Meet neffy: Health Canada approves epinephrine nasal spray for anaphylaxis

TORONTO – Health Canada has approved the first needle-free epinephrine treatment for severe allergic reactions: a nasal spray called neffy.

ALK Canada, which purchased the rights to distribute the drug, says the two-milligram treatment could be on the market as soon as this summer.

The drug was approved for adults and pediatric patients who weigh at least 30 kilograms, which is roughly 66 pounds. A one-milligram dose has been approved in the United States for kids between 15 and 30 kilograms, but not in Canada.

As it stands, epinephrine auto-injectors — a single-use pre-filled device known by the brand name EpiPen — are the only emergency treatment option available for allergic reactions.

“That’s what the game changer is here: short of a needle and syringe or an epinephrine auto-injector, there really hasn’t been any other way to get epinephrine into you in the event of an emergency,” said Dr. Mariam Hanna, an allergist and immunologist who teaches at McMaster University.

“It’s a big deal to us to have something that’s available that’s a different format, that’s needle-free.”

She said neffy has other benefits as well, including that it’s shelf-stable for longer than the EpiPen and able to withstand a broader range of temperatures.

It’s also smaller than the EpiPen, so people may be more likely to carry it with them. Hanna said that’s one barrier to people using the auto-injector, in addition to hesitancy about whether their allergic reaction is really severe enough to warrant a shot and a potential hospital visit.

“Signs and symptoms of anaphylaxis can vary from one person to the other. So it looks different on each person and that can produce a challenge in recognizing … it,” she said.

The most concerning symptoms involve the airway, she said, including coughing, wheezing, trouble breathing, chest tightness and difficulty swallowing. But other signs include a drop in blood pressure, light-headedness and a rash or swelling.

She said some people also feel nauseated, generally unwell or what the literature refers to as “a sense of impending doom.”

Anaphylaxis is often linked to food allergies, venom allergies such as bee stings and allergies to medication.

“Allergic reactions, if we take a step back, occur because of an error in our immune system. And our immune systems continue to change and evolve through the different stages in our life,” Hanna said.

“So it’s actually not uncommon to develop new onset allergies after previously not having issues.”

She said a growing number of people are also reporting severe allergies, so having multiple options for emergency treatment is key.

“This is where it’s important that, as we see this condition happening more and more frequently that we have these kinds of devices quickly accessible, available.”

To that end, she said, she doesn’t think this spells the end of the EpiPen, which has been the only thing on the market in Canada for several years.

“When they go on backorder there’s no alternative, there’s no backup,” she said. “We struggle, we get stuff from the States, we panic. And we’ve done this annually. There’s back orders all the time. So having another device available, be it needle-based or needle-free, it’s options for families.”

This report by The Canadian Press was first published April 15, 2026.