Pouessel Guillaume, Neukirch Catherine
Service de Pédiatrie, Pavillon Médicochirurgical de Pédiatrie, Boulevard Lacordaire, Roubaix, France.
Unité de Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHRU Lille et Université, Lille, France.
Clin Exp Allergy. 2025 Jan;55(1):36-51. doi: 10.1111/cea.14598. Epub 2024 Nov 24.
Adrenaline is the first line treatment for anaphylaxis and adrenaline auto-injectors (AAI) allow reliable, safe and ergonomic administration in the community. However, AAIs have significant limitations and adrenaline is often not used in anaphylaxis. Innovations to administer adrenaline via alternative routes may potentially improve usage rates and treatment effectiveness. Here, we describe the known limitations and barriers to AAI use in anaphylaxis. We then summarise current data for adrenaline devices which use alternative routes of administration for treating anaphylaxis. Several novel devices are in development, which deliver adrenaline via nasal, sublingual or transcutaneous routes. Pharmacokinetic, pharmacodynamic and safety studies have compared these treatments with AAI or intramuscular adrenaline via needle and syringe. The first non-injectable adrenaline delivery device for emergency treatment of anaphylaxis was approved in Europe and the United States. Neffy, an adrenaline nasal spray, is licensed for use in adult and paediatric patients who weigh at least 30 kg. In the near future, multiple alternatives to injectable adrenaline may be available for managing anaphylaxis, overcoming some, but not all of the limitations of AAIs.
肾上腺素是治疗过敏反应的一线药物，肾上腺素自动注射器（AAI）可在社区中实现可靠、安全且符合人体工程学的给药。然而，AAI存在显著局限性，过敏反应中肾上腺素常常未被使用。通过替代途径给药肾上腺素的创新方法可能会提高使用率和治疗效果。在此，我们描述了AAI在过敏反应使用中的已知局限性和障碍。然后我们总结了目前使用替代给药途径治疗过敏反应的肾上腺素装置的数据。有几种新型装置正在研发中，它们通过鼻腔、舌下或经皮途径递送肾上腺素。药代动力学、药效学和安全性研究已将这些治疗方法与通过针头和注射器给药的AAI或肌肉注射肾上腺素进行了比较。首个用于过敏反应急救治疗的非注射式肾上腺素递送装置已在欧洲和美国获批。Neffy，一种肾上腺素鼻喷雾剂，已获许可用于体重至少30千克的成人和儿科患者。在不久的将来，可能会有多种可替代注射用肾上腺素的药物用于管理过敏反应，克服AAI的一些但并非全部局限性。
