NoIn the world of emergency medicine, every second can mean the difference between life and death. For those who suffer from severe allergiesthe timely administration ofadrenaline it’s thethe only effective weapon against anaphylactic shock. But the reality is often more complex: up to 60% of patients delay or refuse to use the autoinjector for fear of the needle, a delay that can cost their lives. From 2026, however, a new tool will also be available in Italy: the adrenaline nasal spray, a device already approved in the United States and Europe, destined to radically change the way we manage allergic emergencies.
An epochal turning point in the management of anaphylaxis
«Allergies are the most widespread chronic disorder in Europe, with approximately 150 million people affected. Among these, 20% live with the daily fear of anaphylactic shock”, he explains Vincenzo Patella, President of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and Director of the Internal Medicine Unit of the Salerno Health Authority.
The arrival of the spray, already approved by the FDA and EMA, e currently on the market in Germanyrepresents a crucial step forward. THE’Italian Medicines Agency (AIFA) the evaluation is completing, with the forecast of placing it on the market in the first months of 2026.
What are anaphylactic reactions
Anaphylactic reactions are sudden, generalized allergic reactions, often triggered by foods, insect bites, or medications.
In Italy there are an estimated 10 thousand cases per year with 60-70 deaths. During anaphylaxis, the body releases large amounts of histamine, which causes dilation of blood vessels, lowering blood pressure and possible difficulty breathing.
«The standard treatment is the immediate administration of epinephrine (adrenaline), which acts rapidly by counteracting cardiovascular and respiratory collapse», specifies Patella. “There timeliness is everything: the longer administration is delayed, the greater the risk of fatal outcome.”
The critical issues of the autoinjector
Despite being the first line of defense, the autoinjector is not without its limitations.
«Between 25% and 60% of patients refuse to inject adrenaline and, in cases where they do, they often intervene with a delay of up to nine minutes – a critical time in an emergency», underlines Patella.
There fear of the needle, anxiety, lack of knowledge of the use of the device and failure to replace it after its expiration represent the main causes of ineffectiveness. «Between 20% and 70% of patients use the autoinjector incorrectly, and up to 50% do not always carry it with them», adds the expert.
Adrenaline nasal spray: features and benefits
Small, needle-free and easy to use, the nasal spray was created to overcome these barriers.
Second Erminia Ridolo, Director of the School of Specialization in Allergology and Clinical Immunology of the University of Parma«the intranasal route can constitute avalid and effective alternative for the emergency administration of adrenaline».
The new device offers several advantages:
Shelf life of 30 months, compared to 18 for the autoinjector.
No need for special storage conditions.
Rapidity of action: the spray enters the circulation in times comparable to intramuscular injection.
A study published in Journal of Allergy & Clinical Immunology in Practice has shown that, in children and adolescents with food allergies, it spray reduces symptoms in 5 minutes and resolves the crisis in about 16 minutes.
Limitations and precautions
Despite the enthusiasm, experts recommend caution.
«To date the spray is indicated only for subjects weighing more than 30 kilograms, therefore not yet suitable for younger children or newborns”, specifies Ridolo.
Furthermore, they remain from verify safety in elderly and cardiac patients, as clinical studies predominantly involved young, healthy adults. The evaluation, the doctors underline, will have to take place case by case, based on the risk-benefit profile.
A step forward for emergency medicine
The arrival of the adrenaline nasal spray represents a significant turning point for Italian allergy patients. It reduces psychological barriers, simplifies administration and increases the likelihood of timely intervention, with a potentially huge impact on survival.
As Patella concludes, «the possibility of having a device Needle-free, easy to use and fast-acting, it can be an ally essential for the safety of allergic patients, making the management of anaphylaxis more immediate and effective”.