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Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone.

Kim L, Nevis IF, Tsai G, Dominic A, Potts R, Chiu J, Kim HL - Allergy Asthma Clin Immunol (2014)

Bottom Line: Baseline characteristics were compared between patients with a STBDmax <12.7 mm vs. ≥12.7 mm.Height (p = 0.02) and weight (p = 0.0002) differed significantly between the two groups.In the multivariable regression analysis, BMI was found to be a significant predictor of STBDmax.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada.

ABSTRACT

Background: The Epipen® Jr and Allerject® 0.15 mg are currently the most commonly prescribed epinephrine auto-injectors (EAIs) for the management of anaphylaxis in pediatric patients in North America and Canada. To ensure rapid absorption, it should be administered intramuscularly into the anterolateral aspect of the thigh. We examined whether the 12.7-mm needle length of the Epipen® Jr and Allerject® 0.15 mg is adequate for delivering epinephrine intramuscularly in pediatric patients who weighed <15 kg.

Methods: Consecutive pediatric patients with food allergy weighing <15 kg who required an EAI were included. Ultrasounds of the mid-anterolateral thigh were performed under minimal (min) and maximal (max) pressure. Skin-to-muscle depth (STMD) and skin-to-bone depth (STBD) measurements were completed. Baseline characteristics were compared between patients with a STBDmax <12.7 mm vs. ≥12.7 mm. Linear regression including variables such as age, sex, body mass index (BMI) and race was performed. The proportion of patients with a STBDmax <12.7 mm was compared in those weighing <10 kg vs. 10-14.9 kg.

Results: One hundred patients were included; 29 (29%) had STBDmax <12.7 mm. Height (p = 0.02) and weight (p = 0.0002) differed significantly between the two groups. Approximately 19% of those weighing 10-14.9 kg and 60% of those <10 kg had a STBDmax <12.7 mm. In the multivariable regression analysis, BMI was found to be a significant predictor of STBDmax.

Conclusions: A large proportion of children <15 kg prescribed an EAI is at risk of having the auto-injector administered into bone. Since alternative EAIs with shorter needle lengths are not currently available, EAIs should be prescribed with appropriate counselling in this population.

No MeSH data available.


Related in: MedlinePlus

Ultrasound image of anterolateral thigh. STMDmax: skin-to-muscle depth with maximal pressure; STBDmax: skin-to-bone depth with maximal pressure.
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Figure 1: Ultrasound image of anterolateral thigh. STMDmax: skin-to-muscle depth with maximal pressure; STBDmax: skin-to-bone depth with maximal pressure.

Mentions: Consecutive pediatric patients with confirmed food allergy weighing less than 15 kg who would benefit from EAI prescriptions in an allergist’s office were included in this trial. The subjects were assessed from July 2012 to November 2013. All subjects’ parents/guardians agreed to participate in the study. An ultrasound on the anterolateral aspect of the right mid thigh (the recommended site for injections with EAIs) was performed to measure four distances of tissue depths: skin-to-muscle depth with minimal pressure (STMDmin), skin-to-muscle depth with maximal pressure (STMDmax), skin-to-bone depth with minimal pressure (STBDmin) and skin-to-bone depth with maximal pressure (STBDmax) (see Figure 1). The investigator applied the pressure while performing the ultrasound measurements on each subject. The estimated maximal force was 2–8 lbs. All ultrasounds were completed by a single physician using a Sonosite Titan® ultrasound machine.


Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone.

Kim L, Nevis IF, Tsai G, Dominic A, Potts R, Chiu J, Kim HL - Allergy Asthma Clin Immunol (2014)

Ultrasound image of anterolateral thigh. STMDmax: skin-to-muscle depth with maximal pressure; STBDmax: skin-to-bone depth with maximal pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126643&req=5

Figure 1: Ultrasound image of anterolateral thigh. STMDmax: skin-to-muscle depth with maximal pressure; STBDmax: skin-to-bone depth with maximal pressure.
Mentions: Consecutive pediatric patients with confirmed food allergy weighing less than 15 kg who would benefit from EAI prescriptions in an allergist’s office were included in this trial. The subjects were assessed from July 2012 to November 2013. All subjects’ parents/guardians agreed to participate in the study. An ultrasound on the anterolateral aspect of the right mid thigh (the recommended site for injections with EAIs) was performed to measure four distances of tissue depths: skin-to-muscle depth with minimal pressure (STMDmin), skin-to-muscle depth with maximal pressure (STMDmax), skin-to-bone depth with minimal pressure (STBDmin) and skin-to-bone depth with maximal pressure (STBDmax) (see Figure 1). The investigator applied the pressure while performing the ultrasound measurements on each subject. The estimated maximal force was 2–8 lbs. All ultrasounds were completed by a single physician using a Sonosite Titan® ultrasound machine.

Bottom Line: Baseline characteristics were compared between patients with a STBDmax <12.7 mm vs. ≥12.7 mm.Height (p = 0.02) and weight (p = 0.0002) differed significantly between the two groups.In the multivariable regression analysis, BMI was found to be a significant predictor of STBDmax.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada.

ABSTRACT

Background: The Epipen® Jr and Allerject® 0.15 mg are currently the most commonly prescribed epinephrine auto-injectors (EAIs) for the management of anaphylaxis in pediatric patients in North America and Canada. To ensure rapid absorption, it should be administered intramuscularly into the anterolateral aspect of the thigh. We examined whether the 12.7-mm needle length of the Epipen® Jr and Allerject® 0.15 mg is adequate for delivering epinephrine intramuscularly in pediatric patients who weighed <15 kg.

Methods: Consecutive pediatric patients with food allergy weighing <15 kg who required an EAI were included. Ultrasounds of the mid-anterolateral thigh were performed under minimal (min) and maximal (max) pressure. Skin-to-muscle depth (STMD) and skin-to-bone depth (STBD) measurements were completed. Baseline characteristics were compared between patients with a STBDmax <12.7 mm vs. ≥12.7 mm. Linear regression including variables such as age, sex, body mass index (BMI) and race was performed. The proportion of patients with a STBDmax <12.7 mm was compared in those weighing <10 kg vs. 10-14.9 kg.

Results: One hundred patients were included; 29 (29%) had STBDmax <12.7 mm. Height (p = 0.02) and weight (p = 0.0002) differed significantly between the two groups. Approximately 19% of those weighing 10-14.9 kg and 60% of those <10 kg had a STBDmax <12.7 mm. In the multivariable regression analysis, BMI was found to be a significant predictor of STBDmax.

Conclusions: A large proportion of children <15 kg prescribed an EAI is at risk of having the auto-injector administered into bone. Since alternative EAIs with shorter needle lengths are not currently available, EAIs should be prescribed with appropriate counselling in this population.

No MeSH data available.


Related in: MedlinePlus