Allergy And Asthma Proceedings[JOURNAL]
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200 papers
Key factors in the diagnosis of sesame allergy in children.
Hismiogullari A, Sancakli O, Ocak M … +5 more , Gunder S, Uzunoglu B, Celebi Celik F, Karkiner CS, Can D
Allergy Asthma Proc · 2026 Jul · PMID 42343506 · Publisher ↗
Sesame allergy (SA) is diagnostically challenging in childhood, and data on its natural course and clinical nonreactivity development are limited. Although oral food challenge (OFC) remains the diagnostic criterion stand...
Sesame allergy (SA) is diagnostically challenging in childhood, and data on its natural course and clinical nonreactivity development are limited. Although oral food challenge (OFC) remains the diagnostic criterion standard, the value of skin-prick tests (SPT) and sesame specific immunoglobulin E (sIgE) in diagnosis and clinical nonreactivity prediction is unclear. The objective was to assess the diagnostic accuracy of tahini SPT and sesame sIgE, and to determine the frequency of clinical nonreactivity and identify clinical and laboratory factors associated with clinical nonreactivity development in children undergoing tahini-based OFC. In this retrospective diagnostic accuracy study, 49 children with suspected SA were included. All participants underwent open tahini-based OFC. The diagnostic performance of tahini SPT and sesame sIgE was assessed by using receiver operating characteristic curve analysis. Of the 49 children included in the study, 21 (42.9%) had a positive tahini-based OFC result. A tahini SPT demonstrated higher predictive performance for OFC positivity compared with sesame sIgE. An optimal cutoff value of 7.5 mm for a tahini SPT result yielded a sensitivity of 81% and a specificity of 85.7%. In contrast, sesame sIgE at a cutoff value of 2.60 kU/L demonstrated lower sensitivity (66.7%) and specificity (82.1%) for predicting OFC outcomes. The sesame sIgE to total IgE ratio was also significantly higher in patients with a positive outcome of OFC (p = 0.049). Patients with a negative outcome of OFC were significantly younger than those with a reactive outcome (p = 0.003). Atopic dermatitis was more prevalent in the negative outcome of the OFC group (p = 0.038), whereas a history of anaphylaxis was not associated with OFC outcomes (p = 0.084). Tahini SPT showed a trend toward better diagnostic performance than did sesame sIgE in predicting clinical reactivity in pediatric SA, although the difference did not reach statistical significance. Younger age and the presence of atopic dermatitis seemed to be associated with a higher likelihood of a negative OFC outcome. However, these findings should be interpreted with caution due to the retrospective design, limited sample size, and single-center setting. Further prospective studies are needed to confirm these observations.
Immunoglobulin E-mediated pumpkin seed allergy in children: Case series and narrative review with a structured literature search.
Acikalin B, Ocak M, Sekerel BE
Allergy Asthma Proc · 2026 Jul · PMID 42343505 · Publisher ↗
Pumpkin seed allergy is a rare but potentially severe immunoglobulin E (IgE) mediated food allergy, with limited pediatric data and few documented cases worldwide. To describe the clinical and diagnostic characteristics...
Pumpkin seed allergy is a rare but potentially severe immunoglobulin E (IgE) mediated food allergy, with limited pediatric data and few documented cases worldwide. To describe the clinical and diagnostic characteristics of pediatric pumpkin seed allergy and to synthesize all previously reported cases through a systematically searched narrative review. We retrospectively reviewed the records of children diagnosed with IgE-mediated pumpkin seed allergy at a tertiary pediatric allergy clinic in Turkey (2016-2024). The diagnosis relied on the clinical history, specific IgE (sIgE), and skin-prick tests (SPT); patients in select cases had oral food challenges. Data on clinical presentation, comorbidities, co-allergies, and laboratory findings were extracted. A structured literature search of medical literature data bases identified all published cases of patients with pumpkin seed allergy, which were qualitatively reviewed. Twenty-five children (76% boys) were identified, with a median diagnosis age of 2.98 years. Immediate reactions were universal, and anaphylaxis occurred in 64%. The median SPT wheal was 13 mm, and the median sIgE level was 10.3 kUA/L. Atopic comorbidities were frequent (atopic dermatitis, 92%; asthma, 48%). Co-allergy was common (tree nuts, 76%; other seeds, 72%); watermelon seed sensitization occurred in 83%, with six patients experiencing clinical reactions after watermelon seed ingestion. Pumpkin pulp was tolerated in all the patients. A literature review revealed 14 previously published cases, mostly adults, with 57% experiencing anaphylaxis. Pumpkin seed allergy, although uncommon, frequently causes systemic reactions in children. Our case series underscores the need for clinician awareness, diagnostic inclusion of pumpkin seed in high-consumption regions, and further research into its molecular allergens and cross-reactivity.
