On August 9, 2024, the U.S. Food and Drug Administration (FDA) approved neffy® nasal spray, the first needle-free form of epinephrine for emergency treatment of allergic reactions, including anaphylaxis. It is approved for use in adults and pediatric patients weighing at least 66 pounds. Anaphylaxis is a severe type of allergic reaction that occurs rapidly after exposure to an allergen and can be life threatening if treatment is not administered in a timely manner. Individuals experiencing anaphylaxis may present with hives, swelling, itching, difficulty of breathing and/or loss of consciousness. The only other treatments for anaphylaxis to date have been injectable epinephrine products, such as an EpiPen. Nasal spray epinephrine provides an effective alternative for treating the life-threatening reaction in patients who are averse to needles. Developed by ARS Pharmaceuticals, neffy® is a single-dose nasal spray that is administered into one nostril. A second dose, using a new nasal spray device, can be administered into the same nostril if there is no improvement in symptoms.
The approval of the nasal spray is based on four studies involving 175 adults without anaphylaxis. Epinephrine blood concentrations were evaluated following neffy® administration versus an epinephrine injection. The results showed similar epinephrine concentrations between both products. Neffy® also demonstrated comparable increases in blood pressure and heart rate relative to the injectable. Another study in children over 66 pounds produced results similar to those found in the studies performed in adults.
There are warnings associated with neffy®, specifically in those with existing nasal polyps or a history of nasal surgery, as this may affect the absorption of the product. Additionally, precaution is advised in individuals with coexisting chronic conditions or allergic reactions associated with sulfite. Potential side effects of neffy® include throat irritation, nasal symptoms (tingling, itching, runniness, sneezing and congestion), headache, jitteriness and tremor.