Douglas P. Mack, a pediatric allergist and assistant clinical professor at McMaster University

Douglas P. Mack

Epinephrine Nasal Spray Shows Strong Patient Preference, With Douglas Mack, MD

2026 American Academy of Allergy, Asthma, & Immunology (AAAAI) 

 a pediatric allergist and assistant clinical professor at McMaster University, on how clinicians can integrate 

into shared decision-making conversations with patients and families. He emphasized that patient preference and real-world usability will likely play a critical role in the success of these therapies.

“We have to, as clinicians, have no preconceptions about what a patient wants,” Mack said. “Some families, we think they're going to want one thing, and they want something separate. Whenever I go into these discussions, I always want to show both options for the families, show how they work, [and] even let them try them. In the end, I know the science. I know what's going to work to some degree, but in the end, if they don't buy into this, it doesn't matter what I give them if they're not going to use it; that dose is never getting into that patient. Shared decision making is absolutely critical in this scenario and having an open mind to what a patient wants.”

New data presented at the meeting found that among 90 participants in a randomized crossover study, 88% reported preferring the intranasal device over injectable epinephrine. Investigators found the preference was consistent regardless of whether participants had prior experience using auto-injectors. Reasons for favoring the nasal spray included the absence of a needle, ease of use, portability, and the perception that it would be easier for bystanders to administer in an emergency.

Among survey responses addressing barriers to carrying epinephrine, 98–100% of participants rated factors such as device size, weight, and temperature flexibility more favorably for the intranasal product. In addition, 93% of participants reported they could bring the nasal spray with them in daily situations, compared with 43% for auto-injectors.

“We already have preliminary data on real-world use of [epinephrine nasal spray], and it… appears to have very similar outcomes to what we see with injectables,” Mack said. “I think once we get more comfortable with that, we [will] see that more patients are using this. What I do wonder is: are we going to see earlier use of this? In the real world, are people actually using this earlier… or more frequently, simply because of the fact that it's needle-free? I think if we do see…less hesitation in the real-world…that's going to be absolutely golden data.”

New data reveals 9 in 10 people prefer EURneffy, a needle-free nasal adrenaline spray, over auto-injectors. BioSpace. Published March 4, 2026. Accessed March 5, 2026. 

https://www.biospace.com/press-releases/new-data-reveals-9-in-10-people-prefer-eurneffy-a-needle-free-nasal-adrenaline-spray-over-auto-injectors

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Research presented at AAAAI 2026 found that 88% of participants preferred intranasal epinephrine over injectables.

 Intranasal Epinephrine Preferred by 88% Over Auto-Injectors, With Douglas Mack, MD

American Academy of Allergy, Asthma & Immunology (AAAAI)

 Annual Meeting 2026 in Philadelphia suggest that patients and caregivers overwhelmingly prefer a needle-free intranasal epinephrine device over traditional auto-injectors for the treatment of 

In a randomized crossover study of 90 participants, 88% preferred the intranasal epinephrine product EURneffy over standard epinephrine auto-injectors. The findings, presented as late-breaking data at the meeting, indicate that device design and usability may play a significant role in whether patients consistently carry and administer epinephrine during severe allergic reactions.

 lead author Douglas P. Mack, a pediatric allergist and assistant clinical professor at McMaster University, said the primary objective of the study was to evaluate user preference between the 2 treatment modalities and better understand what factors drive those preferences. Results showed a strong overall preference for the intranasal option, with nearly 9 in 10 participants selecting it over injectable devices. The team also wanted to see how participants would perform with and without training.

“What was cool with the study is that we had not only patients who had a history of allergy, we had caregivers, we had children, but we also had naive patients who…had no experience whatsoever with auto injectors or with food allergy or any type of allergies,” Mack said. “These were people who had no experience whatsoever. We did absolutely see that almost everybody who was naïve had a preference for the epinephrine auto-injector for the intranasal epinephrine. We still did have about 8% of the population who prefer the epinephrine auto-injection.”

These findings indicate that device familiarity did not impact patient preference. Rather, usability advantages may be particularly meaningful for newly diagnosed patients or those encountering epinephrine therapy for the first time.

Investigators also assessed practical barriers that often limit real-world epinephrine use. Prior research has shown that many individuals prescribed epinephrine do not consistently carry their devices and may hesitate to administer them during an anaphylactic emergency.

According to Mack, several factors, including device size, portability, needle aversion, and concerns about bystander administration, can contribute to these barriers. In the study, participants rated the intranasal device more favorably across multiple usability domains, including ease of carrying, ease of use, and reduced anxiety associated with needle injections.

“I think this is going to hopefully open the door to even further research into…a setting where there [are] no training or [usage] as a stock epinephrine. Our goal is to get this into the patient… having a device that's simple to use, easy to carry, is really what we're looking for. Now, there's always [going to] be people who will still use the auto injector. There's no question. But I think [intranasal epinephrine] provides a choice for families and a choice for patients.”

A randomized crossover study shows that most patients prefer intranasal epinephrine for anaphylaxis due to its ease of use, portability, and the absence of needles.

Douglas P. Mack

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