Allergy And Asthma Proceedings[JOURNAL]
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200 papers
allergen extract potency is maintained in a sublingual immunotherapy maintenance vial of pollens and mites.
Larenas-Linnemann D, Mosges R
Allergy Asthma Proc · 2025 Sep · PMID 41152683 · Publisher ↗
Allergen immunotherapy (IT) in Europe is generally administered as monoallergen IT. However, in some patients and in other parts of the world, multiallergen IT is common practice. A key question is whether allergens in a...
Allergen immunotherapy (IT) in Europe is generally administered as monoallergen IT. However, in some patients and in other parts of the world, multiallergen IT is common practice. A key question is whether allergens in a mixture retain their allergenicity over time. To demonstrate if allergenicity, as measured by skin-prick testing (SPT), is maintained after 6 months in a sublingual immunotherapy (SLIT) maintenance vial with three allergen extracts in a single individual vaccine, including two pollens and Dermatophagoides. We prepared two maintenance SLIT vials that contained mixed Dermatophagoides species (2000 AU/mL), ash tree and Bermuda grass pollens (1:50 w/v), one 6 months before SPT and the second 0-2 weeks before SPT, and three fresh vials (0-2 weeks before SPT) for each individual allergen. Duplicate SPTs were conducted with all five vials, diluent and positive (histamine 1 mg/mL) controls. Wheals were measured at 10 minutes (controls) and 20 minutes (allergen vaccines). The mean wheal diameter was calculated as the average of the longest and orthogonal diameters, i.e., (D + D₂)/2. For each allergen extract, two replicate wheals were obtained per participant; their mean diameters were averaged to yield a patient-level mean wheal diameter. These patient-level means were then averaged across all the participants. The paired t-test was used to calculate statistically significant differences between the mean wheal diameters of the extracts, with significance at p < 0.05. The mean ± standard deviation wheal diameter produced by the 6-month-old and the fresh extracts were 8.7 ± 3.3 mm and 8.4 ± 2.87 mm, respectively. This difference was not significant. Moreover, the potency of both pollen extracts was conserved when mixed with house-dust mite extracts. In our pilot study, allergenicity of tree and grass pollen allergens in an allergen mix with Dermatophagoides in a SLIT maintenance vial was maintained over 6 months. Replication in a larger population would consolidate our findings.
Specific immunoglobulin E for aeroallergens: 0.35 kUA/L cutoff value is too low.
Flugt A, Rasmussen HM, Agertoft L … +2 more , Moller S, Gradman J
Allergy Asthma Proc · 2025 Sep · PMID 41152682 · Publisher ↗
Measurement of specific immunoglobulin E (sIgE) is often used interchangeably with a skin-prick test (SPT) to detect allergic sensitization. Evidence of concordance between the two methods for aeroallergens in children i...
Measurement of specific immunoglobulin E (sIgE) is often used interchangeably with a skin-prick test (SPT) to detect allergic sensitization. Evidence of concordance between the two methods for aeroallergens in children is limited. Potentially, discordance can lead to misclassification in atopy diagnosis and subsequent clinical management. The arbitrary sIgE cutoff value of 0.35 kUA/L is used uniformly for all allergens. The aim of the study was to evaluate the agreement between sIgE with a cutoff of 0.35 kUA/L and a positive SPT result (cutoff of 3 mm) for 10 aeroallergens and to investigate the sIgE level that corresponds best with a positive SPT result in school-age children. Measurement of sIgE and SPT for birch, Timothy grass, mugwort, horse, dog, cat, Dermatophagoides pteronyssinus, Dermatophagoides farinae, Alternaria, and Cladosporium were performed in 300 children ages 6 to 14 years: 132 children with asthma and 168 controls. The agreement between sIgE and SPT results for the individual aeroallergens was assessed by using the Cohen κ coefficient with different sIgE cutoff values. In total, the 300 children had 297 positive SPT results and 445 positive IgE analyses. The incidence of sensitization to Alternaria and Cladosporium was too low for further analysis. The agreement between the sIgE cutoff of 0.35 kUA/L and the SPT result cutoff of 3 mm was moderate to substantial for the remaining eight aeroallergens. The estimated optimal sIgE cutoff level that predicted an SPT result of ≥3 mm was 0.75 kUA/L for grass, horse, dog, and cat; 1.0 kUA/L for mugwort; 3.0 kUA/L for D. pteronyssinus; 5.0 kUA/L for birch; and 10.0 kUA/L for D. farinae. Using an sIgE cutoff of 0.75 kUA/L slightly increased the agreement for all eight allergens. Compared with an SPT result, a cutoff of 3 mm, analysis of our data suggests that an sIgE cutoff of 0.35 kUA/L is too low and that the optimal cutoff differs for the different aeroallergens.
