Current Opinion in Allergy and Clinical Immunology最新文献

{"title":"Skin pain in pediatric atopic dermatitis: mechanisms and management.","authors":"Gabriele Simonetti, Francesca Mori, Greta Tronconi, Teresa Oranges, Romina Nassini, Lawrence F Eichenfield, Mattia Giovannini, Francesco De Logu","doi":"10.1097/ACI.0000000000001125","DOIUrl":"10.1097/ACI.0000000000001125","url":null,"abstract":"<p><strong>Purpose of review: </strong>While itch is the hallmark symptom of atopic dermatitis (AD), skin pain is increasingly recognized as a common and burdensome symptom even in the pediatric population. Despite its prevalence, pain remains underassessed and undertreated in children with AD. This review aims to synthesize current knowledge on the prevalence, pathophysiology, clinical relevance, and management strategies of skin pain in children with AD.</p><p><strong>Recent findings: </strong>Skin pain affects up to 50% of children with AD and is associated with increased disease severity, impaired sleep, reduced quality of life, and higher rates of school absenteeism. Despite its significant impact, few studies have designed pain as a primary outcome, and validated assessment tools for young children are still lacking. Pathophysiological mechanisms involve barrier disruption, neurogenic inflammation, and cytokine-driven sensitization pathways, which may partially diverge from those implicated in itch. Emerging evidence from recent clinical trials suggests that targeted therapies can markedly reduce skin pain, sometimes independently of an improvement in visible lesions. Nonpharmacologic approaches, including emollient therapy, patient education, and psychological support, are also crucial components of a multimodal management strategy.</p><p><strong>Summary: </strong>Skin pain in pediatric AD remains an underrecognized but clinically significant symptom. Incorporating validated, age-appropriate assessment tools and integrated management strategies into clinical practice seems crucial. At the same time, further research should clarify the underlying mechanisms and refine outcome measures to guide the development of targeted therapies for affected children.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"122-130"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667533","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":"Update on occupational contact urticaria: a systematic narrative review.","authors":"Mojca Bizjak-Suran, Ingrid Løken Jørgensen, Jose Hernán Alfonso","doi":"10.1097/ACI.0000000000001138","DOIUrl":"10.1097/ACI.0000000000001138","url":null,"abstract":"<p><strong>Purpose of review: </strong>Occupational contact urticaria (OCU) is an immediate-type skin reaction triggered by chemicals or proteins encountered in the workplace. It is classified as either nonimmunologic (irritant) or immunologic (IgE-mediated), which differ in pathogenesis, diagnostic approach, and clinical severity. Immunologic OCU may present with generalized urticaria and even anaphylaxis. We conducted a systematic narrative review to provide an updated overview of OCU, integrating findings from a structured literature search (2017-2025) with expert clinical interpretation. This review synthesizes knowledge on causative agents, diagnostic strategies, and management approaches, with a focus on emerging occupational exposures.</p><p><strong>Recent findings: </strong>The spectrum of occupational allergens continues to expand, with new reports implicating Cannabis sativa , arthropods (e.g., Anisakis simplex , pine processionary caterpillar), mask materials such as polypropylene, disinfectants (e.g., chloramine-T), antiseptics (e.g., chlorhexidine), cosmetic ingredients (e.g., henna, indigo, and hydrolyzed wheat protein), and enzymes (e.g., alpha-amylase, cellulase, papain, protease, and xylanase). Despite novel exposures, traditional culprits like natural rubber latex, ammonium persulfate, and animal-and plant-derived foods remain prevalent.</p><p><strong>Summary: </strong>Early recognition, diagnostic testing, and prevention are essential to reduce systemic involvement and occupational disability. Strengthening workplace awareness, surveillance programs, and systematic occupational health, safety, and environmental management remains essential to reducing this preventable condition.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"84-94"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773777","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":"Crystalline killer: the molecular cascade of silica toxicity from inflammation to fibrosis.","authors":"Maggie Lam, Michelle D Tate","doi":"10.1097/ACI.0000000000001124","DOIUrl":"10.1097/ACI.0000000000001124","url":null,"abstract":"<p><strong>Purpose of review: </strong>Silicosis, a progressive fibrotic lung disease caused by inhalation of crystalline silica, is resurging due to increased exposure in high-risk industries such as engineered stone fabrication. Characterised by asymptomatic onset and delayed diagnosis, it remains a major occupational health concern. This review synthesises current understanding of silica-induced lung injury, highlighting the physicochemical properties of silica that drive its biological reactivity and persistence in the lung.