Allergy And Asthma Proceedings[JOURNAL]
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200 papers
Breathing through the night: A meta-analysis of childhood asthma and obstructive sleep apnea in sleep-disordered contexts.
Zheng K, Zhao Y, Li J … +1 more , Chen X
Allergy Asthma Proc · 2026 May · PMID 42050836 · Publisher ↗
The study was to systematically evaluate the correlation between childhood asthma and obstructive sleep apnea (OSA). Several medical literature data bases were searched for studies published up to March 2025, by using t...
The study was to systematically evaluate the correlation between childhood asthma and obstructive sleep apnea (OSA). Several medical literature data bases were searched for studies published up to March 2025, by using the keywords "asthma" and "obstructive sleep apnea" and "child*." We included observational studies, children with OSA diagnosed polysomnography, clinical criteria, or validated tools; and asthma confirmed by physician diagnosis, medication use, or validated questionnaires and international code. Eleven studies were included that covered populations in the United States, Europe, and Asia. The pooled odds ratio (OR) for the association between childhood asthma and OSA was 1.66 (95% confidence interval [CI], 1.21-2.26; p < 0.001). Subgroup analysis by study design showed significant associations in cohort (OR 2.00 [95% CI, 1.35-2.96]) and cross-sectional (OR 1.55 [95% CI, 0.69-3.44]) but not in case-control studies (OR 0.85 [95% CI, 0.32-2.28]). Geographically, the association was strongest in America (OR 1.99 [95% CI, 1.35-2.96]) and Asia (OR 1.64 [95% CI, 1.19-2.25]), with a nonsignificant trend in Europe (OR 0.91 [95% CI, 0.34-2.42]). Sensitivity analyses directionally consistent with the results, and Egger's test (p = .587) indicated no significant publication bias. Childhood asthma is significantly associated with an increased risk of OSA, with sleep disorders likely exacerbating this relationship. Integrated screening and management strategies are warranted, particularly in high-risk regions such as America and Asia.
Recurrent full-body rash following chemotherapy initiation in a multiple myeloma patient.
Zhang K, Wangberg H
Allergy Asthma Proc · 2026 May · PMID 42050835 · Publisher ↗
Severe cutaneous adverse reactions are a spectrum of life-threatening immune mediated adverse drug reactions characterized by extensive skin involvement with the potential for organ injury. It is composed of four main en...
Severe cutaneous adverse reactions are a spectrum of life-threatening immune mediated adverse drug reactions characterized by extensive skin involvement with the potential for organ injury. It is composed of four main entities: drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. With prominent hypereosinophilia (>1500 eosinophils/µL), hypereosinophilic syndrome also warrants consideration, albeit rarely triggered by medications. In addition, there may also be concern for infectious etiologies, particularly in patients with notable travel history or immunosuppression. Herein, we present the case of a 65-year-old man with multiple myeloma who was started on several medications simultaneously for the induction of chemotherapy and who developed a full-body pruritic and maculopapular rash and peripheral eosinophilia 2-to-4 weeks after initiation of these medications. He had a recalcitrant course, which required multiple rounds of systemic steroids and other treatments. After a detailed history, physical examination, and additional investigation coupled with high clinical suspicion, a diagnosis, and treatment plan was made.
Comorbidity burden in patients with anaphylaxis: A 25-year nationwide population-based matched case-control study.
Magen E, Magen I, Merzon E … +5 more , Rahamim E, Green I, Golan-Cohen A, Vinker S, Israel A
Allergy Asthma Proc · 2026 May · PMID 42050834 · Publisher ↗
Anaphylaxis is a severe systemic hypersensitivity reaction that occurs in diverse clinical contexts. Its broader comorbidity profile in population-based settings has not been well characterized. The objective was to eva...
