Short Communication

Multicenter real-world experience with epinephrine 0.5 mg dosing for anaphylaxis with allergen immunotherapy

https://orcid.org/0000-0003-0761-0488

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

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Ariba Quidwai

Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5C1, Canada

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Samira Jeimy

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

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Natalie Rondilla

GrandRiver Allergy, Kitchener, ON, N2M 5E2, Canada

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Fred White

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

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William Moote

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

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Mark Kuprowski

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

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Harold Kim

*Author for correspondence: Tel.: +1 519 685 8167;

E-mail Address: harold.kim@lhsc.on.ca

Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, ON, N6A 4V2, Canada

Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada

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Published Online:6 Oct 2021https://doi.org/10.2217/imt-2021-0142

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Abstract

Aim: To determine the safety and efficacy of 0.5 mg intramuscular (IM) epinephrine for the treatment of subcutaneous allergen immunotherapy induced anaphylaxis. Patients & methods: Retrospective chart review of patients who received 0.5 mg of IM epinephrine for treatment of anaphylaxis from subcutaneous allergen immunotherapy at two outpatient allergy and immunology practices. Results: Thirty-eight patients received 0.5 mg IM epinephrine. Eleven patients (29%) required a second dose, and two patients (5%) required a third dose of IM epinephrine. Sixteen patients (42%) were transferred to the emergency department with ongoing symptoms. All had eventual resolution of anaphylaxis. There were no adverse reactions or fatalities. Conclusion: IM epinephrine at a dose of 0.5 mg is safe and effective for treatment of anaphylaxis from subcutaneous allergen immunotherapy.

Lay abstract

The aim of this study to understand whether a 0.5 mg dose of epinephrine injected into the muscle is safe and effective in treating anaphylaxis (a life-threatening allergic reaction) caused by subcutaneous allergen immunotherapy (allergy shots). We reviewed the charts of all patients who received 0.5 mg of epinephrine at two allergy clinics. Thirty-eight patients received 0.5 mg of epinephrine. Twenty-nine percent of patients required a second dose of epinephrine and 5% required a third dose. Forty-two percent of patients were sent to the emergency department due to ongoing symptoms. Anaphylaxis was successfully treated in all patients. There were no side effects or deaths. Epinephrine at 0.5 mg is safe and effective in treating anaphylaxis from subcutaneous allergen immunotherapy.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 13, No. 16

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History

Received 6 June 2021

Accepted 6 August 2021

Published online 6 October 2021

Published in print November 2021

Information

Keywords

Author contributions

S Jeimy, F White, W Moote, M Kuprowski and H Kim contributed to data acquisition. A Quidwai and N Rondilla performed chart reviews. N Correa and H Kim performed data analysis. N Correa, S Jeimy and H Kim contributed to study design and drafted the manuscript. All authors provided critical review of the manuscript for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work related to its accuracy or integrity.

Acknowledgments

The authors thank E Dawson for assistance with statistical analysis.

Financial & competing interests disclosure

S Jeimy has been on speaker’s bureaus for Aralez, Novartis, Astra Zeneca and Sanofi and on the advisory board for Sanofi. H Kim has been on speaker’s bureaus and/or advisory boards for ALK, Aralez, Astra Zeneca, GSK, Kaleo, Mylan, Pediapharm, Pfizer and Stallergenes Greer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This study was a quality improvement initiative and therefore according to local policy (Tri-Council Policy Statement Article 2.5) did not require approval by the research ethics board.

Data sharing statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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