</p><p><strong>Recent findings: </strong>Silica deposition induces lysosomal rupture, oxidative stress, and NLRP3 inflammasome activation, leading to programmed cell death, neutrophil extracellular trap formation, and chronic inflammation. These events culminate in fibrotic remodelling through epithelial-mesenchymal transition and fibroblast activation. Emerging evidence implicates damage-associated molecular patterns and exosomal microRNAs in amplifying fibrogenic signalling. Biomarkers and therapeutic targets may enable earlier diagnosis and intervention.</p><p><strong>Summary: </strong>By bridging mechanistic insights with translational strategies, this review supports precision approaches for screening, monitoring, and treating silica-related lung disease.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"77-83"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495022","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":"Improving machine-learning development in allergology: bridging the gap between open-access and cohort-based databases.","authors":"Aleix Arnau-Soler, Jeremy Corriger, Yannick Chantran, Julien Goret","doi":"10.1097/ACI.0000000000001143","DOIUrl":"10.1097/ACI.0000000000001143","url":null,"abstract":"<p><strong>Purpose of review: </strong>The advent of high-throughput data generation and artificial intelligence has transformed allergy research. Open-access database (OAD) and cohort-based database (CBD) provide essential resources for machine learning (ML)-driven algorithms for risk stratification and decision support. It is crucial for allergologists to understand their construction, strengths, and limitations. We review recently published databases with a focus on how these datasets can be combined to enhance research.</p><p><strong>Recent findings: </strong>OAD, including environmental monitoring resources, omics repositories, and electronic health records, offer scale, diversity, and opportunities for new hypotheses, but are often limited by sparse clinical annotation, heterogeneous data generation, and incomplete linkage to patient-level outcomes. CBD provide well-phenotyped patients, longitudinal follow up, and high-quality clinical and immunological measurements, yet face constraints in sample size, population diversity, and data sharing. Studies integrating OAD breadth with CBD label fidelity report improved predictive performance when paired with disciplined evaluation. Federated learning and portable feature specifications are emerging to enable privacy-preserving collaborations.</p><p><strong>Summary: </strong>Allergologists play a central role in building ML-ready resources. By ensuring rigorous clinical annotation, standardization of data, transparent methods, and independent validation, they can maximize the utility of OAD and CBD and their combination to accelerate progress toward precision allergy medicine.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"138-148"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212442","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":"Eosinophilic gastrointestinal disorders, a new epidemic.","authors":"Carlo Maria Rossi, Antonio di Sabatino","doi":"10.1097/ACI.0000000000001144","DOIUrl":"10.1097/ACI.0000000000001144","url":null,"abstract":"<p><strong>Purpose of review: </strong>Eosinophilic gastrointestinal disorders (EGID) are on the rise and impose a significant burden on patients. EGID other than eosinophilic esophagitis (EoE) remain diagnostically and therapeutically challenging.</p><p><strong>Recent findings: </strong>We revised the current knowledge on primary EGID. Epithelial barrier dysfunction and type 2 inflammation are key elements in EoE pathogenesis, whereas the mechanisms underlying distal EGID are elusive. Clinical presentations of EGID vary by disease location and depth of tissue involvement. Diagnosis relies on biopsy, although eosinophilic histologic thresholds - particularly for distal forms - remain imperfect, and secondary causes must be rigorously excluded. Treatment of EoE is supported by validated clinical endpoints and includes proton pump inhibitors, topical corticosteroids, elimination diets, and the interleukin-4Rα blocker dupilumab. In contrast, management of non-EoE EGID lacks standardisation and relies predominantly on systemic corticosteroids, immunomodulators, dietary therapy, and limited emerging evidence for biologics.</p><p><strong>Summary: </strong>EGID comprise a heterogeneous spectrum of primary diseases with eosinophilic infiltration of the gut. EoE is the most extensively studied among EGID, whereas non-EoE EGID-including eosinophilic gastritis, enteritis, and colitis-remain rare, understudied. The development and validation of disease-specific clinical outcome measures are awaited to design robust clinical trials and advance therapeutic options for non-EoE EGID.