Anaphylactic shock: an adrenaline nasal spray is on the way, due to be available for children this spring

Anaphylactic shock is a severe, systemic and potentially fatal allergic reaction that develops rapidly, often within a few minutes of exposure to the allergen. Triggered by wasp and bee stings, medicines, or foods such as nuts, its symptoms include breathing difficulties and a drop in blood pressure. During an anaphylactic reaction, large quantities of histamine and other substances are released into the body, causing a sudden and rapid dilation of the blood vessels, which may lead to a drop in blood pressure and possible loss of consciousness. In such cases, immediate intervention is required, involving the immediate administration of adrenaline.

“The standard treatment for an anaphylactic reaction,” explains Mario Di Gioacchino, Past President of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) – Senior Consultant at Synergo – Institute of Clinical Immunotherapy and Advanced Biological Treatments in Pescara – is the prompt administration of epinephrine (adrenaline). This drug is essential for counteracting the rapid drop in blood pressure and symptoms affecting the airways (including bronchospasm), and it works by binding to a specific type of receptor, known as adrenergic receptors, thereby reducing the vasodilation and increased permeability of blood vessels caused by histamine released during the response to an allergen. This is why prompt treatment leads to improved blood flow and easier breathing.”

Until now, adrenaline for anaphylactic shock could only be administered via an auto-injector, usually into the thigh, even over clothing. From today, however, a nasal spray version is also available for adults, and from next spring it will also be available for children. The announcement comes during the 38th national congress of the Italian Society of Allergology, Asthma and Clinical Immunology (Siaaic), currently taking place in Salerno: approved in August 2024 by the Food and Drug Administration and the European Medicines Agency, the nasal spray has also been given the green light by AIFA.

“Allergies are the most common chronic condition in Europe, with estimates suggesting that around 150 million Europeans are affected by some form of allergy,” says Vincenzo Patella, president of Siaaic and Head of the Internal Medicine Unit at the Salerno Health Authority. “Among these, around 20 per cent of people suffering from severe allergic conditions live every day in fear of anaphylactic shock or of dying as a result of an uncontrolled reaction. In Italia, there are 10,000 cases recorded each year, with 60 fatalities.”

Over time, critical issues have emerged regarding the use of the auto-injector, particularly in relation to the difficulties experienced by patients and carers. “Although intramuscular adrenaline is recognised as the first-line treatment for anaphylaxis,” emphasises Patella – clinical reality shows that between 25% and 60% of patients refuse to inject themselves with the drug and that, in cases where they do, administration is delayed”. According to the SIAAIC president, the data show that patients or their carers wait up to nine minutes before administering the injection – a delay that can prove critical in an emergency situation where speed is a determining factor in the clinical outcome. “The aim of the spray is to reverse this trend, given that only 7 per cent of adults and 21 per cent of children receive adrenaline in time,” emphasises Patella.