Current Opinion in Allergy and Clinical Immunology最新文献

{"title":"Urine mast cell mediators and anaphylaxis.","authors":"Dayne Voelker, Thanai Pongdee","doi":"10.1097/ACI.0000000000001186","DOIUrl":"10.1097/ACI.0000000000001186","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anaphylaxis is a severe type 1 hypersensitivity reaction which is the result of mast cell degranulation causing multiorgan dysfunction. Currently, the most accepted biomarker measurement for mast cell mediated anaphylaxis is serum tryptase measurement. Serum tryptase measurement has limitations including an ideal window of collection during anaphylaxis and must be obtained by venipuncture collection. Urinary mast cell mediators are emerging mast cell biomarkers that can be used for evaluation of mast cell mediated anaphylaxis and mast cell activation. This review will highlight biomarker measurement with urinary mast cell mediators in anaphylaxis.</p><p><strong>Recent findings: </strong>This review will highlight biomarker measurement of urinary mast cell mediators including N-methylhistamine, leukotriene E4, and 2,3-dinor-11beta-prostaglandin F2 alpha and their role in anaphylaxis.</p><p><strong>Summary: </strong>Urine mast cell mediator collection obtained during acute anaphylaxis and compared to baseline measurements are emerging biomarkers for the detection of mast cell mediated anaphylaxis. Further research is needed to validate the utility of urinary mast cell mediators in anaphylaxis.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"346-351"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms and prospects of fecal microbiota transplantation in urticaria treatment via the gut skin axis.","authors":"Xueli Yao, Keyang Wang, Ping Wang","doi":"10.1097/ACI.0000000000001193","DOIUrl":"10.1097/ACI.0000000000001193","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on fecal microbiota transplantation (FMT) for urticaria via the gut skin axis, highlighting its timeliness and clinical relevance as an emerging strategy for refractory urticaria.</p><p><strong>Recent findings: </strong>Recent studies confirm that gut microbiota dysbiosis drives urticaria pathogenesis via immune regulation and mast cell activation, with preliminary clinical data showing FMT can alleviate symptoms and restore gut barrier function.</p><p><strong>Summary: </strong>FMT holds promise as a novel therapeutic option for urticaria, though further trials are needed to standardize protocols and confirm long-term safety for clinical translation.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"416-423"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaphylaxis in pregnancy: diagnostic blind spots, epinephrine hesitancy, and emerging prevention strategies.","authors":"Luciana Kase Tanno, Pascal Demoly","doi":"10.1097/ACI.0000000000001182","DOIUrl":"10.1097/ACI.0000000000001182","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anaphylaxis during pregnancy is uncommon but remains one of the most critical emergencies in obstetric medicine because maternal deterioration and fetal hypoxia evolve simultaneously. Despite established treatment recommendations, diagnostic uncertainty and persistent concerns regarding epinephrine use continue to contribute to jeopardize preventable morbidity/mortality. This review examines recent advances in the recognition, management, and prevention of pregnancy-associated anaphylaxis, with emphasis on emerging concepts that may improve maternal-fetal safety.</p><p><strong>Recent findings: </strong>Physiological pregnancy-related cardiovascular and respiratory adaptations can obscure classic manifestations of anaphylaxis, creating important diagnostic blind spots and increasing the risk of delayed recognition. Growing evidence indicates that maternal hypotension and hypoxemia represent the main threats to fetal wellbeing. Epinephrine hesitancy remains common in clinical practice. New insights into mast cell disorders, hereditary alpha-tryptasemia, and MRGPRX2-mediated reactions are refining risk stratification and expanding understanding of severe and perioperative anaphylaxis. Recent epidemiological studies also highlight the predominance of drug-related and cesarean-associated triggers and support the implementation of multidisciplinary care pathways, allergy evaluation, and targeted prevention strategies.</p><p><strong>Summary: </strong>Maternal anaphylaxis should be viewed as a time-critical obstetric emergency in which prompt recognition and immediate epinephrine administration are essential to optimize maternal and fetal outcomes. Future progress will depend on pregnancy-adapted diagnostic approaches, improved risk identification, systematic prevention efforts, and coordinated multidisciplinary management across obstetric, anesthetic, emergency, and allergy services.