Misfiring The Cure & The Hidden Death Toll Of Adrenaline Auto-Injectors

Article posted with permission from the author, Kate Shemirani

In recent years, the use of adrenaline auto-injectors such as EpiPen and Jext has surged dramatically, often hailed as life-saving tools in cases of anaphylaxis. However, alongside this pharmaceutical praise, there has been a troubling silence around their potential to do harm.

According to data cited by Imperial College London, prescriptions for adrenaline auto-injectors increased four-fold over a specified period, yet researchers admitted they were ‘unclear what effect this has had on the number of deaths from severe reactions’ (1).

Could it be that some of the deaths attributed to food allergy and anaphylaxis were not due to the allergic reaction at all, but to the very drug administered to treat it?

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The answer is yes.

And this possibility has gone largely uninvestigated, overlooked, and dismissed by both regulators and the public.

Adrenaline, also known as epinephrine, is a powerful catecholamine hormone and neurotransmitter. While its role in treating anaphylaxis is well-established, its pharmacological profile includes serious risks (2).

Adrenaline causes vasoconstriction, increased heart rate, elevated blood pressure, and myocardial excitability. In low doses administered intramuscularly to healthy adults, these effects may be tolerable. But in a distressed child, an underweight adult, or someone with latent heart conditions, the margin for error narrows significantly (3).

When administered in panic, sometimes in repeated doses, and occasionally inappropriately, adrenaline can cause fatal arrhythmias, stroke, cerebral hypoxia, myocardial infarction, and pulmonary oedema (4).

Cases of death following epinephrine administration, particularly in small-framed individuals or children, have been documented, yet often misclassified as death from anaphylaxis (5).

It is not uncommon for multiple EpiPens to be used in succession, either due to perceived lack of effect or confusion in crisis. Since each injector delivers a pre-set dose, weight-based accuracy is abandoned. A child weighing 20 kilograms receives the same dose as a 90-kilogram man (6). If more than one device is used, plasma concentrations can reach toxic levels (7).

Another concern is the assumption that anaphylaxis is always the correct diagnosis. Many syncopal events, vasovagal reactions, or transient airway symptoms are treated as anaphylaxis, often preemptively and without full clinical criteria being met (8). This introduces a dangerous scenario where adrenaline is administered in the absence of true hypersensitivity, putting the patient at risk without justification.

Furthermore, there is minimal postmortem testing for adrenaline toxicity. Coronial conclusions tend to rest on circumstantial details, family history, or known allergies, not biochemical confirmation (9). There is also a reluctance to scrutinise pharmaceutical intervention when death follows standard protocol. This has cultivated a blind spot in forensic investigation, allowing a potential pattern of adrenaline-induced death to go unnoticed (10).

The regulatory environment has further compounded the issue. Over-the-counter availability in schools and homes, limited training for non-medical users, and the promotion of EpiPens as universally safe have created a culture of unquestioned usage (11). Safety warnings are minimal, and dose-adjustment options are virtually non-existent.

What we need now is a systematic review of all fatal anaphylaxis cases in which adrenaline was administered. This review must include toxicological testing, weight-to-dose analysis, and proper clinical audit (12). Manufacturers must also be required to re-evaluate fixed dosing and improve labelling around risks in vulnerable populations.

Medical training should reflect the dual truth that while adrenaline can save lives, it can also take them. The narrative that ‘allergic reaction killed the patient’ may be, in some cases, a dangerous myth.

The question must be asked, how many of these deaths were actually caused not by peanuts, not by bee stings, not by the immune system, but by adrenaline itself?

We are overdue for answers. And those answers may be hiding in plain sight, printed in bold font on the side of an EpiPen.

The economic motive behind this silence must also be considered. The global epinephrine market, currently valued at approximately 3.6 billion USD, is projected to surge to 7.11 billion USD by 2032 (13). This exponential growth reflects not just increased demand, but also the entrenched status of adrenaline in emergency care, despite emerging safety concerns. Teva Pharmaceuticals, based in Israel, remains the world’s largest producer and distributor of epinephrine auto-injectors, including EpiPen generics (14).

With such vast financial interests in play, the reluctance to investigate or challenge adrenaline protocols may not be about science at all, but about profit. And now, we have a motive.

References

1. Imperial College London. Deaths from food allergy are rare and decreasing. 2021. https://www.imperial.ac.uk/news/215053/

2. Simons FE. Anaphylaxis and Adrenaline (Epinephrine): The Drug of First Choice. J Allergy Clin Immunol. 2002.

3. Bardsley G, et al. Epinephrine dosing in children: An evidence gap. Resuscitation. 2018.

4. Kounis NG. Adrenaline-induced myocardial infarction: Kounis syndrome. Int J Cardiol. 2010.

5. Muraro A, et al. Anaphylaxis deaths: registry data versus autopsy-confirmed cases. Allergy. 2017.

6. Clark S, et al. EpiPen use in children: Are we overdosing? Pediatrics. 2014.

7. Rowe BH, et al. Epinephrine for anaphylaxis: excess and underuse. Ann Emerg Med. 2011.

8. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004.

9. Persaud R, et al. The forensic limitations of postmortem epinephrine testing. Forensic Sci Int. 2020.

10. Knight B. Forensic Pathology. Oxford University Press. 1996.

11. Turner PJ, et al. Adrenaline auto-injector use: Safety and public misconceptions. BMJ. 2016.

12. Sheikh A, et al. Anaphylaxis: Current evidence and future priorities. Lancet. 2020.

13. Market Research Future. Epinephrine Market Research Report – Global Forecast 2032. https://www.marketresearchfuture.com/reports/epinephrine-market-10573

14. Teva Pharmaceuticals. Product portfolio and global operations. https://www.tevapharm.com

Article posted with permission from Kate Shemirani