People with allergies to certain substances usually develop mild to moderate symptoms such as watery eyes, runny nose, or a skin rash. But sometimes, exposure to allergic substances (allergens),usually certain foods, insect venom, medications or latex, can cause a severe, potentially life-threatening reaction known as anaphylaxis.
In anaphylaxis, the immune system goes into overdrive releasing a flood of chemicals that can result in the body going into shock with blood pressure dropping sharply, airways narrowing and blocking breathing. In some people a second anaphylactic reaction, known as a biphasic reaction, can occur as long as 12 hours after the initial reaction.
You can develop a food allergy to virtually any food, including common food items such as peanuts, milk, egg, fin fish, shellfish, wheat, soy, and sesame. Allergic reactions can also occur after taking medications such as some antibiotics and even non-steroidal anti-inflammatory drugs like aspirin. Wasp and bee stings are also known to lead to severe allergic reactions.
Among the signs and symptoms of anaphylaxis are low blood pressure (hypotension), constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing, weak but rapid pulse, dizziness, nausea, vomiting or diarrhea, and skin reactions such as itching bumps or swellings (hives), flushed or pale skin. If anaphylaxis is not treated immediately, it can be fatal.
Currently, the treatment involves injecting the patient with epinephrine, a hormone also known as adrenaline. People who have had a severe allergic reaction are at risk for future reactions. Even if the first reaction is mild, future reactions might be more severe. This makes it imperative for people at risk of anaphylaxis to carry a self-injectable dose of epinephrine, currently administered through handy devices.
However, with the prospect of self-administering an injection proving to be difficult and painful, especially for children, the invention of a new nasal spray device to deliver epinephrine appears as an appealing option. The device is expected to become available in the market once it wins approval from the United States Food and Drug Administration (FDA). which is expected by mid-2023.
Study data provided by the device manufacturer to the FDA shows that epinephrine delivered via the nose had a similar influence on heart rate and blood pressure as an injection. This is critical considering that during anaphylaxis, heart rate slows down and blood pressure drops rapidly, making it difficult to get blood pushed throughout the body to major organs.
In addition to tackling reactions in vital organs such as the heart and lungs, the epinephrine also prevents the release of histamine and other chemicals that are responsible for out-spiraling of an allergic reaction. The nasal spray delivers a fine mist of epinephrine solution into the nasal cavity from where it is then rapidly absorbed through the moist nasal passages that are lined with blood vessels.”
Once the epinephrine enters the bloodstream, it binds to specific cell receptors to improve blood flow and reverse the symptoms of a severe allergic reaction. The good news is that the epinephrine gets to work fast, with symptoms beginning to ease within 5-10 minutes after injection into the muscle.
Around 20 percent of anaphylactic patients require a second dose of epinephrine, and delivery may need to be repeated at 5-15 minute intervals if there is no response or inadequate response, or even sooner if symptoms are significantly worsening acutely.
Studies conducted by the manufacturer in over 600 individuals showed that In blood measurements taken 10-20 minutes after administration, epinephrine levels in the body were similar to that delivered by a traditional injectable device. The effects on anaphylactic symptoms were also comparable.
When a second dose of epinephrine was given 10 minutes after the first, both nasal and injectable devices produced similar effects. Some results even showed that the nasal device had a significantly greater influence on blood pressure. More importantly, none of the studies reported any serious adverse effects following the use of the nasal device.
The nasal spray device, since it does not involve a needle, is smaller than the currently available needle-based devices. This could result in more patients finding it easier and more convenient to carry the nasal device around and decrease hesitancy to administer epinephrine. Previous research has shown that 52 percent of people who have been recommended an injectable device do not use it.
If you think a person is experiencing an anaphylactic reaction, call for medical assistance immediately and, in the meantime, if available, use an epinephrine auto-injector. The person experiencing anaphylaxis should be made to lie down on their back, and if they are vomiting, they should be turned on their side to prevent choking.
Even if the patient says they feel better after being administered epinephrine, it is important to visit a hospital to be checked out and monitored by medical professionals. It is also important to watch for recurring symptoms for a few days after the initial bout of anaphylaxis, as symptoms may recur 1 to 72 hours after apparent resolution of the initial phase.
