Peer-reviewed article
International survey of parental and patient perspectives on emerging adrenaline devices for community-based management of anaphylaxis: An EAACI task force report.
M F Gonzalez-Matamala, N Patel, D Kahn-Santoro, R Knibb, G Roberts et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a survey of adult patients and caregivers about their preferences for different ways to deliver adrenaline during anaphylaxis emergencies. It gathers opinions on nasal spray and other emerging devices compared to traditional adrenaline autoinjectors. The study finds that while these new devices are attractive because they avoid needles, respondents have significant concerns about whether they work as well as autoinjectors. Most respondents do not want to use the new devices as their only option.
Key points
- 78% of caregivers and 71% of adults rated effectiveness comparison as 'extremely important'
- 48% of caregivers and 42% of adults were 'extremely worried' the nasal spray may not work as well as autoinjectors
- Only 17.2% of caregivers and 23.2% of adults preferred to be prescribed nasal spray only
- Non-injectable devices were seen as less painful and easier to carry than autoinjectors
- High demand exists for evidence of effectiveness, safety, and real-world feasibility before adoption
Limitations
This survey captures stated preferences and concerns, not actual use or outcomes during real anaphylaxis emergencies. The respondents are self-selected adults and caregivers already prescribed adrenaline autoinjectors, so findings may not represent the broader population with food allergies.
Abstract
INTRODUCTION: Intranasal adrenaline has been approved in multiple countries for anaphylaxis treatment, based primarily on pharmacokinetic/pharmacodynamic comparisons to adrenaline autoinjectors (AAIs). AIM: To assess patient and caregiver perspectives regarding emerging non-injectable adrenaline routes. METHODS: Online survey of adults and caregivers of children with food allergy prescribed AAIs, with international dissemination supported by the European Academy of Allergy and Clinical Immunology (February-April 2025). RESULTS: We analyzed 542 responses from caregivers and 224 from adults with food allergy. Effectiveness of adrenaline nasal spray (ANS) compared to AAI was rated "extremely important" by 78% of caregivers and 71% of adults. 48% of caregivers and 42% of adults were "extremely worried" that ANS may not work as well as AAI, and 50% and 44% (respectively) that it may not work well enough. Compared with AAI, respondents were less worried about ANS being painful or difficult to carry, and about fear/embarrassment around use, but more worried about side effects and knowing how to use it. Most anticipated being more comfortable using ANS than AAI, and over half anticipated earlier use during anaphylaxis. Only 17.2% of caregivers and 23.2% of adults preferred to be prescribed ANS only. There was interest in sublingual adrenaline due to portability and reduced needle-related burden, but confidence depended on comparable speed/effectiveness and feasibility during reactions. CONCLUSIONS: Non-injectable adrenaline is attractive to caregivers and adults, and may improve willingness to carry and use adrenaline. However, demand for evidence of effectiveness, safety, and real-world feasibility is high, highlighting important information needs for shared decision-making.