A groundbreaking development in anaphylaxis treatment has arrived! The Therapeutic Goods Administration (TGA) has approved an adrenaline nasal spray called 'neffy', marking the first new adrenaline delivery method in Australia in over three decades. This innovative approach has sparked excitement and curiosity among medical professionals and patients alike.
Professor Connie Katelaris, a renowned allergist, welcomes this additional treatment option, acknowledging the challenges faced by some patients with anaphylaxis. She emphasizes that neffy has been successfully used overseas and is now accessible to Australians.
But here's where it gets interesting: how does neffy compare to the well-known EpiPen? Let's dive in!
Nasal Spray vs. EpiPen: What's the Difference?
Both neffy and EpiPen deliver adrenaline, the key ingredient in treating anaphylaxis. However, neffy stands out as it doesn't require a needle or injection, offering a needle-free alternative. It employs a similar delivery system as opioid reversal medicines, administering adrenaline through the nasal mucosa for rapid absorption into the bloodstream.
Can It Be Part of a Resuscitation Kit?
The answer is both yes and no. While neffy contains adrenaline for the same purpose as injectable adrenaline in resuscitation kits, there's a crucial difference. Resuscitation kits typically contain Schedule 3 medications, whereas neffy is currently a Prescription-only (Schedule 4) medication.
Who Benefits Most from the Nasal Spray?
Adrenaline nasal spray is specifically designed for emergency anaphylaxis treatment in patients aged 4 years and older, weighing 15 kg or more. It provides a needle-free option, which can be particularly beneficial for needle-phobic individuals, including young children. The medicine comes in two strengths: 1 mg for patients weighing 15-30 kg and 2 mg for those weighing 30 kg or more.
Pharmacists: What You Need to Know
It's important to note that adrenaline nasal spray is not suitable for children under 4 years of age or those weighing less than 15 kg. In such cases, adrenaline auto-injectors, like EpiPen, offer a treatment option with a 0.15 mg dose for children weighing between 7.5 kg and 20 kg. Additionally, the presence of conditions that increase the risk of adverse reactions should not prevent the administration of adrenaline in life-threatening situations. There are no absolute contraindications to adrenaline use in anaphylactic reactions.
Who Might Experience Adverse Effects?
In practice, certain individuals may be more susceptible to adverse effects from adrenaline nasal spray. These include people with raised intraocular pressure, severe renal impairment, prostatic adenoma with residual urine, hypercalcaemia, or hypokalaemia. Those with hyperthyroidism, cardiovascular disease, hypertension, or diabetes, as well as older adults and pregnant individuals, may also be at increased risk. Patients with Parkinson's disease may temporarily experience worsened symptoms like rigidity or tremor.
Challenges with Nasal Administration
The nasal route of administration may pose challenges for specific patient groups. Clinical studies included individuals with a history of allergic rhinitis, but those with structural or anatomical nasal issues, such as polyps, previous nasal fractures, injuries, or nasal surgery, were not part of the studies. The impact of these conditions on neffy's absorption is currently unknown.
Downscheduling Possibilities
There's potential for downscheduling. CSL Seqirus, the product sponsor, has submitted an application to the TGA to register both the 1 mg and 2 mg doses as Schedule 3 medications.
Cost Considerations
The recommended retail price for one box of neffy (containing two nasal sprays) is $194, which is approximately 20% more expensive than EpiPen, excluding prescription consultation fees.
PBS Listing
CSL Seqirus has also applied for adrenaline nasal spray to be subsidized on the Pharmaceutical Benefits Scheme, with the application under consideration at the March 2026 Pharmaceutical Benefits Advisory Committee meeting.
Stay Informed
The PSA is updating the Australian Pharmaceutical Formulary and Handbook, including the adrenaline treatment guideline. Keep an eye out for further updates!
This new treatment option raises intriguing questions and offers a fresh perspective on anaphylaxis care. What are your thoughts on the potential impact of neffy? Share your insights and experiences in the comments below!
