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Intranasal Epinephrine Preferred by 88% Over Auto-Injectors, With Douglas Mack, MD
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.
New data presented at the 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 anaphylaxis.
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.
In an interview with HCPLive, 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.”
Mack has no reported disclosures.
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