A case of anaphylaxis to naproxen

tin (amoxicillin and clavulanic acid; GlaxoSmithKline, Research Triangle Park, NC, USA). The puncture healed without sequelae. Epinephrine injection into digits can cause vasoconstriction and lead to irreversible tissue ischemia. Moreover, the force of a spring-activated needle, such as that in the EpiPen device, apparently does not stop at bone. Potential complications include whitlow, impaired nail growth, osteomyelitis, ischemia or loss of the digit. The alpha-adrenergic blocking characteristics of phentolamine have proven effective in reversing the effects of epinephrine in such cases (4). Patients suffering an accidental injection of epinephrine into a digit should go immediately to the nearest emergency room for treatment. Since autoinjector devices became available in 1980, there have been several case reports of accidental digital injection of epinephrine with an incidence estimated at one accidental injection per 50 000 devices (2). Therefore, patients or any other person who handle EpiPen or EpiPen Jr. should be carefully instructed in their use. A thorough and probably repeated instruction, both written and oral, provided by knowledgeable physicians is mandatory (5). Despite the fact that EpiPen autoinjectors for emergency treatment of allergic anaphylaxis are essential, one must be aware that accidental injections are not rare and emergencies caused by improper application can occur. To avoid these severe complications, professionals as well as patients should be properly and carefully instructed in the use of this disposable drug delivery system. Clearly, a new approach for educating and maintaining such skills is required (6).