Nasal Sprays: A Promising Alternative to Adrenaline Injections for Anaphylaxis
Recent research presented at the European Emergency Medicine Congress has sparked discussion about the potential of nasal sprays as a viable alternative to traditional adrenaline injections for treating anaphylactic reactions. Anaphylaxis is a severe allergic response that can occur after exposure to allergens such as nuts or insect stings. It demands immediate medical intervention, typically delivered through an injection of adrenaline, commonly known by the brand name EpiPen.
Dr. Danielle Furness, a recent medical graduate from the University of Buckingham, conducted a systematic review comparing the effectiveness of intranasal adrenaline delivery systems to intramuscular injections. Her analysis encompassed five international studies from countries including Israel, Canada, Thailand, the United States, and Japan.
The findings indicate that nasal sprays, whether in liquid or powdered form, can deliver adrenaline effectively, often with a quicker onset than injections. Notably, the absorption of adrenaline through nasal sprays was comparable to that of injections, with some nasal formulations reaching the bloodstream more swiftly.
Typical symptoms of anaphylaxis include hives, swelling, difficulty breathing, and gastrointestinal distress, which can escalate rapidly to unconsciousness. Therefore, timely adrenaline administration is critical to counteract these severe reactions. According to Dr. Furness, the nasal spray method may offer a significant advantage for individuals who experience needle phobia or for use in public settings, where ease of administration is crucial.
The review revealed that nasal sprays not only matched but occasionally surpassed the efficacy of injected adrenaline, with effects observable within 2.5 to 20 minutes, compared to 9 to 45 minutes for traditional injections. The study also monitored the cardiovascular responses, showing similar heart rates and blood pressure levels between both delivery methods.
Another significant benefit of nasal sprays is their shelf life; while standard adrenaline injectors require replacement every 12 to 18 months, nasal sprays can remain effective for up to two years. This makes them more portable and easier to carry, potentially encouraging more individuals to keep them on hand in case of emergencies.
Dr. Furness emphasized the importance of clear usage instructions for patients, as proper knowledge regarding the administration of nasal sprays could lead to faster treatment and potentially reduce the rate of hospitalizations due to anaphylaxis. If further studies validate the findings, nasal sprays could be integrated into national guidelines for managing anaphylactic emergencies.
At present, the Neffy nasal spray has received approval in the United States and Europe as the first needle-free emergency treatment for anaphylaxis, with expectations for availability in the UK by the end of 2025. Licensing applications are also under review in several other countries, including China, Japan, and Australia.
While the advantages of intranasal delivery systems are promising, it's important to note that the studies reviewed primarily involved healthy adults and were conducted under controlled conditions. Consequently, more extensive clinical trials are necessary to ensure the long-term safety and efficacy of nasal sprays in real-world situations.
Experts believe that overcoming the barriers associated with needle use, particularly in emergency scenarios, could significantly enhance the management of anaphylaxis. As the medical community continues to evaluate the role of nasal sprays in this context, they may soon provide a much-needed alternative to traditional adrenaline delivery methods.