Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136090
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Mounting evidence suggests atopic dermatitis (AD) is primarily mediated by environmental exposures. This article focuses on specific air pollutants such as isocyanates and those in the benzene, toluene, ethylbenzene, and...Mounting evidence suggests atopic dermatitis (AD) is primarily mediated by environmental exposures. This article focuses on specific air pollutants such as isocyanates and those in the benzene, toluene, ethylbenzene, and xylene family. We discuss the current strength and limitations of the data linking air pollution to AD. Brief mention is given to dietary and water-borne factors of concern. The proposed mechanisms of pathology for these chemicals are detailed. Finally, mitigation strategies are discussed with a focus on facilitating discussion between providers and patients related to the ways of improving AD without a prescription.
Immunol Allergy Clin North Am
· 2025 Nov · PMID 41136089
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Researchers have shown significant interest in the early prediction of atopic dermatitis (AD) and food allergy (FA) by analyzing factors such as genetics, skin barrier function, skin lipid profiles, epidermal cytokine pr...Researchers have shown significant interest in the early prediction of atopic dermatitis (AD) and food allergy (FA) by analyzing factors such as genetics, skin barrier function, skin lipid profiles, epidermal cytokine profiles, cutaneous microbiome, and environmental influences, including air pollution and temperature. Early intervention is critical for preventing and mitigating the severity and progression of AD and FA. This article explored the pathogenesis of both AD and FA and highlighted the potential of skin tape stripping as a promising noninvasive tool for identifying predictive and follow-up biomarkers in infants predisposed to these conditions.
Hoyt AEW, Pappalardo AA, Laubach S
… +1 more, Bingemann TA
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669944
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The management of IgE-mediated food allergies in K-12 schools and early childcare centers poses unique challenges to schools, families of children with food allergies, and allergists and other food allergy-focused health...The management of IgE-mediated food allergies in K-12 schools and early childcare centers poses unique challenges to schools, families of children with food allergies, and allergists and other food allergy-focused health care providers. Despite the shifting landscape of food allergy, children must be kept safe, have access to emergency medications, and be included at school, and a child's education must not suffer due to food allergies. In this article, we describe strategies and evidence, where existent, for managing food allergies at school. We also provide insight into challenges faced by all parties and guidance on successfully navigating such situations.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669943
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Anaphylaxis, leading to a fatal outcome, is extraordinarily rare when it comes to food. In fact, it has been described as the near equivalent of enduring a lightning strike. The day-to-day anxiety, therefore, around this...Anaphylaxis, leading to a fatal outcome, is extraordinarily rare when it comes to food. In fact, it has been described as the near equivalent of enduring a lightning strike. The day-to-day anxiety, therefore, around this very serious outcome is outsized. In those known to be allergic, careful and strict avoidance can markedly reduce the risk of reaction. Yet, because eating is a daily occurrence and often a meal is consumed that one has not prepared, accidents can happen. Therefore, prompt recognition of symptoms and appropriate treatment is a key.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669942
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Individualized avoidance is the cornerstone of immunoglobulin E (IgE)-mediated food allergy (FA) management. Education on proper avoidance, including label reading, avoiding cross-contact, eating safely away from home, a...Individualized avoidance is the cornerstone of immunoglobulin E (IgE)-mediated food allergy (FA) management. Education on proper avoidance, including label reading, avoiding cross-contact, eating safely away from home, and alternatives, is paramount. Individuals with FAs are at increased risk for growth faltering, and the involvement of a dietitian to ensure the diet is complete is essential. Nutrients provided by the avoided food need to be considered, and appropriate substitutions should be offered. Individual needs, based on factors such as the patient's age, cultural background, dietary preferences, etc, should be incorporated into dietary advice.