Predictors of delayed treatment-free remission with omalizumab in chronic spontaneous urticaria.
Aslan Savas S, Colkesen F, Gerek ME … +6 more , Ergun UY, Harman E, Kolak S, Sagun F, Yigitdol I, Arslan S
Allergy Asthma Proc · 2026 Jul · PMID 42343504 · Publisher ↗
Reliable biomarkers that predict delayed treatment-free remission with omalizumab in chronic spontaneous urticaria (CSU) remain unclear. The objective was to identify independent predictors of delayed treatment-free rem...
Reliable biomarkers that predict delayed treatment-free remission with omalizumab in chronic spontaneous urticaria (CSU) remain unclear. The objective was to identify independent predictors of delayed treatment-free remission with omalizumab by comparing patients who achieved treatment-free remission with ≤ 12 doses with those who required > 12 doses. This single-center retrospective study included 163 adult patients with antihistamine-refractory CSU who were treated with omalizumab (300 mg every 4 weeks) between January 2018 and October 2025. Treatment discontinuation was considered only after at least six consecutive doses and complete disease control, defined as a urticaria control test (UCT) score of 16 with no wheals or angioedema. Treatment-free remission was defined as a symptom-free period of at least 6 months without pharmacotherapy after discontinuation. Patients were classified as having early remission (≤12 doses) or delayed remission (>12 doses). Demographic, clinical, and laboratory variables were compared, and multivariable logistic regression was performed. Of the 163 patients (median age, 41 years; 60.1% women), 99 (60.7%) had delayed remission and 64 (39.3%) had early remission. Delayed remission was associated with a higher prevalence of autoimmune disease in the delayed remission group than in the early remission group (27.3% versus 12.5%; p = 0.025) longer symptom duration before omalizumab initiation (p < 0.001), and higher baseline total immunoglobulin E (IgE) levels (p < 0.001). In multivariable analysis, longer pretreatment symptom duration (odds ratio [OR] 1.023 [95% confidence interval {CI}, 1.009-1.038]; p = 0.002) and autoimmune disease (OR 2.984 [95% CI, 1.130-7.882]; p = 0.027) independently predicted delayed remission, whereas the total IgE value did not (p = 0.070). Longer pretreatment symptom duration and coexisting autoimmune disease were the strongest independent predictors of delayed treatment-free remission with omalizumab in CSU.
The digital front door: A national analysis of U.S. allergy and immunology fellowship program web sites.
Hamid N, Merheb D, Love M … +1 more , Gierer S
Allergy Asthma Proc · 2026 Jul · PMID 42343503 · Publisher ↗
Allergy/immunology (A/I) fellowship recruitment occurs within a competitive match environment, with most interviews conducted virtually. Program web sites play a critical role in informing applicants and shaping program...
Allergy/immunology (A/I) fellowship recruitment occurs within a competitive match environment, with most interviews conducted virtually. Program web sites play a critical role in informing applicants and shaping program perception. Despite established literature that demonstrates the importance of program web sites across specialties, the comprehensiveness of A/I fellowship web sites has not been systematically evaluated. The purpose of this study was to evaluate existing A/I fellowship program web sites with the intent to identify opportunities for improvement. A list of 91 A/I fellowship programs was obtained from the American Academy of Allergy, Asthma & Immunology web site. Eighty-nine programs with accessible web sites were included. Each web site was evaluated for the presence of 24 predefined metrics derived from previous residency and fellowship web site studies. Sixteen programs affiliated with World Allergy Organization (WAO) Centers of Excellence in the United States were analyzed as a subgroup. Mean metric counts were compared by using a two-sample t-test. Web sites contained a mean ± standard deviation (SD) of 13.7 ± 4.9 of 24 metrics. WAO-affiliated programs contained a mean ± SD of 13.2 ± 4.6 metrics, with no statistically significant difference when compared with all the programs (p = 0.70). Although most web sites listed program leadership, curriculum, and training sites, fewer included alumni information (40%), job placement (38%), or wellness initiatives (18%). A/I fellowship program web sites vary widely in content and may lack information, particularly with regard to wellness, alumni outcomes, and trainee demographics. Enhancing web site comprehensiveness represents an opportunity to improve recruitment, branding, and applicant engagement in a competitive application environment.
The impact of dietary patterns on the risk of asthma in children.
Liu L, Bai Y, Huang Y … +5 more , Chen J, Su R, Liu C, Zou M, Feng W
Allergy Asthma Proc · 2026 Jul · PMID 42343502 · Publisher ↗
Previous research has predominantly focused on the relationship between individual nutrients and asthma. However, diet involves complex interactions among its various components. Dietary pattern analysis can more accurat...
