ó Quick-acting EpiPens can save kidsí lives during severe
allergic reactions, but the devices may pose an unexpected
risk of serious cuts and other injuries, a Seattle
emergency-medicine doctor has found.
than two dozen reports of lacerations up to 3 inches long and
bent needles embedded like fish hooks under the skin were
among wounds documented after email and online surveys by Dr.
Julie C. Brown of Seattle Childrenís Hospital.
were surprised by the severity of some of these
injuries," said Brown, whose study was published recently
in the Annals of Emergency Medicine.
occurred among children who jerked or thrashed as caregivers
used epinephrine auto-injectors to halt anaphylaxis, a
life-threatening allergic reaction.
food allergies affect nearly 6 million children under 18,
problem was detected with use of the EpiPen, the top-selling
device that accounts for 2.5 million of the 4.7 million
prescriptions for injectable epinephrine in the U.S. each
year, according to IMS Health. No injuries were associated
with Auvi-Q, a recently introduced auto-injector with a
self-retracting needle, Brown said.
be because the EpiPen is in much wider use, or because
instructions advise users to hold the needle in place for 10
seconds to ensure the drug is injected, Brown said.
shows the medication may be dispensed within the first few
seconds, she said. In addition, she said caregivers must be
warned to restrain young children before using the EpiPen.
canít think of anywhere else in pediatric medicine where we
would hold a needle in an awake childís leg for 10
seconds," she said.
Knell, a spokeswoman for Mylan Pharmaceuticals, which makes
the EpiPen, said there are limitations to Brownís study,
which relied on parent or doctor recollections. Estimates of
the length of the wounds may not be accurate, and not all of
the devices were analyzed to confirm the needle was bent
during use, she said.
study "highlights the importance of continued education
and practice with prescribed devices for those managing
potentially life-threatening (severe) allergies," Knell
said in a statement.
Kevin Dooms, a Bellevue, Wash., allergist affiliated with
Swedish Medical Center, said the study flags potential
injuries that might have been missed in the past.
I havenít seen any patients whoíve had this happen, but itís
interesting to see so many stories aggregated," he said.
Dooms nor Brown recommends ignoring the EpiPenís 10-second
prescribing information approved by the Food and Drug
Administration, but say the injury reports raise new
issue came to Brownís attention when she treated a
Seattle-area preschooler who had an allergic reaction and
suffered a bad cut from the EpiPen. Brown emailed colleagues,
and immediately heard about another injury.
when I knew I was onto something," she said.
surveyed two emergency medicine email-discussion lists and
eight Facebook sites dedicated to food allergies, which
reached about 20,000 people.
identified 17 cases of leg lacerations and five other
needle-related traumas between 2005 and 2014, plus three other
cases that had to be excluded. The cases occurred in children
ages 1 to 11, with most under age 6.
Brown and Dooms were quick to caution the injury reports
shouldnít discourage people from using EpiPens or any other
epinephrine is going to save your kidís life and thatís
more important than a leg laceration," she said.
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