Original Articles: Food and Drug Reactions and Anaphylaxis
EpiPen Jr versus EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis,☆☆

https://doi.org/10.1067/mai.2002.120758Get rights and content

Abstract

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. (J Allergy Clin Immunol 2002;109:171-5.)

Section snippets

Methods

The study was approved by the University of Manitoba Research Ethics Board. Assent for participation was obtained from each child; written, informed consent for each child's participation was obtained from his or her parents.

Results

A total of 153 families, each with a child aged 4 to 8 years who was at risk for anaphylaxis and for whom the EpiPen Jr or the EpiPen had been prescribed by his or her personal physician, were telephoned with regard to involvement in this study. Twelve families agreed to participate. Most of the families who were contacted declined because they did not want their children to have an epinephrine injection or a “needle.” Some parents commented that their children would never need the EpiPen Jr or

Discussion

This study was performed in a practical attempt to address the dilemma faced by physicians involved in the care of young children at risk for anaphylaxis outside a hospital setting: how to decide which of the 2 available fixed doses of epinephrine (either 0.15 mg from an EpiPen Jr or 0.3 mg from an EpiPen) to prescribe for a young child weighing between 15 and 30 kg for whom neither dose would be optimal. We have shown that epinephrine injected either from an EpiPen Jr (0.15 mg) or an EpiPen

Acknowledgements

We are grateful to the children who participated in this study and to their parents. We thank Ms Lana M. Johnston, RN, for excellent professional assistance and Janet R. Roberts, MD, FRCPC, Wade T. A. Watson, MD, FRCPC, and Allan B. Becker, MD, FRCPC, for allowing us to study their patients.

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    Supported by the Children's Hospital Foundation of Manitoba, Inc. No financial or in-kind support was provided for this study by any corporate sponsor.

    ☆☆

    Reprint requests: F. E. R. Simons, MD, FRCPC, Children's Hospital of Winnipeg, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9.

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