Dear Bert,
so far in the office , I have not had to give epi thru clothing but you could do that in a very emergent situation where the benefit outweighs the risk of any infection being introduced via clothing. The key of course is early recognition of anaphylaxis and the severity of anaphylaxis. If it is recognized early enough, there is usually enough time to pull the pants down. It is also increasingly recognized that the patient must be recumbent as soon as possible to prevent 'empty heart syndrome' and this is an important factor in reducing mortality . I usually have the patient in a recumbent position first then give the epi.
hope this helps
bala