Anaphylaxis is a severe systemic hypersensitivity reaction that occurs in diverse clinical contexts. Its broader comorbidity profile in population-based settings has not been well characterized. The objective was to evaluate the prevalence and spectrum of comorbid diseases in patients with anaphylaxis compared with matched controls in a nationwide population. We conducted a retrospective population-based matched case-control study by using electronic health record data from a nationwide health maintenance organization in Israel between 2001 and 2024. Anaphylaxis cases were confirmed by manual chart review according to World Allergy Organization criteria with documented epinephrine treatment. The controls were matched on age, sex, and calendar time, and had no history of anaphylaxis. Baseline comorbidities documented at least 3 months before the index date were analyzed by using conditional logistic regression. Multiple comparisons were addressed by using false discovery rate adjustment. The study included 778 patients with anaphylaxis and 3112 matched controls. The patients with anaphylaxis had a significantly higher prevalence of atopic and allergic diseases, including asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, contact dermatitis, and chronic idiopathic urticaria. The composite atopic disease burden was markedly higher in the anaphylaxis group. Selected immune-mediated and cardiovascular conditions were also more prevalent, although the effect sizes were generally modest and several associations did not remain statistically significant after a multiple-comparison correction. An eliciting allergen was identified in 82.4% of the patients, with drugs as the most frequent triggers, followed by food and insect venom. Idiopathic anaphylaxis accounted for 17.6% of the patients. Baseline medication utilization was higher among the patients with anaphylaxis, particularly for allergic, respiratory, and gastrointestinal therapies. In this nationwide adult cohort, individuals with anaphylaxis demonstrated a higher prevalence of atopic disease and modest differences in selected systemic comorbidities compared with matched controls. These findings describe epidemiologic associations and do not imply causality. Further prospective studies are warranted.
Should we follow the penicillin allergy label trail in approaching patients with a sulfonamide allergy label?
Horn SR, Ghaffari G, Al-Shaikhly T
Allergy Asthma Proc · 2026 May · PMID 42050833 · Publisher ↗
A penicillin allergy label increases the risk of hospitalization, length of hospital stays, and even mortality rate. This recognition has led to recommendations for proactive evaluation of penicillin allergy and de-label...
A penicillin allergy label increases the risk of hospitalization, length of hospital stays, and even mortality rate. This recognition has led to recommendations for proactive evaluation of penicillin allergy and de-labeling efforts. Less is known about the impact of the sulfonamide allergy label (SAL), the second-most-common antibiotic allergy label, on morbidity and mortality of patients and the impact on the health-care system. Further, the approach to patients with an SAL is not well characterized. We aimed to review recent evidence that examined the association between an SAL and clinical outcomes, including health-care utilization. We also aimed to review the evolving approach to an SAL, including the incorporation of decision tools and identifying patient populations that may benefit from proactive evaluation. We performed a narrative review of the literature. There is increasing evidence that supports a negative impact for having an SAL on clinical outcomes. An SAL influences antibiotic prescription practices and is associated with an increased risk of opportunistic infections and urinary tract infections among recipients of solid organ transplantation and a small increase in the risk of complications from cystitis. The recent development and validation of the clinical decision tool, trimethoprim-sulfamethoxazole allergy clinical decision rule (SULF-FAST), and the proven feasibility and safety for direct oral challenge present an opportunity to offer proactive evaluation of individuals who might benefit from sulfonamide antibiotics such as individuals who are immunosuppressed, patients with recurrent urinary tract infections, or those with multiple antibiotic allergies. Proactive evaluation and de-labeling of sulfonamide allergy through direct oral challenge with trimethoprim-sulfamethoxazole could be considered in patients who are immunocompromised, patients with recurrent acute cystitis, and those with multiantibiotic allergy. Further research is needed to identify systematic hospital-wide interventions and to elucidate the benefit of such de-labeling on clinical outcomes.
Reply.
Gansert E, Estrada-Mendizabal RJ, Farley MM … +2 more , Voelker DH, Gonzalez-Estrada A
Allergy Asthma Proc · 2026 May · PMID 42050832 · Full text
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Treatment of eosinophilic esophagitis with immune modulating agents.
Pancholy N, Ghaffari G
Allergy Asthma Proc · 2026 May · PMID 42050831 · Publisher ↗
Eosinophilic esophagitis (EoE) is a chronic inflammatory and an immune-mediated condition diagnosed based on both clinical and pathologic findings. EoE has been identified as one of the leading causes of esophageal dysfu...
Eosinophilic esophagitis (EoE) is a chronic inflammatory and an immune-mediated condition diagnosed based on both clinical and pathologic findings. EoE has been identified as one of the leading causes of esophageal dysfunction worldwide. If untreated, EoE often follows a progressive course that leads to fibrosis and esophageal stricture and perforation. The use of biologic therapies that target specific pathways will help us understand the essential pathophysiologic steps in EoE, in addition to providing symptomatic treatment. In this narrative review, we review the potential targeted therapies of these cells and related pathways, the evidence of therapeutic benefit, and suggestions for future therapeutic approaches. An updated review of treatment options is necessary given deeper understanding of the pathogenesis and more recent advances in treatment since the consensus recommendations published in 2016. We sought to review the contemporary data with regard to treatment approaches in EoE, particularly through immune-modulating therapeutic approaches. The MEDLINE (PubMed) data base was queried by using specified search terms. Articles were selected based on their contribution to the understanding of how therapeutics for EoE, particularly those that modulate immunity play a role in the management of this disease. Among immune-modulating therapies for EoE, anti-interleukin (IL) 5/IL-5 Receptor (R) α and anti-IL-13/IL-4 Receptor (R) α therapies have the most accumulated clinical trial and safety data at this time. Other emerging immunologic targets that warrant discussion include thymic stromal lymphopoietin and Sialic acid-binding IG-like lectin 8 (Siglec-8). Furthermore, the contribution of fibroblasts and myofibroblasts to the pathogenesis of EoE also provides many potential therapeutic targets. Allergen-specific immunotherapies have shown variable benefit in the treatment of EoE. Immune-modulating therapies seem to be a promising avenue of the treatment of EoE; both established and emerging targets of therapy exist to manage this condition.
