Abstract
BackgroundAllergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle length of 13 mm. Therefore, there is a risk of intramuscular administration if patients have a skin-to-muscle depth <13 mm, which may increase the risk of anaphylaxis. The objective of this study was to determine whether the needle length of a standard allergy syringe is appropriate for patients receiving subcutaneous immunotherapy.MethodsUltrasounds of the left posterolateral arm were performed to measure skin-to-muscle depth in 200 adults receiving subcutaneous immunotherapy. The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared. The proportion of patients with skin-to-muscle depths > 4 mm, 6 mm, 8 mm and 10 mm were also calculated. Multivariable logistic regression was performed to identify predictors of skin-to-muscle depth.ResultsOf the 200 patients included in the study, 80% had a skin-to-muscle depth ≤13 mm; the majority (91%) had a skin-to-muscle depth >4 mm. Body mass index was found to be a significant predictor of skin-to-muscle-depth.ConclusionsMost patients receiving subcutaneous immunotherapy have a skin-to-muscle depth less than the needle length of a standard allergy syringe (13 mm). These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis. Using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk.
Highlights
Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders
Intramuscular injections should be avoided, as they may be associated with more rapid absorption of the extract, which could lead to an increased risk of systemic reactions [6]
In patients with a subcutaneous tissue depth less than the needle length of the allergy syringe, there is a possibility of inadvertent intramuscular injection of the allergen extract during subcutaneous immunotherapy (SCIT)
Summary
Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Allergen-specific subcutaneous immunotherapy (SCIT) is an effective treatment for allergic disorders such as allergic rhinitis/conjunctivitis and asthma [1,2,3,4,5] It is recommended for patients with these conditions who have not improved clinically following avoidance of their identified allergens and the use of other guideline-recommended medical therapies. In patients with a subcutaneous tissue depth less than the needle length of the allergy syringe, there is a possibility of inadvertent intramuscular injection of the allergen extract during SCIT. This study was performed to determine the subcutaneous tissue depth, that we will refer to as skin-to-muscle depth (STMD), in patients who receive SCIT in order to establish whether the needle length of a standard allergy syringe is appropriate
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