Previous research has predominantly focused on the relationship between individual nutrients and asthma. However, diet involves complex interactions among its various components. Dietary pattern analysis can more accurately reflect the impact of overall diet on disease. Based on the 2011-2020 National Health and Nutrition Examination Survey data base, this study included 7216 children ages 3-17 years. Principal component analysis was used to extract dietary features, and K-means clustering was used to identify typical dietary patterns. Multivariate weighted logistic regression was used to analyze the association between dietary patterns and the risk of asthma. Subgroup analyses were also conducted. Furthermore, ordinal logistic regression was used to explore the relationship between dietary patterns and asthma exacerbation levels. Two primary dietary patterns were identified: a "refined high red meat and high sugar diet pattern" (characterized by high intake of refined grains, red meat, processed meats, solid fats, and added sugars) and a "fruits and vegetables enrichment-balanced diet pattern" (characterized by a balanced diet with adequate intake of fruits and vegetables). After adjusting for covariates, children who followed the refined high red meat and high sugar diet pattern had a 15% higher risk of asthma compared with those who followed the fruits and vegetables enrichment-balanced diet pattern (odds ratio [OR] 1.15; p = 0.04). Notably, in the 3-5-year-old subgroup, the fruits and vegetables enrichment-balanced diet pattern was associated with a 54% reduction in asthma risk (OR 0.46). However, no significant association was found between dietary patterns and asthma exacerbation severity levels (p > 0.05). The refined high red meat and high sugar diet pattern is a modifiable risk factor for childhood asthma, whereas the fruits and vegetables enrichment-balanced diet pattern seems to have a protective effect. Early childhood (ages 3-5 years) may be a critical period for dietary intervention. Analysis of these findings suggests that modifying dietary patterns could be an important strategy for the primary prevention of childhood asthma.
The alpha-gal syndrome: Understanding the role of tick bites, and the delays in severe anaphylaxis.
Platts-Mills TAE, Dunaway CA, Gangwar RS … +2 more , Workman LJ, Wilson JM
Allergy Asthma Proc · 2026 Jul · PMID 42343501 · Full text
The presence of serum immunoglobulin E (IgE) antibodies to the oligosaccharide galactose-alpha-1,3-galactose (α-gal) was first recognized during the investigation of allergic reactions to the monoclonal antibody cetuxima...
The presence of serum immunoglobulin E (IgE) antibodies to the oligosaccharide galactose-alpha-1,3-galactose (α-gal) was first recognized during the investigation of allergic reactions to the monoclonal antibody cetuximab. The availability of an assay for IgE to α-gal made it possible to show that the patients who reported delayed allergic reactions to meat also had IgE to α-gal. This syndrome of delayed reactions to meat in patients with IgE to an oligosaccharide that was present in nonprimate mammals represented a complete contrast to the other forms of food allergy. However, the realization that the sensitization resulted from bites of the lone star tick, Ambloymma americanum, provided an explanation for the increase in cases in an area of the United States where there had been a major increase in the deer population, which is the primary breeding host of this tick. In contrast to almost all other IgE-mediated reactions, there is no relationship between the delay after eating red meat and the severity of allergic reactions. There is also increasing evidence that serum tryptase in the range of 20-90 ng/mL can occur after severe reactions related to α-gal. In addition, a recently reported fatal anaphylaxis, which started 4 hours after the individual ate a hamburger, included a postmortem tryptase of >2000 ng/mL. A working hypothesis to explain the delay in reactions relates to the time taken to process glycolipids in food derived from mammals, first into chylomicrons and, finally, to low-density lipoproteins. However, the quantitative presence of α-gal that remains on these particles may have major individual differences. In contrast to the patients who have symptoms related to eating meat, there are many individuals who are sensitized and who are not aware of any symptoms. In addition, individuals who are sensitized to alpha-gal can react rapidly to intravenous injections to the monoclonal antibody cetuximab, or polyclonal antibodies to venom, or the newer antivenom digested to Fab or Fab'2.
Correlation of disease activity (Urticaria Activity Score over 7 Days) and quality of life (Chronic Urticaria Quality of Life Questionnaire) in patients with chronic spontaneous urticaria: A prospective observational study.
Dash M, Ayub A, Vasudevan B … +1 more , Sood A
Allergy Asthma Proc · 2026 Jul · PMID 42343500 · Publisher ↗
Chronic spontaneous urticaria (CSU) significantly impairs patient quality of life (QoL) through recurrent wheals and pruritus. The urticaria activity score over 7 days (UAS7) and the chronic urticaria quality of life que...
