Phillips KM, Baroody FM, Alicea JR
… +2 more, Sedaghat AR, Laidlaw TM
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241426
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Rhinosinusitis is a spectrum of diseases with varied causes, presentations, and diagnostic approaches-from viral and bacterial acute rhinosinusitis to chronic inflammatory or fungal etiologies. This article reviews the d...Rhinosinusitis is a spectrum of diseases with varied causes, presentations, and diagnostic approaches-from viral and bacterial acute rhinosinusitis to chronic inflammatory or fungal etiologies. This article reviews the diagnosis of acute, chronic, recurrent, and fungal rhinosinusitis, highlighting key clinical, endoscopic, and radiologic features that distinguish these entities. It provides practical guidance on differentiating viral from bacterial causes, assessing chronic inflammation with and without polyps, and recognizing rare but serious fungal infections. It also explores emerging diagnostic tools such as biomarkers and artificial intelligence that are reshaping personalized care in sinusitis.
Bernstein JS, Ware K, Zamora-Sifuentes J
… +2 more, Poole JA, Shusterman D
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241425
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Occupational rhinitis is a frequently underdiagnosed condition that can cause patient morbidity, potentially progress to asthma, and result in economic hardship for both the individual and the workforce. It is important...Occupational rhinitis is a frequently underdiagnosed condition that can cause patient morbidity, potentially progress to asthma, and result in economic hardship for both the individual and the workforce. It is important to screen for work-related exposures and have knowledge of high molecular weight and low molecular weight agents in the workplace, as well as common occupational irritants. Having a methodical diagnostic approach, understanding primary, secondary, and tertiary prevention measures, recognizing comorbid disease and utilizing targeted management strategies will, in all likelihood, improve patient outcomes. Challenging cases may require co-management of Allergy with both Primary Care and Occupational Medicine.
van Waterschoot J, Van Gerven L, Pfirrman S
… +2 more, Greiwe J, Bernstein JA
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241424
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Diagnosis of nonallergic rhinitis (NAR) is made after excluding other etiologies of rhinitis symptoms, such as allergic rhinitis or local allergic rhinitis (LAR). A thorough clinical history, examination and negative all...Diagnosis of nonallergic rhinitis (NAR) is made after excluding other etiologies of rhinitis symptoms, such as allergic rhinitis or local allergic rhinitis (LAR). A thorough clinical history, examination and negative allergy tests-skin prick test or specific IgE-are essential. Special focus should go to symptom patterns, triggers, and comorbidities. Additional diagnostic tools include nasal allergen provocation tests for LAR, cold dry air provocation for idiopathic rhinitis, and nasal cytology to identify inflammatory cell patterns and NAR with eosinophilia syndrome. Accurate diagnosis is crucial to distinguish NAR subtypes and ensure appropriate management strategies.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241423
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The use of artificial intelligence (AI) in medicine has been growing steadily over the past decade, but it has not been until the past few years that it has been employed officially in many different medical environments...The use of artificial intelligence (AI) in medicine has been growing steadily over the past decade, but it has not been until the past few years that it has been employed officially in many different medical environments, from AI-assisted diagnosis to therapeutic decisions and even AI-assisted interventions. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have always been at the avant-garde in embracing new techniques in guideline development since its conception. We present a narrative review of ARIA's developmental stages, particularly focusing on the final one: the integration of AI in the development of the latest update.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241422
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Chronic rhinosinusitis (CRS) is a complex disease with multiple phenotypes. The primary phenotypic division is CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The majority of patients with CRSwNP ha...Chronic rhinosinusitis (CRS) is a complex disease with multiple phenotypes. The primary phenotypic division is CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The majority of patients with CRSwNP have type 2 inflammatory disease characterized by eosinophilic inflammation and type 2 cytokines (primarily interleukin-4, 5, and 13). CRS is not primarily an infectious problem, although viral and bacterial infections or dysbiosis may exacerbate the disease. There is an association of CRS with asthma, particularly CRSwNP. Treatment of the CRS benefits asthma.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241421
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Allergic rhinitis (AR) is a prevalent atopic condition commonly diagnosed based on clinical history and confirmed through skin prick testing or serum-specific immunoglobulin-E (sIgE) measurements. However, some patients...Allergic rhinitis (AR) is a prevalent atopic condition commonly diagnosed based on clinical history and confirmed through skin prick testing or serum-specific immunoglobulin-E (sIgE) measurements. However, some patients present with classic AR symptoms despite negative results on conventional allergy tests, a phenomenon now recognized as local allergic rhinitis (LAR). LAR is characterized by localized IgE production within the nasal mucosa and is diagnosed using nasal allergen provocation testing alongside detection of nasal sIgE. This article provides an overview of current diagnostic approaches for AR and explores the emerging insights into the identification and diagnosis of LAR.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241420
