A nasal spray formulation of adrenaline, offering a needle-free alternative in the emergency treatment of anaphylaxis, has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA).
The adrenaline (epinephrine) nasal spray (brand name EURneffy), already available in Europe, is indicated for use in adults and children who weigh 30 kg (4 stone and 10 pounds, or around 66 pounds) or more.
It is a ready-to-use single dose nasal spray that delivers its entire contents (2mg) upon activation, with the MHRA noting that the plunger should be pressed once the product has been inserted into the nostril. It is suitable for use when the nose is congested due to a cold or allergy.
Healthcare professionals are being encouraged to make sure that patients using the new product are fully familiar with the different procedure for its use, and that patients are also fully aware of the use of other adrenaline auto-injectors.
Patients will be advised to carry two nasal sprays with them in case a second dose is needed and make sure that friends, family and colleagues know they have them in case of an emergency.
The new nasal spray will be continually monitored for safety and effectiveness, and the MHRA is encouraging anyone who suspects they are having a side effect from this medicine to talk to their doctor, pharmacist or nurse as well as reporting it to the Yellow Card scheme.
‘An important new option’
Commenting on the approval, Julian Beach, MHRA interim executive director of healthcare quality and access, said: ‘Patient safety is our top priority, which is why we’re pleased to approve the first needle-free nasal spray formulation of adrenaline for the emergency treatment of anaphylaxis in the UK. Until now, adrenaline for self-administration has only been available via auto-injectors.
‘While this represents an important new option, adrenaline auto-injectors remain a vital and potentially life-saving treatment, giving people experiencing anaphylaxis valuable time before emergency help arrives.
‘We continue to encourage everyone at risk of severe allergic reactions, and those around them, to familiarise themselves with how to respond in an emergency. Resources and guidance are available on the MHRA website to help people be prepared.’
Anaphylaxis treatment
Manufacturing problems for the injectable EpiPen have resulted in widespread shortages since 2017, plus knock-on shortages of other brands of adrenaline auto-injectors.
This month, the charity Anaphylaxis UK shared an update on Anaphylm – a postage-stamp sized film designed to be placed under the tongue to deliver adrenaline during an emergency allergic reaction. An application for the device is now being considered by the US Food and Drug Administration following strong clinical trial results in both children and adults.
Earlier this year, Allergy UK welcomed positive results of the first clinical trial to assess whether immunotherapy can desensitise adults allergic to peanuts. The Grown-Up Peanut Immunology study (GUPI) saw adults with peanut allergy receive repeated supervised doses of the equivalent of 0.5-1% of a whole peanut over several weeks, before increasing the dose and switching to eating peanuts or peanut containing foods, observed by a clinician.
Last year, research from King’s College London found that exposing children to peanuts from infancy to age five reduced the rate of peanut allergy in adolescence by 71%.
And in December, a report on child deaths related to asthma and allergies published by the National Child Mortality Database outlined recommendations and key improvements needed in professional practice to prevent future deaths.
A version of this article was originally published by our sister publication Nursing in Practice.
