The Journal of Allergy and Clinical Immunology: In Practice
Clinical CommunicationsThe deep fascia of the thigh forms an impenetrable barrier to fluid injected subcutaneously by autoinjectors
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Cited by (22)
Implications of variation of epinephrine auto-injector needle length
2019, Annals of Allergy, Asthma and ImmunologyPoint-of-care ultrasonography in the allergy and immunology clinic
2019, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Song et al25 reported that the injection bolus in pig subcutaneous tissue spread 94% beyond the needle tip through propulsion. However, Diacono et al23 reported that the fascia was an impermeable barrier to fluids injected by an EAI. In addition, proper intramuscular injection required the entire needle orifice to be in the muscle.
Adrenaline auto-injectors: What dose? Position statement by the anaphylaxis working group of the French Allergology Society
2018, Revue Francaise d'AllergologieEpinephrine, auto-injectors, and anaphylaxis: Challenges of dose, depth, and device
2018, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Propulsion is clearly capable of delivering medications to the intramuscular space, as evidenced by needle-free intramuscular injection devices that rely on propulsive forces alone.44 Although in vitro studies in pork tissue suggest that fascia may act as a barrier to the movement of drugs from the subcutaneous tissue into muscle,45 in vivo studies demonstrate extensive movement of molecules similar in size to epinephrine through fascia.46 Clinical information on the use of epinephrine in obese patients is limited.
Epinephrine auto-injector needle lengths: Can both subcutaneous and periosteal/intraosseous injection be avoided?
2018, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :There is a risk for injecting epinephrine into subcutaneous tissue instead of the muscular compartment or periosteal or intraosseous deposition. Computed tomography,14 injection in pigs,15–17 ballistic gel,8 and ultrasound of the human mid-anterolateral aspect of the right thigh8,18–23 have been used to estimate the risk of subcutaneous and periosteal or intraosseous injection.8,18–20,24 The recently introduced Auvi-Q 0.1-mg HPEAI is intended for use in small children to avoid periosteal or intraosseous injection of epinephrine.
Contemporary issues in anaphylaxis and the evolution of epinephrine autoinjectors: What will the future bring?
2017, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :It might be expected that an immediately retractable needle, or needless delivery method, would prevent these types of adverse events. Recently, the needle length of available EAIs has become a topic of controversy.27–29 This is based on a few lines of recent evidence.
This study was funded by the Anaphylaxis Campaign, UK. R. S. Pumphrey is on the Clinical & Scientific Panel of the Anaphylaxis Campaign. R. S. Pumphrey, V. Sharma, and P. D. Arkwright have previously received funding to attend scientific conferences from Meda Pharmaceuticals Ltd., ALK-Abello, Lincoln Medical, and iMed. These companies donated the autoinjectors used in this study. Ballistic gelatin was donated by LGC Forensics. Hampshire piglets were a gift of Ms. M. Shah, University of Manchester.
Conflicts of interest: P. D. Arkwright has received travel grants from iMed Systems and ALK. D. Diacono has received research support from Anaphylaxis Campaign. R. S. Pumphrey has received travel grants from iMed Systems and Lincolm Medical; has received fees from Meda for participation in a device review; has provided expert testimony on fatal anaphylaxis from HM Coroners; and has received lecture fees from NHS Hospitals. V. Sharma has received travel grants from ALK-Abello and MEDA.