Nasal adrenaline instead of an Epipen injection? Really?

Childhood allergies are becoming more common, particularly in industrialised nations like Australia.  Understanding what an allergy is and how to treat them is extremely important.

So, what is an allergy?
An allergy occurs when the body’s immune system mistakenly identifies a harmless substance as a threat and mounts an immune response to the substance.  These harmless substances are called allergens.

‍Common allergens can include:

Foods

* Peanuts and tree nuts

* Milk

*‍ Eggs‍

* Shellfish and fish

* Wheat

‍* Soy

‍Insect bites

‍* Bees stings

‍* Wasp stings

* Hornet stings

‍* Ant bites

Medications

‍* Antibiotics

‍* Anti-inflammatory medications

‍* Anaesthetic medications

‍* Some chemotherapy medications

‍Environmental triggers

‍* Grass

*‍ Pollen

‍* Dust

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Common symptoms of allergy include itchy eyes, sneezing and a runny nose. However, allergies can become much more serious and potentially life threatening.  The most serious type of allergic reaction is called anaphylaxis.

What is anaphylaxis?
Anaphylaxis can happen rapidly and is life-threatening if not treated immediately.  Symptoms may include difficulty breathing, swelling of the throat or tongue, dizziness, and a drop in blood pressure, or loss of consciousness.

Treatment and emergency response
For mild allergic reactions, antihistamines are usually enough to manage symptoms.  For severe reactions such as anaphylaxis, an adrenaline injection is the first-line treatment.

Many families are familiar with the EpiPen, an auto-injector that delivers a dose of adrenaline, usually into the thigh. It works quickly to reduce swelling, open airways, and stabilize blood pressure. Children at risk of anaphylaxis are often prescribed one (or two) EpiPen injectors to carry at all times. One is usually kept at school, and teachers are trained how to use them. The Australian Society of Clinical Immunology & Allergy (ASCIA) requires that children have an in date ASCIA allergy and anaphylaxis action plan.

There is now a new option available for treatment of anaphylaxis, called Neffy.  This is a needle-free nasal spray form of adrenaline. It is administered intranasally and offers an alternative for children who are anxious about injections, making it potentially easier to administer in emergencies. It can also be administered to someone who is unconscious as they do not need to sniff the product in. A second dose if needed can be administered to the second nostril.

At the moment, this product is not listed on the PBS so is more expensive at around $100 for 2 doses. It can be prescribed by your GP as long as the initial adrenaline was prescribed by an immunologist. It is also only eligible for those over 4 years of age and over 15 kg.

It is important to remember that in an emergency, regardless of the method of delivery, the key thing with adrenaline is a speedy administration.  It needs to be given as soon as anaphylaxis is suspected.  The patient should always be taken to hospital for observation for 4 hours because when the adrenaline wears off the allergy can start again.

There are new ASCIA anaphylaxis action plans for Neffy.  However, we do not anticipate these to be in wide circulation in NSW schools until 2027 as it will require some training in NSW schools.

Take Home Message

Whilst many allergies are mild, a severe allergy can turn into an anaphylactic reaction which is lire-threatening and requires immediate treatment. 

Anyone with a history of an anaphylactic allergy should always carry adrenaline which can be given as an injection (EpiPen) or intranasally (Neffy).  These are easy, safe and lifesaving treatments.

ASCIA Anaphylaxis  Plans: https://www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis#dev2

ASCIA Allergy Plans: https://www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis#aap2

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