D1.291 - Real-world data of nasal adrenaline spray in anaphylaxis: Review of clinical evidence

Nasal adrenaline is indicated for the treatment of severe allergic reactions, including anaphylaxis. The efficacy and safety of a nasal adrenaline spray have been supported by pharmacokinetic and pharmacodynamic data, a paediatric phase 3 study in oral food challenge, and increasing real-world data. The objective was to summarise currently available real-world data of nasal adrenaline use from clinical practice. 

Congress abstracts and the scientific literature were manually searched and reviewed for real-world data of nasal adrenaline use in anaphylaxis up to November 30, 2025. Key data assessed were the clinical effectiveness and safety.

A total of 39 cases of nasal adrenaline use for treatment of in-clinic anaphylaxis have been reported during oral food challenges or allergen immunotherapy. Majority of the cases treated with nasal adrenaline reported early clinical improvement, typically within minutes. Three cases required a second dose of nasal adrenaline and responded well. In three cases, nasal adrenaline was applied with good clinical effect after intramuscular adrenaline. Total symptom resolution was generally observed between 5 to 60 minutes. Only mild adverse events (primarily application site reactions) were reported. In addition, a survey among 375 US HCPs using nasal adrenaline in a total of 680 patients for the treatment of anaphylaxis following oral food challenges or allergen immunotherapy, revealed that 603 patients (88.7%) were effectively treated with a single dose of nasal adrenaline, and 77 patients (11.3%) required a second dose of nasal adrenaline, similar to previously reported rates for intramuscular adrenaline.

Real-world data of nasal adrenaline demonstrate the clinical effectiveness for treatment of anaphylaxis.