Epinephrine absorption in children with a history of anaphylaxis

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

“…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.…”

“…A study in children not experiencing anaphylaxis demonstrated more rapid absorption and higher plasma epinephrine levels when epinephrine was administered intramuscularly in the anterior-lateral thigh with an autoinjector when compared with values after subcutaneous administration. 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.…”

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

“…Promoting initiatives to make AAIs available in public places is essential to prevent fatal anaphylaxis. Heart rate Plasma adrenaline concentration Figure 5 Systolic and diastolic blood pressure, heart rate and plasma adrenaline concentration plotted against time, after intramuscular injection using the EpiPen â adrenaline auto-injectors or subcutaneous injection of an adrenaline solution (adapted from Simons et al [67] with permission). Despite the recognized importance of AAIs for the emergency treatment of anaphylaxis, the available data on their efficiency are surprisingly limited.…”

“…In a randomized, single-blind, single-dose, parallel-group study (67), anaphylactic children (n = 17, aged 4-12 years), with a history of severe allergies and systemic anaphylaxis, received from a nurse a single im adrenaline injection using the EpiPen â or a sc injection of adrenaline. The children were not studied during an anaphylactic attack and had not had recent anaphylaxis.…”

Diretrizes

“…Pode surgir em poucos minutos, com vasodilatação, hipotensão, edema de laringe, broncoespasmo, prurido, angioedema, náuseas, vômitos, diarreia e dor abdominal. Nesses casos, é fundamental o início rápido de tratamento com administração de adrenalina intramuscular 88 , ou rediluida por via endovenosa em casos muito graves, com resposta terapêutica em poucos minutos.…”