Do needles make you nervous? You’re not alone; the CDC estimates that as many as 2 in 3 children and 1 in 4 adults have a fear of them. Add in the stress of a life-threatening medical event and you can understand why the emergency treatment of severe allergic reactions with injectable epinephrine (often called an EpiPen) isn’t an easy process.
“All allergists have seen times when epinephrine should have been used but wasn’t because of fear,” says UNC Health allergist Edwin Kim, MD. “People hesitate or get nervous to use a needle because they think they’re going to hurt the person who needs it.”
Now, for the first time, people with allergies will have an alternative—a nasal spray containing epinephrine for treatment of allergic reactions, including anaphylaxis, a life-threatening severe reaction.
Marketed as Neffy, the spray was approved this year by the Food and Drug Administration and could be a game-changer for people with allergies, Dr. Kim says.
Epinephrine and Allergic Reactions
When your immune system encounters an allergic trigger, whether that’s food, medication or the venom of an insect, it releases a chemical called histamine that causes the symptoms of an allergic response. While symptoms are sometimes mild and can be treated with an antihistamine medication, a severe reaction might cause difficulty breathing or swallowing; swelling of the lips, tongue or throat; hives and rashes; abdominal pain and vomiting; dizziness or fainting; and cardiovascular issues including a drop in blood pressure and an irregular heart rate.
“Epinephrine, a version of adrenaline, treats all those symptoms in the moment while also stopping the release of histamine, preventing future symptoms,” Dr. Kim says. “The epinephrine maintains a person’s blood pressure, making sure the blood flows where it’s needed, stops the spasms and wheezing in the lungs, and decreases the hive reactions.”
While an antihistamine may take a half-hour or longer to counteract symptoms, epinephrine works within minutes, which is crucial when a person can’t breathe or is losing consciousness.
Dr. Kim says that any alternative to injectable epinephrine had to work as effectively.
“The FDA made it clear: an alternative had to get as much epinephrine to the bloodstream and as quickly as an injector does,” he says. “The makers of Neffy found a way to formulate epinephrine in a nasal spray and demonstrated to the FDA that equal amounts could reach the bloodstream within minutes.”
To use Neffy, you spray the medicine into your nose, where the nasal membranes will absorb it; unlike other nasal sprays, you won’t have to aim for the back of the nose.
Neffy vs. Needles
Not everyone will be able to use Neffy at first. The FDA has approved its use for people who weigh at least 66 pounds, so young children won’t be eligible. Dr. Kim says he anticipates that additional applications to the FDA will be submitted so that children can use the product as well.
Because Neffy is absorbed in the nose, Dr. Kim says that people who have an underlying nasal issue— such as polyps, a deviated septum or previous nasal surgery—may not be good candidates for the spray until more data is available.
For those who do use Neffy, there will be some similarities to the injector experience.
“Neffy will have the same side effects,” Dr. Kim says. “Adrenaline causes the heart rate to go up, and the person might feel lightheaded or look pale as the blood flow starts moving rapidly to the heart.”
Just as it’s sometimes necessary to administer a second dose of injectable epinephrine, you may need a second dose of Neffy. Each unit of Neffy, which is 2.25 inches tall and 1.75 inches wide, is a single dose. (Its size makes it easier to carry around than a clunky injector pen.)
“My main tip for people is going to be to have two on hand,” Dr. Kim says. “If you don’t see a benefit in five to 10 minutes, or if symptoms come back, use the second dose.”
Following use of injectable epinephrine, people are typically advised to visit an emergency department for medical management of the allergic reaction; Dr. Kim says that guideline will be the same for Neffy users.
“When the epinephrine wears off, some symptoms can still be around,” Dr. Kim says. “The emergency department can manage those and give more medication if necessary. I think going to the emergency department will be important until more people are comfortable with this new form of the medication.”
Using Neffy Nasal Spray for Severe Allergic Reactions
If you’re interested in using Neffy, talk to your doctor about a prescription and how and when to use the medication. Dr. Kim also recommends keeping any injectable epinephrine you have on hand until it expires, as a backup.
Dr. Kim acknowledges that some may not yet trust that a nasal spray can be as effective as an injection, particularly if they’ve relied on injectors for years. While the FDA has agreed that the spray matches the efficacy of the injectors, data on how the spray performs in the most severe reactions is limited because it’s not appropriate to force a severe reaction for testing.
Dr. Kim is confident that as people have the chance to use the product, trust will develop.
“This is a form that people won’t be as scared to use and to use earlier, at the first signs of a reaction,” Dr. Kim says. “They won’t wait to be sure that it’s a big reaction but will instead stop the reaction before it becomes uncomfortable.”
And while people with allergies and those who live with them may be used to needles, a nasal form of epinephrine means that friends and bystanders could be more empowered to help during an allergic reaction.
“This could potentially be really helpful and lifesaving if more people are less intimidated by the method,” Dr. Kim says. “I could see nasal epinephrine becoming a standard in first-aid kits, on airplanes, in schools. It’s been a long time coming and really has great potential to change the allergy field.”
Questions about allergy treatments? Talk to your doctor. If you need a doctor, find one near you.The post A Needle-Free Treatment for Severe Allergic Reactions first appeared on UNC Health Talk.
