FAQ

Allergens in the environment include mould, plants (pollens), animals (saliva, pet hair and dander), cockroaches and dust mite.

Smoke and other irritants such as exhaust and strong chemical smells can also trigger allergic reactions.

Some people can be desensitised to some allergens including a variety of pollens and dust mite. This is also known as immunotherapy. Discuss desensitisation with your general practitioner who may then refer you to an allergy specialist.

If you have allergic rhinitis due to rye grass allergy, you are at risk of thunderstorm asthma, whether you have experienced asthma before or not.

Allergic rhinitis is considered severe if your  symptoms lead to you having one or more of the following:

• Disturbed sleep leading to daytime drowsiness
• Frequent waking due to breathing symptoms
• Restricted daily activities, sport or leisure
• Abnormal work and school performance

If symptoms are ongoing or difficult to control, even when taking medication, your doctor may refer you to an allergy specialist for management. You can also request a referral. Your specialist will review your symptoms and treatment and may discuss long term treatment known as allergen immunotherapy.

Symptoms may be regarded as mild when there is no disturbance in sleep, leisure, school or work activities.

When symptoms are long-term, allergic rhinitis may be associated with complications such as snoring, chronic tiredness, ear and sinus infections.

When neffy® becomes available in Australia, it will initially only be possible to get it with a private prescription. 

The recommended retail price (RRP) of one box of neffy® 1mg or 2mg containing two nasal sprays will be $194 (RRP is a guide only and pharmacies may charge more).  

The cost of buying a single neffy® on private prescription is expected to be approximately $97, however the price will depend on the pharmacy. We recommend that you ring a few pharmacies to find the cheapest price. 

Adrenaline injectors have an expiry date of 12-18 months from when they are made overseas.  

neffy® 1mg has an expiry date of 24 months from when they are made overseas. 

neffy® 2mg has an expiry date of 30 months from when they are made overseas. 

Check with the pharmacy what the expiry date is. If it is a lot shorter than the dates listed above, you could ask them to order you a device with a longer expiry date. 

You may have to wait a couple of days for the order to arrive at the pharmacy, so do not leave it until the last minute to renew your adrenaline device prescription. 

You may also like to phone a few pharmacies in your area to see which pharmacy has adrenaline devices with the longest expiry dates. 

On rare occasions, all available adrenaline devices may have a short expiry. If this occurs, it is better to buy an in-date adrenaline device even if the expiry date is short. 

You must replace your adrenaline device if: 

• you have used it 
• it has been fired/triggered by accident 
• it is about to expire  
• the liquid within the adrenaline injector becomes cloudy/discoloured or has floating particles. The neffy® adrenaline nasal spray does not have a viewing window to check liquid. 
• it has been kept in direct sunlight or in extreme temperatures for extended periods of time and the distributor advises it should be replaced 

NOTE: If you have used an adrenaline device, you should replace it immediately. You should always have at least one in-date adrenaline device with you and replace the other as soon as possible. 

Yes you can buy more adrenaline devices. 

EpiPen® Jr and EpiPen® can be bought over the counter from any pharmacy without a prescription. The cost is about $80 to $120 for ONE device.  

EpiPen® Jr and EpiPen® purchased on private prescription will also cost $80-$120 for ONE device.  

The price depends on the pharmacy. We recommend that you ring a few pharmacies to find the cheapest price. 

Some private health insurance funds will cover part of the cost of adrenaline devices purchased on a private prescription (not a PBS authority prescription). 

Check whether you can get a rebate (that is, some money back) through your private health fund with your level of private health cover.  

You will need to get a signed receipt from your pharmacist. You will need this receipt to make a private health insurance claim if you are entitled to it. 

Currently, the only adrenaline devices available to buy for general use (not prescribed for a specific person) are adrenaline injectors. 

As neffy® is only available on private prescription at this stage, it cannot be purchased as a general use adrenaline device. 

Anapen® is currently not available in Australia. 

Adrenaline injectors can be purchased over the counter from any pharmacy without a prescription. The cost will be around $80 to $120 per adrenaline injector. 

There is no government subsidy unless adrenaline devices are prescribed to a specific person on a PBS authority prescription. 

Organisations that buy an adrenaline device for general use should keep an ASCIA First Aid Plan for Anaphylaxis (orange in colour) with the adrenaline device they have bought. The ASCIA First Aid Plan for Anaphylaxis has a QR code to a webpage that shows how to use all adrenaline devices available in Australia.  

ASCIA Action Plans can be printed from the Australasian Society of Clinical Immunology and Allergy (ASCIA) website.

ASCIA has information on adrenaline devices for general use. 

You will be able to buy two adrenaline devices on a PBS authority prescription for the Health Care Card prescription price (currently $7.70). 

There is no discount on over-the-counter devices bought without a PBS authority prescription. 

There is no discount on adrenaline devices purchased with a private prescription. 

As neffy® is only available on private prescription at this stage, it cannot be purchased at a discounted price. 

Your adrenaline device expires at the end of the month shown on the device. 

You should allow enough time to make an appointment to see your doctor/nurse practitioner for a new prescription to take to your pharmacy. 

Remember that the pharmacy may not have the adrenaline device in stock and may need to order it. In metropolitan areas, it may take a couple of days for the adrenaline device to arrive in the pharmacy. In rural, remote, and regional areas, it is likely to take longer. 