The medical management of chronic rhinosinusitis with nasal polyps and aspirin-exacerbated respiratory in the biologic age.
Buchheit KM
Allergy Asthma Proc · 2026 May · PMID 42050830 · Publisher ↗
The advent of biologic therapy for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) has allowed for substantial improvement in symptom control and reduction in medical resource utilization for patients...
The advent of biologic therapy for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) has allowed for substantial improvement in symptom control and reduction in medical resource utilization for patients with CRSwNP. CRSwNP is characterized by chronic symptoms (>12 weeks), including nasal congestion, hyposmia or anosmia, anterior or posterior mucopurulent drainage, and, in some patients, facial pain or pressure, with patients also having objective evidence of CRSwNP on nasal endoscopy or imaging. In Western countries, CRSwNP is most frequently marked by type 2 inflammatory cells and mediators, including tissue eosinophilia, T helper type 2 cells, group 2 innate lymphoid cells, locally produced immunoglobulin E, type 2 cytokines, and mast cell activation. Both CRSwNP and aspirin-exacerbated respiratory disease (AERD), an important, severe phenotype of CRSwNP, are associated with impairments in quality of life, medical resource consumption, and recurrent CRSwNP after functional endoscopic sinus surgery (FESS), with some patients requiring revision FESS. There are now four U.S. Food and Drug Administration approved biologics for treatment of CRSwNP, including dupilumab, omalizumab, mepolizumab, and tezepelumab, and more under investigation for the treatment of CRSwNP. Biologics have been shown to decrease nasal polyp size, improve sense of smell, reduce the need for systemic corticosteroids and FESS, and improve quality of life for patients with CRSwNP. In this review, I discuss guidelines for the treatment of CRSwNP and AERD in the biologic era, efficacy of biologic medications, and emerging real-world evidence for the use of biologic therapy for CRSwNP and AERD.
Utility of basophil activation tests in the diagnosis of cross-intolerance to nonsteroidal anti-inflammatory drug reactions.
Nguyen AQ, Nguyen HTN, Ho NT … +11 more , Vu MT, Pham YTH, Mai HT, Nguyen HHK, Hoang OT, Nguyen NTM, Chu HC, van Nunen S, Craig TJ, Nguyen TD, Nguyen DV
Allergy Asthma Proc · 2026 May · PMID 42050829 · Publisher ↗
Nonsteroidal anti-inflammatory drugs (NSAID) are the second most frequent cause of drug-induced hypersensitivity after β-lactam antibiotics. Diagnosing cross-intolerance reactions to NSAIDs remains challenging because co...
Nonsteroidal anti-inflammatory drugs (NSAID) are the second most frequent cause of drug-induced hypersensitivity after β-lactam antibiotics. Diagnosing cross-intolerance reactions to NSAIDs remains challenging because conventional allergy tests are not useful and drug provocation tests (DPT), the current criterion standard, are resource-intensive and carry risk of severe reactions. Basophil activation testing (BAT) has emerged as a potential ex vivo diagnostic alternative. This study aimed to evaluate the diagnostic utility of the BAT for cross-intolerance reactions to NSAIDs among Vietnamese patients, including the identification of optimal drug type, concentration, and cutoff values. This validation study used a case-control design that involved 38 patients previously diagnosed with cross-intolerance to NSAIDs and 34 healthy controls. The diagnosis of NSAID cross-intolerance was established according to the international consensus guidelines, based on a detailed clinical history and, when indicated, a DPT. Both groups underwent BAT by using two NSAIDs at two concentrations each: acetylsalicylic acid (ASA) at 1.25 mg/mL and 0.5 mg/mL, and ketorolac at 1.25 mg/mL and 0.5 mg/mL. Flow cytometric analysis was performed to assess basophil activation based on CD63 and CD203c expression. ASA 1.25 mg/mL showed the best BAT diagnostic performance for cross-intolerance, achieving 55.3% sensitivity and 91.2% specificity by using cutoffs of ≥4% activated basophils and stimulation index (SI) ≥ 1.5. BAT demonstrates moderate sensitivity but high specificity for NSAID cross-intolerance, particularly when ASA is used as the stimulant. These findings support BAT as a complementary confirmatory tool in selected patients at high risk, although negative results do not exclude hypersensitivity and DPT remains necessary when diagnostic confirmation is required. Further validation in clinically relevant populations is needed before routine clinical implementation.
