{"title":"Risk of anaphylaxis on commercial flights.","authors":"Paul J Turner","doi":"10.1097/ACI.0000000000001090","DOIUrl":"10.1097/ACI.0000000000001090","url":null,"abstract":"<p><strong>Purpose of review: </strong>Air travel has now returned to prepandemic levels, with over 10.5 billion passengers in 2024. Many of these passengers have food allergies, and there is a perception that allergic reactions are common during commercial flights.</p><p><strong>Recent findings: </strong>A recent systematic review and meta-analysis reported an incidence of in-flight medical events due to allergic reactions of 0.7 (95% CI 0.4-1.1) events per million passengers. For those with food allergies, the incidence of allergic reactions is around 10-100 times lower than that reported for reactions 'on the ground' - equivalent to one reaction per 3600 food-allergic passengers in any 1-year period. Reassuringly, there is no evidence that this rate had increased over the past 30 years, despite significant increases in both the prevalence of food allergy and passenger numbers.</p><p><strong>Summary: </strong>Allergic reactions during commercial flights are uncommon; however, this is very likely to be confounded by the many precautions food-allergic passengers and their families take when flying. Nonetheless, the data confirm that flying can be safe for those with food allergies. While air travel continues to present numerous challenges to those with food allergy, this can be mitigated by consistent and helpful airline policies, which address the concerns of food-allergic individuals.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"336-342"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biologic and small molecule therapies in chronic spontaneous urticaria: an update.","authors":"Bettina Wedi","doi":"10.1097/ACI.0000000000001095","DOIUrl":"10.1097/ACI.0000000000001095","url":null,"abstract":"<p><strong>Purpose of review: </strong>Many new treatment options for chronic spontaneous urticaria have been clinically tested in recent years. This narrative review presents the current status of substances furthest along in development.</p><p><strong>Recent findings: </strong>After decades in which only H1 antihistamines were available for treatment, omalizumab was approved as an add-on therapy in 2014. Meanwhile, the first omalizumab biosimilar, CT-P39, has been approved (EMA in March 2024, US FDA in March 2025). Moreover, dupilumab received approval in Japan since February 2024 and in the USA since April 2025. Following publication of two positive phase 3 trials, Remibrutinib was submitted for approval to the EMA and FDA in February 2025. Several anti-KIT mAbs are in clinical trials, the most advanced of which is barzolvolimab with two ongoing phase 3 trials. Ligelizumab, benralizumab and the MRGPRX2 antagonist EP-262 are not being further developed in the chronic spontaneous urticaria (CSU) indication.</p><p><strong>Summary: </strong>The rapid increase in clinical trials in the field of CSU has already led to a significant improvement in treatment options beyond anti-IgE therapy with omalizumab in Japan and the USA, and further approvals of biologics and small molecules are expected shortly. It is expected that with a wider range of different approved therapeutic approaches, the treatment of CSU will have to be tailored to the urticaria subtype or patient profile in the future.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"418-425"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759420","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":"Human mast cells in anaphylaxis: from research to diagnosis.","authors":"Jessy Elst, Didier G Ebo, Vito Sabato","doi":"10.1097/ACI.0000000000001092","DOIUrl":"10.1097/ACI.0000000000001092","url":null,"abstract":"<p><strong>Purpose of review: </strong>Mast cell degranulation in anaphylaxis can result from both IgE-dependent and IgE-independent mechanisms. The two conditions differ in terms of phenotype, diagnosis and specific therapeutic targets.</p><p><strong>Recent findings: </strong>Genetic factors and IgE-sialylation might enhance IgE-dependent degranulation. MRGPRX2-dependent signal might have a synergistic effect on IgE-dependent degranulation. The data on IgG-dependent anaphylaxis highlight the significance of histamine release from mast cells. Recent advances in the field have led to the development of novel targeting treatments for both IgE-dependent and IgE-independent mast cell degranulation.</p><p><strong>Summary: </strong>In-vitro analysis of human mast cells offers the possibility of studying the mechanisms underlying mast cell degranulation in anaphylaxis. The implementation of this analysis in clinical practice can advance diagnosis. Moreover, mechanistic and preclinical studies support the development of targeted treatments for IgE-dependent and IgE-independent anaphylaxis.