AFP: American Family Physician Podcast Episode 249 | March 2026 | Part 1 American Family Physician
Mar 16, 2026
A quick look at intranasal epinephrine as a needle-free option for anaphylaxis. Clear distinctions between acute hives and chronic urticaria with stepwise treatment approaches. New bleeding risk tools for very old patients on DOACs. Practical meningitis diagnosis and early treatment priorities. Evidence supporting mailed FIT for colorectal screening. Topical fluoride benefits and minor fluorosis tradeoffs.
AI Snips
Chapters
Transcript
Episode notes
Intranasal Epinephrine Is A Viable Needle-Free Option
- Intranasal epinephrine (NEFI) is an evidence-backed alternative to IM autoinjectors for patients 4 years and older who refuse needles.
- Pharmacokinetics/pharmacodynamics in healthy subjects are similar to autoinjectors, but no direct studies exist in active anaphylaxis.
Start Urticaria With High Dose Second Generation Antihistamines
- Treat acute urticaria first with a second-generation H1 antihistamine and increase dose up to fourfold if needed.
- Avoid NSAIDs (they can worsen urticaria) and note topical therapies provide no benefit.
Step Up To Omalizumab After Antihistamine Failure
- For chronic spontaneous urticaria refractory to high-dose second-generation antihistamines, add a first-generation antihistamine or leukotriene antagonist, and refer if symptoms persist.
- Consider omalizumab for antihistamine-refractory disease per FDA approval.