Patients Prefer Needle-Free Epinephrine for Anaphylaxis, Survey Shows

Philadelphia — A significant majority of patients at risk for anaphylaxis, and those who care for children with the condition, express a strong preference for needle-free epinephrine delivery methods, according to findings presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting. The survey data highlight a potential opportunity to improve epinephrine access and administration speed by addressing patient anxieties and logistical challenges associated with traditional autoinjectors.

The research, led by De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, chief research officer at Allergy & Asthma Network, surveyed 210 individuals – patients themselves and caregivers – to understand their preferences regarding epinephrine administration. The findings underscore that fear of needles and the practicalities of carrying an autoinjector are substantial barriers to prompt treatment during a potentially life-threatening allergic reaction.

Patient Concerns Beyond the Injection

While the immediate concern with epinephrine delivery is often the injection itself, the survey revealed a broader range of patient and caregiver priorities. A striking 89% of respondents indicated a preference for epinephrine devices that are small and easy to carry. This suggests that the bulkiness of current autoinjectors can discourage consistent carry, potentially delaying critical treatment. Concerns about environmental factors too emerged, with 87% expressing worry about heat affecting epinephrine efficacy and 70% concerned about the impact of cold temperatures.

These concerns are not unfounded. Epinephrine is known to degrade with exposure to both extreme heat and cold, potentially reducing its effectiveness. Recent research has explored alternative delivery methods, such as nasal sprays, partly in response to these limitations.

Weighing Priorities in Epinephrine Choice

The survey delved into the specific factors influencing epinephrine delivery method selection. Ease of use topped the list, with 77% prioritizing a device perceived as the simplest to operate. Closely following was portability (71%), clinician recommendation (61%), device size (47%), temperature stability (42%), and the presence of a needle (33%). This ranking demonstrates that while needle-free options are highly desirable, usability and convenience are also paramount considerations.

Gardner explained to Healio, “The most common route of administration is injection. Still, other forms of epinephrine administration are available or becoming available, including nasal spray and epinephrine film.” The emergence of these alternative methods reflects an ongoing effort to address patient preferences and overcome barriers to timely epinephrine administration.

Speed of Administration: A Critical Factor

Perhaps the most compelling finding of the survey relates to anticipated administration times. Respondents estimated they could administer needle-free epinephrine within 7 minutes of recognizing an allergic reaction, compared to 10 minutes for a traditional autoinjector. While a 3-minute difference may seem small, in the context of anaphylaxis, every second counts.

“We teach patients and caregivers, ‘If you think you necessitate it, use it. Don’t wait,’” Gardner emphasized. Hesitation due to fear or difficulty using an autoinjector can have serious consequences. Faster administration, facilitated by more user-friendly devices, could significantly improve outcomes.

Survey Methodology and Demographics

The Allergy & Asthma Network conducted the online, cross-sectional survey between July 9 and July 12, 2025. The participant pool comprised 210 individuals at risk for anaphylaxis or caregivers of children at risk. The demographic breakdown revealed that 65% of respondents were male, 83% identified as White, and 63% had private health insurance. It’s important to note that this demographic profile may limit the generalizability of the findings to other populations.

The Broader Context of Anaphylaxis Management

Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires immediate treatment with epinephrine. Symptoms can include difficulty breathing, swelling of the throat, hives, and a sudden drop in blood pressure. The Centers for Disease Control and Prevention (CDC) provides comprehensive information on recognizing and managing anaphylaxis, emphasizing the importance of having an epinephrine auto-injector readily available and knowing how to use it.

However, despite the availability of autoinjectors, underuse remains a significant problem. Factors contributing to this include fear of needles, lack of confidence in administration technique, and concerns about accidental injection. The survey findings suggest that addressing these concerns through the development and promotion of needle-free alternatives could play a crucial role in improving anaphylaxis outcomes.

Looking Ahead: Epinephrine Delivery Innovation

The preference for needle-free epinephrine aligns with ongoing research and development efforts in this area. Recent developments include nasal sprays and sublingual epinephrine films, offering alternative routes of administration that bypass the need for an injection. While these options are not yet widely available, they represent a promising step towards more patient-friendly anaphylaxis treatment.

Gardner concluded, “Patients and caregivers of children who are at risk for experiencing anaphylaxis indicated a strong preference for needle-free, highly portable epinephrine forms. Clinicians can use these findings to support patients’ preferences for needle-free administration options for epinephrine.”

For more information:

De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, can be reached at [email protected].