It is best to start the process of getting a new prescription at the beginning of the month your adrenaline device is due to expire in case there are any delays. 

• For information on ordering Anapen® stock, the pharmacy should contact the distributor (Arrotex) on 1800 195 055. 
• For information on ordering EpiPen® stock, the pharmacy should contact the distributor (Viatris) on 1800 931 625. 
• For information on ordering neffy® stock, the pharmacy should contact the distributor (CSL Seqirus) 1800 008 275 

If they are unsuccessful, please ask the pharmacy to call Allergy & Anaphylaxis Australia on 1300 728 000. 

Your doctor/nurse practitioner will prescribe the correct dose of adrenaline device based on the person’s weight. With neffy®, age as well as weight is important. A child must be 4 years or older to be prescribed neffy®. 

Dose recommendations are also written on the ASCIA Action Plan for Anaphylaxis so they are easy to find in an emergency. 

The type of adrenaline device prescribed is based on a medical decision by the doctor/nurse practitioner as well as the patient/carer preference. Considerations include the weight of the patient, age of the patient (for neffy®), history of anaphylaxis and how the device is administered.  Training on the chosen adrenaline device is then given.   

It is very important that you know how to use the type of adrenaline device prescribed, especially if it is different from the one you have used in the past. 

A PBS prescription or a medication that is PBS listed is one where the government pays some of the cost so people pay only the standard price of a prescription (that is currently $25 for most Australians and $7.70 for concession card holders). 

If you are prescribed an adrenaline device on a PBS prescription, you will get 2 adrenaline devices for the price of one prescription. 

When neffy® is available in Australia, it will initially only be possible to purchase it with a private prescription for one or two devices. We anticipate that it will become available on PBS prescription soon. 

Currently, the only adrenaline devices available on PBS in Australia are EpiPen® Jr and EpiPen®. At present, Anapen® is not available in Australia. 

The first PBS authority prescription needs to be provided by or in consultation with an allergy specialist, respiratory physician or a paediatrician.  This means a GP or nurse practitioner can write a first PBS prescription if they speak with one of these specialists who approve the need for an adrenaline device. 

An initial PBS prescription may also be prescribed after you have been discharged from hospital or an emergency department after treatment with adrenaline for anaphylaxis. 

A doctor (including a GP) or nurse practitioner can write follow-up prescriptions without consulting a specialist. The doctor/nurse practitioner will need to get an authority prescription from Services Australia every time. You can only purchase two in-date adrenaline devices through the PBS on authority prescription at any one time. 

If you use one or both of your adrenaline devices you can replace them with another two devices using a PBS authority prescription, even if it has only been a short time since your last adrenaline device PBS authority prescription. You can also replace expired devices with another two devices using a PBS authority prescription. 
 
Your doctor/nurse practitioner should provide an ASCIA Action Plan for Anaphylaxis (red in colour) with every prescription for an adrenaline device, even if your trigger allergens have not changed. 

ASCIA Action Plans can be printed from the Australasian Society of Clinical Immunology and Allergy (ASCIA) website.

The ASCIA Action Plan for Anaphylaxis is reviewed or updated when you see your doctor/nurse practitioner for a new adrenaline device prescription. The ASCIA Action Plan provides instructions on how to manage and treat an allergic reaction, including anaphylaxis. 

NOTE: Adrenaline devices are not usually prescribed for people with medication allergies even if they have had previous anaphylaxis. This is because medications are much easier to avoid than food or insects, for example. 

Whether a child can be excluded from school camp if a waiver/indemnity form is not signed will depend on the circumstances and terms of the waiver and should be discussed with the school. As stated above, the state and territory guidelines for schools generally require schools to make changes to allow students at risk of anaphylaxis to participate in all activities. However, in some instances it may not be possible for the school to make the changes needed for a student with a food allergy. This will depend on factors such as how severe the food allergy is, and the type of camp, including whether it is organised or catered for by another business outside the school.

Each state and territory have specific guidelines or policies in place for the management of student allergies at school. These guidelines and policies generally acknowledge the special duty of care that a school must have to its students. Some schools may require that students sign a waiver/indemnity form before attending a school camp, particularly where that camp is run or catered for by a third party. Whether a waiver/indemnity form for a school camp is unreasonable will depend on the circumstances.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

Properly managing allergic rhinitis can help lower the risk of developing chronic rhinosinusitis (CRS). If allergic rhinitis is left untreated, this can increase the risk of CRS due to chronic inflammation of the nasal airway which reduces the normal mucus drainage from the sinuses, leading to a risk of bacterial overgrowth and infection. 

No. Some people only have allergic rhinitis, and some people only have chronic rhinosinusitis (CRS). Some people have both.  Untreated or poorly controlled allergic rhinitis can increase the risk of developing CRS.  

People with nasal polyps can see an ENT surgeon for surgery to remove the polyps. This helps improve sinus drainage, so medicines and nasal rinses work better. 

After surgery, it’s important to keep using nasal rinses to keep the sinuses clear.  

Surgery removes nasal polyps, but they may grow back because surgery doesn’t treat the underlying cause of chronic rhinosinusitis (CRS). If the polyps return, you can talk to your specialist about other treatment options, such as monoclonal antibody therapy. This is an expensive treatment that is only prescribed by allergy specialists to patients who meet set requirements. 