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"352-357"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mas-related G protein-coupled receptor X2 in non-IgE-mediated mast cell activation and anaphylaxis: a paradigm shift.","authors":"Marco Zurlo, Francesca Levi-Schaffer","doi":"10.1097/ACI.0000000000001187","DOIUrl":"10.1097/ACI.0000000000001187","url":null,"abstract":"<p><strong>Purpose of review: </strong>The understanding of anaphylaxis has evolved over time beyond the classical IgE-mediated paradigm. This review examines the role of Mas-related G protein-coupled receptor X2 (MRGPRX2) in non-IgE-mediated mast cell activation, a mechanism increasingly recognized in mast cell activation, anaphylaxis, and other mast cell-driven conditions.</p><p><strong>Recent findings: </strong>Recent studies have identified MRGPRX2 as a key receptor in rapid mast cell degranulation in response to a broad range of cationic ligands such as drugs, neuropeptides, and host defence-related peptides. Structural and signalling insights have clarified its dual coupling to Gi and Gq pathways. Clinically, MRGPRX2 has been implicated in immediate reactions to antibiotics, neuromuscular blocking agents and other compounds, often occurring upon first exposure. Additionally, emerging evidence suggests roles in chronic urticaria, neurogenic inflammation, and host defence, as well as growing interest in MRGPRX2 as a therapeutic target.</p><p><strong>Summary: </strong>MRGPRX2 represents a paradigm shift in mast cell biology, providing a solid base for non-IgE-mediated hypersensitivity. Improved understanding of this pathway may enhance diagnostic accuracy and enable the development of targeted therapies, although significant challenges remain in distinguishing activation mechanisms in clinical practice.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"372-377"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous adverse events associated with new cancer therapies.","authors":"Raslina Shrestha, Hue T T Tran, Giang H Nguyen","doi":"10.1097/ACI.0000000000001169","DOIUrl":"10.1097/ACI.0000000000001169","url":null,"abstract":"<p><strong>Purpose of review: </strong>Modern oncologic therapies, including immune checkpoint inhibitors (ICIs), targeted kinase inhibitors (TKIs), antibody-drug conjugates (ADCs), bispecific antibodies, and adoptive cellular therapies, have transformed cancer care while introducing diverse cutaneous adverse events (cAEs). This review summarizes recent advances in the mechanistic understanding, clinical patterns, and management of dermatologic toxicities associated with contemporary cancer therapeutics.</p><p><strong>Recent findings: </strong>Emerging evidence indicates that therapy-associated cAEs often reflect distinct biological mechanisms rather than nonspecific drug reactions. These toxicities can be conceptually organized into four major mechanistic paradigms: immune disinhibition, epithelial signaling inhibition, cytotoxic epithelial injury, and cytokine-driven immune activation. While immune checkpoint inhibitors remain the most extensively characterized model, newer therapeutic platforms, including ADCs and immune-engaging cellular therapies, have introduced additional toxicity patterns that are only beginning to be systematically characterized. Recent clinicopathologic studies have clarified cytotoxic epithelial injury patterns associated with ADCs, while early clinical series suggest cytokine-mediated inflammatory eruptions may occur during cellular immunotherapies. At the same time, advances in immunopathologic profiling have supported the development of mechanism-directed management strategies, including targeted cytokine blockade for steroid-refractory immune-mediated dermatoses.</p><p><strong>Summary: </strong>Cutaneous adverse events associated with modern cancer therapies increasingly represent mechanism-based toxicities linked to therapy-specific biological pathways. Integrating clinical morphology with treatment class and immunologic mechanisms provides a practical framework for diagnosis and management. Mechanism-directed dermatologic care, including early recognition, targeted immunomodulation, and multidisciplinary collaboration, may improve toxicity control while preserving oncologic efficacy.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"402-415"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-immunoglobulin E-mediated mechanisms of anaphylaxis.","authors":"Victoria Cardona, Anna Sala-Cunill","doi":"10.1097/ACI.0000000000001185","DOIUrl":"10.1097/ACI.0000000000001185","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anaphylaxis attributable to non-immunoglobulin E (IgE)-mediated mechanisms represents an increasingly recognized and clinically challenging subset of severe hypersensitivity reactions. This review synthesizes recent advances in the understanding of IgE-independent pathways, with emphasis on literature published in the last 18 months, and highlights their implications for precision diagnostics and therapeutic targeting.