Q&A: Real-World Performance of Intranasal Epinephrine (neffy) in Anaphylaxis Management

Intranasal epinephrine (neffy) is the first FDA-approved needle-free epinephrine product for treating severe allergic reactions, including anaphylaxis. As real-world experience grows beyond clinical trial settings, clinicians are seeking clarity on its effectiveness, safety, usability, and role in evolving anaphylaxis management practices. Real-world data recently presented at the 2025 American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting suggest that neffy may offer an effective, needle-free alternative for treatment of severe allergic reactions, including anaphylaxis.

Patient Care^© spoke with lead study author Jonathan Spergel, MD, PhD, to discuss findings from the recent analysis of neffy’s real-world use among nearly 3000 clinicians and 680 patients.

Q: Could you give a brief overview of the study on the real-world performance of neffy? What were the primary objectives and key findings?

A: “The study was to examine if the efficacy and safety of neffy was similar to other epinephrine products. It studied the use in real world situations. They found that just over 10% of the patients needed a second dose of epinephrine, which is almost identical to historic rate of epinephrine use with intramuscular epinephrine.”

Q: Ease-of-use ratings were high among both clinicians (6.6/7) and patients (6.5/7). What aspects of the device do you think contributed most to these ratings?

A: “The ease-of-use was due to it being intranasal device and simple to use.”

Q: How do the findings support the transition from injectable epinephrine to intranasal administration? Do you foresee intranasal epinephrine becoming the standard of care for anaphylaxis management in the near future?

A: “Intranasal epinephrine is an equal option to intramuscular epinephrine. I think the standard of care will be that patients will have a choice and it will be shared decision-making on what device that they will prefer.”

Q: Are there any limitations or patient populations for whom intranasal administration may not be appropriate?

A: “The limitation is right now it is only approved for adults and children four years of age and older who weigh 33 lbs or more. So, children who are 4 and weigh less, or who are younger, cannot use it. They might need a device with a small nozzle. The other two groups with limitations will be patients with nasal abnormalities or fear of nasal sprays.”

Q: What additional real-world data would you most like to gather moving forward, particularly regarding community use outside supervised clinic environments?

A: “I would like to see two things in real-world data. I would like to see a large number of patients in this real-world study. The other study that I am waiting for results is in the randomized study comparing intranasal epinephrine compared to intramuscular epinephrine.”

Q: Would you leave our primary care audience with a few key messages to remember from this research when discussing a transition from injectable to intranasal therapy with their patients?

A: “The message would be it is safe and just as effective as intramuscular epinephrine.”