Nasal polyps are soft, painless, non-cancerous growths in the nose or sinuses, usually shaped like teardrops. They often form where the upper sinuses drain into the nose. 

People with long-term sinus inflammation may develop them. About 20–30 percent of people with chronic rhinosinusitis (CRS) get nasal polyps, which can impact quality of life and mental health. 

They can be diagnosed with a nose camera (endoscopy) or a CT scan.

There’s no cure for chronic rhinosinusitis (CRS), but treatments can help manage the symptoms and improve your quality of life. 

 If a person has symptoms of chronic rhinosinusitis (CRS), they should see their GP. The GP will decide, based on the history and signs and symptoms, whether they can manage the patient themselves or whether the patient needs a referral to an allergist or an ear, nose and throat (ENT) surgeon. 

People with chronic rhinosinusitis (CRS) can manage it in a few different ways: 

1. Medical treatment – This usually includes nasal rinses (salt-water solutions) and daily intranasal corticosteroid sprays to reduce swelling. Antibiotics may be prescribed if there’s an infection, and sometimes a short course of oral steroids is given. 
2. Surgery – If medications don’t help, surgery might be needed to clear blockages and fungal buildup, remove polyps, and improve sinus drainage and breathing. 
3. Monoclonal antibody therapy – For people with ongoing symptoms, even after medicine and surgery, a specialist may consider this advanced treatment. It’s only available to those who meet set requirements. 

Skin prick tests are not used to diagnose chronic rhinosinusitis (CRS). Skin prick tests can be used to help diagnose allergic rhinitis. They can show if you’re sensitised to things like dust mites and pollen which can cause allergic rhinitis, but this isn’t the cause of CRS.

Diagnosis of chronic rhinosinusitis (CRS) is based on symptoms and test findings. 

• Endoscopy (camera into the nose) may show abnormal tissue growths called nasal polyps, thick nasal discharge and swelling around sinus openings. 
• CT scans may show swollen sinuses, mucous membranes, polyps, and blocked drainage of the sinuses.

The most common symptoms of chronic rhinosinusitis (CRS) are blocked nose and post-nasal drip (mucus dripping down the back of the throat).  

You may have CRS if you’ve had two or more of these symptoms for at least 12 weeks: 

• blocked nose on both sides 
• runny nose from both nostrils and post-nasal drip  
• not being able to smell or only being able to smell strong smells 
• pressure and pain in the face  

See a doctor urgently if you have any of these symptoms, as they may be caused by something more serious: 

• Facial pain or headaches without other signs of sinusitis  
• High fever  
• Blocked nose or discharge on one side of nose only  
• Symptoms that are worse on one side   
• Blood in nasal mucus 
• Eye symptoms such as blurred or reduced vision  
• Numbness or tingling in the face 
• Facial swelling, causing the face to look uneven (facial asymmetry) 
• Moderate to severe loss of sense of smell  

Chronic rhinosinusitis (CRS) is more common in adults and becomes more likely to develop as people get older.  It affects 5- 10 percent of people.  

Chronic rhinosinusitis (CRS) can have a big impact on a person’s quality of life and mental health and can lead to decreased physical and social activity. It also impacts the wider community by increasing healthcare costs for things like doctor visits, medicine, and surgery. As it mostly affects people of working age, it can lead to missed work and lower productivity. 

CRS is less common in children, but it can affect their concentration and academic performance.

Although the terms of each waiver/indemnity will differ, a term of a waiver/indemnity that tries to prevent a person from reporting a food service business to the relevant authorities would likely be invalid on the basis that it would not be in the public interest to prevent food standards regulators from being alerted to possible food safety issues.

This will depend on the terms of the waiver/indemnity, you should read the form closely to understand what types of claims the food service business has excluded.

This will depend on the facts of your situation. Venues are required to try to accommodate you, however bringing outside food into a venue may cause other issues for the business, such as food safety concerns. Businesses may, for example, want to reduce any risk that a customer could become sick from external food, which is out of their control. Pre-packaged foods, such as potato chips are less likely to carry this risk and are also less likely to be mistaken for food served by the business in contrast with more substantive foods that require reheating or refrigerating.

A cafe, restaurant or function centre can refuse to provide safe food/drink for you and refuse service. Although the restaurant should try to prepare and serve you food without your allergen(s), it will not be required to do so if this will result in unjustifiable hardship for the venue (that is, it will be extremely difficult). Factors that may be considered by the venue include:

• whether it is too difficult to provide allergen-free substitutes and prepare your food without cross contamination, and
• how severe your food allergy is (and the risk of harm to you, should you have an allergic reaction)

Where the venue considers that it is unable to provide food that is free of your allergen(s), it may be reasonable for the business to refuse service.

A customer can refuse to sign a waiver/indemnity form. It would then be up to the business whether it decides to serve the customer and accept the risk of an allergic reaction happening. Equally, the customer may decide they are not comfortable eating at that business and eat elsewhere.

Yes, businesses are entitled to request that customers sign a waiver/indemnity. From the business’ perspective, a waiver/indemnity is important to protect itself in the event that customers with severe allergies have an allergic reaction, despite the business taking reasonable precautions. Although a serious allergy that causes anaphylaxis can be considered a disability under Anti-Discrimination legislation, it is likely that requesting a waiver/indemnity be signed is a reasonable requirement and would not be discriminatory.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

Many people with eczema have other allergic conditions. Studies have shown that up to 30% of babies with eczema who have a family history of allergy will develop food allergy, and up to 40% develop asthma or allergic rhinitis (hay fever).