Anaphylaxis related to fluoroquinolones: A disproportionality analysis of the FDA Adverse Event Reporting System data base.
Miluski T, Bhattarai B, Al-Shaikhly T
Allergy Asthma Proc · 2025 Sep · PMID 41152681 · Publisher ↗
Hypersensitivity reactions, including anaphylaxis, have been increasingly reported with quinolones. To characterize the association of different quinolones with anaphylaxis reports in the FDA Adverse Event Reporting Sys...
Hypersensitivity reactions, including anaphylaxis, have been increasingly reported with quinolones. To characterize the association of different quinolones with anaphylaxis reports in the FDA Adverse Event Reporting System (FAERS) data base. We searched the FAERS data base for anaphylactic reaction reports (between 2015 and 2024) associated with the three commonly used fluoroquinolones in the United States, viz., levofloxacin, ciprofloxacin, and moxifloxacin. The reporting odds ratio (ROR) was used to assess disproportional reports of anaphylaxis among the individual fluoroquinolones and between the fluoroquinolones and all medications within the data base. We identified 941 anaphylaxis reports (ciprofloxacin, 390; levofloxacin, 299; and moxifloxacin, 252) of 89,351 adverse reactions reported for all fluoroquinolones between 2015 and 2024. There were disproportionally higher reports of anaphylaxis among fluoroquinolones compared with all medications within the data base (ROR 4.56 [95% confidence interval {CI}, 4.28-4.87]) but lower relative to that of amoxicillin (ROR 0.19 [95% CI, 0.17-0.20]). Within the fluoroquinolones, moxifloxacin was associated with the highest disproportionality signal for anaphylaxis relative to all other medications (ROR 8.65 [95% CI, 7.63-9.80]) and relative to all fluoroquinolones (ROR 1.90 [95% CI, 1.65-2.18]), whereas levofloxacin was associated with a disproportionally lower signal when compared with all other fluoroquinolones (ROR 0.77 [95% CI, 0.67-0.88]). The disproportionally higher anaphylaxis report associated with moxifloxacin was especially pronounced among women (ROR 2.11 [95% CI, 1.78-2.49]) and elderly individuals (ROR 2.74 [95% CI, 2.15-3.48]). Moxifloxacin is associated with relatively higher anaphylaxis reports when compared with all other quinolones, especially among female and elderly individuals.
Adaptation of the urticaria patient daily diary for caregiver completion in pediatric chronic spontaneous urticaria.
Whalley D, Balp MM, Naujoks C … +6 more , Gardner DD, Dery E, Weller K, Van Der Poel LA, Erlewyn-Lajeunesse M, Soong W
Allergy Asthma Proc · 2025 Sep · PMID 41152680 · Publisher ↗
The Urticaria Patient Daily Diary (UPDD) assesses patient-reported symptoms (itch, hives, angioedema) and impacts in adults and adolescents with chronic spontaneous urticaria (CSU). The objective was to adapt the UPDD f...
The Urticaria Patient Daily Diary (UPDD) assesses patient-reported symptoms (itch, hives, angioedema) and impacts in adults and adolescents with chronic spontaneous urticaria (CSU). The objective was to adapt the UPDD for caregiver completion for patients ages 2-11 years. To inform modification of the UPDD, two iterative rounds of hybrid concept-elicitation/cognitive-debriefing interviews were conducted with clinical experts and caregivers of children with CSU recruited patient organizations in the United States and Canada. After concept elicitation, the participants reviewed a draft UPDD-Caregiver Version with initial modifications for caregiver completion. Data were analyzed by using thematic analysis. Four clinicians and 12 caregivers were interviewed (round 1:4 clinicians, 5 caregivers; round 2:7 caregivers). Key symptoms reported by the caregivers were itch (n = 12), hives (n = 12), and swelling and/or angioedema (n = 7). All four clinicians confirmed itch and hives to be key symptoms in children ages 2-11 years with CSU, with associated angioedema for some. Scratching was confirmed as the key observable sign of itch. Caregiver-reported impacts included waking in the night (n = 10); difficulty getting to sleep (n = 8); and daily life impacts, including activities at school (n = 10), play (n = 8), with family and/or friends (n = 4), and sports (n = 3). After round 1, minor revisions were made to enhance comprehension of the UPDD-Caregiver Version, and an overall symptom severity item was added. Relevance, acceptability, and comprehension of the final measure were confirmed by round 2 participants; no further changes were required. The UPDD-Caregiver Version is a relevant and acceptable measure for caregiver completion to assess symptoms and impacts of CSU in children ages 2-11 years.
