For more than 25 years, treating a severe allergic reaction, as a first aider in Australia, meant one thing: a jab of adrenaline into the outer thigh. That changed in 2026. Two new adrenaline devices are now listed on the Pharmaceutical Benefits Scheme — including the country’s first needle-free option, a nasal spray called neffy® — and in July 2026 the Australasian Society of Clinical Immunology and Allergy (ASCIA) updated its Acute Management of Anaphylaxis guidelines to bring every approved device into line. For anyone who holds a first aid certificate, works as a first aid officer, or simply keeps an adrenaline device in the family bag, it’s the biggest shake-up in anaphylaxis treatment in a generation.
What ASCIA actually changed in July 2026
ASCIA’s Guidelines for Acute Management of Anaphylaxis are, quietly, one of the most-used clinical resources in the country — around 180,000 views or downloads a year, second only to the ASCIA Action Plans themselves. They’re treated as “living” guidelines, reviewed and reissued as the evidence and the available devices change. The July 2026 revision did three main things.
First, it added instructions and availability details for every adrenaline device now approved to treat anaphylaxis in Australia and New Zealand — not just the familiar injectors. Second, it introduced two new flowcharts to help clinicians work through initial and refractory (non-responding) anaphylaxis in medical settings, so the right steps are easier to find under pressure. Third, it updated the adrenaline dose summaries to include the new intranasal option. ASCIA also refreshed its separate Guidelines for Adrenaline Device Prescription and, helpfully for the rest of us, updated its Anaphylaxis Training Refresher video (still under 20 minutes).
These particular guidelines are written for doctors, nurses, paramedics and other health professionals — including those working in the rural and regional areas that make up much of the Mid North Coast. But the changes flow straight down to community first aid, because the devices described are the same ones now turning up in workplace kits, schools and family handbags.
Meet the new devices: a nasal spray and a new injector
Until this year, Australians had two adrenaline auto-injectors to choose from: EpiPen® and Anapen®. Both are still available and still work exactly as before. What’s new is that they’ve been joined by two more options, and one of them doesn’t involve a needle at all. You can read the full device rundown in the ASCIA Adrenaline Devices FAQ.
neffy® — Australia’s first adrenaline nasal spray
neffy® is a single-dose adrenaline spray delivered into one nostril, where the adrenaline is absorbed through the lining of the nose. It was registered by the Therapeutic Goods Administration in December 2025 and listed on the PBS from 1 July 2026. It comes in two strengths: neffy 2 mg for adults and children who weigh 30 kg or more, and neffy 1 mg for children aged four and over weighing 15–30 kg. As Australian Prescriber notes, it’s the first genuinely new way to give adrenaline for anaphylaxis in more than two decades — and the first that doesn’t rely on an injection.
One important caveat worth repeating: neffy is only approved for people aged four and over who weigh at least 15 kg. It is not a solution for infants and toddlers, who still need an injector. And like every adrenaline device, using it doesn’t replace calling Triple Zero (000) — a second dose may still be needed if there’s no improvement.
Jext® — a new adrenaline auto-injector
Jext® is an adrenaline auto-injector, listed on the PBS from 1 June 2026 in 150 microgram and 300 microgram strengths. It uses a familiar two-step process and retracts the needle automatically after use. If you already know how to use an EpiPen or Anapen, the principle is the same — but the exact technique differs between brands, which is precisely why hands-on practice matters.
EpiPen® and Anapen® aren’t going anywhere
Nothing about the new arrivals retires the injectors most people already carry. EpiPen and Anapen remain fully available and PBS-subsidised. The practical upshot is that there are now up to four different adrenaline devices in circulation, each with its own steps. The device you own may not be the device you find yourself holding when you’re helping a stranger, a workmate or a child — so knowing your way around more than one is no longer a nice-to-have.
Why a needle-free option matters — especially out here
Across rural and regional New South Wales, an ambulance can take noticeably longer to arrive than it would in a capital city. On the Mid North Coast — the smaller towns and rural properties around Port Macquarie and Taree — that gap is where a bystander becomes the difference between a scare and a tragedy. The single most important action in anaphylaxis is giving adrenaline early, and anything that reduces hesitation in that moment is worth taking seriously.
Fear of needles is real, and it causes people to freeze or delay when someone is struggling to breathe. A nasal spray removes that particular barrier. That doesn’t make it “better” than an injector — adrenaline is adrenaline, and the priority is always to give it without delay — but for a nervous carer, a teacher, or a workmate who’s never used an injector, a spray they feel confident using may be the option that actually gets used. The same logic underpins bystander CPR: the best technique is the one a frightened person will actually perform while help is on the way.