</p><p><strong>Recent findings: </strong>Major IgE-independent mechanisms have attracted substantial recent attention. First, the Mas-related G protein-coupled receptor X2 (MRGPRX2) has been consolidated as a central mediator of IgE-independent drug reactions, with new humanized knock-in mouse models revealing its capacity to amplify both IgE-dependent and IgE-independent systemic anaphylaxis. Second, clonal mast cell disorders-including systemic mastocytosis and monoclonal mast cell activation syndrome-are now recognized as major risk amplifiers for severe and fatal anaphylaxis, particularly following Hymenoptera venom exposure, reinforcing the role of the KIT D816V mutation in lowering the mast cell activation threshold. Third, a comprehensive biomarker meta-analysis confirms that tryptase, platelet-activating factor (PAF), and urinary prostaglandin D2 each contribute differentially to non-IgE reactions, with PAF and PAF-acetylhydrolase emerging as particularly relevant in IgE-independent severity pathways.</p><p><strong>Summary: </strong>Non-IgE-mediated anaphylaxis encompasses mechanistically distinct entities that demand tailored diagnostic algorithms. Recognizing MRGPRX2 activation, complement and IgG-dependent pathways, and clonal mast cell disease in the clinical work-up of unexplained or recurrent anaphylaxis is relevant. Emerging biomarkers and therapeutic targets - including MRGPRX2 antagonists - hold promise for transforming the management of this underdiagnosed condition.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"358-363"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision allergy molecular diagnostic applications in anaphylaxis: from triggers to risk stratification and personalized management.","authors":"René Maximiliano Gómez, Mário Morais-Almeida, Ignacio J Ansotegui","doi":"10.1097/ACI.0000000000001189","DOIUrl":"10.1097/ACI.0000000000001189","url":null,"abstract":"<p><strong>Purpose of review: </strong>Precision allergy molecular diagnostic applications (PAMD@), previously referred to as component-resolved diagnosis (CRD), has progressively transformed the diagnostic approach to anaphylaxis. This review aims to provide an updated overview of its clinical utility, focusing on its role in improving etiologic identification, risk stratification, and patient management in anaphylaxis.</p><p><strong>Recent findings: </strong>Advances in molecular allergology have expanded the range of available allergen components and improved the diagnostic accuracy of IgE-mediated testing. Specific molecular patterns are now clearly associated with clinically relevant sensitization and severity risk, particularly in food allergy (e.g. seed storage proteins, nsLTPs), hymenoptera venom allergy, cofactor-enhanced anaphylaxis (e.g. ω-5 gliadin or nsLTP), and delayed red meat allergy (α-gal). PAMD@ has demonstrated higher specificity compared with extract-based tests, allowing better discrimination between true allergy and cross-reactivity, reducing unnecessary dietary restrictions and diagnostic challenges. Emerging evidence also supports its role in guiding allergen immunotherapy and refining risk assessment in complex or idiopathic classified cases.</p><p><strong>Summary: </strong>PAMD@ represents a major step toward precision medicine in anaphylaxis, shifting the paradigm from extract-based sensitization profiling to mechanism-based, clinically actionable diagnosis. Its integration into structured diagnostic algorithms enhances clinical decision-making, supports personalized management strategies, and improves patient safety. However, its optimal use requires careful interpretation within the context of clinical history and local sensitization patterns.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"378-385"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between hypersensitivity and toxicity: the complex spectrum of chemotherapy-induced skin reactions.","authors":"Mona-Rita Yacoub, Maria Bernadette Cilona, Eustachio Nettis","doi":"10.1097/ACI.0000000000001196","DOIUrl":"10.1097/ACI.0000000000001196","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cutaneous adverse reactions are among the most frequent complications of anticancer therapies and a major cause of treatment interruption, dose reduction, or switching to alternative regimens. This review explores the complex interplay between direct tissue toxicity and immune-mediated mechanisms underlying chemotherapy-induced skin reactions.</p><p><strong>Recent findings: </strong>Emerging evidence indicates that chemotherapy-induced skin reactions arise from dynamic interactions among keratinocyte injury, innate immune activation, cytokine-driven inflammation, and adaptive immune responses, resulting in overlapping clinical phenotypes rather than isolated pathogenic processes. This evolving concept is exemplified by common reactions such as maculopapular eruptions, toxic erythema of chemotherapy, hand-foot syndrome, acneiform rash, and radiation recall dermatitis, as well as by immune-mediated conditions including urticaria, fixed drug eruption, severe cutaneous adverse reactions, bullous pemphigoid, and lichenoid eruptions. The expanding use of targeted therapies and immune checkpoint inhibitors further broadened this spectrum and highlighted the complexity of the underlying mechanisms.