Sindher SB, O'Rourke E, Tan W
… +2 more, Chin AR, Chinthrajah RS
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669941
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The recent United States Food and Drug Administration (FDA) approval of omalizumab for the treatment of food allergy has highlighted the potential of targeting the allergic pathways driving food allergy. Many promising t...The recent United States Food and Drug Administration (FDA) approval of omalizumab for the treatment of food allergy has highlighted the potential of targeting the allergic pathways driving food allergy. Many promising therapeutic strategies are emerging that target different aspects of these pathways including immunoglobulin E, interleukin-4 receptor α, alarmins, and Bruton's tyrosine kinase. Several of these novel therapeutics have already been FDA approved for the treatment of other atopic diseases, greatly facilitating their potential translation to food allergy. Further research on these therapeutics can expand the tools available to allergists allowing them to better tailor therapeutics to the specific circumstances and needs of their patients.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669940
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Food allergy is a significant health issue affecting millions of people worldwide, and the prevalence is increasing. Food allergy impacts physical health, finances, school and work attendance, mental health, and quality...Food allergy is a significant health issue affecting millions of people worldwide, and the prevalence is increasing. Food allergy impacts physical health, finances, school and work attendance, mental health, and quality of life. Historically, allergen avoidance, anaphylaxis education, and prompt use of intramuscular epinephrine were the only treatment options. Now, there are 2 Food and Drug Administration-approved products (Palforzia and Xolair), which can help reduce the risk of severe food allergy reactions. There is ongoing research regarding the use of immunotherapy (oral, sublingual, and epicutaneous), other monoclonal antibodies (eg, dupilumab), probiotics and microbiome manipulation, and traditional Chinese medicine.
Catamerò F, Giovannini M, Barni S
… +2 more, Mori F, Upton JEM
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669939
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Milk and egg allergies are of critical importance due to their high prevalence and rising epidemiology. Although they are commonly outgrown, they can be severe, and the foods are difficult to avoid. Nutritional status is...Milk and egg allergies are of critical importance due to their high prevalence and rising epidemiology. Although they are commonly outgrown, they can be severe, and the foods are difficult to avoid. Nutritional status is compromised by avoiding milk. There are important differential diagnoses for milk allergy, including nonimmunoglobulin E-mediated allergies and lactose intolerance. Milk and egg allergies can be managed by allowing baked forms of these proteins into diets with attention to risks and benefits. Milk and egg can be in various medications although for most products their safety in allergic populations has been well-documented.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669938
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Given the significant medical, economic, and psychosocial burden of food allergies, there is great interest in identifying effective strategies in food allergy prevention, diagnosis, and management as early as possible....Given the significant medical, economic, and psychosocial burden of food allergies, there is great interest in identifying effective strategies in food allergy prevention, diagnosis, and management as early as possible. Infants are a unique population regarding food allergy, in that there are significant opportunities for primary prevention or early treatment with hope of disease remission. Unique aspects of infant food allergy include age-specific signs and symptoms of reactions, distinct preparation needs for oral food challenges, as well as attention to nutritional requirements for growth and development.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669937
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Oral food challenges are considered the gold-standard diagnosis of food allergy and are frequently performed in the clinical setting to determine whether a food allergic patient may reintroduce a food to the diet or cont...Oral food challenges are considered the gold-standard diagnosis of food allergy and are frequently performed in the clinical setting to determine whether a food allergic patient may reintroduce a food to the diet or continue strict avoidance; however, they are expensive, time-consuming, and potentially risky. Surrogate biomarkers can help guide management in the clinical setting but do not replace the need for oral food challenges. As providers rely on oral food challenges in their clinical management of patients, it is important to have training and standardized protocols to reduce risk to patients if allergic reactions were to occur.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669936
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Immunoglobulin E-mediated food allergies affect millions of patients worldwide. Understanding food allergies, other food-related clinical phenotypes, and clinically available diagnostic testing options can help providers...Immunoglobulin E-mediated food allergies affect millions of patients worldwide. Understanding food allergies, other food-related clinical phenotypes, and clinically available diagnostic testing options can help providers care for impacted patients. This article seeks to review the performance of currently available food allergy (FA) testing modalities and highlights advancements in the field of diagnostic testing for FA. Novel diagnostics may have considerable implications for advancing accurate risk assessment, patient phenotyping, and FA management.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669935
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Food allergy, now widely recognized since the mid-twentieth century, is an immune reaction to specific proteins, often involving immunoglobulin E antibodies. They can cause symptoms ranging from mild discomfort to life-t...Food allergy, now widely recognized since the mid-twentieth century, is an immune reaction to specific proteins, often involving immunoglobulin E antibodies. They can cause symptoms ranging from mild discomfort to life-threatening responses. Around 4.3% of the global population is affected, with prevalence varying by region: 7.6% in US children compared with 0.61% in Brazil. Common triggers include peanuts, milk, eggs, fish, shellfish, wheat, soy, and sesame, with some, like peanut and tree nut allergies, often lasting into adulthood. Beyond health concerns, food allergies also bring a heavy economic toll through medical costs, lost productivity, and the need for special diets.
