Medline ® Abstracts for References 19,20
of 'Anaphylaxis: Emergency treatment'
Epinephrine absorption in adults: intramuscular versus subcutaneous injection.
Simons FE, Gu X, Simons KJ
J Allergy Clin Immunol. 2001;108(5):871.
We report a prospective, randomized, blinded, placebo-controlled, 6-way crossover study of intramuscular versus subcutaneous injection of epinephrine in young men. Peak plasma epinephrine concentrations were significantly higher (P<.01) after epinephrine was injected intramuscularly into the thigh than after epinephrine was injected intramuscularly or subcutaneously into the upper arm. We recommend intramuscular injection of epinephrine into the thigh as the preferred route and site of injection of this life-saving medication in the initial treatment of anaphylaxis.
Section of Allergy&Clinical Immunology, Department of Pediatrics&Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Epinephrine absorption in children with a history of anaphylaxis.
Simons FE, Roberts JR, Gu X, Simons KJ
J Allergy Clin Immunol. 1998;101(1 Pt 1):33.
BACKGROUND: Prompt injection of epinephrine is the cornerstone of systemic anaphylaxis treatment. The rate of epinephrine absorption has not been reported previously in allergic children.
OBJECTIVE: Our objective was to study the clinical pharmacology of epinephrine in this population.
METHODS: We performed a prospective, randomized, blinded, parallel-group study in 17 children with a history of anaphylaxis to food, Hymenoptera venom, or other substances. We injected 0.01 ml/kg epinephrine solution (maximum 0.3 ml [0.3 mg]) subcutaneously, or 0.3 mg epinephrine intramuscularly from an autoinjector. Plasma epinephrine concentrations, heart rate, blood pressure, and adverse effects were monitored.
RESULTS: In nine children who received epinephrine subcutaneously, the mean maximum plasma epinephrine concentration (+/- SEM) was 1802 +/- 214 pg/ml, achieved at a mean time of 34 +/- 14 minutes (range, 5 to 120 minutes). Only two of the nine children achieved maximum plasma concentrations by 5 minutes. In eight children who received epinephrine intramuscularly, the mean maximum plasma concentration was 2136 +/- 351 pg/ml, achieved at a mean time of 8 +/- 2 minutes, which was significantly faster than the mean time at which maximum plasma concentrations were achieved after subcutaneous epinephrine injection (p<0.05). Six of the eight children achieved maximum plasma concentrations by 5 minutes. The terminal elimination half-life was 43 +/- 15 minutes. No serious adverse effects were noted in any child.
CONCLUSIONS: In children, recommendations for subcutaneous epinephrine injection are based on anecdotal experience, and should be reevaluated in view of our finding of delayed epinephrine absorption when this route is used. This delay might have important clinical implications during an episode of systemic anaphylaxis. The intramuscular route of injection is preferable.
Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.