BACKGROUND: The EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors, widely prescribed for the out-of-hospital treatment of anaphylaxis, have not been compared prospectively in young children. OBJECTIVE: The purpose of this investigation was to study the rate and extent of epinephrine absorption after use of the EpiPen Jr and the EpiPen in children weighing 15 to 30 kg. METHODS: In a randomized, double-blinded, parallel-group pilot study, children at risk for anaphylaxis self-injected epinephrine using either an EpiPen Jr or an EpiPen with the aid of a physician. Plasma epinephrine concentrations, blood glucose, blood pressure, heart rate, and adverse effects were monitored before and for 180 minutes after the injection. RESULTS:Children (age [mean +/- SEM], 5.4 +/- 0.4 years; weight [mean +/- SEM], 18.0 +/- 0.6 kg) who injected epinephrine with an EpiPen Jr achieved a maximum plasma concentration (mean +/- SEM) of 2037 +/- 541 pg/mL at 16 +/- 3 minutes. Children (6.6 +/- 0.5 years; 25.4 +/- 1.5 kg) who injected epinephrine with an EpiPen achieved a maximum plasma concentration of 2289 +/- 405 pg/mL at 15 +/- 3 minutes. Mean systolic blood pressure 30 minutes after epinephrine injection was significantly higher with the EpiPen than with the EpiPen Jr. After injection with the EpiPen Jr, every child experienced transient pallor; some also experienced tremor and anxiety. After injection with the EpiPen, every child developed transient pallor, tremor, anxiety, and palpitations or other cardiovascular effects; some also developed headache and nausea. CONCLUSION:Epinephrine injection with the EpiPen rather than the EpiPen Jr raised the systolic blood pressure significantly but also caused more adverse effects. The beneficial pharmacologic effects and the adverse pharmacologic effects of epinephrine cannot be dissociated. For the out-of-hospital treatment of anaphylaxis, additional premeasured, fixed doses of epinephrine would facilitate more precise dosing in young children.
RCT Entities:
BACKGROUND: The EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors, widely prescribed for the out-of-hospital treatment of anaphylaxis, have not been compared prospectively in young children. OBJECTIVE: The purpose of this investigation was to study the rate and extent of epinephrine absorption after use of the EpiPen Jr and the EpiPen in children weighing 15 to 30 kg. METHODS: In a randomized, double-blinded, parallel-group pilot study, children at risk for anaphylaxis self-injected epinephrine using either an EpiPen Jr or an EpiPen with the aid of a physician. Plasma epinephrine concentrations, blood glucose, blood pressure, heart rate, and adverse effects were monitored before and for 180 minutes after the injection. RESULTS:Children (age [mean +/- SEM], 5.4 +/- 0.4 years; weight [mean +/- SEM], 18.0 +/- 0.6 kg) who injected epinephrine with an EpiPen Jr achieved a maximum plasma concentration (mean +/- SEM) of 2037 +/- 541 pg/mL at 16 +/- 3 minutes. Children (6.6 +/- 0.5 years; 25.4 +/- 1.5 kg) who injected epinephrine with an EpiPen achieved a maximum plasma concentration of 2289 +/- 405 pg/mL at 15 +/- 3 minutes. Mean systolic blood pressure 30 minutes after epinephrine injection was significantly higher with the EpiPen than with the EpiPen Jr. After injection with the EpiPen Jr, every child experienced transient pallor; some also experienced tremor and anxiety. After injection with the EpiPen, every child developed transient pallor, tremor, anxiety, and palpitations or other cardiovascular effects; some also developed headache and nausea. CONCLUSION:Epinephrine injection with the EpiPen rather than the EpiPen Jr raised the systolic blood pressure significantly but also caused more adverse effects. The beneficial pharmacologic effects and the adverse pharmacologic effects of epinephrine cannot be dissociated. For the out-of-hospital treatment of anaphylaxis, additional premeasured, fixed doses of epinephrine would facilitate more precise dosing in young children.
Authors: Joshua A Boyce; Amal Assa'ad; A Wesley Burks; Stacie M Jones; Hugh A Sampson; Robert A Wood; Marshall Plaut; Susan F Cooper; Matthew J Fenton; S Hasan Arshad; Sami L Bahna; Lisa A Beck; Carol Byrd-Bredbenner; Carlos A Camargo; Lawrence Eichenfield; Glenn T Furuta; Jon M Hanifin; Carol Jones; Monica Kraft; Bruce D Levy; Phil Lieberman; Stefano Luccioli; Kathleen M McCall; Lynda C Schneider; Ronald A Simon; F Estelle R Simons; Stephen J Teach; Barbara P Yawn; Julie M Schwaninger Journal: J Allergy Clin Immunol Date: 2010-12 Impact factor: 10.793
Authors: Amy Dodd; Anna Hughes; Nicholas Sargant; Andrew F Whyte; Jasmeet Soar; Paul J Turner Journal: Resuscitation Date: 2021-04-23 Impact factor: 5.262
Authors: Michelle Halbrich; Douglas P Mack; Stuart Carr; Wade Watson; Harold Kim Journal: Allergy Asthma Clin Immunol Date: 2015-06-12 Impact factor: 3.406