People often ask me, are adrenaline injectors dangerous? “If I use one on my child and they weren’t having a severe reaction, could it cause them any harm?”
Is it safe to use an expired EpiPen, Jext of Emerade adrenaline injector?
Could using two auto-injectors ever cause an overdose of adrenaline?
Adrenaline is not dangerous, so if in doubt, inject!
These are all common and understandable worries, but thankfully I can put to rest immediately.
Adrenaline injectors contain a single dose for the use of patients with anaphylaxis. The amount of adrenaline will not cause you any danger as it’s such a small amount. Even using two, if the first doesn’t work, it’s quite safe and won’t cause you any harm.
What if I accidentally inject my finger with adrenaline?
This is becoming more and more common as allergies rise and more adrenaline injectors are prescribed. People who are unsure how to use the injectors can mistakenly hold their finger over the needle end and inject themselves accidentally. If you inject your finger or thumb it can be very painful and you will waste the adrenalin but contrary to myths about the danger this causes apart from swelling and pain the finger should recover with time.
The American Association of Hand Surgery published a paper entitled “Finger Injection with High-Dose (1:1,000) Epinephrine: Does it Cause Finger Necrosis and Should it be Treated?” which concluded that “There is not one case of finger necrosis in all of the 59 reported cases of finger injections with 1:1,000 epinephrine in the world literature.”
Make sure you are familiar with how to safely administer your adrenaline. Get some trainer pens and practise. Check out ‘How to use an Epipen – a simple demonstration’.
So it’s totally safe to inject adrenaline?
There is no danger from using your injector if you administer it correctly.
If in doubt, it is better to use an adrenaline autoinjector, than not use it, even if the reaction is not anaphylaxis. Under-treatment of anaphylaxis is more harmful so if in doubt, use it. Even if you’re not sure and want to wait to see if you or your child recovers naturally, if there is any swelling of the mouth or throat, any difficulty breathing or you are worried at all administer the adrenaline swiftly and call 999.
You are in more danger if you don’t carry your injector with you at all times.
What if I’m allergic to sulphites – adrenalin injectors contain sulphites…
I spoke to the makers of the adrenaline injectors in the UK and they told me that the adrenaline would counter act any reaction to the sulphites in the mixture, which are only used to preserve the drug and extend its shelf life. It is present in very small quantities so shouldn’t cause a problem but I’m not sure how reassuring that statement is for anyone with sulphite allergy.
Overdose of epiniphrine can be dangerous
The only instances I could find of death from epiniphrine (adrenaline) injection were caused by errors at hospital where incorrect doses were given and this is very rare. Steps have been taken to ensure that large doses of adrenaline/epiniphrine phials are not kept in operating theatres and lessons have been learnt, thankfully, from these mistakes. The dose in your adrenaline injector is small and will not cause you any harm but because the drug increases blood pressure, high doses wrongly administered can be dangerous, or if the patient has a pre-existing condition which may be affected by heightened blood pressure.
The dose in your injector is so small that even using two, if you have a secondary reaction, will be completely safe.
I hope this blog post has allayed any fears any of you may have had and apologies for the Daily Fail style sensationalist headline. It’s a little experiment to see if the title affects visits to the site… Are you scared to use yours?
I have also read that if someone injected themselves with lots of out of date epipens that could be very dangerous. Don’t do this, store pens safely and dispose of old ones. Stay safe and store your medication safely.
I hope you found this blog helpful and I’ve helped to allay any fears. If in doubt about whether a reaction is serious enough, always inject.
Very interesting article. I’ve got a ‘confirmed’ sulphite allergy (I use the word ‘confirmed’ carefully as there are no diagnostic tests for it; my GP and I concluded that I had the allergy after years of being very ill). My allergy is so bad that even uncorking a bottle of champagne will cause me huge problems.
