Mannkind developing inhalable epinephrine

#1

This came across a food allergy group I’m in on Facebook. Given all the news about EpiPens as of late, and news about Afrezza on this forum, I thought some of you may be interested in the article.

Many people in the allergy community are pointing out that inhaled epinephrine is pointless if someone needs epinephrine because they can’t breathe in the first place or have passed out from an allergic reaction… Plus, many people with severe allergies also have asthma, a topic which has also been discussed here.

Still, I think this is an interesting development and will be curious to see where it goes.

#2

It’s sort of like “Pouring Water on a Drowning Man.”

#3

I don’t agree, most know well before things get that bad that they need the epi-pen. This would get the medication into thier system faster then anything else and remember it’s a 1 timer. This is not medication you use on a daily basis. To say this wouldn’t work is a bit short sighted. The big question is will Mannkind ever have the money to bring it to market.

#4

Mannkind has enough problems trying to get Afrezza out to market and into HMO formularies.

I’ve never gone so low that I lost consciousness, but my pharmacists made me laugh when I picked up a Glucagon pen.

“Do you know how to use it?”

“If I need it, I probably won’t be administering it. Do YOU know how to use it is a better question.”

#5

Oh I think it’s a lot different for an allergic reaction, although admittedly I can’t speak from experience. My wife is sensitive to a lot of things, nothing to that level, but she knows right away when she’s having a reaction to something and goes right for the Zyrtec. She feels it coming. I’d bet carrying a whistle with a small powder pack would be a lot more convenient then a needle that would require refrigeration. It would make it more readily available in a lot situations where it normally wouldn’t be. It would would also be a lot less intimidating to administer as these are not experienced needle users like diabetics who are use to jabbing themselves. Most people cringe at the thought of having to administer a needle to them selves. A toot on a whistle would be a huge difference. Never the less unfortunately chances are slim this comes to market.

#6

Studies show it’s common, not the exception, to delay using an EpiPen longer than it should have been. There’s are a variety of factors, but determining when a reaction is mild and when a reaction is severe when it’s first starting can be extremely difficult, even for doctors. Especially because an IgE-mediated allergy can go from “mild” to “severe” without any warning.

The big question is, if it did come to market, would people be willing to bet their lives on determining a reaction is severe before it’s too late for something like inhaled epinephrine to work. And, for the people who don’t use it in time, what are their options?

Unlike insulin, an injection with an epinephrine autoinjector kicks in within five minutes. So I don’t think speed is nearly as big of a factor here as it is with insulin.

Epinephrine autoinjectors don’t require refrigeration and never have. They require room temperature only.

I wouldn’t even consider insulin and epinephrine to be in the same league. One is a manual injection the other is an autoinjector; one is subcutaneous the other is intramuscular; one requires extensive training and the other is designed to be used with no training; one is used routinely many times per day and the other is used in stressful, life-threatning emergencies. About the only thing similar between them is that they both happen to be injections.

Also, while the thought of a needle might make people cringe, people get over that quickly when they are dying and know that the needle is their way out. That’s true of both diabetes and anaphylaxis.

#7

To her credit, it is good to know that you know how to use it so that you can train others around you how to use it. :slight_smile:

Also, I mentioend to a CDE this past summer that I had a glucagon kit sititng at home that was useless because I live alone. She pointed out that, if I ever get ill and can’t eat and my blood sugar is dropping, I could use it for mini-dosing glucagon. So I actually went out and bought some syringes (which I haven’t had in years) for this very purpose.

#8

Re: allergic reactions. I am speaking from experience, and I almost always have time to realize what’s happening before it becomes anywhere near incapacitating. This sounds like a godsend, if it works. Just because it might not fit every last person doesn’t mean it wouldn’t have immense value. Like Afrezza, to use the obvious parallel.

#9

neither I or any of my loved ones have severe allergies, but I applaud this companies remarkable innovation.

I hope people with allergies across the board are more inclined to act in their own self interest with this product than people with diabetes have been with afrezza thus far.

When spectacular innovation is no longer rewarded, we are in trouble as a civilization…

#10

Jen,
No need to paraphrase me, as I said I’m not speaking from experience, but I know from my wife that she’s well aware of when reaction is coming, seems David who is speaking from experience agrees. You’re right it doesn’t need to be refrigerated, for some reason I thought it did.

