Insect bites and stings

Intranasal epinephrine (adrenaline)

Intranasal epinephrine may be an option for the acute management of anaphylaxis in some patients. An intranasal formulation of epinephrine was approved in the US and Europe in 2024, and is the first formulation of epinephrine for the management of anaphylaxis that is not delivered by injection. The Food and Drug Administration (FDA) has approved the intranasal formulation for emergency treatment of type 1 allergic reactions, including anaphylaxis. The European Medicines Agency (EMA) has approved the intranasal formulation for allergic reactions (anaphylaxis) caused by insect stings or bites, foods, drugs, and other allergens, as well as idiopathic or exercise-induced anaphylaxis. Epinephrine 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 epinephrine achieves pharmacokinetic and pharmacodynamic profiles that are comparable to, if not better than, intramuscular epinephrine administered by a healthcare professional.[68]Ellis AK, Casale TB, Kaliner M, et al. Development of neffy, an epinephrine nasal spray, for severe allergic reactions. Pharmaceutics. 2024 Jun 14;16(6):811. https://www.mdpi.com/1999-4923/16/6/811 http://www.ncbi.nlm.nih.gov/pubmed/38931932?tool=bestpractice.com ​ 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 anatomic 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.