I heard on the news that there is a new nasal EpiPen, can it really work for anaphylaxis? 

The short, simple and sweet answer is “yes”.  But if you’ve read this newsletter previously you know how I like to elaborate on simple answers.    

The FDA did recently approve “Neffy” a single dose nasal spray containing epinephrine.  It can be used in adults and children who weigh 66 pounds or more.  There is a pediatric spray for smaller children that is also undergoing clinical trials.   

In addition to being “needle free” some additional advantages over the injectable forms (EpiPen and AuviQ) are its compact size, heat stability and ease of use.   

As you may know the mucus membranes in the mouth and nose provide a medium for almost instant absorption of medicines and recreational drugs.  Speaking of recreational drugs, far too many Americans die from opioid overdose.  In this regard the nasal spray Narcan has saved many lives.  Narcan (naloxone) is an opioid antagonist, and the spray is immediately absorbed and can prevent death from an overdose.   

In terms of medications Calcitonin nasal spray is an option for treating loss of bone density (osteopenia/osteoporosis).  It is a salmon derived bone building hormone that is absorbed intact through the nasal membrane.  If it were swallowed its breakdown in stomach would render it useless.   

Two commonly used “instant onset medications” that are absorbed in the mouth are nitroglycerine for angina/heart attacks and ondansetron for relief of nausea/vomiting.    

Currently 33 million Americans have a prescription for injectable epinephrine with this many people at potential risk for anaphylaxis it is not difficult to appreciate that unfortunately there have been some deaths due to fear of injection or due to inadvertent mishap while trying to inject the medicine.  The simple single dose nasal spray should prevent these issues.   

Because of its ease of use and safety it is also being studied for possible use to treat acute severe hives and acute severe asthma.  But the jury is still out in these applications.  However, if it is approved for these situations keep in mind that it is an urgent stop-gap, and as is true with its anaphylaxis application, immediate urgent care is still necessary.