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Epinephrine (aka adrenaline) auto-injectors — more commonly known as EpiPens (although EpiPen is registered trademark product)— are life-saving medications used for severe allergic reactions, also known as anaphylaxis. They are compact, easy to use, and can be carried anywhere, making them essential for individuals with known food, insect bite, or medication allergies. Many patients are advised to keep a pair of auto-injectors with them at all times for emergency use.
However, a common and concerning issue is when to use the epinephrine auto-injectors. While patients are advised to administer it at the first sign of allergic symptoms, hesitation often sets in. The high cost, panic during the episode, or the hope that symptoms might resolve on their own can delay its use. On top of that, the administration involves a jab into the outer thigh, where a long needle delivers epinephrine into the muscle. Understandably, this can be frightening — both for the patient and anyone nearby who might have to help.
But this may soon change. A pharmaceutical company has introduced a needle-free alternative, recently approved in the UK. Following its launch in Germany last month, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) approved EURneffy, an adrenaline nasal spray for treating anaphylactic reactions.
EURneffy is a single-use nasal spray that delivers 2 mg of adrenaline in 100 microlitres. Research has shown that nasal absorption is as effective as intramuscular injection, offering a non-invasive alternative to traditional auto-injectors.
It is approved for use in individuals weighing over 30 kg, including children above that weight. However, it is not yet recommended for younger children or pregnant women, as further studies are needed to establish safety and efficacy in these groups.
People with food, nut, or insect bite allergies are advised to carry two sprays at all times. If exposed to a known allergen and symptoms such as rash, swelling, breathlessness, dizziness, or even seizures appear, EURneffy should be used immediately, followed by a call to emergency services.
Since it's single-use, proper administration is crucial. If symptoms persist beyond 10 minutes or reappear, the second spray can be used. Any further dosing should be handled by medical personnel.
Caution is advised in individuals with cardiovascular disease, renal impairment, hyperthyroidism, high intraocular pressure, Parkinson’s disease, or prostate issues, as adrenaline can cause adverse effects in these conditions.
According to the manufacturer, EURneffy is as effective as auto-injectors, minus the needle. It can be easily administered by the patient or bystanders, making it more accessible in high-stress situations. It also eliminates needle fear, a significant barrier to timely treatment.
Additionally, EURneffy has a longer shelf life — around 30 months, compared to the average 12 months for most auto-injectors. It’s also been shown to withstand high temperatures up to 50°C, making it ideal for travel and storage in warmer climates.
While EURneffy appears promising, especially for those afraid of needles, the cost factor remains a critical question. Epinephrine Auto-injectors are notoriously expensive in many Western countries, and whether EURneffy will be a more cost-effective solution is yet to be seen.
(Rh/Dr. Shubham Halingali/MSM/SE)
