By the time children suffering anaphylaxis arrive at the emergency department, many have received epinephrine exceeding the recommended dose of 0.01mg/kg
Does receiving epinephrine prior to arriving negatively impact the youngest of these children? A study presented at this year’s annual conference of the American College of Allergy, Asthma and Immunology (ACAAI) sought to find out.
The study looked the medical records of children weighing less than 15kg (33lbs) arriving at the urgent care or emergency department of a children’s hospital between July 2015 and April 2018 and compared those receiving epinephrine prior to arrival (PAE) to those that received epinephrine only after arrival. Patient median age was 1.78 years in the PAE group vs 1.48 years in the after arrival group.
Of the 190 eligible patients (median age 1.72 years), 87 (46%) received pre-arrival epinephrine with a mean initial dose was 0.014 mg/kg (range 0.008-0.103). Of the 17.4% receiving a dose ≥0.015 mg/kg, 46.7% required more than one dose. Patients receiving PAE received more overall epinephrine, mean 0.019 mg/kg (range 0.008-0.114), versus 103 who did not, mean 0.01 mg/kg.
PAE was associated with vomiting after the initial epinephrine dose (p<0.05) and an average length-of-stay 60 minutes shorter in the ED or UC (p<0.05). The patients did not differ in mean weight, age, inpatient admission, or LOS for admitted patients. Lastly, there was no difference in other epinephrine-related symptoms such as tremor, pallor, or delayed capillary refill at time of initial presentation.
Patients who received PAE do not present to the emergency department with epinephrine-related symptoms despite many receiving doses exceeding recommendations. Patients weighing <15 kg appear to tolerate intramuscular-epinephrine doses higher than 0.01 mg/kg, which supports the use of 0.15 mg epinephrine auto-injectors in this population when lower-dose auto-injectors are unavailable.