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"315-321"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689455","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":"Unraveling the immune-microbial axis in chronic ocular surface disease.","authors":"Leonard Bielory","doi":"10.1097/ACI.0000000000001108","DOIUrl":"https://doi.org/10.1097/ACI.0000000000001108","url":null,"abstract":"","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"25 5","pages":"349-350"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945997","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":"Unraveling the immune axis of ocular surface microbiota in keratoconus.","authors":"Riham Shawer, Abraham Solomon","doi":"10.1097/ACI.0000000000001098","DOIUrl":"10.1097/ACI.0000000000001098","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review's objective is to give readers an update on recent and developing information about the function of the ocular surface microbiome in keratoconus.</p><p><strong>Recent findings: </strong>The microbiome's function in the pathogenesis of keratoconus is supported by recent research. Numerous metabolites that are produced by the ocular surface bacteria can affect the host tissue. A shift in the microbiota may influence the composition of these metabolites, which could have an effect on keratoconus by altering the cornea's metabolic environment.</p><p><strong>Summary: </strong>Gaining insight into the function of the ocular surface microbiota in keratoconus could open up new avenues for the creation of new therapeutic modalities.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"395-403"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759423","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}
Marco Lombardo, Mario Fruschelli, Sebastiano Serrao
{"title":"The immunopathology of keratoconus: tear film biomarkers and immune pathways.","authors":"Marco Lombardo, Mario Fruschelli, Sebastiano Serrao","doi":"10.1097/ACI.0000000000001099","DOIUrl":"10.1097/ACI.0000000000001099","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores established risk factors for keratoconus and current insights into tear film immune biomarkers, with a focus on the role of chronic low-grade inflammation in disease pathogenesis and emerging targeted therapies.</p><p><strong>Recent findings: </strong>Growing evidence supports immune dysregulation as a key driver in the onset and progression of keratoconus. Genetics establish a foundation for a dysregulated inflammatory response in the ocular surface and corneal microenvironment, which sustains and accelerates disease progression. Elevated tear levels of IL-1, IL-6, TNF-α, HMGB1, and MMP9 reflect these inflammatory changes. Chronic inflammation and repeated mechanical trauma from eye rubbing, especially in adolescents and young adults, are major risk factors for disease progression. Timely screening and regular corneal topography in adolescents with allergic or atopic disorders are essential for early diagnosis and prevention of vision loss.</p><p><strong>Summary: </strong>The tear film and corneal microenvironment contain valuable immune markers that shed light on keratoconus pathophysiology. Advances in precision and predictive medicine hold promise for safer, more effective strategies to halt disease progression.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"351-354"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759422","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}
Pham Thao Van Luong, Pascal Demoly, Luciana Kase Tanno
{"title":"Recurrences of anaphylaxis: trends and risk factors.","authors":"Pham Thao Van Luong, Pascal Demoly, Luciana Kase Tanno","doi":"10.1097/ACI.0000000000001100","DOIUrl":"10.1097/ACI.0000000000001100","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recurrences of anaphylaxis is a concern due to its unpredictability and long-term burden to patients and healthcare systems. This review examines recurrence rates, associated risk factors, and gaps in current knowledge to guide improved clinical management.</p><p><strong>Recent findings: </strong>From 1240 initial records, 11 studies fulfilled the inclusion criteria of our systematic review. Recurrences of anaphylaxis rates range from 2.6 to 17.6% of patients after a first episode of anaphylaxis, with a rising trend over time. Personal history of food allergy is the most consistent associated risk factor, followed by the presence of atopic comorbidities such as asthma and atopic dermatitis. Other potential factors include socioeconomic deprivation, and seasonal variations. There is lack of evidence on contributing factors to volve to more severe episodes and on how etiology may change between episodes.</p><p><strong>Summary: </strong>Recurrences of anaphylaxis is multifactorial, with personal history of food allergy and allergic comorbidities as primary risk factors. Inconsistencies across studies underscore the need for standardized research. Limited data on severity and etiology progression highlight areas for future investigation to improve long-term outcomes.