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. 2014 May 7;10(1):22.
doi: 10.1186/1710-1492-10-22. eCollection 2014.

Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections

Laura Kim  1 , Immaculate Nevis  2 , Ryan Potts  3 , Clark Eeuwes  4 , Arunmozhi Dominic  4 , Harold L Kim  2
Affiliations

Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections

Laura Kim et al. Allergy Asthma Clin Immunol. .

Abstract

Background: Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle length of 13 mm. Therefore, there is a risk of intramuscular administration if patients have a skin-to-muscle depth <13 mm, which may increase the risk of anaphylaxis. The objective of this study was to determine whether the needle length of a standard allergy syringe is appropriate for patients receiving subcutaneous immunotherapy.

Methods: Ultrasounds of the left posterolateral arm were performed to measure skin-to-muscle depth in 200 adults receiving subcutaneous immunotherapy. The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared. The proportion of patients with skin-to-muscle depths > 4 mm, 6 mm, 8 mm and 10 mm were also calculated. Multivariable logistic regression was performed to identify predictors of skin-to-muscle depth.

Results: Of the 200 patients included in the study, 80% had a skin-to-muscle depth ≤13 mm; the majority (91%) had a skin-to-muscle depth >4 mm. Body mass index was found to be a significant predictor of skin-to-muscle-depth.

Conclusions: Most patients receiving subcutaneous immunotherapy have a skin-to-muscle depth less than the needle length of a standard allergy syringe (13 mm). These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis. Using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk.

Keywords: Allergen-specific immunotherapy; Allergy syringe; Injections; Needle length; Skin-to-muscle depth; Subcutaneous immunotherapy; Ultrasound.

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Figures

Figure 1
Figure 1
Proportion of SCIT patients with STMD >13 mm or ≤13 mm.
Figure 2
Figure 2
Image of ultrasound showing skin-to-muscle depth (STMD).
See this image and copyright information in PMC

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