Epinephrine nasal spray works well even if patients sniff while using it, according to an abstract presented at the American College of Allergy, Asthma, and Immunology (ACAAI) 2025 Annual Meeting in Orlando, Florida.
The FDA last year fast-tracked approval of the first nasal epinephrine (neffy). The spray offers patients an alternative to injectable epinephrine pens, but because it is still a new device, “people still have a lot of questions,” said Jonathan Spergel, MD, PhD, chief of the Allergy Section at Children’s Hospital of Philadelphia, Philadelphia, who led the study.
One of those questions is whether sniffing during or after administering nasal epinephrine would alter the efficacy of the drug. Because patients in clinical trials did not sniff while using neffy, patient instructions advise patients against sniffing during or after a dose.
“That’s a natural reaction when people do a nose spray, to sniff,” Spergel said. “People were concerned about whether that was going to affect how well the drug works.”
Spergel and his team recruited 42 adults for a phase 1, single-dose, randomized crossover study. Each patient sprayed 2 mg of nasal epinephrine into their nostril at a doctor’s office and was filmed so the researchers could confirm whether they sniffed while taking the spray. Of the 42 participants, 29 sniffed and 12 did not sniff. Clinicians took plasma samples after each dose, which were tested to determine participants’ concentration of plasma epinephrine.
Taking intranasal epinephrine without sniffing resulted in a slightly higher average maximum epinephrine plasma concentration (484 pg/mL; coefficient of variation [CV], 67%), but the difference was not statistically significant compared with people who sniffed (382 pg/mL; CV, 67%).
In a second part of the study, patients received a 0.3 mg injection of intramuscular epinephrine. The average plasma concentration was slightly lower than it was when people sniffed intranasal epinephrine (322 pg/mL; CV, 65%).
Both options work well, Spergel said, “sniff or no sniff.”
The findings are welcome news for patients, said Ruchi Gupta, MD, MPH, founding director of the Center for Food Allergy & Asthma Research at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago.
“People get apprehensive when there is a new device, so the more data we have, the better,” Gupta said.
Although the study was conducted in adults, the results likely apply to kids, who could especially benefit from needleless options for epinephrine, she said. Gupta has experience with nasal epinephrine, both through her patients and with her own daughter.
“She’s used both the autoinjector and the nasal spray, and there was a pretty equivalent reaction,” she said.
The study was funded by ARS Pharma, the makers of neffy. Spergel reported receiving grant support from and consulting on trial development for ARS Pharma.
Kaitlin Sullivan is a freelance journalist living in Colorado.