Chronic spontaneous urticaria (CSU) significantly impairs patient quality of life (QoL) through recurrent wheals and pruritus. The urticaria activity score over 7 days (UAS7) and the chronic urticaria quality of life questionnaire (CU-Q2oL) are validated patient-reported outcome measures recommended by international guidelines for monitoring CSU. Whether these two measures track in parallel over a structured treatment course, particularly as disease activity diminishes, remains incompletely characterized, especially in South Asian populations. A 6-month prospective observational study was conducted at a tertiary-care dermatology center in India. Fifty adult patients with active CSU were enrolled. All received second-generation H1-antihistamines (cetirizine, levocetirizine, or fexofenadine) with dose up-titration up to fourfold as needed per international urticaria guideline recommendations guideline recommendations. No patients required omalizumab during the study period. The UAS7 and CU-Q2oL scores were recorded at baseline and monthly for 6 months. Baseline total serum immunoglobulin E (IgE) values and absolute eosinophil counts (AEC) were correlated with the clinical scores. Statistical analysis included Wilcoxon signed rank tests for longitudinal change and the Spearman rank correlation at each time point. The sample size was based on clinical feasibility; the study is considered exploratory. The mean ± standard deviation baseline UAS7 score was 30.3 ± 9.1 (severe disease), and the mean ± standard deviation CU-Q2oL score was 51.4 ± 13.2. Both scores improved significantly by 6 months (UAS7 score: 5.1; CU-Q2oL score: 12.5; p < 0.0001 for both). The UAS7-CU-Q2oL correlation was moderate when the disease was active (Spearman r = 0.44, p = 0.002 at 1 month) but weakened substantially as disease activity declined (r ≈ 0.25, p = 0.08 at 3 months; r ≈ 0.08, p > 0.5 at 6 months). Baseline total IgE value and AEC did not correlate with disease severity or QoL at any time point. UAS7 and CU-Q2oL scores correlate during active CSU but diverge as disease is controlled. Even after symptom resolution, some patients retain residual QoL impairment. Routine use of both measures is recommended because UAS7 alone may underestimate the patient burden during remission. The total IgE value and AEC are not reliable surrogate markers of CSU severity or QoL in this exploratory cohort.
34-year-old female with cyclical abdominal pain and rash.
Luu J, Tsai L, Kumar M … +1 more , White A
Allergy Asthma Proc · 2026 Jul · PMID 42343499 · Publisher ↗
A 34-year-old woman presented with recurrent, severe abdominal pain accompanied by nausea, vomiting, and rashes. A careful history revealed a cyclical monthly pattern of symptoms. Through a multidisciplinary approach, ho...
A 34-year-old woman presented with recurrent, severe abdominal pain accompanied by nausea, vomiting, and rashes. A careful history revealed a cyclical monthly pattern of symptoms. Through a multidisciplinary approach, hormonal modulation led to symptom resolution. This case highlights the importance of recognizing a rare diagnosis characterized by cyclical cutaneous and systemic symptoms in women of reproductive age.
Safety of dupilumab use during pregnancy: A composite evaluation of pregnancy outcomes.
Ventura FL, Clayton SB
Allergy Asthma Proc · 2026 Jul · PMID 42343498 · Publisher ↗
Dupilumab is a monoclonal antibody that targets interleukin 4 and interleukin 13 pathways, increasingly used to treat asthma, eczema, and eosinophilic esophagitis (EoE). Currently, there is minimum literature that evalua...
Dupilumab is a monoclonal antibody that targets interleukin 4 and interleukin 13 pathways, increasingly used to treat asthma, eczema, and eosinophilic esophagitis (EoE). Currently, there is minimum literature that evaluated the safety of dupilumab during pregnancy. This study assessed whether dupilumab use is associated with increased pregnancy complications. We conducted a multicenter, retrospective study of pregnant patients exposed to dupilumab between 2017 and 2024 compared with age- and comorbidity-matched controls who were not receiving biologic therapy. The primary outcome was the composite rate of any pregnancy-related complication, analyzed multivariate logistical regression. The data were analyzed both with no covariates and with four covariates (adjusted for age, race/ethnicity, hypertension, and parity). Statistical analyses were conducted by using statistical software, with a two-sided α level of 0.05 considered statistically significant. Secondary outcomes investigated complication rates by subgroups (maternal, labor, and fetal complications). Subgroup data were analyzed via the Wald test. Of the 301 patients identified with both dupilumab exposure and a pregnancy classification of diseases code, 69 unique pregnancies met inclusion criteria for confirmed dupilumab exposure during pregnancy. Several patients carried more than one type 2 inflammatory diagnosis; therefore, diagnosis counts exceed the total number of patients. Among these 69 pregnancies, 39 involved asthma, 37 atopic dermatitis, and 3 EoE, with overlap across diagnoses. There was no significant difference in overall complication rates between the study and control groups (69.6% versus 65.2%; p = 0.5861). This held true in the adjusted model (n = 129) (odds ratio 1.131 [95% confidence interval, 0.505-2.533]; p = 0.7650). No significant differences were noted in the subgroups. The most prominent complications were gestational diabetes, gestational hypertension, preeclampsia, unplanned caesarean sections, and spontaneous abortion (SAB). Although SAB trended toward a higher frequency in the dupilumab group compared with the controls (14.0% versus 5.8%; p = 0.164), it remained within the expected general population rates (10-15%). Dupilumab exposure during pregnancy was not associated with an increased risk of pregnancy complications. These findings support the relative safety of dupilumab in pregnancy and provide reassurance to clinicians managing asthma, eczema, or EoE. Larger prospective studies are needed to confirm these results and assess long-term maternal and neonatal outcomes.
