• adrenaline
• digit
• EpiPen
• children
• epinephrine

The use of adrenaline (epinephrine) containing auto-injector devices as a treatment for severe allergic reactions is now widely accepted and EpiPens are increasingly prescribed for children. It is estimated that 5% of the paediatric population in the United Kingdom have some form of food allergy.¹ In a recent study assessing the extent of nut allergy in school children within the Severn NHS Trust, 26% of allergic children had an EpiPen at school.²

In association with increased prescription of these devices, there is a greater incidence of accidental auto-injection into digits, resulting in significant pain and discomfort, because of severe vasoconstriction.

The presentation of three cases over the past six months in our accident and emergency department prompted a literature search to define the most appropriate evidence based management for this situation. We conclude that the intradigital administration of phentolamine is the preferred management.