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"322-328"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834484","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":"Advances in the treatment of anaphylaxis: intranasal and sublingual versus intramuscular epinephrine.","authors":"Jay Adam Lieberman, Matthew Greenhawt","doi":"10.1097/ACI.0000000000001089","DOIUrl":"10.1097/ACI.0000000000001089","url":null,"abstract":"<p><strong>Purpose of review: </strong>Epinephrine is universally considered the standard of care for the treatment of severe allergic reactions, including anaphylaxis, and, until recently, was preferentially recommended to be given intramuscularly in the thigh. However, newer routes of administration have been studied, with the intranasal route recently approved by regulatory agencies.</p><p><strong>Recent findings: </strong>Pharmacokinetic and pharmacodynamic studies suggest that noninjectable epinephrine routes (e.g., intranasal and sublingual) can achieve epinephrine levels on par with intramuscular administration via autoinjector.</p><p><strong>Summary: </strong>With new routes of epinephrine delivery being studied and approved for use, a new frontier of anaphylaxis management is emerging. There is potential that these routes may change how epinephrine is administered and severe reactions, including anaphylaxis, are treated.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"309-314"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607759","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":"Hymenoptera anaphylaxis and mast cell activation disorders.","authors":"David González-de-Olano, Iván Álvarez-Twose","doi":"10.1097/ACI.0000000000001088","DOIUrl":"10.1097/ACI.0000000000001088","url":null,"abstract":"<p><strong>Purpose of review: </strong>Among patients with hymenoptera venom allergy (HVA), a high proportion have an underlying systemic mastocytosis. It is essential to identify them for an adequate management.</p><p><strong>Recent findings: </strong>The clinical presentation of anaphylaxis after stinging -cardiovascular symptoms and absence of cutaneous- may point to a clonal mast cell disease (MCD). In addition, these patients usually have low mast cell burden, so highly sensitive techniques are needed to detect clonality.</p><p><strong>Summary: </strong>It is important to recognize patients with HVA associated with a clonal MCD since the handling of immunotherapy and the duration of such treatment differs from the general population. Identifying these patients with predictive scores and providing the appropriate techniques to reach the diagnosis may avoid unnecessary studies. Moreover, patients with clonal MCDs, in addition to typical mast cell-mediator release symptomatology may have other complications, such as bone mass loss, that need to be treated.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"303-308"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607760","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":"Chronic urticaria and autoinflammatory syndromes.","authors":"Mona-Rita Yacoub, Arianna Ferlito, Eustachio Nettis","doi":"10.1097/ACI.0000000000001093","DOIUrl":"10.1097/ACI.0000000000001093","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides an updated overview of the association between chronic urticaria (CU) and autoinflammatory syndromes (AS), underlining the diagnostic and therapeutic implications of identifying CU as an initial manifestation of systemic autoinflammatory disorders.</p><p><strong>Recent findings: </strong>emerging evidence has reinforced the role of innate immune dysregulation in the pathogenesis of CU associated with AS, with particular involvement of the pro-inflammatory cytokines such as interleukin (IL)-1β. Several monogenic and multifactorial autoinflammatory diseases, including cryopyrin-associated periodic syndromes (CAPS), Schnitzler syndrome (SchS), Still's disease (SD), and others, may present with CU. Neutrophilic urticarial dermatosis (NUD) has been recognized as a histopathological hallmark. Early diagnosis remains challenging but is crucial, as targeted therapies, especially IL-1 inhibitors, have demonstrated significant efficacy in controlling systemic inflammation and preventing disease progression.</p><p><strong>Summary: </strong>CU refractory to conventional treatment, particularly when associated with systemic symptoms, should prompt suspicion of an underlying autoinflammatory syndrome. A comprehensive diagnostic approach, including clinical assessment, inflammatory markers evaluation, histopathological examination, and genetic testing, is essential. Recognition of the autoinflammatory nature of CU allows for timely initiation of personalized therapies, improving patient prognosis and reducing long-term morbidity.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"411-417"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759421","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}