Patterns of epinephrine prescribing at discharge and length of stay for adult anaphylaxis in U.S. emergency departments.
Liu EY, Zhang C, Ray T … +5 more , Nadeau KC, Valenzuela-Vallejo L, Salifu K, Samelson EJ, Mukamal KJ
Allergy Asthma Proc · 2026 Jul · PMID 42343497 · Full text
Anaphylaxis is a life-threatening allergic reaction that requires prompt epinephrine and post-treatment management. Guidelines recommend prescribing epinephrine at discharge from the emergency department (ED), yet result...
Anaphylaxis is a life-threatening allergic reaction that requires prompt epinephrine and post-treatment management. Guidelines recommend prescribing epinephrine at discharge from the emergency department (ED), yet results of studies show lower-than-recommended prescribing rates and variable ED lengths of stay (LOS). Large-scale analyses of adult anaphylaxis care in U.S. EDs remain limited. The objective was to estimate the proportion of adults discharged from U.S. EDs with an epinephrine prescription, characterize ED LOS, and identify predictors of these outcomes. We analyzed 2013-2015 and 2018-2022 National Hospital Ambulatory Medical Care Survey-ED visits for adults ages ≥ 18 years diagnosed with anaphylaxis who were discharged home. Outcomes were (1) epinephrine prescription at discharge and (2) ED LOS < 4 hours. Patients who arrived by emergency medical services (EMS) were excluded for LOS analysis. Multivariable log-binomial regression estimated risk ratios (RR) between outcomes and clinical predictors. Among 609 ED visits, 14% resulted in an epinephrine prescription at discharge (95% confidence interval [CI], 10%-18%). The median (interquartile range) LOS was 138 minutes (80-199 minutes), with 83% discharged within 4 hours (95% CI, 78%-87%). Older adults (≥42 years) and Hispanic patients were less likely to receive an epinephrine prescription (RR 0.47 [95% CI, 0.25-0.90]; RR 0.34 [95% CI, 0.12-0.95], respectively). Rural visits were more likely to have LOS < 4 hours (RR 1.12 [95% CI, 1.02-1.23]). Epinephrine prescribing at discharge was infrequent across the full cohort, whereas ED LOS was typically brief among the patients who did not arrive by EMS. Older adults and Hispanic patients were less likely to receive epinephrine, and rural visits had shorter LOS. These findings highlight potential disparities in discharge prescribing and ED management of adult anaphylaxis in U.S. EDs.
Food allergy, biologic therapies, and diagnostic precision: Expanding frontiers in allergy and immunology.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2026 Jul · PMID 42343496 · Full text
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Social context factors and disparities in emergency department use in pediatric food allergy.
Esteban CA, Cushman GK, Chandra S … +4 more , Scarpaci MM, Zheng T, Barker D, Mcquaid EL
Allergy Asthma Proc · 2026 Jul · PMID 42343495 · Publisher ↗
Although disparities in food allergy (FA) related emergency department (ED) use exist, social context factors are understudied and may play an important role. We sought to evaluate the role of food security and communit...