My dilemma is this; after being given an auto injector for shellfish allergy a few years ago, I noticed they contained sodium metabisulphite, which is my kryptonite. Touch wood, I’ve never had to use my auto injector. No one can tell me what would happen with my sulphite allergy. My GP, various pharmacists and even a paramedic simply said they assumed the adrenaline would counter any reaction, but they couldn’t say for sure. The rare occasion I’ve needed dental work, I’ve always had to have the Lidocaine without adrenaline (as it uses sulphites as a preservative). As a teen I always wondered why I was so ill after a filling.
It’s ironic that my new EpiPen carries and allergy warning for sulphites. My Jext did too. Surely something can be done about this? More testing? A shorter shelf life? Allergies actually being taken seriously?? Thank god you’re here.
Hi Kerri, thanks for the comment. I wish there was an answer to this but if the US adrenaline injectors don’t contain sulphites why do ours? I guess it’s a toss up between shelf life and purity of the drug in the pen. I wonder if you can get hold of some of the US ones without sulphites? Never say never, it must be possible and the only reason you need it is because there is nothing available here. I have a guy in Eastern Europe with a Bee sting allergy who can’t even get hold of adrenaline at all. Not sure what’s worse, not having an injector or being terrified that the one you have might make you ill? I feel bad about the headline of this blog now… take care and I’m going to look into this. When I was first diagnosed with a nut allergy I had a phial of adrenalin and a syringe. This isn’t ideal, but could you get pure adrenalin in this way to administer yourself? Would you need training to use it? Never used the syringe thing when I had it – too terrified and had no idea how to use it.
Alison Berthelsen says
I think the headline does work,as it will probably strike those who are already worried, and then you reassure them.
Really good factual info.
And Kerri sounds like a sensible girl with a difficult problem-good luck.
Hi Alison, Ha Ha. I was being cheeky with the title but feel slightly bad now for Kerri. Very scary and I couldn’t find a real answer. They all say it ‘should’ be fine. But do they actually know this? For once, when writing this, I was glad I got hardly any useful hits on google for ‘death from adrenalin injector…’
When I was first diagnosed with severe allergic reactions and given an autoinjector, I did some research. I came across an article in The Independent by a lady called Justine Bold and her allergy sulphites. At the time (2010) her problems mirrored my own; no one could tell her how safe her autoinjector was. She managed to source a sulphite-free epinephrine inhaler from the US, but research today has shown this has been pulled by the FDA and is no longer available. Her reactions got much worse after using her autoinjector.
It’s scary enough as it is, but when you’re aware the medication that is supposed to help you may make you worse and no one knows what to do is utterly terrifying.
I just don’t know what to say Kerri… not a lot you can say. However I do have some contacts at the companies who make these pens so I will send them a link to this and see what they have to say and whether they can think about a product without sulphites. Could you learn how to use an injector and buy some phials of adrenalin? CAn you get that without sulphites?
Mohammed Ibrahim says
Honey & yogurt good for allergic or bad
Hi Mohammed, well I have heard of dairy allergy but not honey, but anything is possible…
I couldn’t find your response to the Q, regarding using an expired epi? My daughter requires 4 of these reach year. her school requires 2 and I have one, along with her mother (separated). at $400 per epi, this is a cost very high for separated parents and basically I think it’s a rort. I am interested to know why an expired pen becomes useless on the day of expiry. Is this like food products where the expiry is a recommendation, rather than a rule? If so, what is the best guess regarding how long after the expiry the epi could still have value?
Ruth Holroyd says
Hi James, I will try to find out from manufacturers but I have been told by paramedics that it should be OK for quite a while after expiries. They do err on side of caution. But i’m not a medical professional so I wouldn’t like to say.
Christine Hellawell says
I was very surprised that sulphite is in my epipen, my goodness how much damage can this cause my body?
We cannot win, what with allergies to so many covid injection, having to accept one or not accepting, that does not give as much coverage.
These allergies are really hard to live with
Ruth Holroyd says
Hi Christine, yes it’s a a real struggle for those with a sulphite allergy. I believe that intravenous adrenaline would be safe and the ambulance have that but this doesn’t help you does it? They are hard to live with, for sure. Hope is coming though.. check out https://whatallergy.com/2023/01/adrenaline-auto-injectors-are-they-out-dated/