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Complementary and alternative medications are frequently used by patients with allergic rhinitis based on perceived lack of adequate response to standard therapies that are recommended based on best evidence in clinical...Complementary and alternative medications are frequently used by patients with allergic rhinitis based on perceived lack of adequate response to standard therapies that are recommended based on best evidence in clinical guidelines, and/or concerns regarding potential adverse effects of these conventional medications. Complementary and alternative medications have a variety of pharmacologic actions, untoward effects, and potential drug-drug interactions. This article critically appraises the evidence for efficacy and safety of a number of commonly used complementary and alternative medications for patients with allergic rhinitis.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241419
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Allergen immunotherapy is the only treatment modality that can modify severity of allergic rhinitis. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are both effective treatment options. SLIT has a...Allergen immunotherapy is the only treatment modality that can modify severity of allergic rhinitis. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are both effective treatment options. SLIT has a better safety profile with rare reports of systemic reaction events. In this article, we will review evidence pertaining to efficacy of individual treatment allergens and assess relative efficacy and safety of SLIT versus SCIT.
Immunol Allergy Clin North Am
· 2026 Feb · PMID 41241418
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This article covers the pathophysiology of chronic rhinitis and chronic rhinosinusitis (CRS), focusing on both phenotypic and endotypic distinctions. It highlights how genetic and environmental factors contribute to dise...This article covers the pathophysiology of chronic rhinitis and chronic rhinosinusitis (CRS), focusing on both phenotypic and endotypic distinctions. It highlights how genetic and environmental factors contribute to disease development, emphasizing the roles of epithelial barrier dysfunction and microbiome disruption. The article categorizes CRS into forms with and without nasal polyps, each involving unique immune responses and inflammation types. Specific endotypes are also discussed, highlighting the complexity and heterogeneity of these conditions.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136099
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Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe itch, significantly affecting patients' quality of life. Increased understanding of the underlying pathomechanism has led to the devel...Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe itch, significantly affecting patients' quality of life. Increased understanding of the underlying pathomechanism has led to the development of effective new systemic treatments, including biologics and Janus kinase inhibitors. However, responses to these new treatments vary among patients, highlighting the need for personalized approaches. This article provides an overview of AD's epidemiology, pathogenesis, and management strategies, focusing on the effectiveness and safety of new systemic treatments and patient-centered dosing regimens. It also explores future biomarker predictions and discusses new systemic treatments currently in development.
Bingemann T, Weis EL, El-Feghaly J
… +1 more, De Benedetto A
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136098
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This is an exciting time in the management of atopic dermatitis due to the development of several biologics, Janus Kinase inhibitors, and new topical therapies. Furthermore, evidence-based guidelines allow provision of i...This is an exciting time in the management of atopic dermatitis due to the development of several biologics, Janus Kinase inhibitors, and new topical therapies. Furthermore, evidence-based guidelines allow provision of individualized patient care. Management includes education on trigger avoidance, appropriate use of topicals to ensure efficacy and avoid side effects while attending to the psychosocial needs and priorities of the patient/caregivers. The synthesis of this information facilitates a balanced discussion of risks, benefits, and alternatives to allow for shared decision-making. Together these options provide an opportunity to improve the quality of life of patients with atopic dermatitis.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136097
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Cutaneous lesions of mastocytosis (CLM) are a hallmark for the diagnosis of mastocytosis. The nomenclature of the term "cutaneous mastocytosis" (CM) is ambiguous as it is used both for classification excluding and as a m...Cutaneous lesions of mastocytosis (CLM) are a hallmark for the diagnosis of mastocytosis. The nomenclature of the term "cutaneous mastocytosis" (CM) is ambiguous as it is used both for classification excluding and as a morphologic description including systemic variants of mastocytosis. Recognition of CLM may be delayed by clinically subtle and very heterogeneous presentations. Distinguishing monomorphic versus polymorphic maculopapular CM may be challenging. Less common presentations require a clearly positive Darier's sign, histopathological confirmation, and/or skin D816V kit mutational analysis. Management of patients with CLM requires multidisciplinary therapy, adequate staging, and follow-up to recognize complications.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136096
