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Management of adrenaline (epinephrine) induced digital ischaemia in children after accidental injection from an EpiPen
  1. I Velissariou,
  2. S Cottrell,
  3. K Berry,
  4. B Wilson
  1. Accident and Emergency Department, Birmingham, Children’s Hospital, Birmingham, UK
  1. Correspondence to:
 Dr I Velissariou
 Accident and Emergency, Department, Birmingham Children’s Hospital, Steelhouse, Lane, Birmingham B4 6NH, UK;

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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.


A 15 year old boy was admitted with a cold and pale right thumb after accidental injection of adrenaline 0.3 mg of 1:1000 from an EpiPen he found on a bus. …

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