Evolving therapies for chronic spontaneous urticaria: Addressing unmet needs in adults and children.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2025 Sep · PMID 41152679 · Full text
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Management of chronic urticaria: Treatment options when omalizumab fails.
Lang DM
Allergy Asthma Proc · 2025 Sep · PMID 41152678 · Publisher ↗
Substantial progress in our understanding of chronic urticaria has been accomplished in recent years. We now recognize the heterogeneity of this condition, which is comprised of a number of endotypes and phenotypes. Labo...
Substantial progress in our understanding of chronic urticaria has been accomplished in recent years. We now recognize the heterogeneity of this condition, which is comprised of a number of endotypes and phenotypes. Laboratory testing to identify a cause for chronic urticaria has been discouraged, as this does not lead to improved outcomes and is not cost-effective; however, evidence has shown selected laboratory tests are important for their prognostic value. Therapeutic options for chronic urticaria, particularly for patients who are antihistamine-resistant, have also improved. Despite this, chronic urticaria has continued to be a vexatious condition for both patients and health care providers, and many patients continue to experience unmet needs. Guidelines recommend a step-care approach for management of chronic urticaria that can encourage substantial improvement in clinical course and quality of life. Use of anti-IgE therapy for more than the past decade has enabled many patients with antihistamine-resistant chronic urticaria to achieve improved outcomes; however, a substantial proportion continue to experience ongoing symptoms and impaired quality of life. The armamentarium for management of patients with refractory chronic urticaria has recently expanded, and will soon expand further. This article focuses on the approach to management of antihistamine-resistant patients who continue to experience poorly controlled chronic urticaria despite anti-IgE therapy prescribed at FDA-approved doses.
Aeroallergen immunotherapy update: Developments since the third Practice Parameter.
Bernstein DI
Allergy Asthma Proc · 2025 Sep · PMID 41152677 · Publisher ↗
Allergy immunotherapy is a proven treatment for allergic rhinitis and asthma with the potential to modify the natural history of these disorders. Considerable advances have been seen in the past 15 years since publicatio...
Allergy immunotherapy is a proven treatment for allergic rhinitis and asthma with the potential to modify the natural history of these disorders. Considerable advances have been seen in the past 15 years since publication of the third update of the Allergen Immunotherapy Practice Parameter. The aim was to understand new developments that pertain to subcutaneous immunotherapy and sublingual immunotherapy (SLIT). New evidence related to advances related to efficacy and safety of allergy immunotherapy are presented as well as unmet needs and future directions. Most new evidence has come from large double-blind placebo controlled trials of SLIT tablets, which better define efficacy and safety in patients with allergic rhinitis, allergic asthma, and atopic dermatitis. More evidence has emerged that identifies risk factors for anaphylaxis to subcutaneous injections and approaches to mitigate risk. Two modalities of allergy immunotherapy are available to allergy specialists. Both SLIT and subcutaneous immunotherapy have near equivalent efficacy, but SLIT has a superior safety profile, allowing self-administration.
The value of skin testing with tumor necrosis factor-inhibitors in patients with local and systemic hypersensitivity reactions.
Orak Akbay N, Ozdel Ozturk B, Doganci A … +3 more , Celebi Sozener Z, Ataman S, Bavbek S
Allergy Asthma Proc · 2025 Sep · PMID 41152676 · Publisher ↗
Hypersensitivity reactions (HSR) to tumor necrosis factor α inhibitors (TNFi) can occur but data about skin testing in such reactions are limited. To evaluate skin testing in patients with HSRs to TNFi. A detailed revi...
Hypersensitivity reactions (HSR) to tumor necrosis factor α inhibitors (TNFi) can occur but data about skin testing in such reactions are limited. To evaluate skin testing in patients with HSRs to TNFi. A detailed review of demographics and clinical characteristics, features of index reactions, results of skin tests, and outcomes of desensitization protocols were obtained. The cohort comprised 64 patients (women/men: 41/23). Treatment distribution included etanercept (n = 50 [78.1%]), adalimumab (n = 11 [17.2%]), and infliximab (n = 3 [4.7%]). HSRs were seen as an injection-site reaction (ISR) in 47 patients (73.4%), generalized urticaria in 8 patients (12.5%), and anaphylaxis in 3 patients (4.7%). Forty-four patients (44/64 [72%]) had positivity on skin tests as either skin-prick test (SPT) or intradermal test (IDT). Among other reaction types, the patients with ISRs exhibited the highest skin test positivity (p = 0.043). Among the 17 patients who underwent rapid subcutaneous or intravenous desensitization, 15 patients (88.2%) had positive skin test results, and all desensitization procedures were successfully completed, despite some experiencing local breakthrough reactions (BTR). This study, which includes the largest number of patients reported in the literature, highlights the important role of skin testing in diagnosing HSRs to TNFi. Notably, etanercept demonstrated the highest positivity rate. Successful completion of desensitization protocols despite some BTRs highlights the importance of desensitization in patients experiencing HSRs to these treatments.
