Epinephrine nasal spray for the treatment of anaphylaxis: perspectives in pediatrics

Purpose of review: Anaphylaxis is a severe allergic reaction characterized by a rapid onset and can be potentially life-threatening. Epinephrine is considered the first-line treatment, and until recently, it was available only for intramuscular injection. A new intranasal epinephrine delivery device has now been approved for use in adults and children, offering a needle-free option for emergency treatment of allergic reactions. This narrative review explores its technical characteristics, along with its pharmacokinetic, pharmacodynamic, and safety profiles based on the results of the most recent clinical trials. Recent findings: The key advantages of the intranasal route, including the elimination of needle-length variability, reduced risk of administration errors in obese or underweight patients, and simplified storage requirements, are also discussed. According to recent research, intranasal epinephrine represents an easy-to-use, effective, and well tolerated treatment for severe allergic reactions. Intranasal delivery may offer a painless, easy-to-use, and reliable solution suitable for healthcare professionals, age-appropriate patients and caregivers. Summary: Based on the current evidence, intranasal epinephrine appears to be a promising, well tolerated option that could significantly improve the accessibility and effectiveness of anaphylaxis management in the pediatric setting.