Clinical Reviews in Allergy & Immunology最新文献

{"title":"Immunopathogenesis and Experimental Models of Alopecia Areata: From Mechanistic Insights to Translational Platforms.","authors":"Ying Wang, Yichuan Li, Yinyi Feng, Yong Zhang, Dong Li","doi":"10.1007/s12016-026-09171-5","DOIUrl":"10.1007/s12016-026-09171-5","url":null,"abstract":"<p><p>Alopecia areata (AA) is a common autoimmune, non-scarring hair loss disorder with substantial clinical heterogeneity and psychosocial burden. Although recent therapeutic advances, particularly Janus kinase (JAK) inhibitors, have transformed management, the pathogenic mechanisms underlying disease initiation, progression, and relapse remain incompletely understood. Current evidence supports the collapse of hair follicle immune privilege as a central event in AA, followed by the activation of cytotoxic T-cell-dominant responses and amplification through IFN-γ/IL-15-driven inflammatory circuits. However, the contributions of innate immune populations, neuroimmune stress pathways, and hair follicle resident compartments to disease heterogeneity are still being clarified. In parallel, experimental models have proven essential for mechanistic investigation and therapeutic development. Classical C3H/HeJ mice, humanized models, and genetically engineered systems provide critical insights into immune-mediated follicular injury and serve as valuable platforms for drug screening. Furthermore, in vitro and ex vivo models, including hair follicle organ cultures, scalp explants, and novel bioengineered platforms, facilitate the detailed investigation of early pathological events and their underlying mechanisms. Yet, no single model fully captures the entire disease continuum. This review synthesizes the current understanding of AA immunopathology and systematically evaluates available experimental platforms with an emphasis on their biological fidelity, strengths, limitations, and translational applications. By integrating pathogenic mechanisms with model selection, this review aims to provide a practical framework for future AA research and therapeutic innovation.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tryptophan Metabolism at the Crossroads of Immunity, Barrier Function, and the Microbiome in Atopic Dermatitis.","authors":"Yi Tan, Ge Peng, Alafate Abudouwanli, Wanchen Zhao, Quan Sun, Mengyao Yang, Hideoki Ogawa, Ko Okumura, François Niyonsaba","doi":"10.1007/s12016-026-09172-4","DOIUrl":"10.1007/s12016-026-09172-4","url":null,"abstract":"<p><p>Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by complex interplay among immune imbalance, impaired barrier function, and alterations in host‒microbiome interactions. Accumulating evidence indicates that tryptophan (TRP) metabolism is associated with these core pathological processes. This review summarizes the major TRP metabolic pathways, including the kynurenine pathway, microbial indole production, and the serotonin-melatonin axis, and outlines how their respective metabolites influence cutaneous inflammation, immune regulation, and barrier integrity in the context of AD. We integrate findings from preclinical and clinical studies to describe disease-associated alterations in TRP metabolism in AD and their potential relevance to disease activity. In addition, we examine both existing and emerging therapeutic strategies aimed at correcting TRP metabolic imbalance, including pharmacological agents, dietary interventions, and probiotic supplementation. Overall, elucidating the multifaceted role of TRP metabolism in AD pathophysiology provides a rational foundation for developing more precise diagnostic tools and targeted therapeutic approaches.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dendritic cells as orchestrators in the allergen-specific immunotherapy of allergic diseases.","authors":"Xiyang Dou, Tian Gu, Yu Xu","doi":"10.1007/s12016-026-09170-6","DOIUrl":"10.1007/s12016-026-09170-6","url":null,"abstract":"<p><p>Dendritic cells (DCs) play a pivotal role in regulating immune responses, encompassing both tolerance and activation. Dysregulation of DC function is fundamental in the development of allergic conditions, underscoring their significance as a major focus for allergen-specific immunotherapy (AIT). This review systematically delineates the intricate landscape of DC subsets, comprising conventional DCs, plasmacytoid DCs, monocyte-derived DCs, and Langerhans cells, elucidating their specific contributions to either fostering Th2-driven inflammation or driving regulatory T cell generation. We dissect the multi-layered mechanisms through which DCs orchestrate immune tolerance, spanning cytokine signaling, metabolic reprogramming, epigenetic remodeling, and migratory dynamics. Additionally, the article extensively evaluates and contrasts the distinct roles of DC subsets and their modes of antigen presentation across various AIT administration routes (e.g. subcutaneous, sublingual, oral, epidermal, intranasal, intralymphatic and intratonsillar). Lastly, we highlight next-generation DC-targeted strategies, such as nanoparticle-mediated delivery systems and genetic engineering methodologies, designed to reprogram DCs toward a stable tolerogenic phenotype and enhance therapeutic efficacy. Translating these preclinical advances into personalized clinical interventions represents a pivotal frontier for establishing durable immune tolerance in allergic disorders.