#4-79E. The Resilient Rescue: Superior Stability of Intranasal Epinephrine (JACI In Pract, 2026)

Have you ever had patients express anxiety about maintaining the correct temperature for their epinephrine auto-injectors during sweltering summer or freezing winter months? Today, we discuss "Stability of epinephrine nasal spray under room temperature, freeze-thaw, and extreme temperature conditions," a pivotal study evaluating a novel intranasal epinephrine formulation. The researchers demonstrated that the intranasal spray maintains its potency for up to 24 to 30 months at room temperature and successfully withstands extreme environmental stress, including repeated freeze-thaw cycles and prolonged exposure to 50°C heat. The most striking and clinically significant finding is that this intranasal formulation exhibits markedly superior thermal stability compared to traditional syringe- and cartridge-based auto-injectors, which suffered significant degradation under identical heat conditions. However, when critically appraising this paper, clinicians must remain mindful of potential bias: the study was entirely funded by the manufacturer, ARS Pharmaceuticals, and several authors, including the corresponding author, are company employees. Despite these conflicts of interest, these findings are highly relevant for our daily practice. Prescribing a highly stable, needle-free option could significantly alleviate the strict temperature management burden for our patients, ultimately improving adherence to carrying life-saving emergency medication and ensuring its efficacy during critical anaphylactic events.

Citation: Dorsey, BT., Golden, DBK., Silvers, SK., Bansal, P., Lowenthal, R., Burrell, B., Tanimoto, S. Stability of epinephrine nasal spray under room temperature, freeze-thaw, and extreme temperature conditions. The Journal of Allergy and Clinical Immunology: In Practice. 2026. DOI: 10.1016/j.jaip.2026.05.034

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.