Abstracts presented at the Western Society of Allergy, Asthma & Immunology, February 1-5, 2026, Wailea, Hawaii.
Allergy Asthma Proc · 2026 May · PMID 42050828 · Full text
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Exhaled breath condensate thymic stromal lymphopoietin, OX40 ligand, eotaxin, and interleukin-23 in children with atopic dermatitis and persistent wheeze.
Geyik C, Cansever M, Bektas F … +3 more , Dorterler K, Saraymen B, Tahan F
Allergy Asthma Proc · 2026 Mar · PMID 41840414 · Publisher ↗
Atopic dermatitis is a chronic inflammatory condition. It is estimated that 60% of children with severe atopic dermatitis will go on to develop asthma. This study aimed to assess the presence and extent of early airway i...
Atopic dermatitis is a chronic inflammatory condition. It is estimated that 60% of children with severe atopic dermatitis will go on to develop asthma. This study aimed to assess the presence and extent of early airway inflammation in infants with atopic dermatitis. A total of 73 infants aged <36 months were included in the study, which comprised a group with atopic dermatitis (n = 30), a group with persistent wheezing (n = 22), and a control group of healthy infants (n = 21). The subjects who exhibited persistent wheezing were selected according to the criteria set forth in the Asthma Predictive Index. Exhaled breath condensates (EBC) were collected via the R-tube method. The levels of thymic stromal lymphopoietin (TSLP), OX40 ligand (OX40L), eotaxin, and interleukin-23 (IL-23) in EBCs were determined by using enzyme-linked immunosorbent assay (ELISA). No statistically significant difference was observed in the levels of TSLP and OX40L in EBC among the groups. Eotaxin showed a directionally higher level in the persistent wheezing group; the difference was attenuated after age adjustment and Bonferroni correction but persisted in the 12-30-month sensitivity analysis (persistent wheezing group versus controls, p = 0.011, Bonferroni adjusted). The atopic dermatitis and persistent wheezing groups had lower EBC IL-23 levels than did the controls (age-adjusted analyses, p < 0.001). This study is among the first to quantify TSLP, OX40L, eotaxin, and IL-23 in EBCs from infants with atopic dermatitis, those with persistent wheezing, and healthy controls. Eotaxin levels were directionally higher in the persistent wheezing group than in the controls; however, this difference did not remain statistically significant after age adjustment and Bonferroni correction, and should be interpreted as suggestive rather than confirmatory of eosinophil-associated airway inflammation. In a 12-30-month sensitivity analysis, the persistent wheezing group had a higher natural log-transformed eotaxin concentration than did the controls (p = 0.011, Bonferroni adjusted), which supports this signal within a narrower age window. A lower EBC IL-23 level is biologically intriguing but should be interpreted cautiously given residual confounding and EBC variability.
Cow's milk protein allergy: A risk factor for infections in infants?
Kocatepe G, Uygun DFK, Ture S … +4 more , Velipasaoglu S, Yilmaz H, Erkan M, Bingol A
Allergy Asthma Proc · 2026 Mar · PMID 41840413 · Publisher ↗
Cow's milk protein allergy (CMPA) imposes a significant burden on the lives of infants and families and can cause various complications, but there are limited data on the clinical burden associated with infection. This...
