinephrine concentration is significantly lower and that peak concentration may not be reached for more than 1 hour after injection.2 In a study of 17 children, subcutaneous injection led to only 2 of 9 (22%) achieving maximal epinephrine concentration within 5 minutes, compared with 6 of 8 (75%) if the injection was intramuscular.
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