Anaphylaxis is a severe, potentially fatal allergic reaction and rapid identification and treatment is crucial, with epinephrine being the first-line treatment. In preparation for my Emergency Medicine rotation, I researched what new information and practices are informing emergency care and came across “neffy”, an epinephrine nasal spray that was approved by the USFDA in August 2024 for use in children and adults for anaphylaxis. It (and other non-injectable formulations) was developed as a response to the challenges posed by epinephrine autoinjectors (EAIs), such as device size and needle phobia, all of which lead to delays in treatment and increased risk of hospitalization. This is an exciting development in medicine, and I was really interested in seeing what is understood and what remains to be studied. 

The article discusses the development and effectiveness of neffy. It explains its components, the most interesting of which to me was Intravail, an absorption-enhancing agent that allows better absorption through the nasal mucosa without causing irritation (in turn allowing a lower dose of epinephrine to be administered while maintaining its efficacy, reducing the risk of overdose). The use of Intravail in neffy also ensures optimal drug delivery, minimizing the potential for adverse effects while effectively managing anaphylactic episodes. They did find however, that Neffy’s absorption was minimally affected during upper respiratory infections.

The article also explained that the development of neffy involved over eight years of collaboration with regulatory bodies like the FDA and EMA, including multiple clinical trials to evaluate its pharmacokinetics and pharmacodynamics under various conditions. The studies demonstrated that neffy provides a pharmacokinetic and pharmacodynamic profile comparable to, or better than, EAIs. Overall, the nasal delivery system of neffy offers a needle-free, pain-free alternative that could increase the likelihood of early administration, addressing an unmet need for more user-friendly epinephrine delivery methods.