Immunol Allergy Clin North Am
· 2025 Aug · PMID 40669934
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As the incidence of allergic conditions increases, industrialization and environmental exposures are thought to contribute to the rise in atopy, as genetics alone cannot explain this. Various prenatal and postnasal expos...As the incidence of allergic conditions increases, industrialization and environmental exposures are thought to contribute to the rise in atopy, as genetics alone cannot explain this. Various prenatal and postnasal exposures contribute to epithelial barrier dysfunction, which causes the release of pro-inflammatory cytokines and the inhibition of key proteins and lipids. This allows sensitization to occur through food allergen penetration.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287174
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As immunologists, we evaluate patients with a large spectrum of disorders, which include impaired immunity, autoimmunity, and autoinflammatory features. Recent discoveries in inflammatory pathways have elucidated disease...As immunologists, we evaluate patients with a large spectrum of disorders, which include impaired immunity, autoimmunity, and autoinflammatory features. Recent discoveries in inflammatory pathways have elucidated disease pathogenesis and also treatment targets to best focus on the most involved cytokine pathways. Autoinflammatory diseases center around the inability to quell a nonantigenic inflammatory response due to missing suppressive components of the immune system. Management is mostly directed to minimize the sequelae of uncontrolled, chronic inflammation. In this article, an array of classic periodic fever syndromes will be discussed along with disorders involving dysregulated IL-1, TNF, NF-kb, and Type 1 interferon pathways.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287173
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Chronic granulomatous disease (CGD) is a rare primary phagocytic immunodeficiency characterized by recurrent infections due to impaired NADPH oxidase activity. Balancing the need for additional immune suppression with th...Chronic granulomatous disease (CGD) is a rare primary phagocytic immunodeficiency characterized by recurrent infections due to impaired NADPH oxidase activity. Balancing the need for additional immune suppression with the risk of infection in patients with CGD-associated inflammation can be difficult but increased understanding of the underlying pathophysiology may allow for more targeted and rational therapies. Current treatments for inflammatory complications include glucocorticoids, steroid-sparing immunosuppressive agents, antibiotics, and increasingly the use of targeted biologic agents. However, improved curative therapy strategies for patients with suboptimal donor options are needed and autologous gene therapy remains experimental.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287172
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Common Variable Immunodeficiency (CVID) is a prevalent primary immunodeficiency in adults, marked by low immunoglobulin levels and recurrent infections. This review examines the gastrointestinal complications of CVID, in...Common Variable Immunodeficiency (CVID) is a prevalent primary immunodeficiency in adults, marked by low immunoglobulin levels and recurrent infections. This review examines the gastrointestinal complications of CVID, including both infectious and non-infectious manifestations. It highlights therapeutic strategies, from antimicrobials to novel biologics, and the role of immune modulation. The review also explores the impact of gut microbiota dysbiosis on CVID pathogenesis and emphasizes the need for personalized treatment approaches and routine cancer screening due to the elevated risk of gastrointestinal malignancy in CVID patients.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287171
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Clinical indications for immunoglobulin therapy can be broadly classified into replacement therapy for immunodeficiencies, immunomodulatory treatment of inflammatory conditions, and hyperimmune therapy against specific i...Clinical indications for immunoglobulin therapy can be broadly classified into replacement therapy for immunodeficiencies, immunomodulatory treatment of inflammatory conditions, and hyperimmune therapy against specific infectious agents. When starting immunoglobulin therapy, there are important considerations for the clinician including indication and function, composition, dosing, route, and safety. Immunoglobulin therapy should be tailored to an individual patient. This review discusses our current understanding and practical considerations for using immunoglobulin therapy for both humoral immune reconstitution and immunomodulation.