Waterbury, CT ANAPHYLAXIS IN THE UNITED STATES: AN INVESTIGATION INTO ITS EPIDEMIOLOGY

phylaxis, inhaled epinephrine from a metered-dose inhaler is sometimes recommended as a simple and easily administered alternative to injectable epinephrine. This study evaluated the practicality of inhaled epinephrine in a pediatric population at risk for anaphylaxis by evaluating the rate and extent of epinephrine absorption after inhalation. Study Population. A total of 19 children ages 6 to 14 years with a history of allergy and anaphylaxis. Methods. This was a prospective, randomized, placebo-controlled parallel group study with observer blinding. Based on the child’s weight, 10, 15, or 20 inhalations of epinephrine or placebo were administered. Plasma levels of epinephrine were monitored before and at intervals from 5 to 180 minutes postdosing, along with blood glucose, heart rate, blood pressure, and adverse effects. Results. The 11 children in the epinephrine group were able to inhale 11 2 inhalations (range: 3–30 puffs), which represented 74% 7% of the precalculated dose. The 8 children in the placebo group were able to inhale 12 2 (range: 8–20) puffs, or 89% 3% of the precalculated dose. Peak plasma epinephrine concentrations were 1822 413 for the epinephrine group and 1316 247 for the placebo group. There were no differences between the groups in epinephrine levels, heart rate, or blood pressure. Conclusion. Even with expert coaching, children were unable to achieve adequate plasma epinephrine concentrations with inhaled epinephrine. Reviewer’s Comments. This is a well-conducted study with an important message that inhaled epinephrine should not be used as an alternative to injectable epinephrine.