Although disparities in food allergy (FA) related emergency department (ED) use exist, social context factors are understudied and may play an important role. We sought to evaluate the role of food security and community resources in explaining disparities in FA-related ED usage. Electronic medical record data from Hasbro Children's Hospital's FA clinic were extracted from January 1, 2016, to December 31, 2021, for children ages < 18 years. Diagnostic classification codes and chart reviews were used to identify encounters with immunoglobulin E (IgE) mediated FA-related diagnoses. We evaluated the differences in FA-related ED use by age, race and/or ethnicity, community resources (Child Opportunity Index [COI]), and the percentage of households in the census tract that receive Supplemental Nutrition Assistance Program (SNAP) benefits. Logistic regression was performed to identify predictors of FA-related ED use. A total of 1,512 children were seen at the FA clinic for IgE-mediated FA. Those who used the ED for FA were non-Latino White (NLW) (16.1%), Black (22.0%), Latino (23.1%), and Other (23.5%) (standardized mean difference [SMD], 0.10; p < 0.05). The risk of FA-related ED visits differed by age, with fewer visits for older children (odds ratio [OR], 0.7), and by social economic and neighborhood environment variables, with a lower risk of ED visits for more resourced environments (ORs for public insurance, 1.57; OR for SNAP, 1.19; and OR for COI, 0.80). Disparities in ED usage became negligible for patients already connected to routine allergist care, which demonstrated a potential protective factor. Black and Latino children have an increased risk for FA-related ED visits compared with NLW children, although social contextual factors explained most of the disparities. Analysis of the findings demonstrates the need to consider the social economic and neighborhood environment in FA management to inform place-based interventions.
Icatibant for acute hereditary angioedema attacks in pediatric patients: A systematized review.
Schmalzried S, Beckett RD, Davis H … +1 more , Carreon G
Allergy Asthma Proc · 2026 Jul · PMID 42343494 · Publisher ↗
Hereditary angioedema (HAE) is a rare, potentially life-threatening bradykinin-mediated disorder with limited pediatric treatment options and little comparative evidence. Icatibant, a bradykinin B2 receptor antagonist, h...
Hereditary angioedema (HAE) is a rare, potentially life-threatening bradykinin-mediated disorder with limited pediatric treatment options and little comparative evidence. Icatibant, a bradykinin B2 receptor antagonist, has demonstrated efficacy in adults and has emerging evidence in children. To evaluate and synthesize clinical evidence on the efficacy and safety of icatibant for acute HAE attacks in pediatric patients. A literature search was performed by using medical literature data bases, clinical trial and research registries, and key journals through January 2026. The primary outcome was the time to onset of symptom relief. Secondary outcomes included the time to minimum symptoms, pain scores, adverse events, and feasibility of self- or caregiver administration. All included studies were nonrandomized, single-arm trials with heterogeneous designs and outcomes definitions; therefore, a meta-analysis was not performed, and all studies were descriptively evaluated. This systematic review identified three clinical studies of icatibant for acute HAE attacks in children ages 0 to 17 years. Three open-label, phase III studies, which included 43 pediatric patients were reviewed. Icatibant demonstrated rapid symptom relief, with a median onset at ∼1 hour and minimum symptoms within 2 hours, although repeated dosing showed variability. Icatibant was well tolerated, with injection-site reactions as the most common adverse events and no serious treatment-related events. Self- or caregiver administration was feasible and effective in adolescents. Icatibant was safe and effective in the pediatric studies, providing rapid symptoms relief and a favorable tolerability profile. Despite limitations from small sample sizes and lack of comparator trials, current evidence supports icatibant as a targeted, practical option for treating acute HAE attacks in children.
Local anesthetic hypersensitivity: Frequently suspected, rarely proven: A retrospective study of 101 patients.
Galata Z, Limoncu O, Tunakan Dalgıc C … +4 more , Gumusburun R, Mete Gokmen N, Kokuludag A, Sin AZ
Allergy Asthma Proc · 2026 Jul · PMID 42343493 · Publisher ↗
Local anesthetics (LAs) are commonly used to provide regional insensitivity in dentistry, minor surgical procedures, and general anesthesia but may rarely cause allergic reactions. The file data of 101 patients who were...
Local anesthetics (LAs) are commonly used to provide regional insensitivity in dentistry, minor surgical procedures, and general anesthesia but may rarely cause allergic reactions. The file data of 101 patients who were referred to the Department of Allergy and Immunology, Ege University Faculty of Medicine, with a suspected LA allergy between February 2020 and August 2024 were retrospectively reviewed. Patients included in the study were contacted by phone and asked whether they had used LAs after the test and whether any reactions had developed. Female patients comprised 81% (n = 82) of the study cohort. Patients were predominantly referred from the departments of dentistry (45% [n = 46]) and anesthesiology (22% [n = 22]). Patients were referred due to reactions related to LAs alone (n = 51) and both LAs and other drugs (n = 50). The severity of LA reactions was mild (n = 47), moderate (n = 36), or severe (n = 18), with dyspnea being the most common symptom (n = 47). Prick-intradermal (P-ID) and provocation tests were performed on all the patients (suspected LAs [n = 32], alternative LAs [n = 23], random [n = 46]). Only one patient tested positive in the P-ID test, and a provocation test was performed on this patient with an alternative agent, with a negative result. Of the 80 patients reached by phone, 41 received LAs based on test results and did not develop an allergic reaction, whereas the other 39 patients did not receive LAs. Immunologically mediated reactions to LAs were exceedingly rare in this study. These findings highlight that most suspected reactions are not attributable to confirmed allergic mechanisms and underscore the importance of a careful clinical history and guideline-based evaluation to avoid unnecessary drug avoidance.
