Epinephrine Nasal Spray for Anaphylaxis

On August 9th the FDA approved a 2 mg epinephrine nasal spray (neffy®) for the treatment of anaphylaxis. A neffy prescription consists of two single-dose device that use a technology that temporarily loosens the spaces between the nasal cells to help epinephrine be absorbed rapidly into the bloodstream. Similar to epinephrine auto-injectors, a second dose should be given if there is no improvement in symptoms within five minutes or symptoms worsen. Interestingly, repeat dosing in the same nostril is more effective than dosing once in each nostril.

Study results showed similar epinephrine levels between neffy and auto-injectors demonstrating similar increases in blood pressure and heart rate. A separate study in children weighing more than 66 pounds showed the amount of epinephrine in the blood was similar to adults who received neffy.

Side effects were generally mild and short-lived in the clinical trials and similar to injectable epinephrine with the following exceptions related to the delivery method: throat irritation, nasal discomfort, a tingling or itchy nose, nasal congestion, or runny nose. No serious adverse events were reported.

The spray is effective if you have nasal congestion or runny nose from a cold or seasonal allergy; however, people with nasal polyps or a history of nasal surgery may not receive a full dose and should stick with an injectable form of epinephrine. Caution: The spray will not work if frozen.

Directions are simple: Insert the tip of the device fully into one nostril and firmly press the plunger. Avoid angling the tip towards inside or outside wall. Avoid sniffing during and after inhaling the drug.

NOTE: While studies show the amount of epinephrine in the blood is the same for Neffy and injectable epinephrine, it has not been field tested — that will come with time.

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Want to know more about allergies and annaphylaxis? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

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