Immunol Allergy Clin North Am
· 2025 May · PMID 40287170
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With their groundbreaking clinical responses, immune checkpoint inhibitors (ICIs) have ushered in a new chapter in cancer therapeutics. However, they are often associated with life-threatening or organ-threatening autoim...With their groundbreaking clinical responses, immune checkpoint inhibitors (ICIs) have ushered in a new chapter in cancer therapeutics. However, they are often associated with life-threatening or organ-threatening autoimmune/autoinflammatory phenomena, collectively termed immune-related adverse events (irAEs). In this review, we will first describe the mechanisms of action of ICIs as well as irAEs. Next, we will review biomarkers for predicting the development of irAEs or stratifying risks.
Sadighi Akha AA, Csomós K, Ujházi B
… +2 more, Walter JE, Kumánovics A
Immunol Allergy Clin North Am
· 2025 May · PMID 40287169
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Primary immunodeficiencies were initially identified on the basis of recurrent, severe or unusual infections. Subsequently, it was noted that these diseases can also manifest with autoimmunity, autoinflammation, allergy,...Primary immunodeficiencies were initially identified on the basis of recurrent, severe or unusual infections. Subsequently, it was noted that these diseases can also manifest with autoimmunity, autoinflammation, allergy, lymphoproliferation and malignancy, hence a conceptual change and their renaming as inborn errors of immunity. Ongoing advances in flow cytometry provide the opportunity to expand or modify the utility and scope of existing laboratory tests in this field to mirror this conceptual change. Here we have used the B cell subset, variably known as CD21low B cells, age-associated B cells and T-bet+ B cells, as an example to demonstrate this possibility.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287168
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There are approximately 500 congenital disorders that impair immune cell development and/or function. Patients with these disorders may present with a wide range of symptoms, including increased susceptibility to infecti...There are approximately 500 congenital disorders that impair immune cell development and/or function. Patients with these disorders may present with a wide range of symptoms, including increased susceptibility to infection, autoimmunity, autoinflammation, lymphoproliferation, and/or atopy. Flow cytometry-based immune phenotyping of T and B lymphocytes plays an essential role in the evaluation of patients with these presentations. In this review, we describe the clinical utility of flow cytometry as part of a comprehensive evaluation of immune function and how this testing may be used as a diagnostic tool to identify underlying aberrant immune pathways, monitor disease activity, and assess infection risk.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287167
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Primary immune regulatory disorders (PIRDs) are inborn errors of immunity, with autoimmune, hyperinflammatory, and lymphoproliferative manifestations as presenting features rather than recurrent infections. Genetic testi...Primary immune regulatory disorders (PIRDs) are inborn errors of immunity, with autoimmune, hyperinflammatory, and lymphoproliferative manifestations as presenting features rather than recurrent infections. Genetic testing remains the primary tool for diagnosing patients with immune defects. Not all suspected PIRDs have a known genetic cause. Many hyperinflammatory disorders require urgent intervention, limiting the usefulness of gene sequencing in some cases. Current clinically approved immunology tests can detect immune dysregulation even without apparent immune deficiency. This review presents commonly known patterns of immune dysregulation that can be detected with currently available immune testing and additional testing in the clinical immunology laboratories' pipeline.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287166
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We are just beginning to understand the architectures, landscapes, and paradigms underlying genetically driven immune disorders (GIDs), though have already benefited greatly from the evolution of increasingly sophisticat...We are just beginning to understand the architectures, landscapes, and paradigms underlying genetically driven immune disorders (GIDs), though have already benefited greatly from the evolution of increasingly sophisticated sequencing technologies. Genetic diagnostic strategies are chosen by matching the most appropriate molecular assays and analytical tools to the relevant genetic and genomic features of a patient's differential. This review provides a practical guide for such decision-making. The authors review GID-specific paradigms, compare available and emerging genomic technologies and assays, delineate a typical clinical genomic diagnostic process, and discuss the implications of the current variant classification framework for GIDs.
