Q: What is the preferred route of epinephrine in anaphylaxis?

A) Intra-Venous (IV)
B) Intra-Muscular (IM)
C) Subcutaneous (SC)
D) Oral
E) Nasal


Answer:  B

IM route is the preferred, both over SC and IV routes. Obviously, over SC, it provides a quicker increase in the plasma and tissue concentrations. IM route is also preferred over IV bolus as IV bolus of "Epi" carries an inherent risk of cardiovascular complications.


References:

1. Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108:871.

2. Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract 2015; 3:76.