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Allergen Immunotherapy and Risk of Intramuscular Injections

by / 0 Comments / 11 View / December 14, 2014

Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections

Background:
Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into  the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle  length of 13 mm. Therefore, there is a risk of intramuscular administration if patients have a skin-to-muscle depth <13 mm, which may increase  the risk of anaphylaxis. The objective of this study was to determine whether the needle length of a standard allergy syringe is  appropriate for patients receiving subcutaneous immunotherapy.
Methods:
Ultrasounds of the left posterolateral arm were performed to measure skin-to-muscle depth in 200 adults receiving subcutaneous  immunotherapy. The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared. The proportion of patients with skin-to-muscle depths > 4 mm, 6 mm, 8 mm and 10 mm were also calculated.  Multivariable logistic regression was performed to identify predictors of skin-to-muscle depth.
Results:
Of the 200 patients included in the study, 80% had a skin-to-muscle depth ≤13 mm; the majority (91%) had a skin-to-muscle depth >4 mm.  Body mass index was found to be a significant predictor of skin-to-muscle-depth.
Conclusions:
Most patients receiving subcutaneous immunotherapy have a skin-to-muscle depth less than the needle length of a standard allergy syringe (13mm). These patients are at risk of receiving injections intramuscularly, whichmay increase the risk of anaphylaxis. Using a syringe with a  needle length of 4 mm given at a 45° angle to the skin may decrease this risk.

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