Inhaler recognition as a marker for adherence in pediatric patients with asthma.
Huang J, Kothari M, Revan R … +1 more , Poowuttikul P
Allergy Asthma Proc · 2026 May · PMID 42050842 · Publisher ↗
Poor adherence to daily asthma controller medications contributes to increased emergency department (ED) visits and hospitalizations in children. A simple bedside tool to assess adherence is needed in clinical settings....
Poor adherence to daily asthma controller medications contributes to increased emergency department (ED) visits and hospitalizations in children. A simple bedside tool to assess adherence is needed in clinical settings. The objective was to determine whether a child's or a caregiver's ability to recognize the prescribed daily controller inhaler is associated with poor adherence and increased asthma morbidity. A retrospective chart review was conducted on 163 pediatric patients (ages 3-18 years) admitted for asthma exacerbation on patient's and/or caregiver's ability to identify the patient's prescribed daily controller inhaler. Patients were classified as recognizing or not recognizing their inhaler. Clinical outcomes, including ED visits, hospital admissions, systemic corticosteroid use, and adherence markers (prescription refills and follow-up visits), were compared between the groups. The patients unable to recognize their inhaler had significantly poorer adherence, with fewer prescription refills (p = 0.001) and lower rates of specialty follow-up (p ≤ 0.001). These patients also had higher rates of asthma-related ED visits (p = 0.003) and systemic corticosteroid use (p = 0.010). No significant association was found with inpatient admissions, impairment of daily symptoms, or frequency of albuterol use. Patients with three or more intensive care unit admissions in the past year were more likely to recognize their inhalers (p = 0.013), possibly due to increased exposure to asthma education. The inability to recognize a prescribed daily controller inhaler is associated with poor adherence and increased asthma-related ED visits and systemic corticosteroid use. This simple bedside assessment may help identify patients at high risk and guide targeted interventions to improve adherence and asthma outcome.
Follow-up after discontinuation of omalizumab in patients with moderate-to-severe asthma: A systematic review.
Yan QL, Zhang LY, Niu WS … +4 more , Shi JJ, Chen YQ, Zhang FY, Cheng L
Allergy Asthma Proc · 2026 May · PMID 42050841 · Publisher ↗
Omalizumab is a well-established add-on therapy for patients with moderate-to-severe asthma. However, there is limited systematic evidence on the long-term outcomes after discontinuation of this treatment. To address th...
Omalizumab is a well-established add-on therapy for patients with moderate-to-severe asthma. However, there is limited systematic evidence on the long-term outcomes after discontinuation of this treatment. To address this evidence gap, this review aimed to systematically evaluate the follow-up outcomes in patients with moderate-to-severe asthma after discontinuation of omalizumab treatment. The research was conducted in accordance with the systematic reviews and meta-analyses guidelines. We systematically searched medical literature data bases from December 2003 to August 2025 for observational studies (prospective or retrospective) on omalizumab discontinuation in moderate-to-severe asthma. Data extraction was conducted on key variables: omalizumab treatment regimens, postdiscontinuation long-term outcomes, asthma control status, relapse risk factors, asthma exacerbation rates, corticosteroid use, and patterns of omalizumab reinitiation. A total of 11 eligible studies were included in the review. After discontinuation, most patients showed no remarkable changes in forced expiratory volume in 1 second, fractional exhaled nitric oxide level, total immunoglobulin E value, or absolute eosinophil count. Moreover, no obvious deterioration was observed in patient-reported quality of life. These findings confirm the sustained long-term benefits of previous omalizumab add-on therapy because the majority of patients maintained favorable disease control after discontinuation. Subgroup analyses further indicated that asthma exacerbations, when they occurred, predominantly occurred within the first year after discontinuation. This review indicates that, although most patients maintain stable objective indicators after omalizumab discontinuation, a significant proportion are at increased risk for exacerbations, deterioration in asthma control, and increased corticosteroid use, particularly within the first year.
Clinical characteristics, type 2 comorbidities, and treatment responses in pediatric and adult chronic spontaneous urticaria: A multicenter retrospective cohort study.