Immunol Allergy Clin North Am
· 2025 May · PMID 40287165
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There is an increasing demand for clinical immunology providers. Clinical immunology is a unique field given its complexity, rapid expansion, and reliance on multidisciplinary care. In order to meet this demand, increase...There is an increasing demand for clinical immunology providers. Clinical immunology is a unique field given its complexity, rapid expansion, and reliance on multidisciplinary care. In order to meet this demand, increased prioritization for immunology-focused clinician educators can increase exposure and interest in field at all levels. We surveyed allergy and immunology fellowship program directors, and the majority found current immunology training relatively inadequate. Increasing the volume of immunology faculty and patients were considered most important but less feasible. Increasing immunology didactics may be the best starting point to improve immunology training in allergy and immunology fellowship.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608882
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Exercise-induced bronchoconstriction (EIB), a reversible airflow obstruction triggered by exercise, should be considered in patients presenting with symptoms of dyspnea, cough, wheeze, and chest tightness during or after...Exercise-induced bronchoconstriction (EIB), a reversible airflow obstruction triggered by exercise, should be considered in patients presenting with symptoms of dyspnea, cough, wheeze, and chest tightness during or after vigorous exercise. Over the past several years, various diagnostic modalities have been developed and evaluated for the diagnosis of EIB, giving the clinician multiple options for diagnostic testing. Here, the authors present a review of the various testing options that can be used in the diagnosis of EIB, with a discussion of testing protocols and considerations for choosing the appropriate diagnostic test.
Van Meerbeke SW, McCarty M, Petrov AA
… +1 more, Schonffeldt-Guerrero P
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608881
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Exercise-induced bronchoconstriction (EIB) with or without underlying asthma is a condition with complex pathophysiology, where many factors play a role in its development and clinical presentation. EIB can be impacted b...Exercise-induced bronchoconstriction (EIB) with or without underlying asthma is a condition with complex pathophysiology, where many factors play a role in its development and clinical presentation. EIB can be impacted by various environmental factors including climate, environmental allergens, air pollution, and altitude. Although it might be hard to escape one's environment, patients should nevertheless be counseled on how the environment could impact their symptoms. Patient education regarding environmental factors could help overcome impediments to exercise and improve performance.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608880
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Exercise-induced bronchoconstriction (EIB) refers to temporary lower airway narrowing that occurs during or after vigorous physical exertion, with a high incidence in athletes and individuals with pre-existing asthma. Th...Exercise-induced bronchoconstriction (EIB) refers to temporary lower airway narrowing that occurs during or after vigorous physical exertion, with a high incidence in athletes and individuals with pre-existing asthma. The pathophysiology of EIB is not completely understood, but it is thought to involve a complex interplay among airway epithelial changes, immune responses, and environmental interactions. Phenotypic differences are apparent among those affected by EIB. This clinical review aims to summarize the complex mechanisms underlying EIB, explore the role of biomarkers in the diagnosis and management, and identify current gaps in knowledge to pave the way for future scientific discoveries.
Thirión-Romero I, Alvarado-Amador I, Torre-Bouscoulet L
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608879
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Exercise-induced bronchoconstriction (EIB), subgrouped as exercise-induced bronchoconstriction with asthma (EIBa) or without asthma, is defined as acute airway narrowing that occurs during or after exercise. EIB has been...Exercise-induced bronchoconstriction (EIB), subgrouped as exercise-induced bronchoconstriction with asthma (EIBa) or without asthma, is defined as acute airway narrowing that occurs during or after exercise. EIB has been described mostly in patients with asthma and athletes. Prevalence differs according to the subjects studied, challenge methods, and EIB definition. In the general population, prevalence is approximately 5% to 20%. In EIBa, it can be as high as 90% of patients with baseline asthma. In athletes, reported rates range from 7% to 70%. Some of the risk factors for developing EIB are living in an urban environment, a family history of asthma and atopy, and environmental factors such as low humidity.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608878
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Large airway collapse on expiration is an increasingly recognized cause of airway centric symptoms. The 2 primary conditions are tracheobronchomalacia and excessive dynamic airway collapse, the latter a common comorbidit...Large airway collapse on expiration is an increasingly recognized cause of airway centric symptoms. The 2 primary conditions are tracheobronchomalacia and excessive dynamic airway collapse, the latter a common comorbidity in those with underlying lung disease. The exertional dyspnea associated with these conditions is complex and exercise intolerance is a key clinical feature, despite the fact that the precise relationship is not fully understood. Forced expiratory maneuvers during supine bronchoscopy or imaging studies are used to evaluate these conditions. However, it may be relevant to characterize large airway function during occasions when patients present their symptoms.
