Emerging treatments
New forms of immunotherapy administration
Subcutaneous immunotherapy is a mainstay in the treatment of seasonal allergies. Food allergy studies are under way to determine the safety and efficacy of new ways of immunomodulation to induce clinical tolerance. The main goal of food-allergen specific therapies is to achieve tolerance to the food allergen. Successful treatment would enable patients to consume the food without a reaction and also would allow for periods of avoidance without development of a reaction upon reintroduction. Sublingual, oral, and epicutaneous routes of immunotherapy are possible approaches to the treatment of food allergies and have now been approved for use in the UK.[145]
Intranasal adrenaline (epinephrine)
Intranasal adrenaline (epinephrine) may be an option for the acute management of anaphylaxis in some patients. An intranasal formulation of adrenaline was approved in Europe and the US in 2024, and is the first formulation of adrenaline for the management of anaphylaxis that is not delivered by injection. The European Medicines Agency (EMA) has approved the intranasal formulation for children with a body weight ≥30 kg body weight and adults with allergic reactions (anaphylaxis) caused by insect stings or bites, foods, medications, and other allergens, as well as idiopathic or exercise-induced anaphylaxis. Adrenaline is well absorbed from the nose and is quickly distributed into body tissues, so is an effective rapid treatment of anaphylaxis. Studies show that self-administered intranasal adrenaline achieves pharmacokinetic and pharmacodynamic profiles that are comparable to, if not better than, intramuscular adrenaline administered by a healthcare professional.[146] There are no controlled clinical trials on efficacy in patients with severe allergic reactions as this would be unethical. Absorption may be affected by underlying structural and anatomical nasal conditions (e.g., nasal polyps), and use of an injectable formulation should be considered in these patients. The most common adverse effects were similar to those associated with injections (e.g., headache, nausea, throat irritation, dizziness), as well as nasal discomfort and a runny nose. It is yet to become widely available, and is not yet recommended in guidelines for the management of anaphylaxis.
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