Severe allergic reactions can happen suddenly and escalate within minutes. For individuals at risk of anaphylaxis, immediate access to epinephrine can mean the difference between life and death. For decades, treatment has relied on injectable auto-injectors. Now, a needle-free option is changing the landscape: neffy, developed by ARS Pharmaceuticals.
Approved in both the United States and the United Kingdom — where it is marketed as EURneffy — this innovative nasal spray offers a new way to deliver life-saving epinephrine during an emergency.
Understanding Anaphylaxis
Anaphylaxis is a severe, systemic allergic reaction that can affect multiple organ systems at once. It typically occurs within minutes to hours after exposure to an allergen and can worsen rapidly. Without prompt treatment, it may lead to airway obstruction, dangerously low blood pressure, shock, and even cardiac arrest.
Common triggers include:
• Foods (such as peanuts, tree nuts, shellfish, milk, eggs)
• Insect stings (bees, wasps)
• Medications (including antibiotics and NSAIDs)
• Topical/Touch (such as Latex)
What makes anaphylaxis particularly dangerous is its unpredictability. Someone who has previously experienced only mild allergic symptoms may suddenly develop a life-threatening reaction. Rapid recognition and immediate epinephrine administration are critical.
Learn how to respond affectively to anaphylaxis and emergency situations by completing our Emergency First Aid at Work course.
What Is Neffy?
Neffy is the first nasal epinephrine spray specifically approved for emergency treatment of anaphylaxis. Unlike traditional auto-injectors that deliver epinephrine via intramuscular injection into the thigh, neffy administers a precise dose through the nose. The medication is absorbed through the nasal mucosa and enters the bloodstream quickly, providing the same essential medication — epinephrine — without the use of a needle.
It is currently approved for adults, (to date, awaiting approval for children) who meet specific weight requirements determined by regulatory authorities.
Importantly, neffy is not a replacement for medical evaluation. It is a first-response emergency treatment designed to stabilize the reaction until professional care is available.
Why a Needle-Free Option Matters
For many people, needle anxiety is real and significant. Studies consistently show that fear of injections can delay or prevent the use of auto-injectors during emergencies. This hesitation may occur in:
• Children afraid of needles
• Parents administering treatment to their child
• Caregivers in schools or public settings
• Adults experiencing panic during a reaction
In anaphylaxis, delays can be dangerous. A nasal spray may reduce hesitation and increase the likelihood that epinephrine is administered promptly.
Neffy’s compact design and temperature stability may also improve portability and convenience. Traditional auto-injectors must be protected from extreme temperatures and may be bulky. A smaller, needle-free device may encourage consistent carrying — a crucial factor, since epinephrine is only helpful if it is available at the time of need.
Recognizing the Signs and Symptoms
Anaphylaxis often involves multiple body systems. Early recognition improves outcomes.
Respiratory Symptoms
• Shortness of breath
• Wheezing
• Throat tightness or hoarseness
• Persistent coughing
• Difficulty swallowing
Skin and Mucosal Symptoms
• Hives (urticaria)
• Itching
• Flushed or pale skin
• Swelling of the lips, tongue, or face
Cardiovascular Symptoms
• Rapid or weak pulse
• Dizziness
• Fainting
• Low blood pressure
Gastrointestinal Symptoms
• Nausea
• Vomiting
• Abdominal cramps
• Diarrhea
Commonly, individuals describe a sudden “sense of impending doom” or severe anxiety before other symptoms intensify.
Not every reaction presents identically. In some cases, skin symptoms may be absent, which can make recognition more challenging. Any combination of breathing difficulty, circulatory compromise, or rapidly progressing symptoms after allergen exposure should raise concern for anaphylaxis. Learn more about recognition and how to respond in a medical emergency including anaphalaxis on one of our training courses.
How to Use Neffy During an Emergency
If anaphylaxis is suspected:
1. Administer neffy immediately at the first sign of significant symptoms. Do not wait to see if symptoms improve.
2. Deliver one full dose into one nostril as directed.
3. If symptoms persist or worsen after approximately 5 minutes, administer a second dose using a new device.
4. Call emergency services (999)0 immediately after the first dose is given (or have someone else call).
Patients are typically advised to carry two doses at all times, as some reactions require repeat treatment.
Even if symptoms appear to improve after epinephrine administration, medical observation is essential. Biphasic reactions — where symptoms return hours later — can occur.
If No Epinephrine Is Available
Anaphylaxis does not always occur in someone previously diagnosed with severe allergies. If there is no auto-injector or nasal spray available:
• Call emergency services immediately.
• Clearly state: “This is suspected anaphylaxis.”
• Lay the person flat with legs elevated, unless breathing is difficult (in that case, allow them to sit slightly upright).
• Do not allow standing or walking, as this may worsen shock.
Symptoms can escalate rapidly, even if they initially appear mild.
Cardiac Arrest and CPR
In rare but severe cases, untreated anaphylaxis can progress to cardiac arrest.
Signs include:
• Unresponsiveness
• No normal breathing (only gasping or no breathing)
If this occurs:
1. Call emergency services if not already done.
2. Begin CPR immediately.
3. Continue chest compressions until paramedics arrive or signs of life return.
4. Use an AED if one is available and follow its prompts.
Early CPR through Basic Life Support (BLS) can maintain circulation to the brain and vital organs while awaiting advanced medical care. Basic Life support is included in many of our training courses including BLS, First Aid At work, Peadiatric BLS, and in our commercial first aid courses and Healthcare Sector courses including GP and Dental.
Safety and Side Effects of Neffy
Like all epinephrine products, neffy can cause temporary side effects, including:
• Nasal or throat irritation
• Headache
• Nausea
• Dizziness
• Feelings of anxiety or shakiness
These effects are generally short-lived and far less dangerous than untreated anaphylaxis.
Individuals with heart conditions or those taking certain medications should discuss their medical history with a healthcare provider. However, during a life-threatening allergic reaction, epinephrine remains the first-line and most important treatment.
A Meaningful Step Forward
The introduction of needle-free epinephrine represents an important advancement in allergy management. By removing a major psychological and practical barrier to treatment, neffy has the potential to improve timely administration — and timing is everything in anaphylaxis.
Education remains essential. Knowing the symptoms, carrying emergency medication consistently, and acting quickly can save lives.
If you or a loved one is at risk for severe allergic reactions, speak with your healthcare provider about whether neffy or another epinephrine option is appropriate. Being prepared — and confident in how to respond — is one of the most powerful tools in managing anaphylaxis safely.
Could you be someones HERO?
For further information on the courses, we provide please visit the Courses page on our website. Anaphylaxis, Basic Life support for adults and Basic Life Support for Paediatrics, First Aid at Work Qualifications, Immediate life support and use of Automated defibrillators (AED). If you require a bespoke course for your area of work or social group this can be arranged.
Contact us at First Aid Interventions to find available courses for you or your business.
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