#3-68E. Beyond the Needle: Intranasal Epinephrine for Acute Urticaria (J Allergy Clin Immunol Pract, 2026)

Are you looking for a rapid, needle-free alternative to manage acute flares in Chronic Spontaneous Urticaria (CSU) without resorting to systemic steroids? This episode delves into a pivotal Phase 2, randomized, placebo-controlled, cross-over trial evaluating the efficacy of ARS-2, a novel intranasal epinephrine spray. The study involved 21 adult patients experiencing CSU exacerbations and demonstrated that ARS-2 significantly reduced patient-reported pruritus and hive severity scores compared to placebo, with high tolerability. The critical clinical takeaway is the drug's rapid onset of action, providing significant symptom relief within 5 to 15 minutes, highlighting its potential as an immediate rescue therapy. However, critical appraisal is essential; the study's small sample size (n=21) and the specific exclusion of patients with cardiovascular history limit the generalizability of the safety data to a broader, comorbid population. For physicians, this research is significant as it points toward a future where patients might manage breakthrough symptoms non-invasively, potentially reducing the cumulative burden of corticosteroid use in urticaria management.

Citation: Bernstein DI, Talreja N, Casale TB, Li HH, Kaliner MA, Lowenthal R, Tanimoto S. Efficacy of epinephrine nasal spray in the treatment of urticaria. The Journal of Allergy and Clinical Immunology: In Practice. 2026. DOI: https://doi.org/10.1016/j.jaip.2026.02.010

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