RX Review: The role of needle-free epinephrine in pediatric allergy for 2025

In this Contemporary Pediatrics and HCPLive RX Review discussion, moderator Brian Schroer, MD, speaks with Colleen Kraft, MD, and Russell Traister, MD, about the impact of needle-free epinephrine options, including epinephrine nasal spray (neffy) which received approval for treating type 1 allergic reactions in patients aged 4 years and older weighing at least 30 kg on March 5, 2025.¹

Traister notes that while intranasal epinephrine offers a less invasive option, some children may struggle with nasal sprays, similar to how some resist intranasal steroids like Flonase. He emphasizes the need for individualized patient discussions to determine the best approach.

Kraft expands on the importance of alternative treatments, including FDA-approved oral immunotherapy, which challenges the misconception that allergies can only be managed through avoidance or injections. She notes that these new options make allergy treatment more accessible to families.

Traister adds that Xolair (omalizumab) is particularly beneficial for patients with multiple food allergies, reducing overall reaction risk. However, he acknowledges that committing to biweekly or monthly injections can be challenging. Kraft points out that patients on Xolair often experience reduced anxiety, allowing them to engage in normal activities like school and social events without constant fear of accidental exposure.

*Editor's Note: One panelist makes an error on the currently approved age population for neffy. At the time of filming, neffy 1 mg was approved for children as young as 4 years on March 5.

Our Panelists:
Brian Schroer, MD, is an allergist-immunologist at the Cleveland Clinic Children's Hospital. Board-certified in internal medicine, pediatrics, and allergy and immunology, Schroer serves as the moderator for this panel discussion.

Colleen Kraft, MD, is a clinical professor of Pediatrics at the Keck School of Medicine of USC and an attending physician at the Children’s Hospital Los Angeles. In addition to these roles, Kraft is also the former president of the American Academy of Pediatrics.

Russell Traister, MD, is a pediatric allergy and immunology specialist at Allegheny Health Network’s Pediatric Institute. Board certified in allergy, immunology, and internal medicine, Traister serves as the third panelist for our discussion.

Reference:

1. Fitch J. FDA approves neffy 1 mg for anaphylaxis in children aged 4 years and older. Contemporary Pediatrics. March 5, 2025. Accessed March 11, 2025. https://www.contemporarypediatrics.com/view/fda-approves-neffy-for-anaphylaxis-in-children-aged-4-years-and-older