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"131-137"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194261","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":"STAT wars: how STATopathies sabotage innate immunity.","authors":"Markéta Bloomfield, Klára Šabatková, Zuzana Paračková","doi":"10.1097/ACI.0000000000001139","DOIUrl":"10.1097/ACI.0000000000001139","url":null,"abstract":"<p><strong>Purpose of review: </strong>The Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway is a central conduit linking cytokine signals to immune and tissue homeostasis. Over the past decade, a rapidly expanding spectrum of STATopathies, monogenic inborn errors of immunity caused by loss or gain-of-function mutations in individual STAT genes, has been recognized. This review integrates emerging evidence highlighting that, while STAT proteins have been extensively characterized in adaptive immunity, innate immune mechanisms remain insufficiently explored in many STATopathies, even though they are central to host defense, inflammation, and immune regulation.</p><p><strong>Recent findings: </strong>Recent studies have delineated cell-specific roles of individual STATs in innate lineages, including monocytes, macrophages, dendritic cells, neutrophils, and natural killer cells. Novel insights reveal how aberrant STAT signaling disrupts interferon responsiveness, pathogen sensing, cytokine feedback, and myeloid cell differentiation. Parallel therapeutic advances, such as JAK inhibitors or cytokine blockade and early gene-correcting are reshaping management of STATopathies.</p><p><strong>Summary: </strong>Recognition of innate immune dysregulation as an important driver of STATopathies broadens diagnostic and therapeutic horizons. Integrating innate immune profiling into clinical evaluation may refine prognostication and treatment selection, while mechanistic understanding of STAT control in myeloid lineages paves the way for precision immunomodulation and future curative interventions.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"113-121"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932638","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":"Immunoglobulin disorders in pediatric chronic rhinosinusitis.","authors":"Callum Lewandrowski, Brian P Peppers, Chadi A Makary","doi":"10.1097/ACI.0000000000001135","DOIUrl":"10.1097/ACI.0000000000001135","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides the current understanding on primary antibody deficiencies (PAD) in children with chronic rhinosinusitis (CRS).</p><p><strong>Recent findings: </strong>There is clear evidence that the prevalence of PAD is higher in children with CRS than in the general population. Common disorders include common variable immunoglobulin deficiency (CVID), X-linked agammaglobulinemia (XLA), specific antibody deficiency (SAD), IgG subclass deficiency (IGGSD), selective IgA deficiency (SIGAD), and hyperIgM syndrome. Despite the presence of multiple studies addressing CRS and PAD, the level of evidence supporting different treatment options continues to be lacking. Optimal management requires a multidisciplinary approach through collaboration with clinical immunology.</p><p><strong>Summary: </strong>This review outlines the current approach for diagnosis and treatment of PAD in children with CRS. While some of the disorders can be asymptomatic, children who present with more severe deficiencies will present with chronic and recurrent rhinosinusitis, as well as recurrent otitis media and pneumonia. Otolaryngologists are often at the forefront of early diagnosis of these disorders.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"26 1","pages":"1-6"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833233","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":"Environmental factors influencing the microbiome in adult asthma: emerging mechanistic insights.","authors":"Mário Morais-Almeida, Raquel Baptista-Pestana","doi":"10.1097/ACI.0000000000001131","DOIUrl":"10.1097/ACI.0000000000001131","url":null,"abstract":"<p><strong>Purpose of review: </strong>Asthma is a mosaic of phenotypes shaped by complex host-environment interactions. Among these, the microbiome has moved to a central determinant of disease expression, and airway and gut microbiome should be seen as active players in asthma pathophysiology. This review critically examines how environmental exposures, including pollution, drugs, diet, and climate, remodel microbial ecosystems, and reprogram immune responses in adults with asthma, with emphasis on clinical translation.</p><p><strong>Recent findings: </strong>Advances from multiomics, large-scale cohorts, and Mendelian randomization studies reinforce the concept of the gut-lung axis as a decisive modulator of asthma outcomes. Airway dysbiosis, often marked by Proteobacteria dominance, consistently correlates with poor asthma control, exacerbations, and steroid resistance. Environmental determinants of microbiome reshape erode immune tolerance. Microbial metabolites such as short-chain fatty acids act as molecular messengers capable of restoring epithelial and immune balance. These findings challenge the traditional inflammatory-centric view of asthma and demand broader mechanistic frameworks.