Table 2 Notable case history related to pediatric EAI use
From: Unintentional injection to the bone with a pediatric epinephrine auto-injector
Age at event, years | 6 years (2013) | 7 years (2014) | 9 years (2017) |
|---|---|---|---|
Height (cm) | 117 | 122 | 141 |
Weight (kg) | 17.7 | 25 | 30 |
STBD (with compression, mm) | 10.7 | 11.1 | 12.1 |
Suspected/known allergen | Milk | Cake with cashew | “Snack Pack” bakery shop dessert (tapioca, carrageenan) |
Symptoms/acute care | MS ingested milk and her caregiver administered the EpiPen Jr® because she thought MS complained of throat itchiness | MS had immediate shortness of breath, hives, throat tightness, and lip swelling Her mother gave her the EpiPen Jr® in the right mid-anterolateral thigh Epinephrine worked immediately, and she improved within 30 s MS had transient shakes, tachycardia, fatigue lasting approximately 3 min MS was taken to and observed in the Emergency Department. MS complained of pain immediately in her right thigh at the injection site, which has persisted over time X-ray and ultrasound were negative | MS had an immediate throat swelling and shortness of breath MS was given 2 doses of epinephrine Her symptoms improved within minutes |
Follow up case notes | In August 2017, MS was examined for bony lesions, fracture, or soft tissue disorders that could explain her continued discomfort and pain The previous allergic emergency in 2014 requiring the use of her EAI was noted Negative X-ray and ultrasound of right femur and no evidence of muscular injury or hematoma. No discrete solid or cystic lesions It was noted that she was skeletally immature | ||
Long-term management | Keep prescribed EpiPen Jr® available Instructions on how to give the EpiPen Jr® without full muscle compression Continue strict avoidance of milk, raw peanut, cashew, hazelnut, pecan, and pistachio | ||