Epi Dosing in Anaphylaxis
Did you know that the 0.3mg IM epi dose as treatment for anaphylaxis was first noted in 1918?? This has been the standard of care ever since. This article, albeit in adults, shows us that higher-dose epi can be beneficial without increasing side effects.
The researchers reviewed almost 6 years of data including 338 patients, 254 of whom received 0.3mg IM epi and 84 who received 0.5mg IM epi for suspected anaphylaxis. The primary outcome of the study was "escalation of care" after the initial IM dose of epi, which included any of the following within 6 hours of the initial dose: an additional IM dose of epi, starting an epi infusion, or intubation. They also looked at safety data including peak change in HR and SBP, ischemic changes on EKG, development of an arrythmia, and elevated troponin.
What did they find? Escalation of care was found in 30% of the 0.3mg group compared to 7% of the 0.5mg group, noting that the 0.3mg group mostly required additional dosing. Safety data was limited (not a lot of labs or EKGs done), but from a vital sign perspective, there was no difference between the groups, though the study was not specifically powered to do so.
Some important points: the median weight of patients in this study was 82kg. The authors discuss the recommended weight-based dose of 0.01mg/kg with a max of 0.3mg in children 6-12 years old and 0.5mg in teens and adults (per the World Allergy Organization, American College of Allergy, Asthma and Immunology; and the American Academy of Allergy, Asthma and Immunology). Though these are the current guidelines, they have not been broadly adopted as evidenced by this study and the difference in group size.
Bottom Line: consider using 0.5mg IM Epi as the max dose in our teenagers presenting with anaphylaxis
The researchers reviewed almost 6 years of data including 338 patients, 254 of whom received 0.3mg IM epi and 84 who received 0.5mg IM epi for suspected anaphylaxis. The primary outcome of the study was "escalation of care" after the initial IM dose of epi, which included any of the following within 6 hours of the initial dose: an additional IM dose of epi, starting an epi infusion, or intubation. They also looked at safety data including peak change in HR and SBP, ischemic changes on EKG, development of an arrythmia, and elevated troponin.
What did they find? Escalation of care was found in 30% of the 0.3mg group compared to 7% of the 0.5mg group, noting that the 0.3mg group mostly required additional dosing. Safety data was limited (not a lot of labs or EKGs done), but from a vital sign perspective, there was no difference between the groups, though the study was not specifically powered to do so.
Some important points: the median weight of patients in this study was 82kg. The authors discuss the recommended weight-based dose of 0.01mg/kg with a max of 0.3mg in children 6-12 years old and 0.5mg in teens and adults (per the World Allergy Organization, American College of Allergy, Asthma and Immunology; and the American Academy of Allergy, Asthma and Immunology). Though these are the current guidelines, they have not been broadly adopted as evidenced by this study and the difference in group size.
Bottom Line: consider using 0.5mg IM Epi as the max dose in our teenagers presenting with anaphylaxis
