(Associated Press) – The U.S. Food and Drug Administration declined to approve a nasal spray to treat severe allergic reactions, calling for more research on what would have been the first alternative to injections using devices such as an EpiPen.

The agency told ARS Pharmaceuticals Inc. of San Diego that the company would have to conduct another study comparing repeat doses of epinephrine using the needle-free device, called neffy, compared to injections.

Between 33 million and 45 million Americans suffer from life-threatening allergies.