Cow's milk protein allergy (CMPA) imposes a significant burden on the lives of infants and families and can cause various complications, but there are limited data on the clinical burden associated with infection. This study aimed to compare infection frequency, antibiotic use, and hospitalization rates between children with CMPA and healthy controls. Patients diagnosed with CMPA (IgE-mediated or non-IgE-mediated) in the pediatric allergy-immunology outpatient clinic and healthy infants admitted to the social pediatrics outpatient clinic were evaluated prospectively at initial visit, 6 months, and 12 months. Clinical characteristics, history of respiratory, skin, gastrointestinal, and urinary tract infections, antibiotic use, and hospitalization rates were analyzed. Compared to controls, the CMPA group had significantly lower prevalence and duration of exclusive breastfeeding (p < 0.001 for both) and significantly higher income (p = 0.035), presence of siblings (p < 0.001), household size (p < 0.001), rate of suburban dwelling (p = 0.008), and rate of atopic dermatitis (p = 0.003). Rates of infection (all systems), antibiotic use, and hospitalization were higher in the CMPA group compared to controls (p < 0.001 for all) and among patients with IgE-mediated CMPA compared to those with non-IgE-mediated CMPA (p < 0.05 for all). Respiratory and skin infections were more common and gastrointestinal infections were less common in IgE-mediated CMPA compared to non-IgE-mediated CMPA (p < 0.001 for all). CMPA (especially the IgE phenotype) was associated with increased infection frequency and severity in infants. These findings suggest the need for a more careful approach to infection risk in patients with CMPA and the importance of disease control.
Hypogammaglobulinemia during infancy and atopic dermatitis.
Griffin S, Fishbein J, Wetzel T … +2 more , Puglisi S, Ponda P
Allergy Asthma Proc · 2026 Mar · PMID 41840412 · Publisher ↗
Hypogammaglobulinemia during infancy (HI) is often transient, resolves with time, and typically does not associate with a specific immunologic deficiency. If hypogammaglobulinemia persists, then it may be secondary to an...
Hypogammaglobulinemia during infancy (HI) is often transient, resolves with time, and typically does not associate with a specific immunologic deficiency. If hypogammaglobulinemia persists, then it may be secondary to an immunologic disorder and be associated with significant clinically diagnosed infections. When phenotyping HI, any implications of associated atopic dermatitis (AD) can be clinically helpful. The purpose of this study was to explore the clinical and immunologic differences between patients who have HI and AD versus those with AD alone or with HI alone. We conducted a retrospective record review of patients with AD, HI with AD (HIcAD), and HI only seen in a large academic practice. Patient characteristics, comorbidities, clinical, and laboratory parameters as well as immunoglobulin G (IgG) at the last follow-up were noted. If HI resolved, then the age of resolution was noted. Data were analyzed by using the χ² test, Fisher exact test, Wilcoxon rank sum test, Monte Carlo estimates, and Kaplan-Meier product-limit curves, as appropriate. There was no significant difference in age of presentation, gender at birth, or number or type of clinically diagnosed infections among the groups, but there was a significant difference in the levels of IgG, IgA, IgM, and IgE. More children in the HIcAD group had high IgE levels, significantly higher leukocyte counts, eosinophil counts, T and B cell numbers, and severe AD, and resolved HI in the study period than in the HI-only group. Analysis of our findings suggests that infants with HIcAD are more likely to have severe AD, to resolve hypogammaglobulinemia, and to have immunologic dysregulation without increased clinically diagnosed infections.
What to do when your adult patient with severe asthma does not respond to a biologic.
Ledford DK
Allergy Asthma Proc · 2026 Mar · PMID 41840411 · Publisher ↗
Asthma management has been revolutionized by the introduction and expansion of biologic therapies. Since the approval of omalizumab for allergic asthma in 2003, six additional biologics with an asthma indication have bee...
Asthma management has been revolutionized by the introduction and expansion of biologic therapies. Since the approval of omalizumab for allergic asthma in 2003, six additional biologics with an asthma indication have been FDA-approved, and several more are in late-phase development. The clinical challenge is that all of these therapies reduce exacerbations, but asthma exacerbations are difficult to predict. A subgroup of 20-40% of biologic-treated patients will achieve asthma remission, or near remission depending on the criteria used, during biologic therapy, an ideal outcome. For the remaining 60-80% of treated patients, the benefits are evident but usually less defined or quantifiable. Symptoms often improve, but patient-reported outcomes lack precision to verify efficacy. All biologic therapies reduce exacerbations by an average of 50%; they do not eliminate exacerbations for most patients. In long-term, unblinded, safety trials, the majority of treated subjects have zero to one exacerbation per year. Thus, for an individual patient, assessing response and predicting response can be problematic, and strategies for addressing suboptimal responses are not standardized. This article summarizes a potential approach to use when biologic therapy in adults with asthma is, or appears to be, insufficiently effective. The major points are: 1) set expectations prior to therapy to facilitate decision making and do not expect remission or near remission depending on criteria used; 2) reassess the source of symptoms and findings with the possibility that the asthma diagnosis is not accurate or co-morbidities are the major contributors to the clinical presentation; 3) evaluate adherence with both small molecule therapy (i.e. inhaled controller therapy) and with the biologic regimen if administered in-home; 4) change the biologic to an alternative biologic, generally affecting a different pathway. This strategy is not a guarantee of success but may assist in clinical decision-making.
From molecular pathways to meaningful patient management: Navigating complexity in allergy and immunology.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2026 Mar · PMID 41840410 · Full text
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Comprehensive assessment of allergic manifestations including drug hypersensitivity in adult patients with inborn errors of immunity.
Korkmaz P, Toprak ID, Demir S … +16 more , Yegit OO, Kahveci N, Hormet Igde M, Celik Kamaci S, Aslan AF, Atasever MD, Eyice Karabacak D, Sezgin ME, Guzel SE, Kaya E, Erden B, Kilinc Z, Imren Aksit IG, Bolek L, Unal D, Gelincik A
Allergy Asthma Proc · 2026 Mar · PMID 41840409 · Publisher ↗
The determination of the prevalence and clinical relevance of allergic manifestations in individuals with human inborn errors of immunity (IEI) remains inadequately established. Here, our objective was to assess the alle...
The determination of the prevalence and clinical relevance of allergic manifestations in individuals with human inborn errors of immunity (IEI) remains inadequately established. Here, our objective was to assess the allergic manifestations observed in patients diagnosed with IEI. We evaluated allergic manifestations, including rhinitis, asthma, dermatitis, and venom, drug, and food allergies, in 220 adult patients with IEI. T and B cell subsets, the timing of allergy onset, skin test results, and drug hypersensitivity tests were assessed by using medical records and follow-up data. Antibody deficiencies accounted for 85.9% of the cohort. Allergic rhinitis was the most frequent manifestation (21.8%), followed by asthma (15.9%), atopic dermatitis (12.3%), and drug hypersensitivity (10.9%). Food allergy was rare (0.9%), and no venom allergy was identified. Severe asthma was observed in two patients. Bronchiectasis was more frequent in the patients with asthma versus patients without asthma (28.6% versus 14.4%; p = 0.03). Asthma was more prevalent among patients receiving prophylactic antibiotics (34.1% in those receiving prophylactic antibiotics versus 11.7% in those not receiving prophylactic antibiotics; p = 0.001), and prophylaxis was more common in patients with asthma receiving treatment steps 3-5 than steps 1-2 (57.8% in patients at steps 3-5 versus 18.7% in patients at steps 1-2; p = 0.02). Among 28 drug hypersensitivity reactions in 24 patients (from 47 initially reported cases of patients after exclusion of predictable adverse reactions), immediate-type reactions predominated (78.6%), most commonly urticaria and anaphylaxis (each 21.4%). Among patients with allergic disease, 62% were diagnosed with allergy before IEI. The median (interquartile range) age at the IEI diagnosis was 28 years (18-38 years), and IEI diagnostic delay did not differ by allergy status. The interval between allergy and IEI diagnosis was longer when allergy preceded IEI (median 10 years; p = 0.01). Adult-onset asthma was associated with a higher age at IEI diagnosis (p = 0.004). Aeroallergen sensitization was associated with higher total, memory, and switched memory B cell counts (all p ≤ 0.01) and a higher switched memory B cell proportion (p = 0.04). Allergic manifestations are common in adults with IEI and often occur years before the diagnosis of immunodeficiency. Adult-onset asthma was associated with a higher age at IEI diagnosis, which suggests delayed recognition of underlying immune dysfunction in this subgroup. In addition, aeroallergen sensitization was associated with higher B cell subset counts, which highlights immunologic heterogeneity among adults with allergy and with IEI.
Breaking barriers: A communication bundle for penicillin allergy label removal.
Ray K, Al-Zubaidi K, Seward S … +3 more , Liegl M, Pan AY, Mitchell ML
Allergy Asthma Proc · 2026 Mar · PMID 41840408 · Publisher ↗
Many barriers exist in disseminating the results of successful penicillin allergy delabels and preventing relabels. This study used electronic faxing to directly communicate the completion of successful direct oral chal...
Many barriers exist in disseminating the results of successful penicillin allergy delabels and preventing relabels. This study used electronic faxing to directly communicate the completion of successful direct oral challenges in children hospitalized or in the emergency department to outpatient pharmacies and out-of-network primary care providers. This communication led to a decreased rate of the penicillin allergy label presence in pharmacy records, from 32% (36/112) to 12% (16/136) (p < 0.001). In conjunction with more conventional discharge communication mechanisms, allergy removal rates improved, from 61% (19/31) to 90% (18/20) (p = 0.029) for out-of-network primary care providers. This study demonstrated that the reliable, simple, and time-efficient direct communication between independent health-care systems and pharmacies can be successful when implemented in a streamlined bundled approach.
