ArticleAllergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology2014
Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone.
Article in Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 50 citations in OpenAlex.
- Needle-to-bone safety margin of adrenaline auto-injectors in Japanese children: Impact of injection site variation.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Exploring the anti-anaphylaxis potential of natural products: A Review.Inflammopharmacology · 2025Review
- Anaphylaxis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024Review
- Adrenaline auto injectors pharmacokinetic/pharmacodynamic studies and potential consequences for clinical practice.Clinical and translational allergy · 2023Review
- International recommendations on epinephrine auto-injector doses often differ from standard weight-based guidance: a review and clinical proposals.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2022Review
- CSACI position statement: transition recommendations on existing epinephrine autoinjectors.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2021Article
- Recent update on the management of anaphylaxis.Clinical and experimental emergency medicine · 2021Article
- The pharmacokinetics of epinephrine/adrenaline autoinjectors.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2021Review
- Emerging Therapies in Anaphylaxis: Alternatives to Intramuscular Administration of Epinephrine.Current allergy and asthma reports · 2021Review
- [Paediatric Life Support].Notfall & rettungsmedizin · 2021Review
- Clinical Management of Infant Anaphylaxis.Journal of asthma and allergy · 2021Review
- Epinephrine auto-injector needle length: The impact of winter clothing.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2020Article
- Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities.Journal of asthma and allergy · 2018Review
- Anaphylaxis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2018Review
- Unintentional injection to the bone with a pediatric epinephrine auto-injector.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2018Article
- Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions.The western journal of emergency medicine · 2016Observational
- Anaphylaxis in children.Current opinion in pediatrics · 2016Review
- Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2016Article
- CSACI position statement: epinephrine auto-injectors and children < 15 kg.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2015Review
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsConsecutive 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.
resultsOne 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.
conclusionsA 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.