Christen A, O'Connell A, Mayer I
… +3 more, Tona G, Hilland M, Clemm H
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608877
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This review provides an overview of existing data from the literature summarizing therapies for exercise-induced laryngeal obstruction (EILO) with 2 main areas of focus. We discuss the role of speech-language pathologist...This review provides an overview of existing data from the literature summarizing therapies for exercise-induced laryngeal obstruction (EILO) with 2 main areas of focus. We discuss the role of speech-language pathologists in the assessment and treatment of EILO and an overview of different respiratory retraining techniques used in the behavioral management of the disease. We then discuss the role and some of the technical specifics of supraglottoplasty (SGP) for refractory supraglottic EILO, including patient selection and similarities between SGPs performed for EILO and for infants with laryngomalacia.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608876
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Exercise is strongly recommended in almost all populations for its beneficial effects on physical and mental health. This edition of Clinics features state-of-the-art reviews of the most commonly encountered respiratory...Exercise is strongly recommended in almost all populations for its beneficial effects on physical and mental health. This edition of Clinics features state-of-the-art reviews of the most commonly encountered respiratory causes of shortness of breath during exercise in active individuals, including nasal obstructions, exercise-induced laryngeal obstruction, excessive dynamic airways collapse, exercise-induced bronchoconstriction with and without asthma, and breathing-pattern disorder. The goals of this edition include summarizing knowledge of these conditions, creating a new wave of experts in the field, and inspiring readers to contribute to the field from around the globe.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608875
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Exercise-induced laryngeal obstruction (EILO) poses several diagnostic and management challenges. This review explores EILO's historical evolution, complex nomenclature, global epidemiology, clinical presentation, diagno...Exercise-induced laryngeal obstruction (EILO) poses several diagnostic and management challenges. This review explores EILO's historical evolution, complex nomenclature, global epidemiology, clinical presentation, diagnostic modalities, and underlying pathophysiological mechanisms. Recent efforts to standardize terminology, includes EILO as a subcategory of the broader disorder of inducible laryngeal obstruction. EILO prevalence ranges from 5% to 8%, primarily affecting adolescents and young adults. EILO diagnosis remains challenging, with continuous laryngoscopy during exercise emerging as the gold standard. Multidisciplinary collaboration and adoption of standardized assessments are vital for effective management. Future research should focus on elucidating underlying mechanisms, optimizing diagnostic strategies, and improving EILO-specific outcomes.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608874
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Breathing pattern disorder (BPD) is an abnormal pattern of ventilation and movements of the upper and lower ribcage and abdomen that results in a constellation of symptoms. This paper discusses the management of BPD from...Breathing pattern disorder (BPD) is an abnormal pattern of ventilation and movements of the upper and lower ribcage and abdomen that results in a constellation of symptoms. This paper discusses the management of BPD from a technical standpoint. Since there is not a one-size-fits-all model for practice, we offer a toolbox approach to care with quick reference tables and diagrams that allow the practitioner to easily find treatement approaches that may suite their athlete. While this article uses the athlete as a reference for treatment, there is also a consideration for how to approach the co-morbid patient as well.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608873
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Breathing pattern disorder (BPD) refers to a heterogenous condition, which features altered normal respiratory functioning that cannot be fully attributed to organic causes at the current time. Characteristic symptoms of...Breathing pattern disorder (BPD) refers to a heterogenous condition, which features altered normal respiratory functioning that cannot be fully attributed to organic causes at the current time. Characteristic symptoms of this condition include dyspnea, and irregular ventilation. The diagnosis of BPD is made utilizing a combination of patient-reported experiences in the form of validated questionnaires, direct observation by experienced clinicians, and objective testing in the form of cardiopulmonary exercise testing.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608872
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Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB) are closely related conditions that can make it challenging to differentiate between them. These conditions necessitate that asthmatic patients...Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB) are closely related conditions that can make it challenging to differentiate between them. These conditions necessitate that asthmatic patients adhere to established asthma guidelines for baseline treatment. Short-acting beta-agonists are emphasized as the primary treatment for managing symptoms. The management of EIA and EIB in children is particularly complex due to their high levels of spontaneous physical activity. Patients must identify and avoid environmental triggers that may exacerbate their symptoms whenever possible. For effective management, physicians should regularly assess treatment efficacy through the remission of symptoms. However, athletes may require more specialized and serial testing to tailor their treatment plans effectively and ensure optimal performance. This article encapsulates the critical points concerning managing exercise-induced respiratory issues in asthmatic individuals, highlighting the need for careful and tailored approaches for different patient groups.
Immunol Allergy Clin North Am
· 2025 Feb · PMID 39608871
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The nose filters, moistens, and warms inspired air at rest and during activity. Exercise is associated with an increase in nasal airflow and a decrease in resistance to that flow. Mechanistically, changes in the nasal mu...The nose filters, moistens, and warms inspired air at rest and during activity. Exercise is associated with an increase in nasal airflow and a decrease in resistance to that flow. Mechanistically, changes in the nasal mucosa during exercise may increase neutrophilic infiltration, impair olfaction, and prolong mucociliary transport time. The increased exposure to substances in the exercise environment may also produce rhinitis. Clinically, the prevalence of rhinitis and upper airway infections is increased in athletes. Allergic and non-allergic rhinitis, and rhinosinusitis may be diagnosed clinically, with other studies supporting the diagnosis; their main treatments are topical steroids, antihistamines, and saline.