Link to view the article: https://www.researchgate.net/publication/348204696_Choosing_the_Optimal_Self-Injector_Epinephrine
It is recommended that the patient or caregiver carries at least 2 self- injectable devices, as a second dose is required in 20–36% of cases
Situations that require a second dose include not rapid access to medical care, history of previous severe reaction, elevated body mass index, and asthma, as risk factors, in addition to technical situations such as an error in administration, as well as conditions typical of that condition of anaphylaxis (very severe reaction, biphasic response)
The main factos that determine the correct use of an auto injector are the length of he needle, BMI, use of clothing, type of device and training of the person applying epinephrine.
There are doubts as to whether the intramuscular appication will be successful in overweight patients when using an Epinephrine autoinjector (EAI) and whether it will be necessary to manufacture devices with longer needles.
Children weighing less than 15 kg, the needle length of EAI devices can be excessive increasing the risk of intraosseous or subcutaneous administration with the use of EAI.
In 2017, the FDA approved the use of a pre-filled syringe for manual administration of epinephrine in two forms, 03. mg and 0.15 mg, for patients 9 30 kg and 15–30 kg, respectively.
Conclusion: Dispensation of epinephrine should be available to all patients suffering from anaphylaxis, regardless of setting, be it home, school, work, or medical. Patients, caregivers, and health care personnel should be trained to recognize the signs and symptoms of anaphylaxis and know the correct technique and dose of epinephrine administration.
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