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Intranasal adrenaline formulations represent a paradigm shift addressing these longstanding clinical challenges. This review synthesizes the current evidence on intranasal adrenaline formulations, focusing on clinical efficacy, drug and device technology, and safety profiles. Three leading intranasal adrenaline products are examined:\n                    <jats:italic>neffy<\/jats:italic>\n                    \u00ae (ARS Pharmaceuticals), which utilizes Intravail\u00ae technology and is the first FDA\u2010approved commercially available intranasal adrenaline product; UTULY\u2122 (Bryn Pharma), which employs a high\u2010dose strategy (13.2\u2009mg) to overcome absorption barriers; and FMXIN002 (Nasus Pharma), which features microsphere powder technology with a 5\u2010year room\u2010temperature stability. Pharmacokinetic studies of intranasal products consistently demonstrate plasma concentrations that are comparable to or exceed intramuscular manual injections, with faster absorption kinetics. A Phase 3 clinical study in 15 pediatric patients experiencing anaphylaxis during oral food challenges demonstrated effective symptom resolution with a median time of 16\u2009min and no serious adverse events. Counterintuitively, nasal congestion and upper respiratory tract infections appear to enhance rather than impair adrenaline absorption\u2014a counterintuitive finding that mitigates concerns about delivery reliability. These needle\u2010free formulations offer significant advantages including the elimination of injection\u2010related barriers, simplified administration techniques, enhanced thermal stability, and preserved therapeutic efficacy. Intranasal adrenaline represents a transformative advancement in anaphylaxis management, particularly benefiting pediatric populations where injection anxiety is prevalent.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/pai70316-gra-0001-m.png\">\n                        <jats:alt-text>image<\/jats:alt-text>\n                      <\/jats:graphic>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1111\/pai.70316","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T03:59:34Z","timestamp":1773028774000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intranasal adrenaline: A 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