Accidental injection with adrenaline autoinjectors

Adrenaline (epinephrine) is the treatment of choice for severe anaphylactic reactions. Some manufacturers sell autoinjectors that patients can use for intramuscular self-injection. Case reports describing unintentional injection with these devices have been published, as well as a North American study that identified 15 190 calls to 61 US poison control centres between 1994 and 2007 and a series of 105 cases of unintentional injection reported to the US Food and Drug Administration (FDA). Errors in handling these autoinjectors, particularly by children and healthcare professionals, can result in severe consequences, including death and finger amputation, mainly due to the vasoconstriction caused by adrenaline. Most of these unintentional injections are due to poor knowledge of the proper use of autoinjectors among patients, families and caregivers, although malfunctions and design flaws are also sometimes implicated. In practice, the best way to prevent such handling errors is to provide precise and repeated training in the use of adrenaline autoinjectors to healthcare professionals, patients and their carers.