Simons F Estelle R, Gu Xiaochen, Silver Norman A, Simons Keith J
Department of Pediatrics & Child Health, Faculty of Medicine, University of Manitoba, Canada.
J Allergy Clin Immunol. 2002 Jan;109(1):171-5. doi: 10.1067/mai.2002.120758.
The EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors, widely prescribed for the out-of-hospital treatment of anaphylaxis, have not been compared prospectively in young children.
The purpose of this investigation was to study the rate and extent of epinephrine absorption after use of the EpiPen Jr and the EpiPen in children weighing 15 to 30 kg.
In a randomized, double-blinded, parallel-group pilot study, children at risk for anaphylaxis self-injected epinephrine using either an EpiPen Jr or an EpiPen with the aid of a physician. Plasma epinephrine concentrations, blood glucose, blood pressure, heart rate, and adverse effects were monitored before and for 180 minutes after the injection.
Children (age [mean +/- SEM], 5.4 +/- 0.4 years; weight [mean +/- SEM], 18.0 +/- 0.6 kg) who injected epinephrine with an EpiPen Jr achieved a maximum plasma concentration (mean +/- SEM) of 2037 +/- 541 pg/mL at 16 +/- 3 minutes. Children (6.6 +/- 0.5 years; 25.4 +/- 1.5 kg) who injected epinephrine with an EpiPen achieved a maximum plasma concentration of 2289 +/- 405 pg/mL at 15 +/- 3 minutes. Mean systolic blood pressure 30 minutes after epinephrine injection was significantly higher with the EpiPen than with the EpiPen Jr. After injection with the EpiPen Jr, every child experienced transient pallor; some also experienced tremor and anxiety. After injection with the EpiPen, every child developed transient pallor, tremor, anxiety, and palpitations or other cardiovascular effects; some also developed headache and nausea.
Epinephrine injection with the EpiPen rather than the EpiPen Jr raised the systolic blood pressure significantly but also caused more adverse effects. The beneficial pharmacologic effects and the adverse pharmacologic effects of epinephrine cannot be dissociated. For the out-of-hospital treatment of anaphylaxis, additional premeasured, fixed doses of epinephrine would facilitate more precise dosing in young children.
EpiPen Jr（0.15毫克）和EpiPen（0.3毫克）自动注射器被广泛用于院外过敏性反应的治疗，但尚未在幼儿中进行前瞻性比较。
本研究旨在探讨体重15至30千克的儿童使用EpiPen Jr和EpiPen后肾上腺素的吸收速率和程度。
在一项随机、双盲、平行组的试点研究中，有过敏性反应风险的儿童在医生协助下使用EpiPen Jr或EpiPen自行注射肾上腺素。在注射前及注射后180分钟监测血浆肾上腺素浓度、血糖、血压、心率和不良反应。
使用EpiPen Jr注射肾上腺素的儿童（年龄[均值±标准误]，5.4±0.4岁；体重[均值±标准误]，18.0±0.6千克）在16±3分钟时达到最大血浆浓度（均值±标准误）为2037±541皮克/毫升。使用EpiPen注射肾上腺素的儿童（6.6±0.5岁；25.4±1.5千克）在15±3分钟时达到最大血浆浓度为2289±405皮克/毫升。注射肾上腺素30分钟后，使用EpiPen的儿童平均收缩压显著高于使用EpiPen Jr的儿童。使用EpiPen Jr注射后，每个儿童都出现短暂面色苍白；一些儿童还出现震颤和焦虑。使用EpiPen注射后，每个儿童都出现短暂面色苍白、震颤、焦虑和心悸或其他心血管效应；一些儿童还出现头痛和恶心。
使用EpiPen而非EpiPen Jr注射肾上腺素可显著提高收缩压，但也会引起更多不良反应。肾上腺素的有益药理作用和不良药理作用无法分开。对于院外过敏性反应的治疗，额外预先测量的固定剂量肾上腺素将有助于更精确地给幼儿用药。