Unmasking the underlying cause: A rash with deeper implications.
Upadhyay P, Valdes Camacho J, Khan A … +1 more , Kaufman D
Allergy Asthma Proc · 2025 Sep · PMID 41152675 · Publisher ↗
We present the case of a 9-year-old girl with a medical history of growth hormone deficiency, Hashimoto's thyroiditis, failure to thrive, and eosinophilic colitis, and with a new progressive rash. The rash began as eryth...
We present the case of a 9-year-old girl with a medical history of growth hormone deficiency, Hashimoto's thyroiditis, failure to thrive, and eosinophilic colitis, and with a new progressive rash. The rash began as erythematous, pruritic papules, which gradually spread and evolved into larger, well-circumscribed plaques. Despite treatment with topical corticosteroids and broad antifungal therapy, the rash persisted without improvement. The patient reported no systemic symptoms. On examination, she was well appearing and afebrile, with normal vital signs. Dermatologic findings included erythematous, pruritic plaques on the abdomen, perioral area, and lower extremities. No lymphadenopathy or other abnormalities were noted. After a more thorough evaluation, an unexpected diagnosis was made. This case highlights the clinical challenge of diagnosing dermatologic conditions in pediatric patients with complex medical histories. Although the presentation was suggestive of atopic dermatitis, the morphology and distribution of the lesions, along with resistance to standard therapy, raised concerns for alternative diagnoses. This case underscores the importance of maintaining a broad differential diagnosis when managing chronic or atypical skin eruptions, particularly in patients with multisystem involvement or a history of autoimmune conditions.
Update in stinging insect hypersensitivity.
Golden DBK
Allergy Asthma Proc · 2025 Sep · PMID 40958191 · Publisher ↗
The ACAAI//AAAAI Joint Task Force on Practice Parameters periodically develops updated guidance based on all available evidence. This review summarizes advances in diagnosis and management of insect sting allergy from p...
The ACAAI//AAAAI Joint Task Force on Practice Parameters periodically develops updated guidance based on all available evidence. This review summarizes advances in diagnosis and management of insect sting allergy from published practice parameters, and developments under review for the 2026 update. Changes in the species and distribution of stinging insects in the US may be due to migration and invasion. Overall prevalence has not changed, but fatalities from insect sting allergy increased 50% in 30 years. Diagnostic evaluation includes both skin and serum immunoglobulinE testing although positive predictive value is dependent on the history. Evaluation may include venom component testing. Mastocytosis and hereditary alpha tryptasemia must be considered in many cases; testing for baseline serum tryptase is now routine. Testing for c-KIT gene mutation in peripheral blood and tryptase genotype are important supplemental tests. The risk of beta blockers and angiotensin converting enzyme inhibitors is relatively low in most cases, and they are not contraindicated during venom immunotherapy (VIT). VIT is indicated in high-risk patients (30-70% risk of anaphylaxis), but is not required in those with cutaneous reactions (3-10% risk of anaphylaxis). VIT can be safely initiated with rush regimens. Recurrent systemic reactions are rare, and may require omalizumab treatment (off-label). VIT can be discontinued after 5 years in most patients, but extended or indefinite VIT (often at 12-week intervals) is recommended in patients with known high-risk factors or where stopping would cause markedly impaired quality of life. Continued research has refined our clinical approach to patients with concerns about stinging insect hypersensitivity.
Food allergy concurrent with atopic dermatitis: Correlation with age of onset and severity.
Ozanli I, Uluc NN, Iskender N … +5 more , Akin TY, Varli YZ, Balci S, Simsek IE, Aydogan M
Allergy Asthma Proc · 2025 Sep · PMID 40958190 · Publisher ↗
Data on the frequency of food sensitivity (FS) and food allergy (FA) in patients with atopic dermatitis (AD) differ among studies. The aim of this study was to determine the frequency of FS and FA in different AD phenot...
