Preventable injuries from epinephrine injectors on the rise

The number of people inadvertently injecting either the wrong body part or the wrong person with an epinephrine autoinjector is escalating, according to a review published in the April Annals of Allergy, Asthma & Immunology (link).

"There seems to be a major trend," said Dr. Estelle Simons, lead author and professor in the department of pediatrics at the University of Manitoba in Winnipeg.

Researchers examined the scientific literature and found 26 reports of 69 people who unintentionally had misused this anaphylaxis treatment over the past 20 years. Approximately 98% injected a finger, thumb or palm of the hand, and 65% went to an emergency department for care.

"Sometimes they're just trying to read the instructions and figure out how it works and it goes off in their hands. Children find them in a park," Dr. Simons said. "This happens in lots of different ways. We cannot do without this life-saving medication, but it was not meant to be injected into a finger."

The majority of incidents were within the past six years. And the authors conclude that, although the true prevalence is unknown, injuries are most likely more common than the scientific literature indicates. These injuries also are becoming more frequent because so many more people need to have these devices at hand.

The authors are urging physicians and allied health professionals to instruct patients on how to use these tools, both when the initial prescription is written as well as through periodic refreshers. "We have a responsibility to teach our patients to use these correctly," Dr. Simons said. "And we need the help from all the other health care professionals."

None of the injuries reported in the scientific literature resulted in long-term problems. Most responded to warming or other efforts to dilate the blood vessels. Experts are most concerned about the "lost-dose hazard" when the medication does not end up where it is supposed to. The media have reported children with severe allergies dying because, in the chaos of an emergency, the epinephrine was mistakenly injected into someone else.

Because allergies are becoming more common, related issues increasingly are the subject of medical society attention. The American Medical Association Council on Science and Public Health released a report on childhood anaphylactic reactions in June 2007 (link).

The AMA also urges all schools to have emergency response plans for these situations and supports laws permitting students to carry prescribed epinephrine.