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Background  Histamine release and vasodilation during an allergic reaction can alter the pharmacokinetics of drugs administered via the intranasal (IN) route. The current study evaluated the effects of histamine-induced nasal congestion on epinephrine pharmacokinetics and heart rate changes after IN epinephrine.    Methods  Dogs received 5% histamine or saline IN followed by 4 mg epinephrine IN. Nasal restriction pressure, epinephrine concentration, and heart rate were assessed. Maximum concentration (C max ), area under plasma concentration-time curve from 1 to 90 min (AUC 1–90 ), and time to reach C max  (T max ) were measured. Clinical observations were documented.    Results  In the 12 dogs in this study, nasal congestion occurred at 5–10 min after IN histamine administration versus no nasal congestion after IN saline. After administration of IN epinephrine, IN histamine-mediated nasal congestion was significantly reduced to baseline levels at 60, 80, and 100 min. There were no significant differences in C max  and AUC 1–90  between histamine and saline groups after IN epinephrine delivery (3.5 vs 1.7 ng/mL,  p  = 0.06, and 117 vs 59 ng/mL*minutes,  p  = 0.09, respectively). After receiving IN epinephrine, the histamine group had a significantly lower T max  versus the saline group (6 vs 70 min, respectively;  p  = 0.02). Following IN epinephrine administration, the histamine group showed rapidly increased heart rate at 5 min, while there was a delayed increase in heart rate (occurring 30–60 min after administration) in the saline group. Clinical observations included salivation and emesis.    Conclusion  IN histamine led to more rapid epinephrine absorption and immediately increased heart rate compared with IN saline. IN epinephrine decreased histamine-induced nasal congestion.

Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model