| Intradermal injection | |
|---|---|
 A medical professional performs an intradermal (ID) injection | |
| MeSH | D007271 |
Intradermal injection (also intracutaneous or intradermic, abbreviated asID) is a shallow or superficialinjection of a substance into thedermis, which is located between theepidermis and thehypodermis. For certain substances,administration via an ID route can result in a faster systemic uptake compared withsubcutaneous injections,[1] leading to a stronger immune response to vaccinations, immunology[clarification needed] and novel cancer treatments, and faster drug uptake.[2] Additionally, since administration is closer to the surface of the skin, the body's reaction to substances is more easily visible.[1] However, due to complexity of the procedure compared to subcutaneous injection andintramuscular injection, administration via ID is relatively rare, and is only used fortuberculosis andallergy tests,monkeypox vaccination,[3] and certain therapies.[which?]
For vaccination many clinical studies have proven efficacy of ID administration over subcutaneous (SC), intramuscular (IM) or other routes of administration. Since the COVID19 pandemic (2020)EMA and FDA promote the use of ID route of administration in case of possible vaccine shortage, for example during the Monkeypox outbreak in 2022 where 1/5th intradermal (fractional) dosing was advised, due to a risk of vaccine shortage.
Common injection sites include the inner surface of theforearm, the upper back, deltoid, thigh, and under theshoulder blade.[1] Injections sites are often chosen for skin thickness, preferring thicker skin.
Equipment includesyringes calibrated in tenths and hundredths of amilliliter. The dosage given is usually less than 0.5 mL, less than given subcutaneously or intramuscularly. A1⁄4-to-1⁄2-inch-long (6 to 13 mm) and 26 or 27gauge thickhypodermic needle is used.[1]
The traditional procedure of ID injection known as the Mantoux procedure (as used in theMantoux test) involves injecting at angle of administration of 5 to 15 degrees angle, almost against the skin. Withbevel (opening) side up, the needle is inserted about1⁄8 inch (3 mm) with the entire bevel inside and injected while watching for a smallwheal orblister to appear.
Traditionallyhypodermic needles are used for intradermal injections, instead of intradermic needles. Various microneedle technology researchers worldwide develop new devices and therapies to overcome typical usability issues associated with the traditional Mantoux procedure. Most intradermic needles require a change in injection technique or instruction to use, for example a perpendicular intradermal injection.[4]
Immune reaction tests sometimes use a set of non-hollow needles for scarification, shallowly abrading the skin. The inoculation is limited to the dermis.
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