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

At the 2026 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting in Philadelphia, HCPLive spoke with Douglas P. Mack, MD, a pediatric allergist and assistant clinical professor at McMaster University, on how clinicians can integrate intranasal epinephrine (Neffy) 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.”

Mack has no reported disclosures.

References

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