First needle-free emergency treatment for anaphylaxis approved in UK

A nasal spray formulation of adrenaline, offering a needle-free alternative in the emergency treatment of anaphylaxis, has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA).

The product EURneffy, already available in Europe, is for use in adults and children who weigh 30 kg (about 66 pounds) or more and is suitable for when the nose is congested due to a cold or allergy.

The adrenaline (epinephrine) nasal spray is described as a ready-to-use single dose nasal spray for one nostril that delivers its entire contents (2mg) upon activation.

Healthcare professionals are being encouraged to make sure that patients using the new product are fully familiar with the different procedure for its use, and that patients are also fully aware of the use of other adrenaline auto-injectors.

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Patients will be advised to carry two nasal sprays with them in case a second dose is needed and make sure that friends, family and colleagues know they have them in case of an emergency.

Julian Beach, MHRA interim executive director of healthcare quality and access, said about the approval:

‘Patient safety is our top priority, which is why we’re pleased to approve the first needle-free nasal spray formulation of adrenaline for the emergency treatment of anaphylaxis in the UK. Until now, adrenaline for self-administration has only been available via auto-injectors.

‘While this represents an important new option, adrenaline auto-injectors remain a vital and potentially life-saving treatment, giving people experiencing anaphylaxis valuable time before emergency help arrives.

‘We continue to encourage everyone at risk of severe allergic reactions, and those around them, to familiarise themselves with how to respond in an emergency. Resources and guidance are available on the MHRA website to help people be prepared.’

Manufacturing problems for the injectable EpiPen has resulted in widespread shortages since 2017, plus knock-on shortages of other brands of adrenaline auto-injectors.

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The MHRA recommends that patients with serious allergies using an adrenaline auto-injector carry two with them at all times. In case of an anaphylaxis emergency, patients are advised to use an auto-injector without delay and immediately contact 999. Patients should lay down flat with their legs raised or lay on their left side if they are pregnant. If there is no improvement after five minutes, a second auto-injector should be used.

The new nasal spray will be monitored under the Yellow Card scheme.

This month, the charity Anaphylaxis UK shared an update on Anaphylm, a postage-stamp sized film designed to be placed under the tongue to deliver adrenaline during an emergency allergic reaction. An application for the device is being considered by the US Food & Drug Administration (FDA) after clinical trials.

Earlier this year, Allergy UK welcomed positive results of the first clinical trial to assess whether immunotherapy can desensitise adults allergic to peanuts. The Grown-Up Peanut Immunology study (GUPI) saw adults with peanut allergy receive repeated supervised doses of the equivalent of 0.5-1% of a whole peanut over several weeks, before increasing the dose and switching to eating peanuts or peanut containing foods, observed by a clinician.

In 2023, a 13-year-old girl died after being served a dairy based hot chocolate drink in error at a Costa Coffee franchise in East London and due to national shortages the community pharmacy they went to only had one adrenaline auto-injector available in stock, in a dose that wasn’t sufficient for her reaction.

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The prevalence of food allergies was found to have doubled between 2008 and 2024, with the largest rise in young children.