Intradermal

Parenteral drug administration means the giving of a drug by the subcutaneous (SC), intramuscular (IM), intravenous (IV), or intradermal route (Fig. 2-5). Other routes of parenteral administration that may be used by the primary care provider are intralesional (into a lesion), intra-arterial (into an artery), intracardiac (into the heart), and intra-articular (into a joint), hi some instances, intra-arterial dragp are administered by a nurse. However, administration is not by direct arterial injection but by means of a catheter that has been placed in an artery. 

The nurse observes the following points when administering dragp by the intradermal route ... 

The inner part of the forearm and the upper back may be used for intradermal injections. The area should be hairless areas near moles, scars, or pigmented skin areas should be avoided. The nurse should cleanse the area in the same manner as for SC and IM injections. 

A 1-mL syringe with a 25- to 27-gauge needle that is Vi to 5/e inch long is best suited for intradermal injections. Small volumes (usually <0.1 mL) are used for intradermal injections and administered with Hie bevel up. 

Oral One capsule on alternate days 1 h before a meal for a total of 4 capsules Parenteral Adults and children 10 years and older, 2 doses of 0.5 mL SC children younger than 10 years, 2 doses of 0.25 mL SC Booster 0.1-0.5 mL intraderm ally... 

Toxoids Rabies Vaccine Adsorbed 1 month in countries where rabies is a constant threat) post-exposure prophylaxis bite by a carrier animal that is unprovoked and rabies is present in the area 0.1 mL I.D. (Imovax Rabies I.D.) Fbstexposure Do not give intraderm ally, only IM, 20 lU/kg as soon as possible after exposure, followed by IM vaccine doses on days 0, 3, 7, 14 and 28... 

Fig. 8.4c, d Dark-skinned women are also possible candidates for deep chemical peels. Note the accentuation of intradermal nevus next to the left ala nasi following the peel (d)... 

Mertes PM, Moneret-Vautrin DA Skin reactions to intradermal neuromuscular blocking agent injections a randomized multicenter trial in healthy volunteers. Anesthesiology 2007 107 245. Moneret-Vautrin DA, Gueant JL, Kamel L, Laxenaire MC, el Kholty S, Nicolas JP Anaphylaxis to muscle relaxants cross-sensitivity studied by radioimmunoassays compared to intradermal tests in 34 cases. J Allergy Clin Immunol 1988 82 745. 

In a study performed by Ruzicka et al. [23], 104 patients with positive patch tests to LAs and a history of contact dermatitis were tested with LA in a prick test and in an intradermal setting. All prick tests remained negative. There were 9 persons positive for procaine in the intradermal test and 3 positive for butanilicaine. There was no correlation to history in the patients with skin tests and no correlation between patch test results and results of the intradermal test [23]. 

Skin Test. Usually a battery of LAs is tested in the skin-prick test which is almost always negative. Then the intradermal test is performed with a 1 10 dilution of the substances. Undiluted LA preparations may commonly lead to false-positive reactions [30-32] in a rather high percentage of patients. 

Subcutaneous Provocation Testing. When prick and intradermal tests are negative, subcutaneous provocation testing is started using 0.1 ml of the undiluted LA solution followed by 0.2, 0.5, 1.0 and 2.0 ml into the extensor side of the patients upper arm at 30-min intervals. For most of the patients it is possible to find a tolerable LA which is recommended for future applications [33] (table 3). In a long-term followup, Wasserfallen and Frei [32] found in 28 patients undergoing skin and subcutaneous provocative testing that over 3 years in 19 cases re-exposure to a tolerated LA was well tolerated without untoward reaction. 

Ruzicka T, Gerstmeier M, PrzybiUa B, Ring J Allergy to local anesthetics comparison patch test with prick and intradermal test results. J Am Acad Dermatol 1987 16 1202-1208. 

We have already stressed the potential importance of lipid-rich membranes in the skin as potential targets for ROS-induced damage and ageing of human skin is morphologically identical to changes found by peroxidative processes (Serri et al., 1977). The involvement of AA metabolites in skin disease, and in particular psoriasis, has been the subject of much recent interest. Studies have included topical and intradermal administrations of AA metabolites, and assay of such products in clinical specimens. Results show that concentration of AA, 12-hydroxy-eicosatetraenoic acid (12-HETE), PG and leu-kotrienes are increased in psoriatic lesions (Hammarstrom etal., 1975 Camp etal., 1983 Brain etal., 1984 Duell et al., 1988) and also that full-thickness epidermis from normal and diseased skin has the enzymatic capacity to convert AA to some of the same metabolites (Hammarstrom etal., 1975, 1979 Camp etal., 1983 Brain etal., 1984 Ziboh et al., 1984 DueU et al., 1988). The biological effect of both 12-HETE and leukotrienes was confirmed by both topical application and intradermal injection, which caused epidermal inflammation and... 

Inject one unit (0.1 mL) intradermally on the flexor surface of the forearm... 

If the prick test is non-reactive, proceed to the intradermal test. 

Diagnostic tests optional [e.g., skin test (skin prick or intradermal), serum IgE antibody immunoassay]... 

Vestergaard C, Deleuran M, Gesser B, Larsen CG. Thymus- and activation-regulated chemokine (TARC/CCL17) induces a Th2-dominated inflammatory reaction on intradermal injection in mice. Exp Dermatol 2004 13 265-271. 

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