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pragmatic Strategies for Reducing Variability and Risk in Food Oral Immunotherapy.","authors":"Thomas B Casale, Cosby A Stone, Martin D Chapman, Stephen A Tilles, Antonella Muraro, Anne-Marie Irani, Jaime Sánchez-López, Thierry Batard, Laurent Mascarell","doi":"10.1007/s12016-026-09166-2","DOIUrl":"10.1007/s12016-026-09166-2","url":null,"abstract":"<p><p>Oral immunotherapy (OIT) can be effective and relatively safe for the treatment of food allergies, especially when started early in life. Grocery store foods used in OIT protocols are often heterogeneous in allergen potency and display product-to-product, lot-to-lot, and unit-to-unit variations, due to raw material variability and processing. This variability complicates dosing and poses a potential risk of anaphylaxis and/or subtherapeutic efficacy for patients. To improve practice, a 'gradient of standardization' framework is proposed, comprising four product categories: products assumed to contain the allergens of interest, products known to contain the allergens but in unknown amounts, partially quantified products, and fully standardized preparations. Based on verified allergen content rather than protein amount, this classification would help clinicians weigh safety and efficacy against feasibility and move toward greater conformity and standardization, supporting evidence-based dosing and probably improving patient outcomes. Ideally, foods as medicines for OIT should be well-described, minimally processed, and, preferably, with defined allergen content. Precise dosing, consistent procedures, neutral vehicles, and validated allergen quantification tools could potentially ensure reproducibility, reduce risk, strengthen clinical effectiveness, and facilitate meaningful comparisons across clinical trials and research studies. We suggest that standardized \"pharmaceutical grade\" products, while not always a practical option, should be preferred when available.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T-Cell Immunosenescence in Systemic Lupus Erythematosus: Molecular Mechanisms and Therapeutic Perspectives.","authors":"Suqing Zhou, Lian Jian, Hui Chen, Huan Yin, Fanghan Ji, Ming Yang, Haijing Wu","doi":"10.1007/s12016-026-09164-4","DOIUrl":"10.1007/s12016-026-09164-4","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by chronic immune activation, relapsing-remitting clinical progression, and progressive multi-organ damage. In addition to the classical characteristics of autoantibodies and immune complexes, emerging evidence highlights T-cell immunosenescence as a key factor in SLE pathogenesis. In this review, we elucidate the phenotypic and molecular landscapes of immunosenescent T cells in SLE, highlighting the core cellular programs that reshape their functional identity, including cell cycle arrest, dysregulated apoptosis, oxidative stress and DNA damage, mitochondrial reprogramming, and senescence-associated secretory phenotype (SASP). By integrating these mechanistic insights, we propose an immunosenescence-inflammation vicious cycle in SLE, focusing on how an expanded pool of immunosenescent T cells emerges and how mitochondrial dysfunction sustains this loop. In parallel, we elucidate the molecular crosstalk between inflammatory signaling pathways of SLE and immunosenescence programs. Moreover, evidence linking T-cell immunosenescence to SLE complications, including cardiovascular and metabolic comorbidities, as well as other systemic manifestations, is summarized. Finally, we outline therapeutic perspectives that target T-cell immunosenescence. Specifically, we discuss senolytics (for instance, dasatinib, quercetin, and fisetin) designed to selectively eliminate senescent cells, and senomorphics (for instance, rapamycin and Janus kinase inhibitors) designed to suppress the SASP and improve mitochondrial function, while discussing practical considerations for clinical translation. These advances underscore the potential of biomarker-guided patient stratification for future precision interventions in SLE.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitiligo as a Failure of Immune Resolution and Tissue Regeneration: From Stress Signals to Targeted Immune Modulation.","authors":"Ana Vitória Pupo Silvestrini, Jackeline Marino Lucas, Cristina Ribeiro de Barros Cardoso, Maria Vitória Lopes Badra Bentley","doi":"10.1007/s12016-026-09165-3","DOIUrl":"10.1007/s12016-026-09165-3","url":null,"abstract":"<p><p>Traditionally, vitiligo is known as a cutaneous autoimmune disease characterized by progressive melanocyte loss. However, this paradigm alone does not fully explain disease chronicity, relapse, or the limited therapeutic responses. Evidence supports a broader conceptual framework in which vitiligo is sustained by defective immune control of dysregulated responses, coupled with impaired regeneration, resulting in persistent inflammation and failure to restore cutaneous homeostasis. Here, we reinterpret vitiligo immunopathogenesis as a disorder of failed restoration of immunological homeostasis, extending beyond classical immune activation to include defects in regulatory mechanisms that normally constrain autoreactive responses. Rather than focusing