Hazards of unintentional injection of epinephrine from autoinjectors: A systematic review

Annals of Allergy, Asthma and Immunology

Volumn 102, Issue 4, 2009, Pages 282-287

  Simons, F Estelle R ^a,b,e   Lieberman, Phillip L ^c   Read Jr , Edward J ^c   Edwards, Eric S ^d  

^a UNIVERSITY OF MANITOBA   (Canada)

^b UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE   (United States)

^c VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF MEDICINE   (United States)

^d VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^e NONE   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ADRENALIN; GLYCERYL TRINITRATE; LIDOCAINE; PHENTOLAMINE;

ANAPHYLAXIS; EMERGENCY CARE; FIRST AID; HUMAN; NEEDLESTICK INJURY; PRIORITY JOURNAL; REVIEW; SELF INJECTION; SEX RATIO;

EID: 65249188740     PISSN: 10811206     EISSN: 15344436     Source Type: Journal    
DOI: 10.1016/S1081-1206(10)60332-8     Document Type: Review

References (41)

1. Kemp SF, Lockey RF, Simons FER. Epinephrine: the drug of choice for anaphylaxis: a statement of the World Allergy Organization. Allergy. 2008;63:1061-1070.
2. Soar J, Pumphrey R, Cant A, et al. Emergency treatment of anaphylactic reactions: guidelines for healthcare providers. Resuscitation. 2008;77: 157-169.
3. Simons FER. Anaphylaxis, killer allergy: long-term management in the community. J Allergy Clin Immunol. 2006;117:367-377.
4. Kelso JM. A second dose of epinephrine for anaphylaxis: how often needed and how to carry. J Allergy Clin Immunol. 2006;117:464-465.
5. Brown SG, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust. 2006;185:283-289.
6. McLean-Tooke APC, Bethune CA, Fay AC, Spickett GP. Adrenaline in the treatment of anaphylaxis: what is the evidence? BMJ. 2003;327:1332-1335.
7. Schintler MV, Arbab E, Aberer W, Spendel S, Scharnagl E. Accidental perforating bone injury using the EpiPen autoinjection device. Allergy. 2005;60:259-260.
8. Skorpinski EW, McGeady SJ, Yousef E. Two cases of accidental epinephrine injection into a finger. J Allergy Clin Immunol. 2006;117: 463-464.
9. Deshmukh N, Tolland JT. Treatment of accidental epinephrine injection in a finger. J Emerg Med. 1989;7:408.
10. Maguire WM, Reisdorff EJ, Smith D, Wiegenstein JG. Epinephrine-induced vasospasm reversed by phentolamine digital block. Am J Emerg Med. 1990;8:46-47.
11. Markovchick V, Burkhart KK. The reversal of the ischemic effects of epinephrine on a finger with local injections of phentolamine. J Emerg Med. 1991;9:323-324.
12. McCauley WA, Gerace RV, Scilley C. Treatment of accidental digital injection of epinephrine. Ann Emerg Med. 1991;20:665-668.
13. Mol CJ, Gaver J. A 39-year-old nurse with accidental discharge of an epinephrine autoinjector into the left index finger. J Emerg Nurs. 1992;18:306-307.
14. Hinterberger JW, Kintzi HE. Phentolamine reversal of epinephrine-induced digital vasospasm: how to save an ischemic finger. Arch Fam Med. 1994;3:193-195.
15. Claudy FR. Pertinent medical intelligence: accidental digital injection of epinephrine. Md Med J. 1995;44:292-293.
16. Hardy SJ, Agostini DE. Accidental epinephrine auto-injector-induced digital ischemia reversed by phentolamine digital block. J Am Osteopath Assoc. 1995;95:377-378.
17. Ahearn MA. A pulseless hand: accidental epinephrine injection. Am Fam Physician. 1998;57:1238.
18. El Maraghy MW, ElMaraghy AW, Evans HB. Digital adrenaline injection injuries: a case series and review. Can J Plast Surg. 1998;6:196 -200.
19. Murali KS, Nayeem N. Accidental digital injection of adrenaline from an autoinjector device. J Accid Emerg Med. 1998;15:287.
20. Stier PA, Bogner MP, Webster K, Leikin JB, Burda A. Use of subcutaneous terbutaline to reverse peripheral ischemia. Am J Emerg Med. 1999;17:91-94.
21. Sellens C, Morrison L. Accidental injection of epinephrine by a child: a unique approach to treatment. CJEM. 1999;1:34-36.
22. Barkhordarian AR, Wakelin SH, Paes TR. Accidental digital injection of adrenaline from an autoinjector device. Br J Dermatol. 2000;143:1359.
23. Khairalla E. Epinephrine-induced digital ischemia relieved by phentolamine. Plast Reconstr Surg. 2001;108:1831-1832.
24. Mrvos R, Anderson BD, Krenzelok EP. Accidental injection of epinephrine from an autoinjector: invasive treatment not always required. South Med J. 2002;95:318 -320.
25. Turner MJA, Purushotham AD. Accidental Epipen injection into a digit: the value of a Google search. Ann R Coll Surg Engl. 2004;86:218 -219.
26. Velissariou I, Cottrell S, Berry K, Wilson B. Management of adrenaline (epinephrine) induced digital ischaemia in children after accidental injection from an EpiPen. Emerg Med J. 2004;21:387-388.
27. Davies P, Shah P, Goldsworthy L. Accidental discharges of EpiPen devices: a case series. Arch Dis Child. 2006;91:A29.
28. Molony D. Adrenaline-induced digital ischaemia reversed with phentolamine. ANZ J Surg. 2006;76:1125-1126.
29. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with highdose (1:1000) epinephrine: does it cause finger necrosis and should it be treated? Hand. 2007;2:5-11.
30. Silverberg M, Manoach S. Accidental self-administration of epinephrine with an auto-injector. Clin Toxicol (Phila). 2007;45:83-84.
31. Singh T, Randhawa S, Khanna R. The EpiPen and the ischaemic finger. Eur J Emerg Med. 2007;14:222-223.
32. Ismail Y, Juma A. Re: spasm of the digital vessels after accidental Epipen release: a simple solution to a potentially increasing problem. J Hand Surg Eur Vol. 2008;33:215-216.
33. Muck A, Bebarta V, Borys D, Morgan D. Six years of acute unintentional epinephrine digital injections: lack of ischemia or significant systemic effects [abstract]. Acad Emerg Med. 2007;14:S196.
34. Liebelt EL, King W. Outcome of parenteral epinephrine autoinjector exposures: a 12 year review [abstract]. Clin Toxicol (Phila). 2008;46:389.
35. Lieberman P, Camargo CA Jr., Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97:596-602.
36. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108:114-124.
37. Mehr S, Robinson M, Tang M. Doctor-how do I use my EpiPen? Pediatr Allergy Immunol. 2007;18:448-452.
38. Sicherer SH, Forman JA, Noone SA. Use assessment of self- administered epinephrine among food-allergic children and pediatricians. Pediatrics. 2000;105:359-362.
39. Gosbee LL. Nuts! I can't figure out how to use my life-saving epinephrine auto-injector! Jt Comm J Qual Saf. 2004;30:220-223.
40. Gosbee JW. Conclusion: you need human factors engineering expertise to see design hazards that are hiding in "plain sight!" Jt Comm J Qual Saf. 2004;30:696-700.
41. Kaye R, Crowley J. Guidance for industry and FDA premarket and design control reviewers-medical device use-safety: incorporating human factors engineering into risk management (issued on July 18, 2000). http://www.fda.gov/ cdrh/humfac/1497.html. Accessed October 20, 2008.