</p><p><strong>Summary: </strong>Recognizing the complex interplay between tissue toxicity and immune activation provides a more comprehensive framework for interpreting chemotherapy-induced skin reactions. Improved clinical phenotyping, integrated allergologic assessment, and close collaboration between oncologists and allergists are essential to optimize diagnosis, guide rechallenge or desensitization strategies and avoid unnecessary discontinuation of effective anticancer therapies.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"386-394"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bruton's tyrosine kinase inhibition for food-induced anaphylaxis.","authors":"Betania Arce, Melanie C Dispenza","doi":"10.1097/ACI.0000000000001183","DOIUrl":"10.1097/ACI.0000000000001183","url":null,"abstract":"<p><strong>Purpose of review: </strong>The recent approval of the Bruton's tyrosine kinase inhibitor (BTKi) remibrutinib for the treatment of chronic spontaneous urticaria opened a new therapeutic class of drugs for the allergy space. This review summarizes findings from recent BTKi clinical trials, with a focus on practical considerations for the practicing allergist.</p><p><strong>Recent findings: </strong>In its phase 2 trial, 4  weeks of remibrutinib treatment demonstrated remarkable efficacy in preventing food-induced anaphylaxis to peanut in adults. Additionally, in a phase 3 trial for inducible urticarias, it improved symptoms and physical stimulation threshold in patients with dermographism, cold urticaria, and cholinergic urticaria within 2  weeks. Safety signals were comparable in remibrutinib and placebo groups, with the exception of transient petechiae, which was observed in patients treated with remibrutinib in the trials for chronic spontaneous urticaria and chronic inducible urticarias, but not in the peanut allergy trial.</p><p><strong>Summary: </strong>With their pan-allergen efficacy and favorable safety profiles, BTKis including remibrutinib could be effective therapeutic options for preventing food-induced anaphylaxis. Because they have rapid onset of action and transient efficacy, they may also be useful adjunct therapies for a variety of context such as food immunotherapy build-up or drug desensitizations.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"340-345"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiota and anaphylaxis: emerging insights into immune regulation and clinical implications.","authors":"Martina Ottoni, Antonio Nouvenne, Erminia Ridolo","doi":"10.1097/ACI.0000000000001184","DOIUrl":"10.1097/ACI.0000000000001184","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anaphylaxis is a life-threatening systemic hypersensitivity reaction with highly variable clinical expression and unpredictable severity. Increasing evidence suggests that host-microbiota interactions may contribute to interindividual variability in allergic sensitization and effector responses. This review summarizes current mechanistic, preclinical, and emerging human data supporting a role for the microbiota in modulating anaphylaxis risk and severity.</p><p><strong>Recent findings: </strong>Recent experimental studies demonstrate that gut microbial composition and function influence susceptibility to systemic allergic reactions through effects on immune maturation, epithelial barrier integrity, and mast cell biology. Microbiota-derived metabolites, particularly short-chain fatty acids, can directly suppress mast cell activation and degranulation via epigenetic mechanisms. In parallel, preclinical models indicate that dysbiosis exacerbates anaphylactic responses, whereas microbial restoration attenuates disease severity. Emerging translational evidence further suggests that commensal bacteria may directly metabolize food allergens, reducing IgE-binding capacity and effector cell activation. Human studies, although limited, report associations between microbial signatures, allergen-specific IgE levels, and clinical phenotypes, as well as links between microbiota composition and oral immunotherapy outcomes.</p><p><strong>Summary: </strong>Current evidence supports a biologically plausible role for the microbiota in shaping anaphylaxis susceptibility and severity; however, findings remain largely associative. Future longitudinal and mechanistic studies are needed to establish causality and evaluate the translational potential of microbiota-targeted strategies for the prevention and management of anaphylaxis.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"364-371"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}