exclusively on broad immunosuppression, emerging strategies increasingly aim to restore local immune regulation, constrain pathogenic immune memory, and preserve or reconstitute melanocyte regenerative niches. Advances in cutaneous immunology and biotechnology have expanded the therapeutic landscape to include targeted cytokine and kinase inhibition, immune checkpoint modulation, pro-melanogenic and regenerative approaches, cell- and vesicle-based therapies, nucleic acid-based interventions, and advanced skin delivery systems. Accumulating knowledge supports combined and sequential treatment paradigms integrating immune modulation, induction of repigmentation, and long-term maintenance. Nevertheless, translation into routine clinical practice remains limited by cutaneous pharmacokinetic barriers, regulatory and manufacturing constraints, and the lack of long-term safety and efficacy data. Within this evolving landscape, precision medicine offers a framework for patient stratification, therapeutic timing, and rational treatment design. Importantly, many of these approaches remain in early or preclinical stages, highlighting the need for robust translational validation. On the other hand, delivery platforms based on nanotechnology emerge as potential tools capable of bridging diverse therapeutic modalities by enhancing stability, targeting, and cutaneous bioavailability. Finally, this review positions vitiligo as a disease of failed immune resolution and impaired tissue regeneration, highlighting precision immunoengineering and technological innovation as promising pathways toward more targeted, personalized, and durable disease-modifying therapies.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"γδ T Cell-Mediated Neuroimmune Interactions in Skin Inflammation and Allergy.","authors":"Shixiong Peng, Tetsuya Honda","doi":"10.1007/s12016-026-09168-0","DOIUrl":"10.1007/s12016-026-09168-0","url":null,"abstract":"<p><p>γδ T cells represent a distinct subset of immune cells that play pivotal roles in maintaining cutaneous immune homeostasis and regulating inflammatory responses. Accumulating evidence has established neuro-immune interactions as critical modulators of skin inflammation and allergic reactions, with γδ T cells emerging as a key cellular link between the nervous and immune systems. This review summarizes recent advances in our understanding of how γδ T cells coordinate neuroimmune crosstalk in inflammatory and allergic skin diseases. γδ T cells are characterized by rapid effector responses and pronounced functional heterogeneity, enabling them to sense neuronal cues and, in turn, modulate sensory neuron activity. Through the production of cytokines such as IL-17, IL-22 and IL-3, γδ T cells influence neuronal excitability, neuropeptide release, and itch transmission, thereby shaping both inflammatory intensity and sensory outcomes. Conversely, subsets of γδ T cells express receptors for neurotransmitters, allowing them to directly respond to signals derived from sensory neurons. This bidirectional communication positions γδ T cells as critical regulators linking neural sensing to innate and adaptive immune responses in the skin. Furthermore, we discuss the current blind spots in γδ T cell-related neuro-immune research, as well as potential perspectives and future directions for the field. A deeper understanding of γδ T cell subset specialization, neuron-immune coupling specificity, and tissue-context-dependent regulation will be essential for translating these insights into precise interventions for inflammatory and allergic skin disorders.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Acute-onset Autoimmune Hepatitis From Drug-Induced Autoimmune-like Hepatitis: A Multicenter Study and Score Development.","authors":"Haoyu Wen, Yu Chen, Qiuxiang Lin, Yujie Zhou, Tianyu Mao, Chenyi Jiang, You Li, Huayang Zhang, Xiting Pu, Yunwei Du, Li Wang, Ruqi Tang, Li Sheng, Jing Hua, Hai Li, Xiaoyu Chen, Qixia Wang, Li Yan, Zhengrui You, Min Lian, Yongjian Zhou, Qi Miao, Zuxiong Huang, Yongfeng Yang, Xiong Ma, Xiao Xiao","doi":"10.1007/s12016-026-09167-1","DOIUrl":"10.1007/s12016-026-09167-1","url":null,"abstract":"<p><p>The incidence of acute-onset autoimmune hepatitis (A-AIH) is increasing, yet diagnosis remains challenging, especially in patients with recent hepatotoxic drug exposure. The clinical presentations of A-AIH and drug-induced autoimmune-like hepatitis (DI-ALH) at onset are often indistinguishable, complicating timely diagnosis. We conducted a three-center retrospective study in China, screening patients with acute liver injury, hepatotoxic drug exposure, and autoimmune features. Patients were ultimately classified as DI-ALH if they achieved sustained remission after culprit drug cessation, or as A-AIH if they relapsed. We compared baseline demographics, laboratory indices, immunological profiles, liver histology, and established AIH diagnostic criteria. We developed and independently validated a multivariable logistic regression model to improve discrimination between A-AIH and DI-ALH. Of 458 patients screened, 238 met inclusion criteria and constituted the final cohort (94 A-AIH and 144 DI-ALH). Compared to DI-ALH, A-AIH showed significantly higher IgG levels, lower platelet counts, and higher autoantibody titers. Histologically, A-AIH exhibited more severe portal inflammation, interface hepatitis, fibrosis, and rosette formation. The discriminatory capacity of the 2022 and 2008 histological criteria was limited and comparable (AUC 0.62 vs. 0.59, p = 0.616). The Dx-AID score, incorporating platelet count, IgG, autoantibodies, and histological features, achieved high diagnostic accuracy in both the derivation cohort (AUC 0.84, 95% CI: 0.77-0.91) and the validation cohort (AUC 0.83, 95% CI: 0.72-0.94). Although A-AIH and DI-ALH share similarities, they differ in immunological and histological profiles. The Dx-AID score integrates these differences into a practical tool for early differentiation and guides personalized treatment decisions.