Needle-free nasal epinephrine spray effective for treating allergic symptoms in children undergoing doctor-supervised diagnostic feeding tests

Published online July 8, 2025

For patients with severe food allergies, prompt use of epinephrine immediately upon symptoms is associated with a decreased risk of complications, including hospitalization and death. However, patients and caregivers frequently hesitate to use auto-injectors, often due to fear of the needle or reluctance to carry the device. These challenges highlight the need for a needle-free option. An intranasal (IN) spray could address these concerns.

A study published in The Journal of Allergy and Clinical Immunology: In Practice by Ebisawa et al, explored the use of neffy (epinephrine nasal spray) for treating food allergy reactions in children undergoing diagnostic oral food challenges (OFC). The small Phase 3, open-label trial enrolled 15 pediatric patients, ages 6 to 17 years, who were participating in an in-clinic OFC. Each participant developed at least moderate anaphylaxis during the OFC, providing a controlled setting in which to evaluate neffy in a “real-world” setting. Dosing was weight-depending, with children weighing 15–<30 kg receiving  1 mg and those weighing ≥30 kg receiving 2 mg doses from the device. The study assessed both efficacy, as defined by the resolution of symptoms after a single dose as well as safety and tolerability.

All 15 participants exhibited resolution of symptoms following a single dose of nasal epinephrine, with a median time to resolution of 16 minutes. None of the children required a second dose for the initial reaction, although one patient later experienced a biphasic reaction and was treated with intramuscular epinephrine. Reported side effects were mostly mild, including temporary nasal redness and tremor. Overall, the findings suggest that neffy may provide a safe, effective, and more accessible alternative to injectable devices for children experiencing food-induced anaphylaxis.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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