By now, we all know that epinephrine is the first – and best – line of defense against a severe food allergy reaction called anaphylaxis. But when symptoms of anaphylaxis first appear, many patients and caregivers hesitate to give it. Why?
Not only are patients unsure about the timing to deliver a dose of the life-saving medication, but they tend to pause at the idea of giving an injection. Parents worry that it will be difficult to administer or that it will scare/hurt their children. And, patients are at risk for minor injuries associated with delivery such as lacerations and misfirings. Doctors and clinicians say epinephrine auto-injectors are “underused” in an emergency. Delays in administration of epinephrine during anaphylaxis put the patient at risk for a more severe reaction that could require more medication to stabilize.
To date, patients have had a single option for getting a dose of epinephrine: an injection given to the patient through the outer, muscular part of the thigh. But the food allergy community has long wondered, is there another way?
Enter: intranasal epinephrine.
Essentially: epinephrine delivered through a nasal spray.
Researchers have examined how well the body absorbs epinephrine when it is given intranasally as compared to intramuscular injection (the way epinephrine is currently administered through auto-injectors). What they found surprised us all: epinephrine can be absorbed and distributed throughout the body as a nasal spray just as well as it would an injection.
This is wonderful news for patients and caregivers that are afraid of needles. But it’s also good news for those wanting to help in an emergency. Because nasal sprays are a less invasive treatment, patients and caregivers may find themselves more likely to act quickly, administering much-needed epinephrine sooner and more frequently than they would otherwise. Nasal sprays could make acting in those first critical minutes of anaphylaxis easier which could make follow-on emergency treatment less complicated and would ultimately save lives.
A few pharmaceutical companies have begun developing intranasal epinephrine products. One such company is Bryn Pharma which developed a portable, easy-to-use spray (currently referred to as BRYN-NDS1C). BRYN-NDS1C was granted Fast Track Designation by the FDA and is currently undergoing human trials. Bryn’s nasal delivery device has already been approved for use in other conditions by the FDA.
Another company, ARS Pharmaceuticals, whose product is called ARS-1, was also given Fast Track Designation to develop intranasal epinephrine.
Studies and trials continue, while questions remain about the efficacy of this delivery system when a patient experiences such factors as nasal/sinus swelling or moderate to severe congestion.
Although final approval by the FDA and ultimate delivery of this medication to customers is still unknown, we should all have high hopes for more and innovative epinephrine options to consider in the future.