Q:

12/15/2011
I was recently told by a new hire that in her previous practice she was advised that when serum is administered in the posterior subcutaneous tissue (arm of course) that patients were more likely to have significant localized reactions. Her technique is to inject more anteriorly which I believe presents the risk of IM deltoid injection on the leaner patient. There is more subcutaneous tissue posteriorly and in my experience this is the appropriate injection site. Can you please provide direction as to what is the best location for serum administration?

A:

Thank you for your inquiry.

We received a very similar inquiry which was posted on our website on October 20, 2011. I believe that the response to that inquiry applies to your question as well, even though the sites you mentioned are slightly different. For your convenience, I have copied the question as well as the response below. I might mention, parenthetically and anecdotally that as a patient who has received allergy injections as well as a physician who has given them I find the best place to be posterior subcutaneous tissue as well. But as you can see from reading the response below we really have no data to confirm either opinion.

Thank you again for your inquiry and we hope this response is helpful to you.

Posted 10/20/2011
Preferred location for allergy shots

Question: Will giving allergy shots SQ in the distal part of the upper arm (closer to the elbow) cause bruising and extensive edema versus giving the injection in the medial/back portion of the upper arm? Patients c/o the above issues when our MA gives the allergy shots and the only thing I've observed is that it is given much lower than where I give the shots. Any ideas?

Answer: Unfortunately we cannot give you a definitive answer to your question because there are no studies that have compared the locations you mention. I can only express a bias based on personal experience as both a patient who has received allergy injections and as a physician who has administered them.

I have found that injections given in the medial/back portion of the upper arm to be more comfortable and less likely to cause local reactions.

Parenthetically you might find the link below helpful in regards to the technique involved to administer allergy injections.

http://www.fauquierent.net/allergyshotinstruct.htm

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology