Nasal spray offers similar results to injected adrenaline

The Medicines and Healthcare products Regulatory Agency (MHRA) has approved the first nasal spray alternative to injected adrenaline (epinephrine) to be used for the emergency treatment of serious allergic reactions, including anaphylaxis.

Anaphylaxis is a sudden, severe and sometimes life-threatening allergic reaction that causes a drop in blood pressure and breathing difficulties.

Adrenaline is a well-established treatment for anaphylaxis, commonly administered through auto-injectors. The approval of EURneffy® marks the introduction of a nasal spray formulation, providing a needle-free alternative for the emergency administration of a potentially life-saving medication.

Dr Helen Evans-Howells, GP, Allergy specialist and Chair of the Anaphylaxis UK Clinical and Scientific Panel, said: 'Anaphylaxis is a severe allergic reaction that can involve difficulty in breathing, affect blood pressure, lead to unconsciousness and even, on rare occasion, be fatal. It can occur within minutes of exposure to allergens and rapid treatment with adrenaline is vital.

'However, we continue to see persistent challenges within the community, with a large proportion of people with severe allergies, or their carers, not carrying or delaying use of an injectable adrenaline pen. This markedly increases the risk of negative outcomes and the need for additional emergency medical treatment. A nasal adrenaline spray addresses several critical barriers seen with the current standard of care, such as portability, fear, hesitancy to act and incorrect administration. With this option , prescribers will have important additional alternatives to discuss with their patients and we hope and expect to see an increase in the number of patients and carers who both carry and confidently administer adrenaline promptly when needed.'

Data presented at the recent European Academy of Allergy & Clinical Immunology Congress showed that the adrenaline nasal spray offers a comparable clinical pharmacological response to intramuscular adrenaline injection, despite congestion associated with allergic rhinitis.

Dr Anne Ellis, Professor and Chair of the Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada, and lead study investigator said: 'Injectable adrenaline has been the cornerstone of treatment for many years, significantly reducing morbidity and mortality, but people not carrying or delaying the use of their adrenaline can greatly impact outcomes.

‘An adrenaline nasal spray offers an alternative method of adrenaline delivery that may be easier for patients to manage and administer, leading to timely treatment and potentially better results. Nasal spray delivery has been proven to provide a comparable pharmacological response to injected adrenaline across many dosing considerations, including in this study regardless of nasal congestion associated with allergic rhinitis.’

The results of the randomised, crossover, pharmacokinetic (PK) and pharmacodynamic (PD) study* demonstrated that in the presence of allergic rhinitis symptoms, two doses of EURneffy® 2 mg nasal adrenaline spray resulted in similar or higher PK/PD responses compared with two doses of 0.3 mg intramuscular adrenaline injection administered manually, suggesting that nasal congestion does not interfere with the pharmacological response of the nasal spray in patients requiring a second dose of adrenaline.1

EURneffy® 2 mg is licensed for the emergency treatment of allergic reactions (anaphylaxis) due to insect stings or bites, foods, medicinal products and other allergens, as well as idiopathic or exercise-induced anaphylaxis in adults and children who weigh ≥30 kg. The manufacturer, ALK, expects to start launching the product later this year.

*PK and PD studies were used because it is not considered ethical nor practical to study such treatments in people experiencing anaphylaxis

Ellis AK, et al. Presented at EAACI congress; June 13 - 16, 2025; Glasgow, UK