Q:

11/8/2013
I have a question about children with food allergies at risk for anaphylaxis who are also on non-selective beta blockers. I know that glucagon can be given for refractory anaphylaxis. All the information I have found recommends a glucagon IV infusion. I need to know if glucagon given IM is effective for refractory anaphylaxis, and if so, what is the recommended dose?

Also is glucagon recommended in addition to epinephrine for the home allergy plan for patients on non-selective beta-blockers if epinephrine is not effective?

A:

Thank you for your inquiry.

To my knowledge, there are no reported cases of the administration of glucagon for anaphylaxis given by the intramuscular route. But glucagon can be given both subcutaneously and intramuscularly and, as you may know, is available in an “administration kit” that is normally given for hypoglycemic episodes. An intramuscular or subcutaneous dose for anaphylaxis has not been established, but we would assume it would be similar to the dose that one uses for hypoglycemia. This dose is copied for you below.

Also, for your information, there is a link copied below to information about glucagon use for hypoglycemia and a link to a video demonstrating the technique used to administer the kit.

This technique requires that a patient take a syringe, place it into a vial of liquid, withdraw the liquid, then add the liquid to a bottle containing glucagon. The patient then draws up the appropriate dose of drug from the bottle. Considering the stress that one would be under during an anaphylactic event, and the fact that the patient would have already administered at least two doses of epinephrine prior to considering using glucagon (since glucagon is only indicated in patients who fail to respond to epinephrine), in my opinion the use of glucagon would be impractical in this setting. For this reason, I have not personally utilized this drug in this context, but have preferred that patients, after taking their first injection of epinephrine, go immediately to an emergency medical facility or call 911.

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

Hypoglycemia - How to Use GlucaGen Hypokit - Glucagon Injection Kit for Hypoglycemic Emergency

As an emergency treatment for hypoglycemia:
Adults and children weighing 20 kilograms (kg) (44 pounds) or more: 1 milligram (mg). The dose may be repeated after fifteen minutes if necessary.

Children weighing up to 20 kg (44 pounds): 0.5 mg or 20 to 30 micrograms (mcg) per kg (9.1 to 13.6 mcg per pound) of body weight. The dose may be repeated after fifteen minutes if necessary

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology