Allergy And Asthma Proceedings[JOURNAL]
Sun
200 papers
Rethinking the management of hereditary angioedema.
Busse P, Wilson K, Farkas H … +6 more , Fishel S, Athavale A, Silber A, Goldman E, Miller C, Nambiar S
Allergy Asthma Proc · 2026 Mar · PMID 41698689 · Publisher ↗
Hereditary angioedema with C1INH deficiency (HAE-C1INH) is a rare, debilitating genetic disorder characterized by recurrent, unpredictable attacks. Although treatments exist, patients with HAE still alter their lives to...
Hereditary angioedema with C1INH deficiency (HAE-C1INH) is a rare, debilitating genetic disorder characterized by recurrent, unpredictable attacks. Although treatments exist, patients with HAE still alter their lives to avoid triggers and experience substantial physical, psychosocial, and financial burdens. To estimate the burden that HAE-C1INH patients experience despite currently approved therapies, aiming to identify unmet needs related to HAE, its therapies and the ability to achieve normalization of life. A web-based survey was conducted from March to April 2025 among 100 US adults with HAE-C1INH currently receiving long-term prophylaxis and/or on-demand therapies. Responses captured attack frequency, the impact of living with HAE, avoidance of attack triggers, and the patients' unmet needs. Descriptive statistical analysis was conducted. Even with treatment, 80% of respondents reported ≥1 HAE attack in the past year and 61% thought about HAE at least weekly. Mental health was the aspect that respondents felt was most impacted by HAE (54% of respondents), and 73% reported taking ≥2 measures to avoid attack triggers. Several concerns impacted the ability to reach normalization; lifetime use of medication was the most commonly reported concern (68% of respondents). The greatest unmet needs associated with long-term prophylaxis were cost- and access-related. Substantial unmet needs related to disease control and achieving normalization remain for patients with HAE-C1INH, despite existing treatments. This study re-enforces the need to not only assess the frequency and severity of attacks, but also the psychosocial, mental, logistical, and financial burden of lifelong management of HAE-C1INH in clinical practice.
Incorrect perceptions of first-line treatment of severe allergic reactions with over-the-counter products and how the epinephrine drug delivery system impacts behavior.
Tachdjian R, Chase N, Burnette A … +3 more , Kaufman D, Tanimoto S, Kafal A
Allergy Asthma Proc · 2026 Jan · PMID 41514192 · Publisher ↗
Epinephrine is the first-line treatment for anaphylaxis, a potentially life-threatening allergic reaction. Despite this, real-world epinephrine use remains suboptimal. In this survey study of patients and caregivers of...
Epinephrine is the first-line treatment for anaphylaxis, a potentially life-threatening allergic reaction. Despite this, real-world epinephrine use remains suboptimal. In this survey study of patients and caregivers of patients with anaphylaxis, the objective was to characterize real-world use of over-the-counter (OTC) medications alone or before epinephrine and to evaluate factors inherent to epinephrine delivery devices in contributing to delayed epinephrine use. Participants included U.S. patients (n = 100) and caregivers of patients with immunoglobulin E (IgE) mediated allergy (n = 100) who used an epinephrine autoinjector (EAI) in the past 12 months. A double-blind online survey evaluated allergy history, management of severe allergic reactions, and reasons for delaying epinephrine use. Most respondents reported using OTC medications alone (88%) or before using an EAI (89%) to manage allergic reactions. During their most recent reactions, 42% of the respondents delayed or hesitated to use an EAI, with an average of 8.8 minutes before administration. The most impactful factor that contributes to delayed EAI use was concern about the device needle. Respondents who reported using OTC medications to manage most allergic reactions estimated that they would use needle-free epinephrine over OTC medications approximately three-fourths of the time. Despite potential risks of delaying using epinephrine, OTC medications are commonly used alone or before epinephrine use. Given the concerns about device needles identified in this survey, needle-free epinephrine offers an alternative to EAIs.
Scroll, like, diagnose? Evaluating mast cell activation syndrome information on TikTok.
Gansert E, Estrada-Mendizabal RJ, Farley MM … +2 more , Voelker DH, Gonzalez-Estrada A
Allergy Asthma Proc · 2026 Jan · PMID 41514191 · Publisher ↗
One in five Americans turn to TikTok before calling their own physician. With social media on the rise as a source of health-related information, we aimed to investigate and evaluate popular content about mast cell acti...
One in five Americans turn to TikTok before calling their own physician. With social media on the rise as a source of health-related information, we aimed to investigate and evaluate popular content about mast cell activation syndrome (MCAS) on TikTok. Between June 14 and 16, 2024, four different MCAS-relevant phrases were searched on TikTok, and the top 50 most watched videos were analyzed independently by three subinvestigators. The global quality score (GQS) (range from 1 to 5) was applied to assess the value of the educational videos. The profession of the content creator, use of MCAS Vienna diagnostic criteria, association with postural orthostatic syndrome (POTS)/Ehlers Danlos syndrome (EDS), and information trends were also analyzed. The 50 most watched MCAS-related videos collectively had > 6.5 million views, and the average number of views per video was 131,500. Most videos were created by health-care professionals (58%), including physicians (26%) and other health-care professionals (32%), whereas the minority were created by non-health-care professionals (42%). Only one video included the MCAS Vienna criteria (2%), and 12 videos associated MCAS with POTS and/or EDS (24%). The average GQS was 1.94 (SD 0.34). Common MCAS misinformation trends included the following: inaccuracy of symptoms, diagnostic criteria, triggers, and treatment options. Most MCAS videos on TikTok contained misinformation, did not include key diagnostic criteria, and had poor GQS. The most viewed videos were primarily created by health-care professionals. Patients and health-care providers need to be aware of the quality of health-care information on social media.
House dust allergens of children with newly diagnosed hazelnut or sesame allergy.
Hakverdi O, Ocak M, Sahiner UM … +2 more , Soyer O, Sekerel BE
Allergy Asthma Proc · 2026 Jan · PMID 41514190 · Publisher ↗
Hazelnut and sesame are among the leading causes of immunoglobulin E mediated food allergies in the eastern Mediterranean region. Notably, initial allergic reactions often occur on the first known oral exposure, which su...
Hazelnut and sesame are among the leading causes of immunoglobulin E mediated food allergies in the eastern Mediterranean region. Notably, initial allergic reactions often occur on the first known oral exposure, which suggests a potential role of non-oral routes of sensitization, including environmental exposure. The study aimed to investigate the presence of environmental hazelnut and sesame allergens. House dust samples were collected from the homes of children newly diagnosed, previously diagnosed, and nonallergic (control) with or without hazelnut or sesame allergy. A total of 57 and 63 house dust samples were analyzed for hazelnut and sesame allergens, respectively. In the hazelnut allergy group, newly diagnosed patients had a significantly higher rate of detectable hazelnut antigen (53%) compared with both previously diagnosed (20%) and control (15%) groups (p < 0.001 for both comparisons). Moreover, the amount of hazelnut antigen was higher in the newly diagnosed group compared with controls (median [interquartile range {IQR}] 0.1 µg/mL [0-0.8 µg/mL] versus 0.0 µg/mL [0-0 µg/mL]; p < 0.001). For sesame allergy, the previously diagnosed group had lower rates of detectable antigen (55%) compared with the newly diagnosed (74%) and control (100%) groups (p < 0.001 for both). In addition, the quantity of sesame antigen was higher in the control group compared with the previously diagnosed group (median [IQR] 1.41 µg/mL [0-1.085 µg/mL] versus 0.39 µg/mL [0.882-3.645 µg/mL]; p < 0.001). Notably, within the control homes, sesame antigen was detected more frequently (100% versus 15%) and in greater amounts (median [IQR] 1.21 µg/mL [0.88-3.64 µg/mL] versus 0.0 µg/mL [0-0 µg/mL]) versus hazelnut antigen. The detection of hazelnut and sesame allergens in household dust, particularly at higher rates and quantities in the environments of patients with newly diagnosed allergy, supports the potential role of environmental exposure in the development of these food allergies. Further studies are needed to clarify the timing, dose, and clinical relevance of such exposures in sensitization pathways.
An infant with chronic relapsing urticaria.
Gard CN, Blase J, Speck A
Allergy Asthma Proc · 2026 Jan · PMID 41514189 · Publisher ↗
Chronic urticaria in children can be related to viral infections, physical stimuli, autoimmune representation, autoinflammatory, or idiopathic. The cause of chronic urticaria, however, is rarely identified. We present a...
Chronic urticaria in children can be related to viral infections, physical stimuli, autoimmune representation, autoinflammatory, or idiopathic. The cause of chronic urticaria, however, is rarely identified. We present a case of a 7-month-old girl with persistent urticaria that started at age 5 months, with poor response to H1 and H2 blockade, with a focus on identifying probable causes of her chronic urticaria. This case highlights the importance of an urticaria history and considerations for a broader evaluation given the clinical characteristics and patient's age.
Global, regional, and national burden of asthma and risk factors from 1990 to 2021: Global Burden of Disease study 2021.
Qi H, Jiao N, Qi Y … +4 more , Sun Y, Zhang X, Li X, Yang F
Allergy Asthma Proc · 2026 Jan · PMID 41514188 · Publisher ↗
Asthma remains a substantial global health challenge, whereas epidemiologic data beyond 2019, particularly in the post-coronavirus disease 2019 era, are limited. This study aimed to provide a comprehensive view of the te...
Asthma remains a substantial global health challenge, whereas epidemiologic data beyond 2019, particularly in the post-coronavirus disease 2019 era, are limited. This study aimed to provide a comprehensive view of the temporal and spatial trend of asthma burden and its attributable risk factors from 1990 to 2021. By using data from the Global Burden of Disease 2021 study, we analyzed the global, regional, and national trends in asthma incidence, deaths, and disability-adjusted life years (DALY) from 1990 to 2021. The smoothing splines models were applied to assess the relationship between the asthma burden and the sociodemographic index (SDI). An age-period-cohort (APC) model was used to study the detailed trend, and risk factor contributions were quantified. Globally, asthma showed a favorable downward trend of incidence, deaths, and DALYs from 1990 to 2021. A negative correlation was found between SDI and the asthma burden. The APC analysis showed a relative high incidence rate in childhood and a high death rate in the elderly. A favorable period and cohort effect was observed. High body mass index has surpassed smoking as the leading risk factor for asthma-related deaths and DALYs. Although the asthma burden declined from 1990 to 2021, the overall issue with national and regional discrepancies persists. The shift in the leading risk factor necessitates targeted public health policies and interventions to effectively mitigate its impact.
Unmasking multifactorial dermatitis: The case for comprehensive diagnostic guidelines in adult atopic dermatitis.
Patin E, Murase EM, Kourosh AS … +1 more , Murase JE
Allergy Asthma Proc · 2026 Jan · PMID 41514187 · Publisher ↗
Eczematous dermatitis is a heterogeneous group of inflammatory skin disorders characterized by pruritus, erythema, and scaling. The most common subtype is atopic dermatitis (AD), which has a continuously rising prevalenc...
Eczematous dermatitis is a heterogeneous group of inflammatory skin disorders characterized by pruritus, erythema, and scaling. The most common subtype is atopic dermatitis (AD), which has a continuously rising prevalence, particularly within industrialized regions, e.g., the United States. Distinguishing AD from other dermatoses, particularly among adult patients with recalcitrant disease, can be challenging. Conditions such as allergic contact dermatitis may mimic or coexist with AD, which complicate both diagnosis and management. This diagnostic complexity has been unmasked with the introduction of targeted biologic therapies, including interleukin (IL) 4, IL-13, and IL-31 inhibitors, which have brought meaningful advances to the treatment landscape but also demands greater diagnostic precision. In this context, failure to identify overlapping or alternative conditions may delay optimal patient management or result in unnecessary therapeutic escalation to systemic agents, some of which have notable risk profiles. This review highlights the critical need for comprehensive diagnostic guidelines for the evaluation of adults with presumed AD, particularly those who exhibit an incomplete response to therapy. Diagnostic tools such as biopsies, cultures, laboratory studies, and expanded series patch testing have the potential to reveal underlying or comorbid conditions that fundamentally alter management strategies. With evidence that substantiates that a majority of patients with AD and with residual dermatitis on biologic therapy test positive for relevant contact allergen(s) on expanded series patch testing, the Clear, Patch, Avoid, and Treat strategy exemplifies a practical, stepwise framework for evaluating treatment-resistant eczematous dermatitis, which reinforces the clinical value of early diagnostic assessment and allergen avoidance. Establishing clear, evidence-based protocols is essential to support dermatologists and allergists in delivering individualized, high-quality care. In the absence of such guidelines, a methodical and comprehensive diagnostic approach remains the best tool to improve outcomes and reduce the burden of misdiagnosis in patients with complex or treatment-resistant dermatitis.
Across the arc of allergy: From maternal immune tolerance to food sensitization pathways and lifesaving anaphylaxis care.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2026 Jan · PMID 41514186 · Full text
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Risk of developing eosinophilic esophagitis with preexisting asthma, allergic rhinitis, atopic dermatitis, or food allergy.
Haber C, Al-Shaikhly T, Jhaveri P
Allergy Asthma Proc · 2026 Jan · PMID 41514185 · Full text
Eosinophilic esophagitis (EoE) prevalence has been increasing in recent years and is associated with other atopic conditions. The association between EoE and the different atopic conditions is not well characterized. Th...
Eosinophilic esophagitis (EoE) prevalence has been increasing in recent years and is associated with other atopic conditions. The association between EoE and the different atopic conditions is not well characterized. The objective was to assess the probability of developing EoE given different atopic conditions. Our retrospective cohort study used a de-identified electronic database of patient information to identify pediatric patients diagnosed with asthma, allergic rhinitis, atopic dermatitis, or food allergy. We ran separate analyses for each atopic condition and compared the probability of developing EoE with a control group that consisted of patients who had any diagnosis but without the one atopic diagnosis being studied. Cases and controls were matched for demographic factors and other atopic conditions. We contrasted the 3-year probability for developing EoE between matched cohorts and calculated the hazard ratios (HR) to quantify this interaction. All studied atopic conditions studied were associated with an increased probability of developing EoE. Food allergy had the highest risk of developing EoE (HR 9.46 [95% confidence interval {CI}, 7.33-12.21]), followed by asthma (HR 4.11 [95% CI, 3.53-4.78]) and atopic dermatitis (HR 2.98 [95% CI, 2.42-3.67]), and was lowest for allergic rhinitis (HR 2.57 [95% CI, 2.21-3.00]). All atopic conditions, especially food allergy and asthma, were associated with an increased risk of developing EoE, which further supports the overlap among the different atopic diatheses.
Predictors of relapse after omalizumab withdrawal in chronic spontaneous urticaria: Role of baseline autoimmunity and hematologic indices: CSU Relapse After Omalizumab Withdrawal.
Koc Yildirim S, Erbagci E, Demirel Ogut N … +2 more , Unal S, Gokyayla E
Allergy Asthma Proc · 2026 Jan · PMID 41514184 · Publisher ↗
There is currently no accepted biomarker for predicting which patients will experience relapse after discontinuation of omalizumab therapy. This retrospective study aimed to identify clinical and laboratory markers asso...
There is currently no accepted biomarker for predicting which patients will experience relapse after discontinuation of omalizumab therapy. This retrospective study aimed to identify clinical and laboratory markers associated with chronic spontaneous urticaria relapse. "Relapse" was defined as a urticaria control test score of <12 during the 6-month follow-up after treatment interruption after 24 weeks of therapy. Baseline demographic characteristics and laboratory values, including total immunoglobulin E (IgE), anti-thyroid peroxidase (TPO), C-reactive protein (CRP), and complete blood cell count parameters, were compared between patients who did and patients who did not experience relapse. In the cohort of 43 patients, relapse occurred in 13 (30.2%). There were no significant differences between the patients who relapsed and those who did not relapse with respect to gender, age, disease duration, disease activity, concomitant angioedema, chronic inducible urticaria, atopic comorbidity, total IgE levels, or CRP levels. The median anti-TPO level was significantly higher in the relapsed group (p = 0.039), with an optimal predictive cutoff value of 67 IU/mL, with 62.5% sensitivity and 84.2% specificity (area under the curve 0.753; p = 0.041). Among the hematologic parameters, the mean platelet volume (MPV) was the only variable to differ significantly (p = 0.028), being lower in the relapsed group than in the non-relapsed group, and yielded an optimal cutoff value of 10.25 fL, with 92.3% sensitivity and 34.5% specificity (area under the curve 0.712; p = 0.03). In this retrospective, small-sample study, the anti-TPO level and MPV emerged as exploratory predictors of recurrence; however, their clinical utility requires validation in larger, prospective cohorts before implementation.
Navigating asthma in pregnancy: Immunologic changes, barriers, and disparities in management.
O'Mara M, Bishop R, Aguilar N … +1 more , Navalpakam A
Allergy Asthma Proc · 2026 Jan · PMID 41514183 · Publisher ↗
Asthma is the most prevalent chronic condition in pregnancy. It is associated with an increased risk of maternal and perinatal complications, including low birth weight, preeclampsia, and preterm delivery. In women with...
Asthma is the most prevalent chronic condition in pregnancy. It is associated with an increased risk of maternal and perinatal complications, including low birth weight, preeclampsia, and preterm delivery. In women with asthma, pregnancy-induced immunologic changes are dysregulated, including a high T helper type 17 (Th17) to regulatory T cell ratio, a shift from Th1 to Th2 immunity, and an increase in proinflammatory cytokines. Multiple barriers exist that prevent optimal asthma management during pregnancy. This review examines the multifaceted relationship between asthma and pregnancy and discusses the challenges and opportunities for allergists in the management of asthma during pregnancy. A relevant literature search was performed by using the PubMed data base. Selected peer-reviewed journal articles published from April 1999 to March 2025, were identified. The data extracted were categorized into the following themes: immunologic changes in pregnancy, barriers to asthma management during pregnancy, and socioeconomic disparities of expectant mothers with asthma. The immunologic changes with asthma in pregnancy lead to worsened severity and thereby worsened control of asthma. Management of asthma during pregnancy is further challenging due to barriers such as the lack of patient education; poor self-management skills; concerns around medication safety; health-care provider competence and hesitancy; and health-care disparities. including race, gender, and socioeconomic status considerations. There is a pressing need for evidence-based information on the safety of asthma medications during pregnancy and lactation, the impact of health-care disparities on asthma during pregnancy, provider education on asthma management, and self-management skills. Allergists must manage the proinflammatory immunologic milieu as well as address barriers such as medication nonadherence, patient education, provider hesitancy and competency, and social determinants of health to improve maternal health and pregnancy outcomes. Whereas research exists on the impact of asthma on pregnancy outcomes, there is a need for further evidence of the safety of medications during pregnancy and lactation.
Optimizing diagnostic approaches for allergic bronchopulmonary aspergillosis: Comparative analysis of IgG/IgE ELISA and serum precipitins assays.
Shukla P, Chiu A, Elms N … +1 more , MacGinnitie A
Allergy Asthma Proc · 2026 Jan · PMID 41514182 · Publisher ↗
Allergic bronchopulmonary aspergillosis (ABPA) is a chronic lung condition that results from an overexuberant immune response, primarily to Aspergillus fumigatus. Diagnostic criteria have varied over time but current con...
Allergic bronchopulmonary aspergillosis (ABPA) is a chronic lung condition that results from an overexuberant immune response, primarily to Aspergillus fumigatus. Diagnostic criteria have varied over time but current consensus requires elevated total immunoglobulin E (IgE) levels, A. fumigatus-specific IgE, and at least two of three of IgG response to A. fumigatus, elevated eosinophil levels, and imaging changes consistent with ABPA. The differentiation of asthma with A. fumigatus sensitization and ABPA remains controversial. To examine the results from a referral laboratory that provided analysis of specific antibody response to A. fumigatus via three assays: IgG index, IgE index, and IgG precipitins. The first two are measured by using an enzyme-linked immunosorbent assay (ELISA). Testing done for 539 consecutive patients evaluated for possible ABPA was analyzed. Only 58 samples were positive for both IgG and IgE indexes, thereby meeting stringent serologic criteria for a diagnosis of ABPA. Only one third of the patients with a positive IgG index result also had positive precipitins results. Overall, the percentage of positive test results increased with age. Finally, the distribution of both A. fumigatus-specific IgG and IgE levels were approximately normal, not bimodal, which provides evidence that ABPA may exist on a spectrum with asthma with fungal sensitization. In this cohort, evidence of both an IgG and an IgE response to A. fumigatus was only seen in ∼10% of the samples, which indicated that ABPA is only found in a minority of patients in whom it is considered. ELISA is more sensitive than precipitins for identification of an overexuberant IgG response.
Winged hymenoptera: Discordance between In vitro and In vivo sensitization.
Alix V, Abdul Raheem J, Gabreski L … +1 more , Adams K
Allergy Asthma Proc · 2026 Jan · PMID 41514181 · Publisher ↗
An Hymenoptera venom allergy diagnosis requires sting-triggered systemic reaction symptoms and evidence of venom-specific immunoglobulin E (IgE) through skin or serologic testing. A lack of concordance between skin and s...
An Hymenoptera venom allergy diagnosis requires sting-triggered systemic reaction symptoms and evidence of venom-specific immunoglobulin E (IgE) through skin or serologic testing. A lack of concordance between skin and serologic testing has been reported previously; using these tests in a complementary fashion has been emphasized in published guidelines. We assessed skin and serologic venom-specific IgE testing discordance and factors that impact the testing. A retrospective review of patients with allergist-diagnosed winged Hymenoptera venom allergy prescribed venom immunotherapy at one center from 2005 to 2023 was completed. Record review included demographics, Mueller grading reaction severity, and venom testing results. Patients were included if they had both skin and serologic testing results. A total of 125 records were reviewed, with 33 meeting inclusion criteria. Patients were 7-69 years old, 55% female, and Mueller grade 2 and above reactions occurred in 94%. Kappa coefficients for both tests for individual winged Hymenoptera were all <0.35. Discordance occurred 37% of the time overall; no venom was found to be more or less discordant than the others. Skin testing results were found to be positive more frequently than were serologic testing results overall (p = 0.0126), in male individuals (p = 0.007), when the initial sting was at >18 years old (p = 0.016), when testing was completed at >30 years old (p = 0.006), and when there were >5 years between the initial sting and testing (p = 0.007). Skin and serologic testing for winged Hymenoptera are frequently discordant, and both should be tested to confirm or refute negative results. In certain populations, skin testing should be completed first.
Is atopic comorbidity increased in proctocolitis?
Iskender N, Ozanli I, Uluc NN … +8 more , Ipekci B, Akın TY, Cogurlu MT, Uncuoglu A, Aksu NU, Balci S, Simsek IE, Aydogan M
Allergy Asthma Proc · 2026 Jan · PMID 41514180 · Publisher ↗
Allergic march refers to the association of multiple allergic diseases but current understanding primarily focuses on immunoglobulin E (IgE) mediated food allergies (FA) (IgE-FA). The impact of non-IgE-FAs on allergic ma...
Allergic march refers to the association of multiple allergic diseases but current understanding primarily focuses on immunoglobulin E (IgE) mediated food allergies (FA) (IgE-FA). The impact of non-IgE-FAs on allergic march remains unclear. To determine whether food protein-induced allergic proctocolitis (FPIAP), a non-IgE-FA, coexists with other allergic diseases during follow-up and to identify predictive factors. Eighty-four patients diagnosed with FPIAP who had been followed up for at least 3 years and 89 age- and gender-matched controls were compared for the presence of concomitant allergic conditions. Patients with FPIAP who were followed up regularly for at least 3 years were evaluated for the presence of concurrent allergic diseases at a median (interquartile range [IQR]) age of 50 months (47-54 months), whereas, in the age- and gender-matched control group, the median (IQR) age at evaluation was 51 months (47.5-57.5 months). Asthma, allergic rhinitis (AR), and IgE-FA rates in the FPIAP group were 29.8% (n = 25), 29.8% (n = 25), and 15.5% (n = 13), respectively, compared with 14.6% (n = 13), 13.5% (n = 12), and 3.4% (n = 3), respectively, in the control group. Asthma, AR, and IgE-FA were significantly more frequent in the FPIAP group (p = 0.03, p = 0.02, p = 0.01, respectively). Atopic dermatitis in those under the age of 2 years was more prevalent in the FPIAP group (38.6%, [n = 32]) compared with the controls (10.6% [n = 9]) (p = 0.001). Although vomiting at onset was identified as a predictive factor for asthma, maternal rhinitis and delayed introduction of complementary feeding were associated with an increased risk of developing AR in the FPIAP group. This study demonstrated a higher rate of asthma, AR, and IgE-FA in patients with FPIAP compared with age- and gender-matched controls. These findings emphasize the importance of increasing awareness of the potential coexistence of FPIAP with other allergic diseases.
Evaluation of diagnostic tests for suspected hypersensitivity reactions to proton pump inhibitors in children.
Yilmaz D, Yilmaz Topal O, Sengul Emeksiz Z … +1 more , Dibek Misirlioglu E
Allergy Asthma Proc · 2025 Sep · PMID 41152689 · Publisher ↗
Proton-pump inhibitors (PPI) are widely used in pediatric populations, although hypersensitivity reactions (HSR) to these agents are rare and not well characterized in children. This study aimed to evaluate the clinical...
Proton-pump inhibitors (PPI) are widely used in pediatric populations, although hypersensitivity reactions (HSR) to these agents are rare and not well characterized in children. This study aimed to evaluate the clinical characteristics and diagnostic findings of pediatric patients with suspected HSRs to PPIs. Pediatric patients referred to our allergy clinic with suspected PPI-related HSRs between January 2012 and October 2023 were retrospectively analyzed. Data on demographics, reaction characteristics, comorbidities, and diagnostic test outcomes (skin-prick test, intradermal test, and drug provocation test) were collected. Twenty-two patients (median age, 12 years; 81% girls) were included. Lansoprazole was the most commonly implicated PPI (64%). Clinical manifestations included urticaria (41%), anaphylaxis (36%), maculopapular eruption (14%), angioedema (4.5%), and toxic epidermal necrolysis (4.5%). Most reactions (77%) occurred within 6 hours of drug intake. Among 18 patients undergoing diagnostic evaluation, 11 were tested with the suspected PPI and 7 were tested with an alternative PPI. One patient had a positive intradermal test result to omeprazole but tolerated lansoprazole. In total, 10 patients had their PPI allergy label removed after a negative diagnostic workup; 9 tolerated an alternative PPI. Urticaria and anaphylaxis were the most common presentations of PPI hypersensitivity. Lansoprazole was the most frequently suspected drug. Skin testing, followed by a drug provocation test with a tolerated alternative, remains essential for diagnostic clarification. Clinicians should be aware of possible cross-reactivity among PPIs. Further pediatric studies are needed to optimize diagnostic and management strategies for PPI-induced HSRs.
Food allergy referral patterns from 2013-2015 to 2016-2018 at Texas Children's Hospital.
Davis J, Ward ER, Huang X … +2 more , Staggers KA, Davis CM
Allergy Asthma Proc · 2025 Sep · PMID 41152688 · Publisher ↗
Food allergy (FA) is a prevalent condition in the United States that can cause anaphylaxis. FA cases are becoming increasingly concerning in the United States, with rising trends in the pediatric population. However, inc...