Topical steroid creams and ointments are a safe and effective treatment when they are used as directed by your doctor or nurse practitioner. Skin damage can be prevented by applying creams/ointments, including steroid creams and ointments, prescribed by your doctor as soon as itchy or rough skin is noticed. Not using enough of the eczema treatments can cause skin damage due to itching, which can lead to sores, scabs and scarring. Additionally, people who have eczema that is not well managed are more likely to have skin infections.

The following actions may reduce itch, to help control the scratch and itch cycle of eczema:

• Keep skin well moisturised. Moisturise at least twice every day.
• Use cold compresses (such as a wet face cloth) and wet dressings/wraps, as directed.
• If advised to use antihistamines, use non-sedating antihistamines. Sedating antihistamines are generally not recommended and should not be used in young children without specialist supervision.

Eczema is not caused by food, but food may trigger eczema flares. It is important to seek professional medical advice for eczema management and not restrict foods from the diet unless under medical direction. Removing foods can affect growth and nutrition.

It is best to use skincare products that do not contain any food products, fragrances or plant extracts. Just because a product claims to be ‘natural’ does not mean it is good for eczema. Talk to your doctor or nurse practitioner for the best options to suit your needs.

Eczema is a type of dermatitis (atopic dermatitis), which simply means red and inflamed skin.

It is important to go back to your doctor (dermatologist/allergy specialist/ GP/paediatrician) to discuss treatment options. There are new and very effective treatments available in Australia for severe eczema.

There are a number of things that you can do to help manage eczema:

• Reduce exposure to trigger factors (where possible). This may include an allergy assessment by an allergist or dermatologist to properly identify allergic triggers.
• Have a short, warm (not hot) bath or shower daily. Do not use soap or bubble bath. Use a soap-free wash.
• Apply topical steroid cream/ointment (as prescribed) and moisturisers straight after bathing and patting dry with a soft, clean towel.
• Use moisturiser twice a day and use enough to help maintain the skin barrier.

Did you know that doctors can prescribe more than one tube of steroid eczema cream/ointment at a time?

Depending on the amount of your body that is affected by eczema, your GP can prescribe up to 10 tubes of steroid based cream/ointment per purchase on authority script with several repeats.

In general, one script purchase should be adequate supply for one month of use. This means that if you have a large body surface area affected by eczema you might only pay the price of a regular prescription for 3, 5 or even 10 tubes of steroid cream/ointment.

Most airline terms of service say they are not responsible for any loss due to an anaphylaxis on board their aircraft. Further, some airlines require that passengers do not hold the airline responsible for any costs due to an allergic reaction. The conditions of flying with the airline are often agreed to at the time an airline ticket is purchased, regardless of whether the airline later asks that passengers sign an indemnity/waiver. If a passenger’s allergic reaction increases costs to the airline (for example, where the airline has to divert the aircraft), the passenger may have to pay these costs.

Passengers travelling with a food allergy should read the airline terms of service and conditions of travel (sometimes referred to as conditions of carriage) as these should explain whether the airline is willing to make any changes (for example wiping down the tray table) if not told in advance of passenger allergies, and whether the airline will refuse to accept responsibility for an anaphylaxis.

Each airline has its own policies and conditions which explain the changes they will make and the level of risk they will take on. It is important to review these policies before buying your ticket, as many of the rules will apply as soon as you buy your ticket. Airline policies will likely say whether a waiver/indemnity form is needed.

Whether a child can be excluded from school camp if a waiver/indemnity form is not signed will depend on the circumstances and terms of the waiver and should be discussed with the school. As stated above, the state and territory guidelines for schools generally require schools to make changes to allow students at risk of anaphylaxis to participate in all activities. However, in some instances it may not be possible for the school to make the changes needed for a student with a food allergy. This will depend on factors such as how severe the food allergy is, and the type of camp, including whether it is organised or catered for by another business outside the school.

Each state and territory have specific guidelines or policies in place for the management of student allergies at school. These guidelines and policies generally acknowledge the special duty of care that a school must have to its students. Some schools may require that students sign a waiver/indemnity form before attending a school camp, particularly where that camp is run or catered for by a third party. Whether a waiver/indemnity form for a school camp is unreasonable will depend on the circumstances.

Although the terms of each waiver/indemnity will differ, a term of a waiver/indemnity that tries to prevent a person from reporting a food service business to the relevant authorities would likely be invalid on the basis that it would not be in the public interest to prevent food standards regulators from being alerted to possible food safety issues.

This will depend on the terms of the waiver/indemnity, you should read the form closely to understand what types of claims the food service business has excluded.

This will depend on the facts of your situation. Venues are required to try to accommodate you, however bringing outside food into a venue may cause other issues for the business, such as food safety concerns. Businesses may, for example, want to reduce any risk that a customer could become sick from external food, which is out of their control. Pre-packaged foods, such as potato chips are less likely to carry this risk and are also less likely to be mistaken for food served by the business in contrast with more substantive foods that require reheating or refrigerating.