Data on the frequency of food sensitivity (FS) and food allergy (FA) in patients with atopic dermatitis (AD) differ among studies. The aim of this study was to determine the frequency of FS and FA in different AD phenotypes according to the age of onset and severity of AD. In addition, we aimed to investigate the risk of FA in these patients. Patients diagnosed with AD between 2022 and 2024 were included in the study. All patients with AD admitted during this period were analyzed for the coexistence of FA and FS. The study included 257 children with AD. Of these patients, 147 of 257 were girls (57.2%). The median (interquartile range [IQR]) age of onset of AD was 6 months (2.5-30 months). By the age of AD onset, FS and FA were present in 60.3% and 32.5%, respectively, in patients with moderate-to-severe AD, with disease onset between ages 0 and 3 months. Among the patients with disease onset between ages 4 and 11 months, the corresponding rates in moderate-to-severe cases were 59.6% for FS and 17.4% for FA. FS was present in 39.3% of moderate-to-severe cases with AD onset age after 12 months, but none had FA. Being in the moderate-to-severe category for AD increased the risk of FA 14-16 times compared with the mild AD group. FS is significantly more prevalent than FA in patients with AD. In children in whom FS test results are positive, the diagnosis of AD-FA coexistence should not be made without performing an elimination diet and oral food challenge test. This approach will help prevent unnecessary food elimination.
Impact of nasal congestion on intranasal rescue medication absorption and efficacy: A systematic review.
Blaiss M, Wallace D, Han JK … +1 more , Rance K
Allergy Asthma Proc · 2025 Sep · PMID 40958189 · Publisher ↗
It is critical for rescue medications to have rapid absorption and onset of action. Although intranasal formulations of rescue medications have advantages over other forms of administration, the impact of nasal congestio...
It is critical for rescue medications to have rapid absorption and onset of action. Although intranasal formulations of rescue medications have advantages over other forms of administration, the impact of nasal congestion on drug absorption has been questioned. We aimed to determine if nasal congestion impacts the absorption and efficacy of intranasal rescue medications. A rescue medication is used as needed for the immediate treatment of an episodic medical event that requires urgent intervention. Systematic searches for 15 pre-identified intranasal rescue medications were conducted in PubMED/MEDLINE up to July 2, 2024. Eligible studies were controlled human studies that compared the absorption or efficacy of an identical dose of intranasal rescue medication administered with and without the presence of nasal congestion that was induced by allergen challenge or that was associated with a medical condition (e.g., allergic rhinitis). The searches identified 160 articles; six studies, all open-label, were eligible for final inclusion. Two intranasal epinephrine studies showed increased maximum plasma concentrations after allergen-induced congestion; one of these epinephrine studies also showed a faster time to maximum plasma concentration. Three additional studies that evaluated epinephrine, glucagon, and fentanyl found no effect of congestion on absorption. In the sixth study, congestion had no effect on zolmitriptan efficacy. Available evidence indicates no negative impact of nasal congestion on the absorption of intranasal rescue medications. Congestion may actually increase absorption of some intranasal epinephrine formulations. The impact of congestion on intranasal medication absorption is likely dependent on each drug's properties, mode of action, and formulation.
Baseline disease characteristics among patients with chronic rhinosinusitis with nasal polyps in AROMA: A global registry study.
Peters AT, Shah R, Heffler E … +7 more , Wagenmann M, Fujieda S, Xia C, Nash S, Clotz M, Corbett M, Radwan A
Allergy Asthma Proc · 2025 Sep · PMID 40958188 · Publisher ↗
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease of the nasal and paranasal sinuses. In phase III clinical trials, dupilumab significantly improved objective and patient-re...
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease of the nasal and paranasal sinuses. In phase III clinical trials, dupilumab significantly improved objective and patient-reported measures of CRSwNP versus placebo. However, a real-world evidence gap exists between efficacy and effectiveness data for dupilumab in CRSwNP, particularly in the United States. Assessing Long-teRm Outcomes of dupiluMAb Treatment in Adult Patients With CRSwNP (AROMA) aims to characterize patients who receive dupilumab for CRSwNP in a real-world setting and evaluate long-term effectiveness. AROMA is a prospective global registry study that is recruiting adult patients with uncontrolled CRSwNP who were initiating dupilumab and following them for up to 36 months. Baseline demographics and disease characteristics were assessed for all patients entering the registry. As of February 2023, the study had recruited 303 patients of a target enrollment of 700, with a mean age of 50.8 years, and 57.1% were recruited in the United States. A history of asthma was reported in 70.6% of the patients and a history of allergic rhinitis in 70.6% of the patients. In the 24 months before enrollment, 61.7% of the patients had at least one sinonasal surgery and 68.6% used systemic corticosteroids. At baseline, 35.0% of the patients were receiving intranasal corticosteroids and 33.3% were receiving leukotriene receptor antagonists. In the Global Patient Assessment, 31.7% and 29.7% of the patients reported moderate and severe CRSwNP symptoms, respectively, during the past week. Patients in AROMA had a high disease burden in terms of symptoms, comorbidities, and treatment burden. Nearly two-thirds of patients with CRSwNP had at least one sinonasal surgery before initiating dupilumab.Clinical trial NCT04959448 (AROMA), <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link>.