Food allergy (FA) is a prevalent condition in the United States that can cause anaphylaxis. FA cases are becoming increasingly concerning in the United States, with rising trends in the pediatric population. However, increases have not been proportional across racial and/or ethnic groups, with studies that show rapid increases in minority populations. Due to this trend, we investigated if FA prevalence increased in patients at Texas Children's Hospital (TCH) based on race and gender. We retrospectively compared patients at TCH between the years 2013 and 2015 (time frame 1) and 2016 and 2018 (time frame 2). Patient FA history was diagnosed via medical diagnosis codes. Patients were stratified by gender and five race categories: Asian, black/African American (AA), Hispanic/Latino, non-Hispanic white, and "other." The prevalence of an FA was calculated by dividing the number of patients with an FA by the total number of patients seen at TCH within a given race, gender, and time frame. The χ² test was used, and two-sided p-values of <0.05 were considered statistically significant. The prevalence of an FA at TCH significantly increased within each race and gender except for patients who self-reported as "other" race. Asian patients had the highest increase in FAs among all the races between the two time frames. Black/AA American patients also had a clinically significant increase, with FA prevalence increased by 1.5 times from time frame 1 to 2. The prevalence increased more for male patients (0.43%) than for female patients (0.28%). The increase for male patients was similar to the increase for blacks (0.46%). FA prevalence increased for all race and gender subcohorts except for those who identified as "other" race, with clinically significant increases noted in males, Asian, and black/AA populations. This increase in FA prevalence suggests that there may be children of specific racial or ethnic groups who are at an increased risk of developing an FA.
Caregiver perceptions of β-lactam allergy testing for serum sickness-like reactions.
Selner GE, Nicolaides RE, Chow TG
Allergy Asthma Proc · 2025 Sep · PMID 41152687 · Publisher ↗
Beta-lactam allergy (BLA) labels are common in children but often disproven when formally evaluated. This diagnostic discrepancy leads to higher health-care costs and increased adverse outcomes. Beta-lactam antibiotics a...
Beta-lactam allergy (BLA) labels are common in children but often disproven when formally evaluated. This diagnostic discrepancy leads to higher health-care costs and increased adverse outcomes. Beta-lactam antibiotics are associated with a variety of adverse reactions in children. A serum sickness-like reaction (SSLR) is one adverse reaction that is complex in its diagnosis and management due to its heterogeneous clinical presentation and poorly understood mechanism. This unclear presentation and diagnostic criteria can be confusing for patients, families, and health-care professionals, leading to allergy evaluation hesitancy. With updated drug practice parameters that support the utility of oral drug challenges for patients with SSLRs related to beta-lactams, barriers remain for these patients to seek allergy evaluation. The objective was to assess caregiver perspectives on BLA delabeling and identify barriers to drug challenge testing in children with a history of SSLRs. We conducted an 18-question telephone survey with 14 caregivers of children with a history of beta-lactam-associated SSLR. The survey assessed attitudes toward allergy delabeling, understanding of challenge testing, and perceived barriers to testing. Most caregivers demonstrated an understanding of the importance of allergy delabeling; however, the comfort level with challenge testing varied, depending on the setting, provider, and perceived risk of SSLR recurrence. Of the caregivers, 62.4% reported feeling comfortable with their child's pediatrician performing the testing. When asked about their concerns about testing, nearly 50% of caregivers expressed concern about the possibility of a repeated SSLR. The overall positive attitude toward BLA testing, especially in a primary care setting, highlights an opportunity to make testing more accessible for patients. However, the unpredictable nature of SSLRs seems to contribute to caregiver reservations about pursuing testing for their child. To mitigate this, targeted education from health-care professionals, such as physicians, advanced practice providers, and nurses, may reduce caregiver hesitancy and facilitate BLA delabeling for patients with SSLRs.
Comparative analysis of demographic and clinical features in common variable immunodeficiency and selective immunoglobulin G deficiency.
Gerek ME, Colkesen F, Onalan T … +5 more , Akkus FA, Kilinc M, Evcen R, Kahraman S, Arslan S
Allergy Asthma Proc · 2025 Sep · PMID 41152686 · Publisher ↗
Common variable immunodeficiency (CVID) and selective immunoglobulin G (IgG) deficiency (sIgGD) are primary antibody deficiencies with divergent clinical trajectories. CVID is characterized by recurrent infections and sy...