A cafe, restaurant or function centre can refuse to provide safe food/drink for you and refuse service. Although the restaurant should try to prepare and serve you food without your allergen(s), it will not be required to do so if this will result in unjustifiable hardship for the venue (that is, it will be extremely difficult). Factors that may be considered by the venue include:

• whether it is too difficult to provide allergen-free substitutes and prepare your food without cross contamination, and
• how severe your food allergy is (and the risk of harm to you, should you have an allergic reaction)

Where the venue considers that it is unable to provide food that is free of your allergen(s), it may be reasonable for the business to refuse service.

A customer can refuse to sign a waiver/indemnity form. It would then be up to the business whether it decides to serve the customer and accept the risk of an allergic reaction happening. Equally, the customer may decide they are not comfortable eating at that business and eat elsewhere.

Yes, businesses are entitled to request that customers sign a waiver/indemnity. From the business’ perspective, a waiver/indemnity is important to protect itself in the event that customers with severe allergies have an allergic reaction, despite the business taking reasonable precautions. Although a serious allergy that causes anaphylaxis can be considered a disability under Anti-Discrimination legislation, it is likely that requesting a waiver/indemnity be signed is a reasonable requirement and would not be discriminatory.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

No. At present, both 1mg and 2mg neffy® are only available on private prescription.

The recommended retail price (RRP) of one box of neffy® 1mg or 2mg containing two nasal sprays is $194. RRP is a guide only and pharmacies may charge more, so you may choose to compare prices between pharmacies. If you only want to buy ONE neffy®, hopefully the pharmacist will sell you one device out of the box of 2, with a RRP of $97.

We anticipate that neffy® will be available OTC but there is no timeframe for this yet.

We anticipate that neffy® will be available on PBS prescription but there is no timeframe for this yet.

They can be purchased from Allergy & Anaphylaxis Australia.

The neffy® trainer must be cleaned if it has been put in a person’s nose. This will reduce the chance of spreading infection. It should be wiped with 70% isopropyl alcohol. Allow the alcohol to dry before putting the neffy® trainer in the nose to avoid irritation.  

If you are concerned about spreading infection from nose to nose when using the neffy® trainer, you may choose to put the neffy® trainer on the outside of the nose instead. Make sure you still point the neffy® trainer in the correct direction. Remember when using the real neffy® it must be inserted into the nose. 

When the plunger is pressed to give the neffy® dose, a click is heard. The plunger, once pressed hard, will shorten and stay in place. This makes it easy to see the adrenaline has been given.  

No. There were no children under the age of 4 years included in the neffy® registration studies and neffy® is not approved for use in children aged less than 4 years in Australia.

No, neffy® does not have a window to check medication.  

Adrenaline injector devices have a clear window so you can check the liquid inside for cloudiness.  

Check the expiry date on neffy® before use.  

neffy® 1mg expires 24 months after it is made overseas.

neffy® 2mg expires 30 months after it is made overseas.

Each neffy® contains 0.1ml of liquid. The dose will be sprayed into the nose once the plunger is pressed hard.

The plunger must be pressed hard to give neffy®, so it is unlikely neffy® can be accidentally sprayed. 

DO NOT TEST or pre-spray as each neffy® only contains one dose of adrenaline.  

Each neffy® comes in an individual blister pack. Keep neffy® in the blister pack or a neffy® carry case until use. 

neffy® should be stored at room temperature below 25 degrees Celsius.   

Do not store in the fridge as there’s a risk it may accidently freeze. If frozen, the device will not spray. Allow neffy® to thaw (defrost) for at least one hour at room temperature. It should not be used if the contents are still frozen or not completely thawed.

If someone is experiencing anaphylaxis and neffy® is frozen, use another adrenaline device if available. Do not wait for neffy® to thaw before treating anaphylaxis. 

Freezing does not affect its shelf life. 

neffy® can be exposed to temperatures up to 50 degrees Celsius for short periods. Please contact CSL Medical Information 1800 642 865 for further information. 

Yes – see product information.

No, people do not need to blow their nose or sniff to have the neffy® nose spray.

Yes. Follow the instructions on your ASCIA Action Plan for Anaphylaxis or First Aid Plan for Anaphylaxis 

LAY PERSON FLAT – do NOT allow them to stand or walk  

If unconscious or pregnant, place in recovery position – on left side if pregnant.

If breathing is difficult allow them to sit with legs outstretched. 

Hold young children flat, not upright.

No, the school cannot refuse, however it may take time for staff to complete anaphylaxis training that includes how to use neffy®. 

Most children in childcare will not fit the age and weight limits for neffy® (1mg: for children 4 years and over who weigh 15kg to less than 30kg). However, if the child is prescribed neffy®, the childcare cannot refuse to have the device. It may take time for staff to complete anaphylaxis training that includes how to use neffy®. 

No, OSHC cannot refuse, however it may take time for staff to complete anaphylaxis training that includes how to use neffy®. 

Currently neffy® is only available on private prescription so schools and children’s services cannot purchase it over the counter as their general use adrenaline device. Once neffy® is available over the counter, schools and children’s services will have to follow the advice in their state or territory.

neffy® is TGA (Therapeutic Goods Administration) registered in Australia. The TGA assesses medications for safety and effectiveness. In research studies neffy® has been shown to work in treating anaphylaxis 

USA – August 2024.

