Abstract
BackgroundFood allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15–30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe.MethodsThe distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (max) or slight pressure (min) in 102 children weighing 15–30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2).ResultsUsing a high pressure EAI (HPEAI), Epipen Jr® and Auvi-Q®/Allerject® 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext®, had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade®. In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %.ConclusionThere is a risk of intraosseous injection using HPEAI (Epipen®/Epipen Jr®, Auvi-Q®/Allerject® and especially Jext®) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.Electronic supplementary materialThe online version of this article (doi:10.1186/s13223-016-0110-8) contains supplementary material, which is available to authorized users.
Highlights
Food allergy is the most common cause of anaphylaxis in children
Consecutive patients who were less than 18 years of age, with diagnosed food allergy based on an appropriate history and positive skin prick testing were recruited into the study
The compression originated mainly from the muscle compartment, mean of 91.3 %, quartiles 8.8–96.4 %. This is the first study assessing whether epinephrine auto-injectors (EAI) would deliver epinephrine into the intramuscular space in children with food allergy who are in the proper weight indications for the Epipen® and Auvi-Q®/Allerject®
Summary
Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15–30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe. Food allergy is the most common identified cause of anaphylaxis [1]. There has been concern that the EAI may not deliver epinephrine to the intramuscular space in both adults and children. In both adults and children with and without risk of anaphylaxis, it has been identified that a significant number of patients may receive epinephrine subcutaneously with the currently available EAI [7,8,9,10]. There has been a contradictory study showing that in children weighing
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