</p><p><strong>Summary: </strong>The microbiome should be considered a central piece of the puzzle in asthma research. Precision medicine in adult asthma will remain aspirational unless microbiome-informed biomarkers and interventions are embraced. Robust interventional studies are urgently needed to translate this promise into practice.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"45-51"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699833","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":"Stromal and immune cell interplay promotes neutrophilic inflammation in chronic rhinosinusitis with nasal polyps.","authors":"Ruo-Yu Lu, Cui-Lian Guo, Zheng Liu","doi":"10.1097/ACI.0000000000001130","DOIUrl":"10.1097/ACI.0000000000001130","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder, with neutrophilic inflammation representing a clinically challenging endotype due to its resistance to corticosteroids and biologics targeting type 2 responses. Single-cell RNA sequencing (scRNA-seq) studies are providing novel insights into the pathogenesis of CRSwNP, particularly the roles of neutrophils and stromal cells. This review discusses how scRNA-seq has inspired a new focus on stromal-immune cell crosstalk as a driver of neutrophilic inflammation. We emphasize the pathogenic contributions of fibroblasts, granzyme K-expressing (GZMK+) CD8+ T cells, and dysregulated cytokine networks such as interleukin (IL)-1β and C-X-C motif chemokine ligand (CXCL). Understanding these interactions is critical for developing endotype-specific therapies for refractory CRSwNP characterized by neutrophilic inflammation.</p><p><strong>Recent findings: </strong>ScRNA-seq has revealed a significant heterogeneity in neutrophils and stromal cell populations within CRSwNP, with distinct subpopulations exhibiting unique functional profiles. The IL-1β-activated indoleamine 2,3-dioxygenase 1-expressing (IDO1+) fibroblast subset drives neutrophilic inflammation in CRSwNP through secreting a number of CXCL chemokines. Lymphocyte antigen 6 family member D-expressing (LY6D+) club cells in nasal epithelium express high levels of S100 calcium binding protein A (S100A) 8 and S100A9, known as chemoattractants for neutrophils, under IL-1β stimulation. Fibroblast-derived CXCL12 recruits C-X-C motif chemokine receptor (CXCR) 4+GZMK+CD8+ T cells, establishing a feed-forward inflammatory loop. This cycle is driven by GZMK-mediated stromal activation, resulting in the secretion of potent neutrophil chemokines. Therapeutics targeting of IL-1β and CXCL12-CXCR4 signaling show potential for suppressing neutrophilic inflammation in CRSwNP.</p><p><strong>Summary: </strong>Stromal and immune cell interactions drive neutrophilic inflammation in CRSwNP. Targeting these cells and their signaling networks offers promising avenues for precision therapy, aiming to control neutrophilic inflammation, reduce associated polyp recurrence, and improve long-term disease outcomes.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"26 1","pages":"7-14"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833267","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":"Modifying the course of asthma: mechanisms and strategies for clinical remission.","authors":"Benedetta Bondi, Diego Bagnasco, Fulvio Braido","doi":"10.1097/ACI.0000000000001129","DOIUrl":"10.1097/ACI.0000000000001129","url":null,"abstract":"<p><strong>Purpose of review: </strong>Asthma management is ongoing a paradigm shift from symptom control and exacerbation prevention toward the more comprehensive goal of clinical remission. This review is timely because biologic therapies, precision medicine, and improved understanding of immunopathological mechanisms have made remission a realistic therapeutic goal. By integrating clinical, functional, and biological outcomes, remission offers a more comprehensive framework for assessing long-term disease control.</p><p><strong>Recent findings: </strong>Recent evidence demonstrate that biologic drugs, such as Mepolizumab, Omalizumab, Dupilumab, Benralizumab, and Tezepelumab, allow clinical remission to be achieved in many patients affected by severe asthma particularly those who show a phenotyping polarized toward T2-High. Lifestyle change, particularly weight loss and smoking cessation, early intervention, and the use of allergen immunotherapy may increase the chances of achieving remission. Real-world data confirm that remission rates vary depending on the definition applied, going from clinical to complete remission, highlighting the lack of a universally shared definition of remission and the need for standardized criteria.</p><p><strong>Summary: </strong>Clinical remission in asthma is now a feasible target. Achieving this goal requires a multidimensional approach that integrates biologics, early treatment, comorbidity management, and lifestyle interventions. Standardized definitions and biomarkers are essential to guide therapeutic decisions and predict long-term outcomes.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"52-58"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12911486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660596","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}