Presentations

Abstract

Introduction: The gold-standard for anaphylaxis treatment is epinephrine administered intramuscularly, with most cases resolving promptly to a single dose. However, it is estimated that about 7.7% of anaphylaxis cases require multiple doses of epinephrine. A higher BMI and consequently a higher skin-to-muscle distance (STMD) may hinder the systemic delivery of epinephrine, causing patients to require additional doses. Conversely, there is limited and conflicting data regarding this topic. Duvauchelle et al. and Worm et al. both demonstrated adequate systemic delivery of epinephrine among patients with a higher STMD. Whereas Bernstein et al. found an inverse relationship between peak concentration of epinephrine and BMI. This study aims to clarify the impact of BMI on the efficacy of epinephrine in resolving anaphylaxis.

Methods: A retrospective chart review was conducted at CHKD Allergy & Asthma clinic using electronic medical records of patients who had received at least 1 dose of epinephrine during a physician supervised oral food challenge between January 1st, 2018, to December 31st, 2023. A total of 151 subjects met inclusion criteria; however, 52 subjects were excluded from the analysis due to missing BMI.

Results: In the final analysis of 99 subjects, the number of individuals receiving more than one dose of epinephrine varied across different BMI categories. Specifically, 2 underweight subjects (28.57%), 14 normal weight subjects (20%), 2 overweight subjects (20%), and 2 obese subjects (16.67%) required multiple doses.

Conclusion: These results revealed no significant association between BMI and the administration of multiple epinephrine doses (p<0.94).