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Children who have an allergy that could cause anaphylaxis symptoms such throat swelling and other severe reactions have long had to carry an epinephrine injectable pen with them or have one stored at school.
Those pens, known under the brand name EpiPen, can become unusable if subjected to heat like in a hot car in a Texas summer. They also have a one-year shelf life, which means families have to fill a new prescription each school year for hundreds of dollars and then supply it to the school nurse’s office.
Last year, the U.S. Food and Drug Administration approved Neffy, a nasal spray form of epinephrine for people who weigh 66 pounds or more, and this month it approved a lower dose spray for children ages 4 and older who are between 33 pounds and 66 pounds.
This is great news, but families can’t just hand over the nasal spray form to their school nurse. The Texas law allowing school nurses to give epinephrine uses the phrase “auto-injectors” when referring to delivering the drug to students who have a prescription for it. That means only the pen form.
Senate Bill 1619 and House Bill 2283 both aim to rectify that by simply taking out the phrase “auto-injector” and changing it to “delivery devices.”
“This is a happy bill,” said Dr. Allen Lieberman of Austin Family Allergy and Asthma. “There is no downside to it.”
This new nasal spray delivers medicine the same way as a nasal allergy spray like Flonase or the same way as Narcan for people experiencing an opioid overdose. You put the nozzle into one nostril and push down on the plunger to spray the medicine into the nose. It’s easy to use, and people are less intimidated by it than by the idea of giving someone a shot.
The nasal spray offers the same medical results as the auto-injectors, but it has some other advantages, Lieberman said. If you want to buy the nasal spray without insurance, a two-pack is about $200, Lieberman said, compared with $600 for one auto-injector. Neffy comes in a two-pack because if a first dose doesn’t improve the symptoms, you can give a second dose. With the traditional pen, it’s just one dose.
The sprays also remain effective for two years instead of one, and they don’t have heat restrictions like the injectables do.
Lieberman is now prescribing the nasal sprays and getting it approved by insurance about 50% of the time, and “the more we write for it, the more insurance sees it, and will approve it,” he said.
He encourages people, especially in Texas, who have a prescription for an EpiPen to consider the Neffy instead. He has had many patients with auto-injectors accidentally leave them in a bag in the trunk of a car for days or weeks in the Texas heat and then have to throw the auto-injector away and get a new one. With the nasal spray, that spray would still be effective.
It’s going to be “a game-changer,” Lieberman said.
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