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

Ann Allergy Asthma Immunol. 2009 Apr;102(4):282-7. doi: 10.1016/S1081-1206(10)60332-8.


Objectives: To ascertain the rate of occurrence of unintentional injections from epinephrine autoinjectors used in the first aid treatment of anaphylaxis and to provide information about the resulting needle stick injuries.

Data sources: A systematic review was performed. The MEDLINE, Scirus, CINAHL, ISI Web of Science, and Google Scholar databases were searched by title and abstract to identify reports of unintentional injections from epinephrine autoinjectors published in peer-reviewed journals.

Study selection: Publications were selected for inclusion based on predefined strict criteria.

Results: In 26 reports published during the past 20 years, we identified 69 people with an unintentional injection of epinephrine from an autoinjector. More than 68% of them were reported in the past 6.3 years, 58% were female, 42% were injured in the home, and 91% sustained injury to a finger or thumb. More than 65% of the 69 individuals were evaluated in an emergency department; 13% of the 69 were not treated or were treated only with observation. Warming of the injured part was used in 25%, nitroglycerin paste application in 9%, local injections of phentolamine and/or lidocaine in 22%, and other treatments in 20%; treatment, or lack thereof, was not described in 12%. No permanent sequelae were reported.

Conclusions: The true rate of occurrence of unintentional injection of epinephrine from autoinjectors is unknown but is increasing. People at risk for anaphylaxis need regular coaching in how to use epinephrine autoinjectors correctly and safely. Improved autoinjector design will address the safety concerns identified in this review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Anaphylaxis / drug therapy*
  • Bronchodilator Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Epinephrine / administration & dosage*
  • Female
  • First Aid / adverse effects*
  • Humans
  • Injections / adverse effects
  • Injections / instrumentation
  • Male
  • Middle Aged
  • Needlestick Injuries / epidemiology*
  • United States / epidemiology


  • Bronchodilator Agents
  • Epinephrine