Europe (called EURneffy) – August 2024.  

UK (called EURneffy) – July 2025. 

Japan – September 2025.

neffy® contains Intravail® (dodecyl-maltoside) which opens cells in areas such as the nose to increase the absorption of medication, including adrenaline. This ingredient is a safe food additive (sugar based not protein based) that helps adrenaline get into the body quickly. 

Intravail® has been used for years in other nasal spray medications, some of which are used to treat other medical emergencies. 

It is recommended to give a second dose of neffy® in the same nostril as the first dose. This is because the adrenaline is absorbed quicker due to the first dose containing Intravail®, which opens cells in the nose. However, if the second dose is given in the other nostril, neffy® will still be absorbed. 

Research trials only included giving one or two doses of neffy®. As per the ASCIA Action Plan for Anaphylaxis, immediately after the first dose of neffy® an ambulance should be called. If symptoms do not start to improve after 5 minutes, another dose of neffy® (or another adrenaline device) can be given while waiting for an ambulance. Continue to follow your ASCIA Action Plan and take the advice of emergency services.

Yes. If there is no response after 5 minutes, further adrenaline should be given. This adrenaline can be via nasal spray device or injector device. 

Yes, patients with a cold, runny or blocked nose can use neffy®. Research trials for neffy® included people with allergic rhinitis and upper respiratory tract infections (such as a virus or a cold).

Adrenaline should be used if a pregnant person is experiencing anaphylaxis. Their prescribed device or an available device should be given following instructions on the ASCIA Action Plan for Anaphylaxis or ASCIA First Aid Plan for Anaphylaxis.  

neffy® can be given if someone is unconscious or is having trouble breathing because the medicine is absorbed through the lining of the nose and not breathed in to the lungs.

The research trials for neffy® did not include people with nasal conditions like polyps or a deviated septum (middle of inside of nose). These issues are not expected to affect how well the adrenaline is absorbed. Patients with these conditions should speak with their doctor for more information. 

Research trials for neffy® did not include people with piercings in their nose. If someone has bulky nose piercings that stop a nasal spray from going into the nose neffy® will not work properly. Please contact CSL Medical Information 1800 642 865 for further information. 

Note: In an emergency, if neffy® is the only device available and the piercing which blocks the nostrils can be removed quickly, remove it and then give neffy®. 

The most common side effects reported in research trials were mild and included nose discomfort/pain, runny nose, headache, a fast heartbeat, and feeling shaky. Headache, fast heartbeat and feeling shaky are common after any dose of adrenaline. 

Virgin has announced that it plans to allow small cats and dogs on some domestic flights in the future. A&AA understand that these pets will need to be kept in a pet carrier that fits under the seat in front of the pet owner and will only be in certain rows of selected flights. More information can be found on the Virgin website Virgin Pet travel. If you have an allergy to cats and/or dogs, we recommend you consider whether you are comfortable travelling with Virgin once pets are allowed. Speak with your GP or allergy specialist about a treatment plan for travelling with cats/dogs on flights. If animals will be on your flight you may wish to take medication such as antihistamines prior to the flight. Make sure you have taken preventative nasal corticosteroid sprays or asthma inhalers leading up to the flight and always have asthma reliever inhalers with you and easily accessible (not in check-in luggage) on the flight.

Most airline terms of service say they are not responsible for any loss due to an anaphylaxis on board their aircraft. Further, some airlines require that passengers do not hold the airline responsible for any costs due to an allergic reaction. The conditions of flying with the airline are often agreed to at the time an airline ticket is purchased, regardless of whether the airline later asks that passengers sign an indemnity/waiver. If a passenger’s allergic reaction increases costs to the airline (for example, where the airline has to divert the aircraft), the passenger may have to pay these costs.

Passengers travelling with a food allergy should read the airline terms of service and conditions of travel (sometimes referred to as conditions of carriage) as these should explain whether the airline is willing to make any changes (for example wiping down the tray table) if not told in advance of passenger allergies, and whether the airline will refuse to accept responsibility for an anaphylaxis.

Each airline has its own policies and conditions which explain the changes they will make and the level of risk they will take on. It is important to review these policies before buying your ticket, as many of the rules will apply as soon as you buy your ticket. Airline policies will likely say whether a waiver/indemnity form is needed.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

You should travel with your ASCIA Action Plan for anaphylaxis and your ASCIA Travel Plan for people at risk of anaphylaxis.

Some airlines ask you to bring a letter or medical clearance from a doctor when flying with food allergy. Some airlines require you to complete a Medical Information Form (MEDIF) before the flight and get approval to fly. Some airlines require you to sign a waver. Check with your airline.

For more information see Airline policy comparison for food allergy

Take your own food. See Food for a long flight with allergies.

Keep adrenaline devices near you. Store your adrenaline devices and your ASCIA Action Plan for Anaphylaxis where you can easily reach them when you have your seatbelt on, such as under the seat in front of you or in your seat pocket.

Clean surfaces to remove any possible allergen to reduce the risk of an allergic reaction.

• Research shows that particles of food allergens, including peanuts, can be found on surfaces such as seats, trays, entertainment systems (TV screens) and seatbelts.² However, studies also tell us that cleaning all surfaces that you may touch with detergent is a good way to remove food allergens.² Wet wipes and soap-based cleansers are better than water. Many airlines let passengers with food allergies board the plane before other passengers so they can clean these surfaces before the rest of the passengers are allowed on.
• Hand sanitiser, which kills germs, does not remove food allergens from hands or surfaces.