Smiley K, Galli L, Grippen Goddard A … +10 more , Moore L, Smigiel C, Tambay A, Barseghyan E, Probst A, Nguyen L, Navasero N, Wetklow B, Oldenburg R, Geng B
Allergy Asthma Proc · 2026 May · PMID 42050840 · Publisher ↗
Chronic spontaneous urticaria (CSU) presents with unpredictable, often debilitating symptoms, yet detailed clinical characterization, particularly in pediatric populations, remains limited. Improved understanding of clin...
Chronic spontaneous urticaria (CSU) presents with unpredictable, often debilitating symptoms, yet detailed clinical characterization, particularly in pediatric populations, remains limited. Improved understanding of clinical profiles and comorbidities may guide management strategies. The objective was to characterize clinical presentation, comorbid type 2 inflammatory diseases, and treatment responses in a large cohort of pediatric and adult patients with CSU across multiple allergy practices. A retrospective observational cohort study was conducted across four U.S. allergy clinics, including two pediatric- and two adult-focused practices. Medical records of 400 patients with CSU (189 pediatric patients, 211 adults) with ≥ 6 months of follow-up between 2013 and 2023 were reviewed for demographic data, comorbidities, clinical presentation, clinician-documented disease severity, and treatment outcomes. Disease severity spanned mild (24%), moderate (28%), and severe (48%) disease; adults more often presented with severe disease (65% versus 32% in pediatric patients). Atopic comorbidities were common, including allergic rhinitis (72%), asthma (38%), and atopic dermatitis (17%), with 43% of patients having two or more type 2 inflammatory comorbidities. H-antihistamines were the most frequently used therapies, with cetirizine being most common. Omalizumab showed effectiveness in most patients, although ∼31% experienced partial or no response. Systemic corticosteroids and cyclosporine were used infrequently. Sparse documentation of physical findings and laboratory analysis limited further objective analysis. This U.S. multicenter study highlights the substantial burden of atopic disease and refractory CSU in both pediatric and adult populations. These findings emphasize the need for prospective studies with standardized clinical documentation to better understand CSU phenotypes and optimize individualized treatment strategies.
Clinical outcomes and risk factors associated with breakthrough reactions in chemotherapy desensitization.
Kayikci H, Damadoglu E, Cihanbeylerden M … +6 more , Tuccar C, Pehlivanlar Ustaoglu A, Cayiroz K, Hatipoglu E, Karakaya G, Kalyoncu AF
Allergy Asthma Proc · 2026 May · PMID 42050839 · Publisher ↗
Rapid drug desensitization (RDD) is a safe and effective option for patients who are hypersensitive when no alternatives are available; however, breakthrough reactions (BTR) may still occur. This study aimed to evaluate...
Rapid drug desensitization (RDD) is a safe and effective option for patients who are hypersensitive when no alternatives are available; however, breakthrough reactions (BTR) may still occur. This study aimed to evaluate chemotherapeutic RDD outcomes and identify risk factors for BTRs. This retrospective study included patients who underwent chemotherapeutic RDD between 2019 and 2023 at a tertiary adult allergy clinic. BTR rates and potential risk factors were assessed. Among 197 patients with chemotherapy-induced immediate hypersensitivity reactions, 132 (95 women [72.0%]) were included in the final analysis. A total of 552 RDD procedures (range, 1-17) were performed, most frequently with carboplatin (43.1%), oxaliplatin (28.0%), and cisplatin (10.6%). Among these patients, 45 (34.0%) experienced a total of 72 BTRs (13.0%). BTRs occurred at a median of 2 cycles (range, 1-16 cycles) and the 16th step (range, 1-20 steps). Of all the procedures, 533 (96.6%) were successfully completed. Compared with the 16-step protocol, the 12-step protocol was associated with an increased BTR risk (odds ratio [OR] 4.05 [95% confidence interval {CI}, 1.7-9.5]; p = 0.001). Multivariate analysis revealed that the BTR risk increased with the total number of RDDs (OR 1.13 [95% CI, 1.0-1.2]; p = 0.026). Skin test positivity was identified as the strongest risk factor for BTRs (OR 2.767 [95% CI, 1.131-6.768]; p = 0.026). Chemotherapy RDD was effective and safe, achieving a 96.6% success rate. The total number of desensitization procedures and skin test positivities were significant predictors of BTRs, indicating that the risk may persist despite successful initial desensitization. Careful risk assessment and close monitoring are essential to ensure patient safety during repeated RDD cycles.
Time for action: How to combat myths and misinformation on social media.
Stone S, Henao MP, Al-Shaikhly T
Allergy Asthma Proc · 2026 May · PMID 42050838 · Full text
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The evolving spectrum of type 2 inflammation and beyond.
Allergy Asthma Proc · 2026 May · PMID 42050837 · Full text
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