Self-injectable epinephrine for first-aid management of anaphylaxis

Scott H. Sicherer, F. Estelle R. Simons, Paul V. Williams, Sami L. Bahna, Bradley E. Chipps, Mary Beth Fasano, Mitchell R. Lester, Frank S. Virant, Michael J. Welch, John M. Kelso, Todd A. Mahr, Dennis Randall Ownby, Gary S. Rachelefsky, Debra Burrowes

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126 Scopus citations

Abstract

Anaphylaxis is a severe, potentially fatal systemic allergic reaction that is rapid in onset and may cause death. Epinephrine is the primary medical therapy, and it must be administered promptly. This clinical report focuses on practical issues concerning the administration of self-injectable epinephrine for first-aid treatment of anaphylaxis in the community. The recommended epinephrine dose for anaphylaxis in children, based primarily on anecdotal evidence, is 0.01 mg/kg, up to 0.30 mg. Intramuscular injection of epinephrine into the lateral thigh (vastus lateralis) is the preferred route for therapy in first-aid treatment. Epinephrine autoinjectors are currently available in only 2 fixed doses: 0.15 and 0.30 mg. On the basis of current, albeit limited, data, it seems reasonable to recommend autoinjectors with 0.15 mg of epinephrine for otherwise healthy young children who weigh 10 to 25 kg (22-55 lb) and autoinjectors with 0.30 mg of epinephrine for those who weigh approximately 25 kg (55 lb) or more; however, specific clinical circumstances must be considered in these decisions. This report also describes several quandaries in regard to management, including the selection of dose, indications for prescribing an autoinjector, and decisions regarding when to inject epinephrine. Effective care for individuals at risk of anaphylaxis requires a comprehensive management approach involving families, allergic children, schools, camps, and other youth organizations. Risk reduction entails confirmation of the trigger, discussion of avoidance of the relevant allergen, a written individualized emergency anaphylaxis action plan, and education of supervising adults with regard to recognition and treatment of anaphylaxis.

Original languageEnglish (US)
Pages (from-to)638-646
Number of pages9
JournalPediatrics
Volume119
Issue number3
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Keywords

  • Anaphylaxis
  • Epinephrine
  • Food allergy
  • Insect-sting allergy
  • Self-injectable epinephrine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Sicherer, S. H., Simons, F. E. R., Williams, P. V., Bahna, S. L., Chipps, B. E., Fasano, M. B., Lester, M. R., Virant, F. S., Welch, M. J., Kelso, J. M., Mahr, T. A., Ownby, D. R., Rachelefsky, G. S., & Burrowes, D. (2007). Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics, 119(3), 638-646. https://doi.org/10.1542/peds.2006-3689