Epinephrine absorption in adults: Intramuscular versus subcutaneous injection

Simons, F. Estelle R.; Gu, Xiaochen; Simons, Keith J.

doi:10.1067/mai.2001.119409

Cited by 430 publications

(250 citation statements)

References 3 publications

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“…17 Similarly, in adults not experiencing anaphylaxis, peak plasma epinephrine concentrations were attained more quickly and were higher after intramuscular epinephrine was injected into the thigh than after epinephrine was injected intramuscularly or subcutaneously into the upper arm (deltoid). 18 Similar results were obtained with both an ampule of epinephrine or a spring-loaded (eg, EpiPen [Dey, Napa, Calif]) automatic epinephrine device. 17,18 Epinephrine injected intramuscularly into the deltoid or subcutaneously over the deltoid did not result in a significant increase of plasma epinephrine levels over endogenous epinephrine levels.…”

Section: Epinephrinesupporting

confidence: 56%

“…18 Similar results were obtained with both an ampule of epinephrine or a spring-loaded (eg, EpiPen [Dey, Napa, Calif]) automatic epinephrine device. 17,18 Epinephrine injected intramuscularly into the deltoid or subcutaneously over the deltoid did not result in a significant increase of plasma epinephrine levels over endogenous epinephrine levels. It should be noted that studies of the route of injection have not been performed in patients experiencing anaphylaxis.…”

Section: Epinephrinesupporting

confidence: 56%

See 1 more Smart Citation

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson

Muñoz-Furlong²,

Campbell

et al. 2006

Journal of Allergy and Clinical Immunology

1,908

1,114

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Section: Epinephrinesupporting

confidence: 56%

Section: Epinephrinesupporting

confidence: 56%

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson

Muñoz-Furlong²,

Campbell

et al. 2006

Journal of Allergy and Clinical Immunology

1,908

1,114

View full text Add to dashboard Cite

“…49 In a recent study, Simons et al 50 have confirmed the results previously obtained with children showing that the intramuscular administration of epinephrine into the lateral face of the thigh warrants higher serum concentrations and a more prompt therapeutic response than the subcutaneous administration into the deltoid muscle. Furthermore, its use has been better tolerated.…”

Section: Clinical Managementsupporting

confidence: 75%

Reações alérgicas a medicamentos

Nagão-Dias¹,

Barros-Nunes²,

Coêlho³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: This review addresses the most recent published literature regarding drug allergy, in order to provide physicians with a background for a better understanding of this problem of great relevance for public health. Sources of data:The sources of data for obtaining the original and review articles published in the last 10 years were MEDLINE, Pubmed and Lilacs. The articles chosen for this review relate drug allergy to immunological mechanisms, epidemiology, clinical and laboratory evaluation, skin lesions, clinical management, and re-exposure to the drug.Summary of the findings: Allergic reactions represent one third of adverse drug reactions. They are considered rare but with high morbimortality. Gell & Coombs definition has been useful for classifying some types of drug allergic reactions; however, some still remain without classification because of poor knowledge of the mechanisms involved. The existence of T cell subpopulations with diverse characteristics reveals the complexity of the subject and, at the same time, elucidates several questions raised about it. It was recently postulated a new concept of chemically inert drug presentation to T cells, restricted to the major histocompatibility complex, but in a non-covalent and labile way. In clinical practice, without adequate laboratory tests, it is difficult to correlate clinical symptoms and immunological mechanisms. In vitro and in vivo skin tests have been employed in cases of suspected drug allergy reaction. However, there are very few commercially available reagents.Conclusions: Drug allergy constitutes an important problem in adverse drug reactions because of its potential of morbidity and mortality. It is necessary to emphasize the relevance of pharmacovigilance during treatment of patients, as well as the identification of possible immunological mechanisms involved in the events, through laboratory tests and detailed history and clinical evaluation.

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“…Simons et al clearly demonstrated the superiority of the absorption of epinephrine injected intramuscularly in the thigh [21,22]. In our study, 78% of epinephrine administered in ED was by the subcutaneous route, being only in 19% of cases administered intramuscularly.…”

Section: Discussionmentioning

confidence: 69%

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Guevara

Laffond

Bara

et al. 2018

J Investig Allergol Clin Immunol

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Background:To date, few studies have evaluated the degree of compliance with recommendations of anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines recommendations in an ED of a tertiary hospital. Methods: Medical records of patients that were assisted in the ED of the University Hospital of Salamanca (Spain) were reviewed. Those patients fulfilling anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During one year period, we identified 89 patients, 74 adults and 15 children. In the 65% of adults the anaphylactic reaction was moderate, in 34% severe and in 1% very severe. In children, all reactions were moderate. Less than half (42%) of patients received adrenaline at ED, which was administered intramuscularly only in 19% of the cases. Regarding the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were no treated with adrenaline. At discharge from ED, an adrenaline auto-injector was recommended only to 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs. 27% children, p=0.047), 29% instructions about avoidance of triggers (31% adults vs. 20% children, n.s.), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs. 100% children, p<0.001). Conclusion: The results of the study show a large discrepancy between guidelines recommendations and anaphylaxis management in ED. Additional efforts in education to improve the treatment of patients with anaphylactic reactions are needed.

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Epinephrine absorption in adults: Intramuscular versus subcutaneous injection

Cited by 430 publications

References 3 publications

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Reações alérgicas a medicamentos

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

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