Wear long pants and long sleeves. This limits skin contact with the seats, armrests and tray tables and may reduce the risk of becoming itchy.

Wash your hands. Wash your hands before eating. If you cannot go to the bathroom to do this, use disposable wipes.

Consider where you seat children with food allergies. It may be safer to sit them between parents or carers or in a window seat, where food is less likely to spill or fall on them. Think about what is best for your situation.

Things that may make you feel more comfortable but are not proven to reduce risk

Wear a mask. There is no evidence that people are at risk of anaphylaxis from breathing in food allergens on planes. Still, a mask may make people feel more comfortable and may make strong smells less worrying while others are eating.

Don’t eat while others are eating. Some people with food allergy feel more comfortable not eating at the same time as other people who may be eating food that they are allergic to.

^2. Turner P, Dowdall N. Flying with nut and other food allergies: unravelling fact from fiction. Arch Dis Child. Published online December 28, 2024. doi:10.1136/archdischild-2024-327848

People with peanut and tree nut allergy are sometimes worried about hundreds of people opening packets of peanuts or tree nuts at the same time. While some airlines choose not to serve peanuts or tree nuts as snacks, others do. If you are worried about this, you can contact the airline to ask whether they serve these snacks before buying your air tickets.

Research shows that the risk of anaphylaxis caused by inhaling food particles is extremely low.²

Can people with food allergy react to food particles in the air of the plane cabin?

Aerosolising means changing something like a food into particles small and light enough to be carried in the air. This does not happen easily with most food proteins.

A review that looked at all the recent studies of allergic reactions during flights found that reactions to airborne food particles are very rare.²

Aerosolisation of nut allergens from other passengers removing the shell of peanuts or other nuts and eating them has not been shown to cause anaphylaxis, even in small, closed-in spaces, like on a plane.²

However, allergen particles can stick to surfaces such as tray tables, screens and seat belts, for example.² If someone touches a surface that has an allergen on it, they could experience an allergic reaction. Most reactions caused by touching an allergen cause mild to moderate skin reactions that can be treated with antihistamines. Touch reactions rarely lead to anaphylaxis unless a contaminated hand is put in the mouth.

A study found that when 84 children with peanut allergy were put in a room and sat half a meter away from a bowl of peanuts for 30 minutes, there were no moderate to severe allergic reactions, and only two children (2%) had mild symptoms during the hour of observation sitting in the room near the bowl of peanuts.³

Studies show that peanut allergens that can be transferred through touch are more of a risk than the breathing in of nut particles in the air when other passengers eat nuts during a flight.²

Some people with food allergy do not like the smell of the food they are allergic to. This is the case for many people with peanut allergy, for example. Smelling peanut butter or satay can make them feel uncomfortable. However, the particles responsible for the smell are not the proteins that trigger allergic reactions. Wearing a face mask may reduce the smell of the allergen.

Can food allergens be spread through aircraft cabin ventilation systems?

Companies that make air filter systems, including those for planes, use HEPA filters that remove 99.97% of particles, including allergens. Air circulation in the cabin moves across the plane rather than along it and is also filtered many times. This helps prevent the spread of airborne particles.²

^2. Turner P, Dowdall N. Flying with nut and other food allergies: unravelling fact from fiction. Arch Dis Child. Published online December 28, 2024. doi:10.1136/archdischild-2024-327848

^3. Lovén Björkman S, Sederholm U, Ballardini N, et al. Peanuts in the air – clinical and experimental studies. Clin Exp Allergy. 2021;51(4):585-593. doi:10.1111/cea.13848

It’s not just peanuts and tree nuts that can trigger anaphylaxis. An allergy to any food for example milk, egg or wheat is just as serious as an allergy to peanut and tree nuts.

• Passengers can bring their own food on to a plane and this could include peanuts and tree nuts. The airline has no control over this.
• In some countries, peanuts and tree nuts are used in many foods. People from these countries who fly may want to eat foods they are used to when they travel.
• Food allergy is much less common in some countries and so some airlines do not think it is a priority
• In some countries, peanut and tree nut allergies are uncommon

Taking your own food is the safest option. Reasons for this include:

• Airline staff serving the meal are not aware of the manufacturing processes. They may not be able to provide passengers with all the correct information when asked questions about the food content.
• Many meals on flights now have allergens listed; however, common allergens and labelling laws vary between countries.
• Eating a meal on a plane is like eating out in a restaurant, mistakes can be made, and the meal may accidentally contain the allergen. However, there is a greater risk if something goes wrong during air travel, as there is no access to emergency care.
• Even if an airline does provide allergen free meals, there is a risk that a passenger with food allergies could either get the wrong meal or not get a meal at all if it is accidentally given to someone else.

Special meals for people with other dietary, religious and cultural needs (not food allergy) very rarely cause a life-threatening emergency if the wrong meal is served. It is not likely that a person’s physical health is greatly harmed from being served the wrong special meal. As a result, airlines are more likely to offer these special meals.