Vaccinating patients on biologics for atopic disease: Clinical considerations and evidence-based recommendations.
Chase NM
Allergy Asthma Proc · 2026 Mar · PMID 41840407 · Publisher ↗
Biologics that target type 2 inflammation have transformed the management of atopic diseases, but questions remain with regard to vaccine administration in these patients. Current product labeling recommends caution with...
Biologics that target type 2 inflammation have transformed the management of atopic diseases, but questions remain with regard to vaccine administration in these patients. Current product labeling recommends caution with vaccine administration in patients taking these medications, particularly live-attenuated vaccines, despite limited evidence of actual risk. The objective was to review clinical concerns and available evidence, and to provide practical recommendations for vaccination in patients receiving biologics for atopic diseases, with a focus on dupilumab. A comprehensive PubMed/MEDLINE literature search was conducted to identify relevant studies and clinical guidance with regard to vaccination strategies in patients receiving biologic therapy. The primary search terms included the following: "biologic therapy" or "biologic therapy" or "monoclonal antibodies" combined with "vaccination" or "immunization" or "vaccine response" or "live vaccines" or "inactivated vaccines." Priority was given to randomized controlled trials, large observational studies, and registry data published within the past 10 years. For non-live vaccines, evidence supports safety and efficacy, although results of some studies suggest moderately reduced responses. A randomized controlled trial found comparable antibody responses between dupilumab and placebo groups for tetanus (83.3% versus 83.7%) and meningococcal vaccines (86.7% versus 87.0%). Coronavirus disease 2019 (COVID-19) vaccine studies show mixed results, with some reporting lower antibody levels and neutralization capacity in patients on biologics. For live-attenuated vaccines, emerging evidence challenges traditional prohibitions. Current evidence supports the safety and efficacy of non-live vaccines in patients receiving biologics for atopic diseases, although responses may be moderately reduced. Analysis of emerging data suggests certain live-attenuated vaccines may be safer than previously thought, particularly in pediatric patients on dupilumab. Vaccination decisions should be individualized based on risk-benefit assessment. Further research is needed to establish definitive guidelines, particularly for live vaccines and long-term immunity.
Mosquito bite hypersensitivity in children: Clinical features outweigh specific IgE in diagnosis.
Dolu KO, Unay IF, Tepe Y … +5 more , Baser Sinoplu ZE, Karavaizoglu C, Karimov EY, Cinar HU, Akar HH
Allergy Asthma Proc · 2026 Mar · PMID 41840406 · Publisher ↗
Mosquito bite hypersensitivity results from abnormal immune responses to salivary proteins with potent immunomodulatory properties. In children, both type I (immunoglobulin E [IgE] mediated) and type IV (cell mediated) m...
Mosquito bite hypersensitivity results from abnormal immune responses to salivary proteins with potent immunomodulatory properties. In children, both type I (immunoglobulin E [IgE] mediated) and type IV (cell mediated) mechanisms contribute to the reaction spectrum, ranging from localized erythema to extensive inflammatory lesions. Although mosquito-specific IgE assays are commercially available, their diagnostic utility and correlation with clinical severity remain unclear. The objective was to describe the clinical and immunologic characteristics of children with mosquito hypersensitivity, evaluate the diagnostic relevance of mosquito-specific IgE, and explore associations with atopic background. A retrospective study was conducted on 206 children who underwent mosquito-specific IgE testing between June 2023 and June 2025. The mosquito allergy group included children with large local reactions, prolonged lesions, or systemic symptoms; the controls had typical reactions only. Clinical features, atopic comorbidities, total IgE levels, eosinophil percentages, and inhalant sensitizations were compared between the groups. Atopic diseases were significantly more common in the mosquito allergy group versus the controls (87.0% versus 52.7%; p < 0.001). Mosquito-specific IgE positivity was low and similar across the groups (mosquito allergy group 6/77 [7.8%] vs controls 13/129 [10.1%]; p = 0.63), which showed no correlation with reaction type, duration, or severity. The total IgE levels were significantly higher in the mosquito allergy group (p = 0.045). The most frequent lesions were erythematous papules (88.3%) and immediate wheals (89.6%), whereas bullous lesions were rare (7.8%) and self-limited. Quality of life was mainly affected by avoidance of outdoor activities (16.9%) and psychological distress (15.6%). In pediatric mosquito hypersensitivity, clinical assessment outweighs mosquito-specific IgE testing for diagnosis. Despite the strong association with atopy, specific IgE positivity remains low, which supports the primacy of clinical history and lesion morphology in diagnostic decision-making.
