• Posted October 2, 2025

Adrenaline Nasal Sprays Work As Well As EpiPen For Allergic Shock

People with extreme, life-threatening allergic reactions might do as well to use a nasal spray as jab themselves in a thigh with an EpiPen, a new evidence review says.

Adrenaline delivered with liquid or powder nasal sprays is as effective, and sometimes even better, than injected adrenaline, researchers reported Tuesday at the European Emergency Medicine Congress in Vienna.

“My review found that intranasal adrenaline, a needle-free alternative delivered as a liquid or dry powder spray, can be as effective as the EpiPen, with some forms reaching the bloodstream even faster,” researcher Dr. Danielle Furness said in a news release. She’s a resident doctor at the Royal Derby Hospital in the U.K.

“Nasal sprays could become a suitable and equally effective needle-free alternative to the EpiPen, which is the current treatment for anaphylaxis,” Furness added.

The U.S. Food and Drug Administration approved the first nasal spray for emergency treatment of allergic reactions in August 2024.

The product, neffy, is produced by ARS Pharma and available to adults and children weighing at least 66 pounds. Epinephrine is another name for adrenaline.

For the review, Furness analyzed data from five previous international studies comparing injected adrenaline to adrenaline nasal sprays. The studies took place in Israel, Canada, Thailand, the United States and Japan.

People with powerful allergies to things like nuts or insect bites can go into anaphylactic shock, where their throat closes and they have trouble breathing. They can collapse and become unconscious quickly, unless treated with adrenaline, researchers said in background notes.

Results showed that absorption of the nasal sprays was comparable to or even faster than injections. Adrenaline from a nasal spray took a maximum of 2.5 to 20 minutes to reach the bloodstream, versus 9 to 45 minutes for injected adrenaline.

Similar or higher levels of adrenaline were found in the blood from nasal sprays compared to injections, researchers found. At the same time, heart rate and blood pressure were similar for people using either method.

Nasal sprays also appear to last longer and are more portable than injectables, Furness noted.

The shelf life of an adrenaline nasal spray is two years, while injection devices must be replaced every year to year and a half, she said.

“Patients would still need clear instructions on how and when to use a nasal spray, but it could improve timely administration of adrenaline, especially for people who are afraid of needles, or in public, out-of-hospital settings, which could reduce the rates of hospitalizations,” Furness said in a news release.

“I believe that once strong, real-world evidence supports the safety and effectiveness of nasal sprays, they could be incorporated into national anaphylaxis guidelines,” she added. “An initial rollout should include close and strict monitoring, encouraging doctors to report any cases where it may not have worked as expected, to ensure patient safety and maintain confidence in the treatment.”

Dr. Felix Lorang, head of the emergency department at SRH Zentralklinikum Suhl in Thuringia, Germany, agreed that adrenaline nasal sprays provide a very useful alternative to injectables.

“Some patients experience barriers to using them for reasons such as needle phobia, or how easy they are to carry around all the time,” said Lorang, who was not involved in the study. “From my experience, many people also hesitate when using a needle on a relative or friend for fear of hurting or injuring the person.”

He said nasal sprays appear to overcome these barriers. 

"If further studies confirm their safety and efficacy, they will be a useful alternative for patients as well as an extra tool for medical staff to use,” Lorang added.

Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

The Mayo Clinic has more on treating anaphylaxis.

SOURCE: European Emergency Medicine Congress, news release, Sept. 30, 2025