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Epinephrine for Infants and Toddlers: New CSACI Position Statement

baby_dec15Parents and physicians have long sought informed guidance on how much, and when, to give epinephrine to infants and young toddlers suffering a severe allergic reaction (anaphylaxis).

Fortunately, the Canadian Society of Allergy and Immunology (CSACI) has issued a new Position Statement clarifying the need to treat all incidents of anaphylaxis with an epinephrine auto-injector, stating that the risks of using epinephrine for a child weighing under 15 kg are “expected to be mild and transient” — but the consequences of not using an epinephrine auto-injector “can include fatality.”

The amount recommended by the CSACI is equivalent to an EpiPen Jr. ® or an Allerject ® 0.15 mg/0.15mL (1mg/mL).

Dr. Douglas Mack, co-author of the statement and Anaphylaxis Section Head of the CSACI, notes: “While some physicians in the past have prescribed an epinephrine ampule and syringe, unfortunately because of concerns about dosing inaccuracy and delayed time for administration, this is not recommended. We are recommending that an auto-injector be used instead.”

In the Position Statement, the CSACI states “Epinephrine (adrenaline) is the treatment of choice for anaphylaxis. While other medications including H1-antihistamines, H2-antihistamines, corticosteroids, and inhaled beta-2 agonists are often used to treat anaphylaxis in the emergency setting, none of these medications has been shown to reverse anaphylaxis. Fatal anaphylaxis is related to the delayed use of epinephrine.”

The CSACI continues: “…The Canadian Society of Allergy and Immunology (CSACI) therefore recommends, for the child weighing less than 15 kg, given the lack of a suitable alternative, prescribing the 0.15 mg epinephrine autoinjector. Adverse effects of an epinephrine dose of 0.15 mg given intramuscularly in infants or children weighing less than 15 kg are expected to be mild and transient at the plasma epinephrine concentrations achieved.”

To read the entire CSACI statement in the November 20, 2015 issue of Allergy, Asthma & Clinical Immunology, view the open access document.