Common variable immunodeficiency (CVID) and selective immunoglobulin G (IgG) deficiency (sIgGD) are primary antibody deficiencies with divergent clinical trajectories. CVID is characterized by recurrent infections and systemic noninfectious complications, whereas sIgGD typically follows a milder course. Despite sharing clinical features such as recurrent infections, comparative data on complications and mortality remain limited, which hinders risk-stratified management. This study compared the prevalence, clinical impact, and mortality associated with noninfectious complications in CVID and sIgGD, and identified predictors of adverse outcomes to support risk-stratified management and examined clinical differences within the CVID group based on baseline serum IgM levels. A single-center retrospective cohort study (2018-2024) included 111 patients with CVID and 19 patients with sIgGD. Diagnostic criteria for CVID included hypogammaglobulinemia (IgG level < 400 mg/dL with low IgA/IgM), impaired vaccine responses, and exclusion of secondary causes. The sIgGD required isolated IgG deficiency with normal IgA/IgM and intact vaccine responses. Noninfectious complications, including organ-specific and systemic manifestations as well as bronchiectasis were evaluated. In patients with CVID, a predefined subgroup analysis was performed based on baseline serum IgM levels (normal versus <40 mg/dL). Multivariate logistic regression identified mortality predictors. The patients with CVID exhibited significantly higher rates of recurrent sinopulmonary infections (70.3% versus 42.1%), bronchiectasis (46.8% versus 21.1%), and noninfectious complications (57.7% versus 31.6%), including autoimmune disorders such as hematologic manifestations (33.3% versus 10.5%). In the CVID group, the patients with low IgM levels exhibited a significantly higher prevalence of gastrointestinal involvement (24.0% versus 5.6%; p = 0.035). Bronchiectasis (odds ratio [OR] 5.22) and noninfectious complications (OR 7.95) independently predicted mortality in CVID. Male sex showed borderline risk. In contrast, no mortality was observed in the sIgGD cohort over the study period. CVID is associated with substantial noninfectious morbidity and mortality, which necessitates early identification and long-term monitoring. In contrast, sIgGD exhibits a milder clinical phenotype, although preventive care remains important. These findings support distinct management strategies and highlight the utility of clinical markers for risk stratification.
Pediatric ondansetron hypersensitivity: Clinical features and a preliminary diagnostic approach.
Genis C, Torun Ozel C, Selmanoglu A … +2 more , Sengul Emeksiz Z, Dibek Misirlioglu E
Allergy Asthma Proc · 2025 Sep · PMID 41152685 · Publisher ↗
Ondansetron is a common antiemetic that rarely causes hypersensitivity. Skin-prick testing (SPT) and intradermal testing (IDT) may assist in diagnosing ondansetron hypersensitivity; however, their sensitivity, specificit...
Ondansetron is a common antiemetic that rarely causes hypersensitivity. Skin-prick testing (SPT) and intradermal testing (IDT) may assist in diagnosing ondansetron hypersensitivity; however, their sensitivity, specificity, and optimal concentrations remain unclear. To our knowledge, drug provocation testing (DPT), the criterion standard for diagnosis, has not been previously applied in pediatric cases. In this study, we aimed to evaluate ondansetron hypersensitivity in children by using a preliminary diagnostic approach that incorporated SPT, IDT, and DPT. We retrospectively reviewed pediatric patients who were evaluated for suspected ondansetron hypersensitivity between 2019 and 2025. We performed an SPT by using an ondansetron concentration of 2 mg/mL, followed by an IDT with concentrations of 0.02 and 0.2 mg/mL in patients with negative SPT results. In cases of patients with negative skin test results, we conducted DPTs. We included seven pediatric patients ages 3-16 years. All had negative SPT results, which underscores its limited sensitivity. IDT results were positive in three patients with a history of anaphylaxis (one at 0.02 mg/mL, two at 0.2 mg/mL); DPT was not performed in these patients. Among the four with negative skin test results, DPT was performed in three and yielded negative results. We confirmed hypersensitivity in three patients. In another three, no clinical reactivity was observed at the time of DPT, and the diagnosis remained inconclusive in one patient. To our knowledge, this is the first pediatric case series to propose a preliminary diagnostic approach that incorporated DPT in the evaluation of suspected ondansetron hypersensitivity. The findings highlight the limited sensitivity of SPT, emphasize the diagnostic value of IDT, particularly in patients with anaphylaxis, and support the safe applicability of DPT in patients with negative skin test results, with all three DPTs yielding negative results.
Managing food allergies in each stage of life.
Gupta RS, Yang MS
Allergy Asthma Proc · 2025 Sep · PMID 41152684 · Publisher ↗
Food allergy (FA) affects more than 30 million individuals in the United States and presents challenges that extend far beyond clinical symptoms. From infancy to adulthood, FA impacts quality of life, mental health, soci...
Food allergy (FA) affects more than 30 million individuals in the United States and presents challenges that extend far beyond clinical symptoms. From infancy to adulthood, FA impacts quality of life, mental health, social participation, and access to safe environments. These burdens are often compounded by limited emergency preparedness, lack of institutional support, and social stigma. This narrative review synthesizes disparities and barriers faced by individuals with FA across key life stages, including early childhood, elementary and middle school, high school, college, and the transition to the workplace. It also highlights evidence-based strategies and resources developed by a leading national center for food allergy and asthma research that address FA barriers throughout the lifespan. Findings demonstrate that despite advances in FA innovation and treatment, disparities in education, preparedness, and accommodation persist. These inequities disproportionately affect underserved populations and environments where awareness and policy enforcement are limited. Promoting inclusion and safety across the lifespan requires a coordinated, multi-sector approach that equips caregivers, educators, peers, and employers with the tools and training necessary to support individuals with FA in every setting.
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