Real-world quality of life in patients with hereditary angioedema receiving lanadelumab or other long-term prophylaxis.
Davis-Lorton M, Soteres D, Lumry WR … +6 more , Hall J, Connolly H, Fox D, Sing K, Schultz BG, Juethner S
Allergy Asthma Proc · 2026 Mar · PMID 41840405 · Publisher ↗
Hereditary angioedema (HAE) is a rare, potentially fatal genetic disorder characterized by unpredictable attacks of bodily swelling that substantially impair patients' quality of life (QoL). Lanadelumab is approved for l...
Hereditary angioedema (HAE) is a rare, potentially fatal genetic disorder characterized by unpredictable attacks of bodily swelling that substantially impair patients' quality of life (QoL). Lanadelumab is approved for long-term prophylaxis (LTP) in patients with HAE; however, there are limited real-world data that compare lanadelumab with other treatments to guide patient care. The objective was to describe real-world QoL and related outcomes of patients with HAE who received lanadelumab versus other LTP. Data were drawn from a real-world, cross-sectional survey of physicians and their consulting patients with HAE in the United States from January 2023 to January 2024. Physician-reported attack and disease severity, pain, fatigue, QoL, and patient-reported outcomes were compared among patients receiving lanadelumab or other LTP. Physicians reported data on 86 patients treated with lanadelumab and 84 treated with other LTP. A statistically significantly higher proportion of patients receiving lanadelumab had no chronic pain (58.1%) and no chronic fatigue (51.2%) at the time of the survey than those receiving other LTP (38.1% [p = 0.0023] and 34.9% [p = 0.0037], respectively). More patients receiving lanadelumab had "very good" physician-reported QoL and less patient-reported QoL impairment at the time of the survey compared with those receiving other LTP (p = 0.0102). A higher proportion of patients receiving lanadelumab compared with other LTP reported complete satisfaction overall with their treatment (30.2% versus 17.9%, respectively; p = 0.0144) and complete satisfaction with the efficacy of their treatment (44.2% versus 11.9%, respectively; p < 0.0001). In this real-world study, physicians reported a higher proportion of patients receiving lanadelumab had no chronic pain or fatigue compared with those receiving other LTP. Both physicians and patients reported higher QoL in those receiving lanadelumab. Continued real-world research in patients with HAE to further assess the effect of lanadelumab on QoL will help guide patient care.
Comparison of clinical characteristics in primary immunodeficiency patients based on the presence of autoimmunity or autoinflammation.
Kolak S, Çölkesen F, Gerek ME … +4 more , Sağun F, Harman E, Savaş ŞA, Arslan Ş
Allergy Asthma Proc · 2026 Mar · PMID 41840404 · Publisher ↗
Autoimmunity and autoinflammation are increasingly recognized manifestations of immune dysregulation in patients with primary immunodeficiency (PID), alongside recurrent infections. The objectives were to determine the...
Autoimmunity and autoinflammation are increasingly recognized manifestations of immune dysregulation in patients with primary immunodeficiency (PID), alongside recurrent infections. The objectives were to determine the prevalence of autoimmune and autoinflammatory findings in patients with PID and to compare their clinical, laboratory, and immunologic characteristics. This retrospective study included 130 adult patients with PID who were followed up at a tertiary university immunology clinic. The patients were divided into three groups: those without immune dysregulation (group 1), those with predominant autoimmune features (group 2), and those with predominant autoinflammatory features (group 3). Demographic data, laboratory parameters, immunoglobulin levels, lymphocyte subsets, switched memory B cells, and genetic mutation data were analyzed. Autoimmune manifestations were predominant in 32.3% and autoinflammatory findings were predominant in 9.2% of the patients. The patients in group 3 showed significantly elevated C-reactive protein, erythrocyte sedimentation rate (ESR), and fibrinogen levels (p < 0.05). Of the patients in group 2, the platelet count, serum immunoglobulin E (IgE) level, and switched memory B cells were significantly lower compared with other groups (p = 0.001, p = 0.007, p = 0.005, respectively). There were no significant differences in genetic mutation frequency or mortality among groups. Autoimmunity and autoinflammation are frequent in PID and associated with distinct immunologic profiles. Elevated acute phase reactants may indicate autoinflammation, whereas low IgE levels and decreased switched memory B cells may serve as early markers of autoimmunity. Routine evaluation for immune dysregulation in patients with PID is recommended.
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