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Dimensional Perspective of the Gene and Environmental Interaction in Asthma.","authors":"Kwei-Yan Liu, Hui-Ru Kuo, Zhanling Liang, Meiqi Huang, Yuan-Ting Hsu, Xiaojun Xiao, Shau-Ku Huang","doi":"10.1007/s12016-026-09162-6","DOIUrl":"10.1007/s12016-026-09162-6","url":null,"abstract":"<p><p>Asthma is a debilitating disease, and its diagnosis and disease management remain imprecise. It continues to impose a major global burden on public health, medicine, and the economy. Asthma exhibits marked heterogeneity in clinical phenotypes, and environmental and genetic risk factors remain incompletely defined. Moreover, its significant geographical and ethnic variation limits diagnostic precision. They also hinder effective risk stratification and accurate prediction of disease exacerbations. To date, most asthma research and therapeutic development have focused on allergen-mediated immune responses. Conversely, the adverse effects of environmental chemical pollutants have received less attention. This imbalance has limited the development of a comprehensive understanding of asthma pathogenesis. It has also slowed progress toward truly precision-based therapies. Simultaneously, growing experimental and clinical evidence highlights causal links between environmental exposures and disease. The concepts of the exposome and exposomics have also emerged. These provide useful frameworks to study disease development and progression. In this review, we summarize recent multicenter studies on asthma. These studies show that environmental determinants of asthma are not uniform, as different asthma phenotypic clusters have distinct environmental exposure profiles. Moreover, environmentally driven metabolic reprogramming plays an important role, resulting in bioactive metabolites that also deserve careful attention. These factors are crucial for advancing precision environmental medicine.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Management of Antirheumatic Drug Exposure During Therapeutic Plasma Exchange.","authors":"Ziyan Ding, Jing Li, Xue Zhong","doi":"10.1007/s12016-026-09163-5","DOIUrl":"10.1007/s12016-026-09163-5","url":null,"abstract":"<p><p>Therapeutic plasma exchange (TPE) is being increasingly utilized in the clinical management of severe rheumatic immune diseases, providing an effective means for rapidly removing pathogenic autoantibodies and inflammatory mediators. However, the non-selective nature of this technique can also lead to the unintended clearance of concomitantly administered antirheumatic drugs, potentially compromising therapeutic efficacy and disease control. Therefore, effective management of potential drug removal process during TPE and the implementation of individualized risk assessment are crucial for optimizing treatment outcomes in patients undergoing TPE. The variability in the extent of drug removal during TPE is primarily determined by their distinct pharmacokinetic characteristics, necessitating the establishment of a systematic, evidence-based strategy for adjusting drug administration regimens in patients receiving TPE treatment. This review synthesizes current evidence from 65 studies on the removal of antirheumatic drugs during TPE, identifying key determinants influencing clearance rates, including volume of distribution, protein binding, molecular size, and elimination half-life. Our analysis reveals that the risk of drug removal exists as a continuous spectrum: large monoclonal antibodies (e.g., rituximab, natalizumab), characterized by a large molecule size, low volume of distribution, with which mostly confined to the vascular space, are cleared with high efficiency. This finding supports the clinical recommendation of administering such drugs after TPE. For drugs with limited direct evidence, we propose a predictive model based on fundamental pharmacokinetic parameters to estimate their removal risk and guide clinical decision-making. Based on this evidence, we have constructed a stratified clinical management framework. It aims to maintain effective therapeutic drug exposure levels during chronic TPE therapy and to provide a rationale for the judicious application of TPE in overdose scenarios. Implementing this pharmacokinetic-informed, risk-adapted individualized strategy is important for ensuring treatment continuity, enhancing patient safety, and advancing empiricism-based therapy towards precision medicine.</p>","PeriodicalId":10423,"journal":{"name":"Clinical Reviews in Allergy & Immunology","volume":"69 1","pages":""},"PeriodicalIF":11.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}