The impact of aeroallergen sensitization on bronchial hyperreactivity in adults.
Telli O, Aksu K, Akkale O … +7 more , Tuglu HC, Celik FD, Yagdiran M, Buhari GK, Nazik Bahcecioglu S, Vural Solak GT, Aksu F
Allergy Asthma Proc · 2025 Sep · PMID 40958187 · Publisher ↗
Although the relationship of seasonal allergens with allergic rhinitis is well known, conflicting results exist with regard to their association with asthma. To investigate the effect of seasonal allergen sensitization...
Although the relationship of seasonal allergens with allergic rhinitis is well known, conflicting results exist with regard to their association with asthma. To investigate the effect of seasonal allergen sensitization on the severity of bronchial hyperreactivity (BHR) and variables that affect BHR in individuals without any chronic respiratory disease who presented to the outpatient clinic with asthma symptoms. Adult subjects who were admitted to our hospital's allergy outpatient clinic between January 2016 and May 2023, presented with at least one of the symptoms of dyspnea, wheezing or cough, and underwent bronchial provocation test (BPT) for the differential diagnosis of asthma were included in the study. Patients with any chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD) or bronchiectasis, were excluded. Demographic characteristics and clinical features of the patients, including admission symptoms, BPT results, skin-prick test results, IgE results, and allergy history were obtained by reviewing patient records. A total of 325 patients were included in the study, 248 (76.3%) of whom were women, and the median (min-max) age was 40 years (18-82 years). Aeroallergen sensitization was positive in 131 patients (40.3%), of whom 38 (11.7%) had single and 93 (28.6%) had multiple allergen sensitization. Sensitization was to perennial allergens in 53 patients (16.3%), to seasonal allergens in 40 patients (12.3%), and to both in 38 patients (11.7%). BPT was positive in 105 patients (32.3%). Among the patients with BHR, 73 (69.5%) had at least one allergen sensitization. The BHR risk was 7.13 times higher in patients sensitized to perennial allergens, 4.14 times higher in those sensitized to seasonal allergens, and 8.67 times higher in patients with sensitization to both. There was no significant difference in PC20 values according to the type of allergen sensitization (perennial allergens, seasonal allergens, mixed type) (p = 0.878). Both seasonal and perennial allergens can elevate the risk of BHR.
Comparison of negative predictive values of single- and two-day provocation tests with suspected nonsteroidal anti-inflammatory drug and paracetamol allergy in children.
Tekcan D, Guler T, Comert M … +2 more , Artac H, Kulhas Celik I
Allergy Asthma Proc · 2025 Sep · PMID 40958186 · Publisher ↗
Drug provocation tests (DPT) are the criterion standard method for diagnosing nonsteroidal anti-inflammatory drugs (NSAID) and paracetamol hypersensitivity reactions in children. However, there is no consensus in the lit...
Drug provocation tests (DPT) are the criterion standard method for diagnosing nonsteroidal anti-inflammatory drugs (NSAID) and paracetamol hypersensitivity reactions in children. However, there is no consensus in the literature with regard to the duration of DPTs. The objective was to compare the negative predictive values (NPV) of single- and 2-day DPTs for NSAID and paracetamol hypersensitivity diagnosis in pediatric patients. We retrospectively evaluated children (ages 1-18 years) with a history of NSAID and paracetamol hypersensitivity. The patients were categorized into two groups based on drug provocation duration: short (single-day test) and extended (test continued on the second day at home). Patients with negative DPT results for the suspected agent were contacted to determine whether they reused the drug and, if so, whether there was a reaction. The NPVs of the DPTs performed for both groups were calculated. The DPT results of 104 patients (53.8% boys) were negative for 116 suspected agents: 67 (57.7%) tested with short DPT and 49 (42.2%) with extended DPT. No significant differences in age, sex, reaction type, or comorbidities were observed between the two groups. In the follow-up, 114 DPTs were performed for 102 patients, of whom 93 used the suspected drug(s) after the tests but none developed a reaction. The NPV was the same for both groups: 100%. To the best of our knowledge, this is the first study to compare the NPVs of single- and 2-day DPTs for children who present with suspected NSAID and paracetamol hypersensitivity. Our results indicate that both approaches have the same NPV and suggest that single-day DPT is sufficient to exclude suspicion of NSAID and paracetamol hypersensitivity in children.
Egg allergy in children: Patterns of consumption of homemade fermented milk products by mothers during pregnancy.
