The Evolution of Epinephrine
In today’s post, we’re discussing the history of epinephrine, the different products that administer this drug, and what’s on the horizon for this life-saving technology.
First, let’s talk about what it is.
Epinephrine is the drug form of adrenaline: a hormone naturally produced in the body. Adrenaline is released from the adrenal glands when your body is in “fight or flight” mode and perceives a threat.
For the food allergy community, this medication has life-saving potential, and it’s the first line of defense for treating anaphylaxis—a life-threatening allergic reaction marked by constricted airways that occurs when an over-release of histamine and other chemicals flood the body. Epinephrine works instantly to open up the airways, divert blood away from the skin to reduce hives, and even prevent further release of histamine.
The History of the EpiPen
In the 1970s, auto-injector technology was developed for military use as an antidote to nerve gas. This breakthrough led to the creation of the EpiPen, the first epinephrine auto-injector.
In 1987, the FDA approved the EpiPen, which was then owned by Meridian Medical Technologies. The company was eventually acquired by Mylan, a pharmaceutical company that partners with Pfizer to produce the product. For a time, the EpiPen was the only epinephrine auto-injector on the market—that has since changed.
The Rise of Competition
Until recently, there were three main epinephrine brands on the market: EpiPen, Auvi-Q, and Symjepi—as well as a few pharmaceutical companies selling generic alternatives. They all come in packs of two and have a shelf life of approximately 12 to 18 months.
Each is designed with a spring-loaded, one-time-use needle to inject a dose of either 0.15mg or 0.30mg of epinephrine into a person’s thigh. In addition, they’re portable and meant to be carried around at all times for those at risk of an anaphylactic reaction. Even with many similarities, each brand does have at least one key differentiator they can tout:
EPIPEN
EPIPEN is the original epinephrine auto-injector with a trusted name.
Auvi-Q
AUVI-Q offers a smaller shape for easier portability and provides auditory instructions to guide the user through injecting epinephrine.
Symjepi
SYMJEPI offers a smaller needle & user-controlled injection that reduces product-related injury.
The Future of Epinephrine Delivery: The Nose
In August of 2024, the FDA approved Neffy—an intranasal epinephrine nasal spray for the treatment of allergic reactions, including anaphylaxis. Neffy is a single-dose nasal spray that is administered into one nostril.
Neffy is the first brand to create a major shake-up in the epinephrine market in a while, although there are others on the horizon. Bryn Pharma,* for example, is similarly looking to offer a nasal spray epinephrine product and is moving through the FDA approval process. A few other companies are working on developing improved injectable options and some are even promising sublingual delivery!
For the past 40 years, the epinephrine auto-injector industry has been dominated by the EpiPen. As someone who has managed my child’s food allergies for 10+ years, it’s exciting to see newer, easier, and less expensive solutions on the horizon!
— Meg and the Allergy Amulet Team
Disclosure: Amulet investor AllerFund is a minority investor in Bryn Pharma.
This is an updated version of an article originally posted in August 2022.