title: CSACI position statement: epinephrine auto-injectors and children < 15 kg.
abstract: 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. In community settings, epinephrine is available as an auto-injector in two doses, 0.15 mg and 0.3 mg. The recommended dose for children is 0.01 mg per kilogram. For infants at risk of anaphylaxis in the community, there are few options with regard to providing an optimal epinephrine dose for first-aid treatment. 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; therefore, these effects need to be measured against the consequences of not receiving epinephrine at all, which can include fatality.
authors.affiliation: Paediatric Allergy, Asthma and Clinical Immunology, Winnipeg Clinic, University of Manitoba, Winnipeg, MB Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Halbrich
authors.affiliation: Department of Pediatrics, McMaster University, Pediatric Allergy, Asthma and Immunology, Assistant Clinical Professor, McMaster University, Joseph Brant Memorial Hospital, Burlington, ON Canada.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Mack
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Carr
authors.affiliation: Department of Pediatrics, Dalhousie University, Head, Division of Allergy, IWK Health Centre, Halifax, NS Canada.
authors.forename: Wade
authors.initials: W
authors.lastname: Watson
authors.affiliation: Western University, London, ON Canada ; McMaster University, Hamilton, ON Canada.
authors.forename: Harold
authors.initials: H
authors.lastname: Kim
keywords: Allergy; Anaphylaxis; CSACI position statement; Epinephrine; Infant