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.