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Patch testing presents multiple challenges apart from the technical aspects of the test itself. This article reviews issues that arise in routine practice including managing patient expectations, determining clinical rel...Patch testing presents multiple challenges apart from the technical aspects of the test itself. This article reviews issues that arise in routine practice including managing patient expectations, determining clinical relevance of positive reactions, and ensuring successful contact allergen avoidance.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136095
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This article examines current and emerging therapeutic perspectives in chronic urticaria management. It describes the established stepwise therapeutic algorithm, from second-generation H1-antihistamines to cyclosporine,...This article examines current and emerging therapeutic perspectives in chronic urticaria management. It describes the established stepwise therapeutic algorithm, from second-generation H1-antihistamines to cyclosporine, emphasizing the importance of continuous administration and periodic evaluation. The article analyzes emerging therapies, including BTK inhibitors, new specific receptor antagonists, and biological therapies, which promise more targeted and personalized options. The evolution toward treatments based on specific disease mechanisms is highlighted, offering hope for patients refractory to conventional therapies. Recent developments in understanding molecular mechanisms have led to novel therapeutic approaches that address different aspects of mast cell activation and inflammatory cascades.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136094
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Itch is one of the most commonly encountered symptoms in allergy clinics. Until recently, effective therapies for itch were limited, but now there are multiple classes of drugs that can target distinct forms of itch. Des...Itch is one of the most commonly encountered symptoms in allergy clinics. Until recently, effective therapies for itch were limited, but now there are multiple classes of drugs that can target distinct forms of itch. Despite this remarkable progress, variability in therapeutic outcomes underscores unmet needs in treating pruritic skin diseases. As a paradigm of neuroimmune crosstalk, insight into basic mechanisms of itch may shed new light on conditions beyond the skin. This article discusses basic preclinical scientific studies of itch neuroimmunology and how approved medications for pruritic skin diseases are informing development of the next generation of treatments.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136093
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Full text
Atopic dermatitis (AD) is a chronic inflammatory skin disorder, which often precedes food allergy, asthma, and allergic rhinitis-a progression known as the atopic march. A key feature of AD is elevated allergen-specific...Atopic dermatitis (AD) is a chronic inflammatory skin disorder, which often precedes food allergy, asthma, and allergic rhinitis-a progression known as the atopic march. A key feature of AD is elevated allergen-specific immunoglobulin E (IgE), indicating sensitization to environmental, microbial, and self-antigens. This study examines the mechanisms driving IgE sensitization in AD, including epidermal barrier dysfunction, immune dysregulation, antigen presentation, microbial imbalance, and genetic susceptibility. Understanding these pathways is essential for developing targeted therapies to prevent allergic disease progression and improve clinical outcomes.
Chan-Ng PPL, Leung ASY, Goleva E
… +1 more, Tham EH
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136092
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Key strategies for atopic dermatitis prevention have been reviewed, which include maternal dietary modifications, breastfeeding, and early allergen introduction to promote immune tolerance. Maintaining skin barrier integ...Key strategies for atopic dermatitis prevention have been reviewed, which include maternal dietary modifications, breastfeeding, and early allergen introduction to promote immune tolerance. Maintaining skin barrier integrity is critical, with early emollient use in high-risk infants showing promise, but clarity on optimal emollient type, duration, and window of intervention is needed. Probiotic supplementation in pregnancy, lactation, and in early life, as well as infant dietary diversity from an early age may be beneficial. Evidence for omega-3 and vitamin D supplementation is inconclusive. Microbiome-targeted therapies are emerging areas for future research but have yet to reach clinical practice.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136091
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The skin microbiome in patients with atopic dermatitis (AD) is dysregulated with disproportionate dominance of Staphylococcus aureus, decreased microbial diversity, and decline in populations of commensal organisms with...The skin microbiome in patients with atopic dermatitis (AD) is dysregulated with disproportionate dominance of Staphylococcus aureus, decreased microbial diversity, and decline in populations of commensal organisms with beneficial antimicrobial properties, such as coagulase-negative Staphylococci (CoNS). Emerging therapeutics target dysbiosis, S aureus elimination, CoNS growth, and microbial diversity improvement in the treatment and prevention of AD.