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As an alternative of stabbing your self, or another person, within the thigh with a needle to ship a dose of adrenaline to counter anaphylactic shock, wouldn’t it not be simpler to make use of a nasal spray as a substitute?
A examine introduced on the European Emergency Drugs Congress reveals that liquid or powder nasal sprays are as efficient and typically even higher than injection units comparable to EpiPens for delivering adrenaline.
Anaphylaxis is an acute allergic response to substances, comparable to nuts or insect bites or stings, and is a life-threatening emergency.
A affected person who goes into anaphylactic shock will typically develop some or the entire following signs: itchy pores and skin or a pink rash, swollen eyes, arms, ft, mouth, tongue and throat, issue respiratory, wheeze, belly ache, nausea and vomiting. They’ll collapse and change into unconscious in a short time. It must be handled urgently with adrenaline (also referred to as epinephrine), normally through an injection or a drip within the affected person’s vein.
Dr. Danielle Furness carried out a scientific overview of 5 worldwide research evaluating intramuscular-injected adrenaline units, comparable to EpiPens, with nasal sprays whereas she was ending her medical diploma on the College of Buckingham, UK. The research happened in Israel, Canada, Thailand, the U.S. and Japan.
She informed the Congress, “My review found that intranasal adrenaline, a needle-free alternative delivered as a liquid or dry powder spray, can be as effective as the EpiPen, with some forms reaching the bloodstream even faster.”
Dr. Furness, who’s now a Basis 12 months 1 physician on the Royal Derby Hospital, UK, selected to check rising choices for anaphylaxis, comparable to nasal sprays, with present tips and the gold normal suggestions whereas she was finding out acute take care of her diploma. She centered on needle-free options for sufferers with needle phobia or different limitations to utilizing EpiPens.
She evaluated the security and efficacy of the completely different adrenaline supply programs, and likewise the pharmacokinetics—the method of how the drug strikes into, via and out of the physique, specializing in absorption, distribution and metabolism.
She discovered that absorption of the nasal sprays was comparable and even quicker than injections, taking a most of two.5 to twenty minutes, in comparison with 9 to 45 minutes for the injected adrenaline.
Related or increased ranges of adrenaline had been seen in blood plasma for the nasal sprays, whereas coronary heart charge and blood strain had been related between sufferers who obtained adrenaline through a nasal spray or an injection. Uncomfortable side effects of the nasal spray had been delicate and handed rapidly.
Importantly, nasal sprays last more and are extra moveable than injection units. The shelf lifetime of nasal sprays is 2 years, whereas injection units have to get replaced each 12–18 months. The nasal sprays are usually smaller and extra moveable than injection units, such because the EpiPen. The neffy nasal spray is simply over six centimeters lengthy, whereas an EpiPen is simply over 15 cm lengthy.
Dr. Furness stated, “If authorised to be used, nasal sprays might change into an appropriate and equally efficient needle-free different to the EpiPen, which is the present therapy for anaphylaxis.
“Sufferers would nonetheless want clear directions on how and when to make use of a nasal spray, but it surely might enhance well timed administration of adrenaline, particularly for people who find themselves afraid of needles, or in public, out-of-hospital settings, which might scale back the charges of hospitalizations. For docs, it’s one other device that might assist stop delays in therapy.
“I believe that once strong, real-world evidence supports the safety and effectiveness of nasal sprays, they could be incorporated into national anaphylaxis guidelines. An initial rollout should include close and strict monitoring, encouraging doctors to report any cases where it may not have worked as expected, to ensure patient safety and maintain confidence in the treatment.”
Neffy is the primary nasal spray to be authorised and prescribed within the U.S. and Europe, together with Norway and Iceland. Within the UK, the Medicines and Healthcare merchandise Regulatory Company (MHRA) has authorised it as the primary needle-free emergency therapy for anaphylaxis. It’s anticipated to change into obtainable within the UK in direction of the top of 2025. Licensing functions have been filed in China, Japan, and Australia, and it’s below overview in Canada.
Strengths of the overview embrace that it checked out each liquid and dry powder-based nasal spray, evaluating them on to the present gold normal of injected adrenaline; it investigated the results of the completely different supply programs on blood strain and coronary heart charge, and never simply how rapidly the drug entered the bloodstream; and the trials had been carried out in a number of completely different international locations.
Limitations embrace that every one the research had been early, part I trials, wherein the completely different supply programs are examined in wholesome adults who weren’t experiencing anaphylaxis; a few of the research reviewed had small numbers of sufferers and there have been variations within the doses and supply units examined; there are not any long-term security knowledge but; and it’s unsure how the nasal sprays will carry out in on a regular basis use outdoors of managed trial circumstances.
Dr. Felix Lorang is a member of the EUSEM summary choice committee. He’s head of the emergency division at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not concerned with the analysis.
He stated, “Injection units, comparable to EpiPens, have been in use for many years to ship adrenaline to sufferers with anaphylaxis. Nevertheless, some sufferers expertise limitations to utilizing them for causes comparable to needle phobia, or how straightforward they’re to hold round on a regular basis. From my expertise, many individuals additionally hesitate when utilizing a needle on a relative or pal for concern of injuring or injuring the individual.
“Nasal sprays appear to overcome these barriers and, if further studies confirm their safety and efficacy, they will be a useful alternative for patients as well as an extra tool for medical staff to use.”
Extra data:
Summary no: OA063, “Intranasal adrenaline in comparison with intramuscular adrenaline for adults with anaphylaxis: a systematic review of pharmacokinetics, safety, and efficacy” Danielle Furness, Infectious ailments session, Tuesday 30 September, 14:45–16:15 hrs CEST, Schubert 4 room: https://eusem.floq.stay/kiosk/eusem-2025/dailyprogramme?objectClass=timeslot&objectId=68871e9e626af251d24be3d3&kind=element
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European Society for Emergency Drugs (EUSEM)
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Might nasal sprays exchange needles for delivering adrenaline to anaphylactic sufferers? (2025, September 29)
retrieved 30 September 2025
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