Delayed adrenaline administration is a major risk factor for poor outcomes in anaphylaxis, yet 45% of patients do not always carry their autoinjector—and even a history of anaphylaxis does not ensure compliance, Australian research suggests.¹ With the adrenaline nasal spray ‘neffy’ now listed on the PBS, there’s a needle-free option for adults and children.

It won’t replace autoinjectors, but it provides another comparable option that some patients may be more comfortable with, says Dr Shruti Swamy, an allergist and paediatric Immunologist at the Royal Prince Alfred, Royal North Shore and Sydney Children’s hospitals and clinical lecturer with the University of Sydney.

Here’s what to know about the single-use intranasal adrenaline spray neffy.

Neffy is indicated for emergency treatment of anaphylaxis in adults and children aged 4 years and up who weigh 15 kg or more and comes in two doses:²

• 1mg for patients weighing 15kg to less than 30kg
• 2mg for patients weighing 30kg or more

“It’s the same adrenaline as we find in the injecting devices,” Dr Swamy says. “And it has a component called Intravail in it, which relaxes your tight junctions in your mucosa, allowing for quicker systemic absorption of the adrenaline”

This allows the adrenaline to be absorbed regardless of nasal congestion or allergic rhinitis.^2,3

How well does it work?

Early studies of neffy compared it with other adrenaline products administered by different routes, to determine the maximum blood concentrations of epinephrine reached, how quickly these levels were achieved, and the impact of this epinephrine on the body.^3,4 In adults, epinephrine blood levels and timing following neffy administration were comparable to those seen with IM devices, and its effects on blood pressure and heart rate were similar;^3,4 administration of neffy in children had similar effects to those seen in adults.⁵ Overall, these results suggested that neffy would be a safe and effective option for both adults and children.^3-5

A Japanese study of 15 children with food allergies tested the effectiveness of neffy by inducing anaphylaxis symptoms with a food challenge, administering neffy once symptoms became moderate.⁶ All patients achieved symptom resolution after one dose, with symptoms improving within five minutes and resolving within a median of 16 minutes. Evidence from an early Australian patient access programme showed that 80% of anaphylaxis symptoms from a diverse range of allergens resolved after one dose of neffy.⁷

Safety and tolerability

Neffy was well tolerated in clinical trials, with no serious adverse events reported.^5-6 Common side effects with neffy in clinical trials and in patients treated in real-world settings include nasal discomfort, throat irritation, headache, and feeling jittery.^5-7 There is no risk of needle-related injuries with neffy, such as lacerations, finger-stick injuries, or blood vessel injections.^8-9

Prescribing considerations

Ultimately, the best choice is the one a patient will carry and use, Dr Swamy stresses.

“I don’t think one device fits all. There are patients who are going to feel much more comfortable and benefit more from IM adrenaline, and there are patients who are going to be more comfortable and benefit more with intranasal adrenaline.”

As with adrenaline auto-injectors, the PBS criteria require consultation with an allergist for the initial supply, and GPs can switch patients who have previously been given an authority prescription.

Patients cannot be prescribed two devices at the same time, Dr Swamy adds. “So it’s either intranasal adrenaline, or it’s intramuscular.”

Adrenaline should always be prescribed in line with ASCIA Guidelines, including a device specific ASCIA Action Plan for Anaphylaxis.¹⁰

Neffy comes in a blister pack with two devices per carton.² The device is inserted into a nostril and pressed to deliver the dose, with no need for priming.

“For little kids who have smaller noses, you don’t have to push it all the way up, as long as the tip is within the nostril, and then you squirt. There’s no need to breathe strongly,” Dr Swamy says.

It has a shelf life of up to 2.5 years for the 2 mg device, and up to 2 years for the 1 mg device. Neffy should be stored at or below 25°C, although it can withstand temperatures of up to 50°C for short periods.²

Importantly, anaphylaxis management principles are the same regardless of the adrenaline delivery method.

“Always call an ambulance after the use of any adrenaline device,” Dr Swamy stresses.

Patients whose symptoms have not improved within five minutes should receive a second adrenaline dose, she says.

“And if you’ve used the neffy device in one nostril, and you’re administering another dose of neffy, I would recommend using it in the same nostril,” she says, noting this compounds the effect of the Intravail component.

You can request a training device and resources on the neffy website.

Key takeaways

• Although it’s important to treat anaphylaxis quickly, many patients do not always carry their autoinjector
• Neffy provides a comparable, needle-free option for adults and children that can be absorbed regardless of nasal congestion or allergic rhinitis
• Neffy is effective at treating anaphylaxis from a wide range of allergens, with most patients using neffy achieving symptom resolution after one dose
• Patients whose symptoms have not improved within five minutes should receive a second dose
• Neffy is well tolerated, with side effects including nasal discomfort, throat irritation, headache, and feeling jittery
• The availability of this needle-free option will allow for tailoring the adrenaline option to the patient’s preferences, with the best choice being one a patient will carry and use

References

1. Lao JC, et al. Clin Exp Allergy. 2026. doi: 10.1111/cea.70316

2. neffy® adrenaline (epinephrine) nasal spray. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2025-PI-02436-1&d=20260824172310101&d=20260907172310101 [Accessed September 7, 2026

3. Ellis AK, et al. Pharmaceutics. 2024;16(6):811.

4. Casale TB, et al. J Allergy Clin Immunol. 2023;152(6):1587-1596.

5. Fleischer DM, et al. J Allergy Clin Immunol Pract. 2025;13(6):1335-1341.e1.

6. Ebisawa M, et al. J Allergy Clin Immunol Pract. 2025;13(10):2787-2794.

7. CSL Seqirus Data on File June 2026.

8. Posner LS and Camargo Jr CA. Drug Healthc Patient Saf. 2017:9:9-18.

9. Ebisawa M, et al. J Allergy Clin Immunol Glob. 2023;2(3):100118.

10. ASCIA Action Plans and First Aid Plan for Anaphylaxis. Available from: https://www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis [Accessed September 7, 2026].