Inter-muscular, training or no training makes no difference. You can paraphrase this one ;). Poking yourself with a needle anywhere is not something most people are comfortable with. I don’t mind needles, but much prefer a medical professional do it rather then myself. My heart goes out to those who have to do this several times a day, but I’m sure they become experts at it. I had to give my wife several injections years ago, it was inter-muscular, can’t remember what it was, but it was to help with fertility, we both hated it. Could not agree more with David.

#11

Must respectfully disagree. Five minutes isn’t very long when trying to bring down hyperglycemia. It’s an eternity when dealing with anaphylaxis. In extreme cases it can be the difference between life and death. Feeling shaky, nauseous, or weak, even severely, isn’t quite equivalent to being unable to breathe, or nearly.

#12

True about the five minutes and breathing, I thought about that after I posted.

I do have severe allergies, but have never used my EpiPen and do hesitate every time I’ve considered using it (for a variety of reasons, not least is conflicting advice I’ve received from allergists about when to use it). I’ve also had at least one reaction, as a teenager, which was not to food and where I didn’t realize anything was wrong until about five seconds before I collapsed (I hadn’t realized I’d broken out in hives).

Maybe an inhaled medication would seem less intimidating and cause people to use it sooner. I also wonder whether it’s not really “inhaled” in the same way as the insulin. Maybe it’s more like the nasal glucagon that’s being developed, where it could just be squirted in someone’s nose regardless of what state they’re in and would be absorbed that way. That would make a lot more sense to me.

#13

I think the parallels to Afrezza are quite strong. It wouldn’t be for everyone or every circumstance, and I don’t think it would make epipens obsolete. But if it pans out, it would be another (very powerful) weapon in the arsenal.

#14

Interestingly, they’re not the first to do it. I don’t know much about it, but apparently there was an epinephrine inhaler on the market years ago that was taken off the market for some reason.

#15

Afrezza has actually grown on me from reading this forum. Being outside the US, I don’t have access to it, and I don’t even know if I could get access to it if I was in the US since I have asthma. But if I were in the US and could get it, I’d use it only to bring down extreme highs. I think even just that use would be helpful and not dangerous as long as it didn’t trigger an asthma attack.

#16

I’ve gotta agree with David here. 5 minutes of anaphylaxis would be pure torture, and terrifying. 'Been there – thankfully only once, decades ago, in response to an immunotherapy antigen injection (hayfever) – the experience seared into my aging memory.

Stopping an anaphylactic reaction within a minute vs. 5 is enormously valuable.

#17

Yep, I agree with you and @David_dns. I retract my earlier statement. I thought of the obvious after I posted.

I’ve been doing immunotherapy for just over two years and, although I had one reaction of flushing and throat tingling/tightness and upset stomach after one shot, that reaction thankfully went no further.

#18

I think this is exactly why this concept is valuable. My son Caleb has type 1 diabetes and a peanut allergy. The thought of administering an Epi-Pen is intimidating to me. Far more intimidating that a glucagon injection. Caleb has had 2 suspected allergic reactions, and we’ve treated with benedryl and watched and waited to see if it got worse before administering epinephrine. That is consistent with his medical instructions. I’ve heard differing opinions on this approach, and it makes me very uneasy.

I’d be interested to know what the protocol following an inhaled dose of epinephrine would be. I’ve administered mini-doses of glucagon to Caleb in a situation where he was just bolused for high carb meal, but began vomiting and could not ingest food or drink. Could inhaled epinephrine be administered in a similarly calm way, not requiring a trip to the ER?

For us, our two choices for responding to an allergic reaction are extreme differences - one if calm and self-administered, the other is urgent, painful and requires an emergency trip to the hospital. It would be nice to have something in the middle that we have a high level of confidence will work.

#19

This is exactly my problem. I’ve had many systemic allergic reactions where I’ve taken Benadryl and waited for hours for it to go away. Yet it scares me when taking two Benadryl doesn’t resolve symptoms. I’ve read online (and heard from friends with food allergies) that an EpiPen should be used at the first sign of symptoms, yet my allergist says to wait until there’s outright difficulty breathing. So on one hand, I don’t wnat to over-react, but on the other hand, I don’t want to wait until it’s too late.

My understanding is that you need to go to the hospital because you’ve just had a severe allergic reaction that required epinephrine, not because of the epinephrine itself (epinephrine is safe unless someone has certain heart conditions).

Although, maybe you are right, maybe there will end up being a three-tiered system of severity that one responds to with Benadryl, inhaled epinphrine, or epinephrine injection depending on symptoms. It’ll be interesting to see what happens.