For those with food allergies, every meal is a potential life-or-death situation. Yet throughout history, allergies were poorly understood and rarely treated. Reports from ancient China, Rome, Egypt, and Greece confirm that antibody-antigen interactions have existed for millenia, though the term “allergy” was only coined in 1906, by Clemens von Pirquet [1]. Despite their prevalence, scientists only came to understand the mechanisms behind allergies in the middle of the 20th century; in 1967, the crucial antibody immunoglobulin was identified. The modern standard of care, the EpiPen epinephrine auto-injector, was patented in 1977 and FDA approved in 1987 [1, 2]. Since then, the Epipen has revolutionized the treatment of severe anaphylactic shock and has saved countless lives. Nonetheless, epinephrine delivered via injection comes with challenges regarding needle use, administration complexity, and accessibility.
Neffy, a new nasal epinephrine delivery system, represents a promising advancement in allergy medicine administration by offering a needle-free option that could significantly impact emergency care for anaphylactic patients. By improving the public’s ability to administer epinephrine quickly and effectively, Neffy could positively affect anaphylaxis response times and survival rates. However, these benefits must be weighed against considerations of safety and equitable access.
With the current standard of care being injectable forms of epinephrine, people with allergies may be intimidated about using their delivery systems. In particular, many children face challenges with epinephrine auto-injectors due to needle phobias. Neffy provides a less threatening alternative: a nasal spray which might improve the willingness of patients and caregivers to administer life-saving treatment promptly. According to a survey of patients and caregivers, “72% would prefer using an epinephrine nasal spray instead of an auto-injector” [3]. Willingness to administer epinephrine has substantial effects on survival rates, as “delayed use of epinephrine during an anaphylactic reaction has been associated with deaths” [4]. Additionally, the nasal spray is both user-friendly and FDA approved, showing “greater or similar” efficacy to an auto-injector [3]. Finally, the cost provides an added benefit for those without insurance coverage—a package of 2 auto-injectors costs approximately $600-750, whereas 2 of the Neffy nasal sprays cost $498 [3,5]. Overall, a nasal delivery system may be a very attractive option to many people with severe allergies.
Despite these benefits, Neffy’s use raises ethical concerns, particularly regarding safety and efficacy. Since Neffy is a newer technology, it is crucial to evaluate whether it delivers epinephrine as effectively as injectables; the FDA approved it based on four studies (on healthy adults without anaphylaxis), but new evidence may come out to the contrary. Additional clinical trials should be done verifying Neffy’s effectiveness in patients actually experiencing anaphylactic shock, rather than just measuring epinephrine absorption. One of the biggest questions raised is whether one should prefer Neffy to a traditional auto-injector in an emergency. Many patients have used EpiPens for years and are comfortable with using them. For those who still carry an EpiPen but have decided to purchase Neffy, the dilemma of deciding between a trusted medication and Neffy may cause hesitation in a moment of distress. Even if patients carry both, they and their caregivers should have a clear plan in mind of which delivery system they plan to default to. One final concern lies with access equity: though the cost of Neffy and other innovative nasal therapies appear to be manageable, asymmetric distribution in the next few years might leave certain areas without access. Nevertheless, this is the case with many innovative treatments; with time, Neffy and other alternative nasal epinephrine delivery systems will hopefully become widely available.
With its nasal spray design, Neffy could increase accessibility and lower rates of medical errors by reducing the complexity of epinephrine administration. However, ensuring its efficacy remains crucial, as does conducting rigorous clinical trials to confirm its reliability. Future research and policy initiatives will play key roles in Neffy’s adoption. Should these concerns be addressed, Neffy has the potential to become a staple in life-saving allergy care, giving peace of mind to millions who worry about allergies daily.
Reviewed by Abby Winslow
Graphic by Haynes Lewis
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