Karatas P, Gulec Koksal Z, Uysal P
Allergy Asthma Proc · 2025 Sep · PMID 40958185 · Publisher ↗
During pregnancy, the mother's gut microbiota is passed onto the baby and the baby's gut microbiota resembles the mother's. The bioactive peptides and microbial metabolites contained in fermented foods help the formation...
During pregnancy, the mother's gut microbiota is passed onto the baby and the baby's gut microbiota resembles the mother's. The bioactive peptides and microbial metabolites contained in fermented foods help the formation of healthy gut microbiota. The aim of this study was to investigate habits of consumption of homemade fermented milk and dairy products (FMP) during pregnancy by mothers of children with egg allergy. Mothers of children with egg allergy ages < 3 years (EA group [n = 93]) and age- and sex-matched healthy children (HC group [n = 77]) admitted to the pediatric allergy and immunology outpatient clinic between January 2023 and June 2023 were included in this case-control study. Data were collected by using the random sampling method. A sociodemographic form was used for the mother and child, and the frequency, amount, and variety of weekly consumption of FMPs (yogurt, cheese, tarhana, and kefir) during pregnancy were investigated. The homemade FMPs during pregnancy of the mothers of the EA group were yogurt, tarhana, and cheese. The number of mothers in the EA group who consumed homemade yogurt (p = 0.049) and tarhana (p < 0.001) was lower than those in the HC group. Mothers in the EA group were also less likely to consume yogurt regularly (p = 0.036). Mothers in the EA group also consumed less homemade yogurt (p = 0.020), cheese (p = 0.001), and tarhana (p < 0.001) than those in the HC group. The diversity of homemade yogurt and cheese (p = 0.048); yogurt, cheese, and tarhana (p < 0.001) consumed during pregnancy was lower in the EA group compared with the HC group. Mothers of children with egg allergy exhibited lower frequencies, quantities, and varieties of homemade FMPs consumption during pregnancy. Consumption of homemade FMPs by mothers during pregnancy may protect against egg allergy in their children.
Multicenter questionnaire study investigating characteristics of adults with unexplained chronic cough versus explained chronic cough.
Gnaensky A, Mahdavinia M, Mustafa S … +7 more , Poole JA, Sher M, Tachdjian R, White A, Bernstein JS, Singh U, Bernstein JA
Allergy Asthma Proc · 2025 Sep · PMID 40958184 · Publisher ↗
Previously, we reported that older women taking increased numbers of cough medications with increased number and frequency of medical encounters and normal or near-normal lung function more likely had unexplained chronic...
Previously, we reported that older women taking increased numbers of cough medications with increased number and frequency of medical encounters and normal or near-normal lung function more likely had unexplained chronic cough (UCC) versus asthma and/or chronic obstructive pulmonary disease. This study sought to identify clinical risk factors that could differentiate UCC from explained chronic cough (ECC). A validated electronic questionnaire was distributed to patients with chronic cough (CC) at seven cough centers throughout the United States. The mean ± standard error, frequencies of continuous variables (one-way analysis), and cross-tabulation frequencies for categorical variables (two-way analysis) were calculated. Univariate comparisons between UCC and ECC were performed by using the t-test and nonparametric one-way analysis. Significant determinants of UCC and cough severity were assessed by using multiple logistic regression. A total of 150 patients were enrolled, of whom 29 of 150 were classified as having UCC, and 121 of 150 were classified as having ECC. No significant differences for family history, age, gender, and race, or seasonality differentiated UCC from ECC. Multiple logistic regression revealed the absence of postnasal drip significantly differentiated UCC from ECC (odds ratio 4.8 [95% Confidence Level, 1.6-15.3]). The severity of CC was worse for patients with UCC, patients with chronic bronchitis and/or emphysema, hypertension, ex-smoking history, high body mass index, female gender, education level, and reactivity to more environmental irritants (perfume, p = 0.006; household cleaners, p = 0.01; air fresheners, p = 0.03; cold air, p = 0.007; cigarette smoke, p = 0.05). Patients with UCC more frequently presented with specific demographic features, comorbid characteristics, and more severe cough induced by environmental irritants compared with ECC. These clinical characteristics may be useful for identifying risk factors that can accelerate the diagnosis of UCC.
Quality of life and burden of disease in patients with hereditary angioedema and their caregivers.
Levy DS, Nagase FI, Cheung A … +2 more , Rodeberg DA, Manning ME
Allergy Asthma Proc · 2025 Sep · PMID 40958183 · Publisher ↗
Hereditary angioedema (HAE) substantially impairs patients' quality of life (QoL), both physically and psychologically, with unpredictable attacks that cause disruptions in education, work, and social life. To identify...