What it means for workplaces, schools and childcare
If you’re a nominated first aid officer, a business owner, or you run a school or an education and care service, the mixed device landscape has practical consequences. Anaphylaxis management plans and first aid kits across your organisation may now contain different devices for different people — an injector for one child, a nasal spray for a staff member, an EpiPen in the office kit. Your team can only respond calmly to that variety if they’ve been shown each type.
For early childhood services, the age and weight limits on the nasal spray matter enormously: because neffy isn’t approved for children under four or under 15 kg, centres caring for babies and toddlers will still rely on adrenaline injectors. National Quality Framework obligations around anaphylaxis haven’t changed — the ACECQA guidance on medical conditions and anaphylaxis remains the reference point — and educators need current, hands-on training. Our Child Care First Aid course (HLTAID012) covers anaphylaxis and adrenaline devices to the standard education and care staff are required to hold.
For everyone else, the fix is straightforward: make sure workplace first aiders are trained on current devices and refresh that training rather than assuming a certificate from a few years ago still reflects what’s in the kit. We can bring that training to your team — request workplace or group training and we’ll tailor it to the devices your people actually carry.
The first aid steps for anaphylaxis haven’t changed
Amid all the news about new devices, the core first aid response to a severe allergic reaction is reassuringly unchanged. If you suspect anaphylaxis — difficulty or noisy breathing, swelling of the tongue or throat, a wheeze or persistent cough, a hoarse voice, collapse, or paleness and floppiness in a young child — act on it.
Lay the person flat and don’t let them stand or walk, because sudden standing can be dangerous in anaphylaxis; if breathing is difficult, allow them to sit but keep them from getting up. ASCIA has clear guidance on how to position a person having anaphylaxis, including how to hold an infant. Give adrenaline without delay using whichever device is available, following that device’s instructions. Then call Triple Zero (000) for an ambulance and, if there’s no improvement after five minutes and a second device is on hand, give a further dose. If the person becomes unresponsive and isn’t breathing normally, start CPR — the reason we treat CPR skills as everyday knowledge, not specialist knowledge.
Getting trained on the Mid North Coast
Having knowledge of these ASCIA updates and new adrenaline devices is important. However, having actual first aid training will allow you to act confidently in providing this life saving first aid care and also provide you the skill to administer these devices properly, when it matters the most.
Anaphylaxis recognition and adrenaline device use are built into nationally recognised first aid training. Our Provide First Aid course (HLTAID011) includes managing a severe allergic reaction and using an adrenaline auto-injector, and our trainers keep the content current as devices like neffy and Jext come into circulation. We run regular classes for locals in both Port Macquarie and Taree, plus dedicated CPR courses for those who just need to refresh the life-support essentials.
If it’s been a few years since your last course, this is a sensible moment to update — both to renew the qualification and to get hands-on with the devices you’re now likely to encounter. You can view upcoming course dates to find a class that suits, enrol in a first aid course online in a couple of minutes, or organise a group booking if you’d like to train a team, sporting club or community group together.
Frequently asked questions
Is the neffy nasal spray as effective as an EpiPen?
neffy is approved by the TGA to treat anaphylaxis, which means it’s been assessed as a genuine treatment option, not a lesser substitute. The active ingredient is the same adrenaline delivered by an injector; the difference is how it gets into the body. As with any device, the most important thing is giving it early and then calling for an ambulance. For specific medical advice about which device is right for a particular person, that’s a conversation for their doctor or pharmacist.
Does the nasal spray replace adrenaline injectors?
No. neffy is an additional option, not a replacement. EpiPen and Anapen remain available, and injectors are still essential for people the spray isn’t approved for — in particular children under four years of age or under 15 kg. Many households and organisations will end up with a mix of devices.
Which adrenaline device will I be trained on in a first aid course?
A good course teaches the principles that apply across devices and gives you hands-on practice with trainer units. Because there are now up to four devices in circulation, we focus on making sure you can read and follow the instructions on whichever one you’re handed — that’s the skill that transfers to a real emergency.
Can childcare centres use the nasal spray for young children?
Not for the youngest ones. Because neffy is only approved for people aged four and over who weigh at least 15 kg, education and care services looking after infants and toddlers will continue to rely on adrenaline injectors. Staff training and up-to-date anaphylaxis plans remain a requirement regardless of the device.
Do the new devices change the first aid steps for anaphylaxis?
The sequence is the same: lay the person flat, give adrenaline without delay, call Triple Zero (000), give a second dose after five minutes if needed and available, and start CPR if the person becomes unresponsive and isn’t breathing normally. What changes is the specific technique for administering the device in front of you, which is why current, practical training matters.
Where can I do a first aid or CPR course near Port Macquarie or Taree?
Coastal First Aid runs regular nationally recognised courses across the Mid North Coast. You can view upcoming course dates, enrol in a first aid course, or get in touch if you’d like help choosing the right course for your workplace or family.
