Epinephrine
Epinephrine is the only first-line treatment for anaphylaxis, a severe and potentially life-threatening allergic reaction. For people with food allergy, having a current prescription for epinephrine and keeping it immediately accessible at all times, whether in the form of an autoinjector, nasal spray, or other FDA-approved method, is critical.
Allergic reactions can escalate quickly, and prompt administration of epinephrine can stop the progression of symptoms, restore breathing, and stabilize blood pressure. This makes it paramount to continue improving and expanding administration options, encouraging prompt administration based on recognizing the symptoms of anaphylaxis, and increasing public awareness and the availability of unassigned or stock epinephrine.
Despite its proven safety and effectiveness, research shows that epinephrine is often under-carried and underused. Ensuring readiness, including access, training, and confidence in recognizing anaphylaxis, is a vital part of managing food allergy. Delayed administration of epinephrine has been implicated in contributing to fatalities, according to the NIH’s Guidelines for the Diagnosis and Management of Food Allergy in the United States.
Although most patients and caregivers of children with food allergy who were prescribed epinephrine filled that prescription, about one in ten did not. The most commonly cited reasons for not filling epinephrine prescriptions were not having a history of reactions (26%), cost (25%), and not believing it was needed (23%).
For those without a previously diagnosed allergy or anyone who experiences a reaction and does not have epinephrine with them, having access to undesignated epinephrine—doses that are not prescribed to a particular individual and may be stocked in public places—can be life-saving.
New delivery devices
A needle-free, nasal spray form of epinephrine is now available for the treatment of anaphylaxis, with studies showing similar drug absorption and effects as intramuscular epinephrine. Additional needle-free products are in development, including other intranasal formulations and a sublingual (under-the-tongue) option. Early studies suggest these alternatives offer similar absorption compared with traditional intramuscular injections, making them promising options for emergency use.
Many patients and caregivers report fear of needles or pain as a reason for delaying epinephrine use, so the availability of needle-free options may help reduce hesitation and improve timely treatment. Some of these needle-free forms of epinephrine are also designed to be smaller and easier to carry, have longer shelf-life, and be more stable across temperature variations than current injectable formulations. While more research is needed to understand the real-world impact of needle-free epinephrine on food allergy management, these new formats are likely to be welcomed by many food allergy patients and caregivers.
Stock Epinephrine Policies
“Stock” epinephrine policies are designed to expand access to emergency epinephrine by allowing “undesignated” doses—those not prescribed to a specific individual—to be made available in public settings. This approach is similar to how automated external defibrillators are widely placed in public areas for cardiac emergencies. Schools have been at the forefront of this effort. Since the passage of the School Access to Emergency Epinephrine Act, which incentivizes state-level adoption of stock epinephrine policies through grant preferences, all states except Hawaii have enacted laws supporting the stocking of undesignated epinephrine in schools. A key aspect of these policies is ensuring that school staff are properly trained to recognize signs of anaphylaxis and administer epinephrine quickly and effectively. As such, these laws also typically include legal protections for individuals who provide emergency care in good faith, helping reduce concerns about liability.
In addition to allowing stock epinephrine in schools, many states also have laws allowing public venues (e.g., arenas, malls, theme parks) to stock epinephrine to treat severe allergic reactions. This type of legislation is known as an “entity law.” At this time, 36 states have entity laws, and three states have pending legislation.
FARE works to increase the availability of undesignated epinephrine auto-injectors through legislation at the national and state levels.
K-12 School Access to Epinephrine
Nearly every state has passed legislation regarding stocking undesignated epinephrine auto-injectors in K-12 schools. Click here for more information about school access to epinephrine.
College and University Access to Epinephrine
Click here for more information about epinephrine on college campuses. In select states, colleges and universities may be covered under legislation that allows public venues, referred to as entities, to stock undesignated epinephrine. Click here for more information about public access to epinephrine.
FARE efforts
FARE is actively involved in numerous state efforts to expand access to epinephrine. In 2025, for example, FARE successfully collaborated with the New York State Assembly to pass two laws, capping the price of autoinjectors to $100 per pack and expanding the definition of epinephrine to include nasal spray and any future FDA-approved delivery devices, such as a sublingual option.
If you are interested in learning more about what is happening in your state and how to get involved, please use our Contact Us form and select Advocacy for your subject line.