Hereditary angioedema (HAE) substantially impairs patients' quality of life (QoL), both physically and psychologically, with unpredictable attacks that cause disruptions in education, work, and social life. To identify key themes and existing knowledge gaps around the multifaceted burden of HAE. A literature review was conducted in January 2024 through a search of medical literature data bases. English-language studies considered relevant to patient burden and QoL were selected for analysis. A total of 48 studies were included in the analysis; 50% were cross-sectional and 54% were conducted in North America. Twenty-three studies reported outcomes on QoL and pain, 10 studies reported outcomes on psychological distress, 16 studies reported outcomes on experiences with long-term prophylaxis, 36 studies reported outcomes on HAE attacks, and one study detailed caregiver burden. Patients with HAE had worse QoL compared with the general population, and worse QoL was associated with a higher frequency or severity of attacks, anxiety, and depression. The use of long-term prophylaxis improved QoL, and treatment satisfaction was driven by improvements in mental health and fostering a sense of control and independence. HAE continues to substantially impact QoL of patients. Although recent work has demonstrated progress in standardizing assessment tools for QoL in HAE, additional research is needed to determine the correlation between individual patient factors and QoL.
Pediatric allergen immunotherapy in the United States: Current practice, safety, and unmet needs for long-term and preventive outcomes.
Wallace DV
Allergy Asthma Proc · 2025 Sep · PMID 40958182 · Publisher ↗
Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR), allergic asthma, and, potentially, atopic dermatitis (AD) in children. Despite demonstrated efficacy, AIT remains underutil...
Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR), allergic asthma, and, potentially, atopic dermatitis (AD) in children. Despite demonstrated efficacy, AIT remains underutilized in the United States. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) both reduce symptoms and medication use, although much supporting evidence comes from non-U.S. studies by using extracts not approved domestically. Moreover, most U.S. trials of multiallergen SCIT lack rigorous placebo controlled data. The objectives were to examine current evidence on pediatric AIT, evaluate clinical efficacy and safety, and highlight key research gaps, particularly within the U.S. context. A literature search was conducted by using terms that included pediatric AIT, SCIT, SLIT tablets; SLIT drops; and off-label SLIT. The review focused on AIT for AR, asthma, and AD in children, with comparative analysis of SCIT and SLIT in terms of efficacy, safety, and preventative potential. Both SCIT and SLIT are effective for AR and, to a lesser extent, asthma and AD. SLIT tablets offer the advantages of at-home use and a favorable safety profile but in the U.S. are limited to single allergens, which poses challenges for patients who were polysensitized. AIT shows potential for tertiary prevention, such as delaying asthma onset or reducing new sensitizations, although more U.S.-based pediatric data are needed. SCIT carries a risk of systemic reactions; SLIT maintains excellent safety. Knowledge gaps remain with regard to optimal treatment duration, extract formulation, and multiallergen use in children who are polyallergic. AIT is a valuable disease-modifying option for pediatric allergic diseases, but broader U.S. adoption is hindered by regulatory, reimbursement, and evidence limitations. Shared decision-making is critical to align treatment with patient needs. High-quality U.S.-based studies are essential to optimize care and long-term outcomes for children who are allergic.
The lymphocyte-eosinophil to neutrophil-monocyte ratio as a potential composite biomarker associated with asthma exacerbations in adults.
Zhang N, Xie C, Chen J … +1 more , Chen H
Allergy Asthma Proc · 2025 Sep · PMID 40958181 · Publisher ↗
This study evaluates the lymphocyte-eosinophil to neutrophil-monocyte ratio (LENMR) as a novel inflammatory indicator of the exacerbation risk in adults with asthma. This cross-sectional study included 1344 adults with...
This study evaluates the lymphocyte-eosinophil to neutrophil-monocyte ratio (LENMR) as a novel inflammatory indicator of the exacerbation risk in adults with asthma. This cross-sectional study included 1344 adults with asthma from the 2007-2012 cycles of the National Health and Nutrition Examination Survey. The association between LENMR and asthma exacerbations was evaluated by using multivariable logistic regression with progressive adjustment for confounders. Subgroup analyses were conducted to assess the consistency of associations. Restricted cubic spline and threshold effect models were used to explore potential nonlinear relationships. A higher LENMR was significantly associated with an increased risk of asthma exacerbations. In the fully adjusted model, the participants in the highest quartile had a 77% higher odds of exacerbation compared with the lowest quartile (odds ratio 1.77 [95% confidence interval, 1.19-2.65]; p = 0.007). Associations were consistent across subgroups. Restricted cubic spline analysis revealed a significant nonlinear relationship, with a threshold effect identified at LENMR = 0.31. An elevated LENMR is positively associated with asthma exacerbations under specific thresholds.
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