Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone

Area of Science:

• Pediatric Anaphylaxis Management
• Medical Device Safety
• Pharmacology

Background:

• Epinephrine auto-injectors (EAIs) like EpiPen® Jr and Allerject® 0.15 mg are standard for pediatric anaphylaxis.
• Correct intramuscular administration into the anterolateral thigh is crucial for rapid epinephrine absorption.
• The adequacy of the 12.7-mm needle length for children weighing <15 kg requires investigation.

Purpose of the Study:

• To determine if the 12.7-mm needle length of common EAIs is sufficient for intramuscular delivery in pediatric patients weighing less than 15 kg.
• To assess the risk of subcutaneous or intramuscular injection into bone in this population.

Main Methods:

• Ultrasound measurements of skin-to-muscle depth (STMD) and skin-to-bone depth (STBD) were taken on the anterolateral thigh of pediatric patients (<15 kg) under minimal and maximal pressure.
• Patients were stratified by weight (<10 kg vs. 10-14.9 kg) and STBDmax (<12.7 mm vs. ≥12.7 mm).
• Linear regression analysis identified predictors of STBDmax, including age, sex, BMI, and race.

Main Results:

• 29% of 100 pediatric patients had a maximum skin-to-bone depth less than the 12.7-mm needle length.
• Patients weighing <10 kg (60%) were more likely to have STBDmax <12.7 mm compared to those weighing 10-14.9 kg (19%).
• Body Mass Index (BMI) was a significant predictor of skin-to-bone depth.

Conclusions:

• A significant proportion of young children (<15 kg) are at risk of epinephrine auto-injector administration into bone due to inadequate needle length.
• Current EAI needle lengths may not be suitable for all pediatric patients, particularly those under 10 kg.
• Prescribing EAIs for this population necessitates careful patient selection and thorough counseling on administration techniques.