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During a recent basic life support update at my practice, the use of adrenaline nasal sprays in anaphylaxis was briefly mentioned. Given that this innovative method of adrenaline administration in anaphylaxis has been available in the UK for less than 12 months, this seemed like a good subject to describe in this month’s email.

Adrenaline nasal sprays provide a needle-free delivery system for patients weighing 30 kg or more. Each device is engineered to deliver a single 2 mg dose of adrenaline directly to the nasal mucosa.

Because each device contains only a single dose, it is critical that the plunger is not pressed before the tip is inserted into the nostril; doing so will result in the loss of the medication. The spray remains effective even if the patient is suffering from nasal congestion owing to a cold or allergies. To ensure the medication works rapidly, the formula includes a specialised carrier substance that increases the permeability of mucosal cells, facilitating quicker absorption into the bloodstream.

In terms of clinical application, if a patient’s symptoms do not show signs of improvement within 10 minutes of the initial administration, a second dose is recommended.

While the treatment is generally well tolerated, the most common adverse reaction is localised irritation of the nasal mucosa. Note also that systemic side effects, such as headaches, nervousness and tremors, have been observed. This is particularly the case following the administration of a second dose.

For more detailed information, please see GPnotebook.

Other highlights in this month’s email include an explanation of the use of multiparametric MRI in the diagnosis of prostate cancer, a meningitis patient factsheet and ruxolitinib for treatment of vitiligo.

• Multiparametric MRI in the diagnosis of prostate cancer: Multiparametric MRI, typically performed using a 3T scanner, is the current gold standard for the non-invasive detection and localisation of prostate cancer. This diagnostic method is detailed on GPnotebook.
• A meningitis patient factsheet: A summary of the “key facts” for patients is available on GPnotebook.
• Ruxolitinib for treatment of vitiligo: This innovative therapy option for vitiligo is detailed on GPnotebook.
• Adrenaline nasal spray in anaphylaxis: The practicalities of using this therapy are described.
• Investigations indicated for male factor infertility problems: What investigations should be considered if there is possible male infertility? This new section on GPnotebook provides the answers.
• Herpes zoster vaccination: This section has been updated and includes evidence of possible protective effects of the zoster vaccine with respect to dementia. It also describes studies showing a reduction in the risk of cardiovascular disease for those individuals who have had the vaccine.