D3.332 - Patient Preferences for Nasal Adrenaline Spray versus Adrenaline Auto-Injectors in Anaphylaxis: A Multi-Country Discrete Choice Experiment

Effective management of anaphylaxis depends not only on access to adrenaline but also on patients’ willingness and ability to carry and use emergency treatment. Despite widespread availability of adrenaline auto-injectors (AAIs), real-world use remains suboptimal due to behavioural and practical barriers, including forgetting to carry the device, hesitance to act, and discomfort with needle-based administration. Nasal adrenaline spray (NAS) represents a needle-free alternative that may better align with patient preferences. This study explored patient experiences and quantified preferences for NAS versus AAIs using a discrete choice experiment (DCE).

A cross-sectional survey was conducted among 1,238 adults at risk of severe allergic reactions across Canada, France, Germany, and the UK. Respondents were recruited via a validated online research platform and self-reported diagnosis of anaphylaxis. The survey captured demographics, allergy reaction experience, and adherence to AAIs. A DCE quantified preferences and willingness-to-pay for treatment attributes, including mode of administration (nasal spray vs. injection), shelf life, temperature stability, device size/weight, and cost.

Food allergy was the most common trigger for severe reactions (57%), followed by insect stings (32%). Over half of the respondents had experienced a severe reaction in the past six months mostly at home, but many in public settings. Adherence to AAIs was inconsistent: nearly 40% did not carry their device regularly, 54% had been without an AAI when needed, and around 20% never filled their prescription. Many reported hesitation/difficulties using AAIs, often due to fear of needles or uncertainty during reactions. In the DCE, NAS administration was strongly and consistently preferred over AAI across all countries (OR 1.20-1.33, p<0.01), especially among naïve and infrequent users (OR 1.39-1.53, p<0.01). Longer shelf life was valued positively, while device size and weight had minimal influence on choice. Respondents expressed a willingness to pay more for NAS administration.

This large multi-country survey underscores persistent gaps between clinical guidelines and real-world AAI use. Strong preference for NAS suggests that needle-free administration could reduce behavioural barriers, better meet patient needs, and improve adherence, reinforcing the importance of patient-centred solutions in anaphylaxis management.