Intranasal epinephrine is effective and comparable to epinephrine injection products for severe allergic reactions, according to study results presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2025 Annual Scientific Meeting, November 6 to 10, in Orlando. Researchers surveyed health care providers (HCP) about treatment outcomes with intranasal epinephrine spray 2 mg for patients with severe allergic reactions.

The survey included questions about the number of patients treated, the number of patients who needed a second dose of epinephrine to treat their allergic reactions, and its ease of use on a scale of 1 to 7. Of 2947 participating HCPs, 375 responded that they had used intranasal epinephrine in 680 patients. The indications for use included anaphylaxis after treatment with an oral food challenge or allergen immunotherapy. Among the patients who received intranasal epinephrine, treatment was effective for 603 (88.7%) with a single dose of intranasal epinephrine, which was comparable to the rate for injectable epinephrine.

A second dose of epinephrine was required in 77 patients (11.3%), which is similar to reports after food-induced anaphylaxis (11.1%) and lower compared with what has been reported following allergen immunotherapy (30.5%). Ratings for ease of use were 6.6 out of 7 for HCPs and 6.5 out of 7 for patients.

“Intranasal epinephrine demonstrated clinical efficacy comparable to that expected for epinephrine injection products and was judged easy to use by both HCPs and patients,” the study authors concluded. “Thus, it is an effective alternative to injectable epinephrine.”