Accidental self injection of adrenaline autoinjections in Australia over 6 years.

Abstract

Background: There are anecdotal cases of accidental self-injection of AAIs by allergic individuals, family members or health care workers. The rates of accidental self-injection of AAI has not been studied in Australia. Aim: To ascertain the rate of unintentional AAI use in Australia reported to Poison Information Centres (PIC) across Australia characterising the population of those injected, site of injection and treatment advised Method: We reviewed the PIC databases between 2010 and 2016 from four major PICs in Australia (covering all states and territories). Results: There were 1140 accidental self-injections (all EpiPen or EpiPen Junior) over the 6 year period (a rate of 2 accidental AAI injections per 1,000 AAI prescription per year). 58% were male, 64% occurred in children, and in most cases the accidental injection was by the allergic child or by their sibling. The majority of cases (95%) were managed at home. Most injections occurred in the thumb/finger (41%), palm (14%) or thigh (5%). Usually no symptoms were reported (55%), although local pain (23%), pallor (8%) and paraesthesia (4%) were not uncommon. PICs usually suggested local measures only (98%) (immersion in warm water and/or massage), and in 1.8% of cases GTN to the affected area was suggested. Conclusion: AAI self injection is not uncommon and likely under-reported. Digits are the most common site injected, but symptoms are mild and in most cases local measures are only required. We suggest ASCIA Anaphylaxis Action Plans to be updated to ring PICs if accidental self-injection occurs.