Adrenalin Administration in Anaphylaxis

In standard references the subcutaneous (SC) route of epinephrine injection is recommended for use in children with anaphylaxis. The intramuscular (IM) route is seldom given as the preferred route.

Because the rate of absorption of epinephrine had not been reported previously in allergic children, Simons et al (Univ. Manitoba) report a randomized, blind, parallel-group study of 17 children (4 to 12 years of age) with a history of anaphylaxis to food, Hymenoptera venom, or other substances. The children all had a history of severe allergies with systemic anaphylaxis and carried injectible epinephrine at all times.

There was a striking difference in the time of the maximum concentration of epinephrine in the plasma of children given IM epinephrine over those receiving SC epinephrine (average time of 8 minutes for the IM group vs 34 minutes for the SC group). The average maximum plasma concentration was also significantly higher for the IM group than the SC group.

(Simons F et al. J Allergy Clin Immunol 1998; 101:33-37)

COMMENT: I now recommend the I. M. route for anaphylaxis.