Epinephrine auto-injectors needle length is important to ensure that the drug gets where its needed and there have been concerns with some brands of auto-injector that the needle length is not sufficient when used on some children and adolescents in the treatment of food allergies. A new report published on the Emerade website published the results.
The research looked at if children could be at risk of the epinephrine not being delivered into the intramuscular space and they looked at two target weight groups, 15 to 30kg and those over 30kg
The basic trial data as from the Emerade website is as follows:
The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (max) or slight pressure (min) in:
- 102 children weighing 15–30 kg (group 1)
- 100 children and adolescents, weighing more than 30 kg (group 2).
Group 1, 15-30 kg:
- Using a high pressure EAI – Epipen Jr® and Auvi-Q®/Allerject® 0.15 mg – 11 % children had a STMDmax that showed a risk of intraosseous injection.
- Using another high pressure EAI – Jext® – 38 % had a STMDmax that showed a risk of intraosseous injection.
- There was a 1 % risk of subcutaneous injection with these devices.
- Using a low pressure EAI, Emerade®, there was no risk of intraosseous injection.
Group 2, more than 30 kg:
- Using a high pressure EAI, the risk of intraosseous injection was 3 %.
- Using a low pressure EAI, such as Emerade, there was no risk of intraosseous injection.
- However, the risk of subcutaneous injection using a high pressure EAI was 9 % and using a low pressure EAI was 2 %.
There is a risk of intraosseous injection using high pressure EAI (Epipen®/Epipen Jr®, Auvi-Q®/Allerject® and especially Jext®) in children at risk of anaphylaxis.
There was also a risk of subcutaneous injection using the currently available high pressure EAI in children and adolescents.
Emerade adrenaline auto-injector has a longer needle, 25 mm for 500 and 300 micrograms, 16 mm for 150 microgram.