Some airlines do offer a nut fee meal. Even if a nut free meal is offered, we recommend you don’t eat it because:

• There is a risk that the passenger with food allergy will not get the right meal. Meals sometimes go missing or are given to another passenger by mistake. The passenger with food allergy could either get the wrong meal or not get a meal at all.
• There is no guarantee that the nut free meal will not accidentally contain nuts.

People can be allergic to any food, so nut free meals are not safe for people allergic to foods other than nuts.

Ingredient lists on packaged food help people make informed choices about whether to eat it. However, food labelling laws vary between countries, resulting in different rules on what must be included on a food label. If food is imported into Australia, it must be labelled according to Australian food law.

Language and translation challenges can also complicate matters when on an airline or in another country.  If a food is made in another country and served while outside of Australia or its airspace, Australian food labelling rules do not apply. 

Also, Precautionary Allergen Labelling (PAL) statements, such as “May contain” on packaged food are not regulated in Australia or in most other countries, so they are not enforceable under the law. In Australia, food manufacturers do not have to include a PAL statement on their packaged food, even if there is a risk of cross-contamination. While some manufacturers use formal risk assessments to help them decide whether to include a PAL statement, others do not. A&AA strongly advises people with food allergies not to eat any food with a PAL statement during air travel, even if they typically eat foods these foods, as it is hard to get medical help while in a plane.

Currently, the only adrenaline injector available in Australia is EpiPen® and EpiPen®Jnr.  

Anapen® 500 is unavailable and Anapen® 150 and 300 have been discontinued. 

From February 2026 neffy® 1mg and 2mg devices will be available on private prescription only. We anticipate they will become available on PBS prescription and over the counter in the future. 

If someone is experiencing anaphylaxis, an adrenaline device (injector or nasal spray) should be given. 

If the prescribed dosage or brand of adrenaline device is not available, any available adrenaline device should still be given using the following dosing guide. This includes any brand (Anapen® or EpiPen® or neffy®). 

Injector devices:

Nasal spray device

The below table shows the adrenaline device options available in Australia depending on the weight of the person. Your doctor or allergy specialist will discuss the most appropriate adrenaline device for you. 

More detailed information can be found at ASCIA’s Frequently Asked Questions on Adrenaline Devices.

Adrenaline injectors Anapen® and EpiPen® both have windows on the devices to check to see what the fluid (adrenaline) inside the injector looks like.   

The adrenaline nasal device neffy® does not have a window to check colour of the fluid.  

Check the colour of the fluid in the adrenaline injector when it is not an emergency, for example, check the fluid when you check the device expiry. A&AA recommends you routinely check your device to make sure it is still clear and not discoloured and has not expired.  

Adrenaline injectors with discoloured adrenaline or expired adrenaline devices do not work as well and should not be relied on to treat anaphylaxis. However, the most recently expired adrenaline device available should be used if there is no in-date device available. 

Adrenaline injectors 

Used and unused (and expired) adrenaline injectors contain a needle that can be dangerous if not handled carefully. They should never be thrown in the regular or recycling bin. 

• Unused, expired adrenaline injectors should be taken to a pharmacy for safe disposal. 

• Used adrenaline injectors should be safely disposed of in a sharps container. They can be given to ambulance or hospital staff so the dose given can be recorded before putting in a sharps container.  

When EpiPen® has been used, the orange needle shield extends to cover the needle. 

When Anapen® has been used, the needle is exposed and there is a risk of needle stick injury (accidentally pricking yourself or someone else with the needle). Information about how to safely store the Anapen® until it can be given to ambulance paramedics or hospital staff can be found on our Anapen® webpage.  

Adrenaline nasal spray 

• Unused, expired neffy® should be taken to a pharmacy for safe disposal. Do not put in the rubbish bin as it contains adrenaline 

• Used neffy® should be given to the ambulance or hospital staff so they can record the dose given. It can then be put in the rubbish bin. Do not recycle. 

RUM is the National Return and Disposal of Unwanted Medicines (also known as the RUM Project), which some pharmacies will use to dispose of medicines. 

It is very rare for something to go wrong with an adrenaline device. In an emergency where you are treating anaphylaxis, if the adrenaline device has not worked and you have another adrenaline device available, this should be used. Use the table above to check you are using an adrenaline device that is appropriate for the person’s age and weight. Call triple zero (000) for advice. 

If you find that your adrenaline device has not worked when you have tried to give it, we recommend you report this once the emergency has been managed. 

• Keep the device, take note of the serial number and expiry date, and take some photos of it. 
• Contact Allergy & Anaphylaxis Australia on 1300 728 000 for support 
• You may wish to report the problem yourself. You can do this through the Therapeutic Goods Administration (TGA) at Report a problem or side effect | TGA 
• Contact the manufacturer at: 
  • Anapen® – Arrotex 1800 195 055 
  • EpiPen® – Viatris 1800 931 625 
  • neffy® – CSL Seqirus 1800 008 275 

Adrenaline injectors (EpiPen®, Anapen®) are injected into the thigh muscle. There is no evidence that injecting the second dose of adrenaline into the same thigh muscle as the first dose is a problem. The most important thing is to follow the ASCIA Action Plan and give another dose of adrenaline after 5 minutes if there is no response. 

The adrenaline nasal spray, neffy®, is sprayed into the nostril. If a second dose is needed after 5 minutes, it is better to spray into the same nostril as absorption will be better. If, however, you spray the second dose into the other nostril, neffy® will still work.