Current Opinion in Allergy and Clinical Immunology最新文献

{"title":"Environmental exposures, epithelial barrier dysfunction, and the evolving landscape of allergic disorders and asthma.","authors":"Roman Fenner, Russell A Norris, Anne Maitland","doi":"10.1097/ACI.0000000000001136","DOIUrl":"10.1097/ACI.0000000000001136","url":null,"abstract":"<p><strong>Purpose of review: </strong>Immediate hypersensitivity disorders, such as asthma, food intolerance, and anaphylaxis, have risen dramatically since the 20th century, marking a shift in the global disease burden. While mast cells have been associated with IgE-mediated disorders, they also play important roles in homeostasis. To prevent chronic inflammation and aberrant tissue remodeling, tight regulation of mast cells is essential in response to microorganisms, autoantigens, and environmental changes.</p><p><strong>Recent findings: </strong>The surge in mast cell-mediated disorders and evidence of mast cell interactions with epithelial and neural networks have led to the epithelial barrier hypothesis. This hypothesis extends the protective role of the epithelium by highlighting its integrated communication with both the nervous and immune systems, proposing that dysregulated nerve-mast cell signaling at epithelial barriers contributes to the development of immediate hypersensitivity disorders - both allergic and nonallergic phenotypes. In turn, it offers new strategies for prevention and treatment, focusing on restoring barrier integrity and modulating neuroimmune pathways.</p><p><strong>Summary: </strong>Clinical populations including hypermobility syndromes, such as certain Ehlers-Danlos syndrome variants and Job syndrome, exemplify the systemic consequences of disrupted epithelial barriers and chronic nerve-mast cell dysregulation. Accordingly, this review discusses the co-emergence of hypersensitivity and hypermobility syndromes as manifestations of immune-neuro-epithelial dysfunction in the context of modern environmental change.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"29-36"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699847","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":"The concept of environmental injustice in allergy and asthma.","authors":"Ekta Perera, Christopher Codispoti, Mahboobeh Mahdavinia","doi":"10.1097/ACI.0000000000001127","DOIUrl":"10.1097/ACI.0000000000001127","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines how environmental injustice contributes to disparities in allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis. It focuses on the role of social, geographic, and economic inequities in shaping disease prevalence, severity, and access to care among underrepresented racial and ethnic communities.</p><p><strong>Recent findings: </strong>Recent studies emphasize the persistent exposure of low-income and racially marginalized populations to environmental hazards such as air pollution, substandard housing, and climate-related changes, factors that are linked to increased prevalence and severity of allergic diseases. While environmental policies have led to overall improvements in air quality, disparities in exposure and outcomes persist. Emerging policies show promise in reducing these gaps through more equitable and inclusive approaches.</p><p><strong>Summary: </strong>Environmental injustice is a key driver of health disparities in allergic diseases and asthma. Structural inequities continue to place marginalized communities at higher risk of harmful exposures and adverse health outcomes. Addressing these disparities requires collaboration between policymakers, healthcare workers, researchers, and affected communities.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"21-28"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721560","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":"Mammalian meat allergy and beyond: overview of alpha-gal syndrome.","authors":"Rebekah L Browning, Onyinye I Iweala, Maya R Jerath","doi":"10.1097/ACI.0000000000001126","DOIUrl":"10.1097/ACI.0000000000001126","url":null,"abstract":"<p><strong>Purpose of review: </strong>Alpha-gal syndrome (AGS) is a unique allergy to the carbohydrate galactose-alpha-1,3-galactose, which is found in mammalian products, excluding humans and Old World primates. As its prevalence increases, we are learning that AGS has broader geographical range and wider medical impact than initially recognized.</p><p><strong>Recent findings: </strong>Time to diagnosis has improved in recent years, but AGS still presents challenges for diagnosis and management, AGS may be found in a larger geographic distribution than originally supposed, and new potential arthropod triggers have been identified. Recent research demonstrates some of the immunologic changes that occur after arthropod bites that can lead to the production of alpha-gal IgE, but we still do not understand why certain individuals become allergic while others are only sensitized. Presentation can vary widely, and reactions may be inconsistent. The list of foods and medical products recognized to have potential for causing reactions continues to expand, which has implications for management of other conditions in patients with AGS.</p><p><strong>Summary: </strong>With the growing prevalence of AGS, it is increasingly important for clinicians to recognize the syndrome and understand its management.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"37-44"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660510","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":"Impact of type 2-targeted therapies on respiratory infection risk.","authors":"Kathryn Smiley, Nora Zuhdi, Bob Geng","doi":"10.1097/ACI.0000000000001134","DOIUrl":"10.1097/ACI.0000000000001134","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize the effects of type 2 (T2) cytokine-targeting therapies on respiratory infection risk in patients with allergic diseases, with a focus on the interplay between epithelial barrier restoration and immune rebalancing.</p><p><strong>Recent findings: </strong>T2 inflammation, driven by IL-4, IL-13, IL-5, and IgE, disrupts epithelial integrity and impairs mucosal defenses, increasing susceptibility to infections. Biologics targeting these pathways restore barrier function and modulate immune responses, promoting Th1/Th17-mediated antimicrobial activity. Dupilumab improves epithelial integrity and Th1/Th17 activity, with post hoc analyses from QUEST and SINUS-52 showing fewer respiratory infections compared to placebo. IL-13-specific therapies (tralokinumab, lebrikizumab) reduce excessive Th2 signaling and effector T-cell transdifferentiation, supporting mucosal homeostasis and low infection rates. IL-5-targeted biologics (mepolizumab, benralizumab) decrease eosinophil-mediated tissue injury without significantly increasing respiratory infections, despite theoretical concerns regarding antiviral defense. Omalizumab enhances Th1 antiviral pathways while reducing IgE-mediated inflammation, preserving infection control.</p><p><strong>Summary: </strong>T2-modulating biologics not only control allergic inflammation but also restore epithelial and immune homeostasis, contributing to maintained or reduced respiratory infection risk. These therapies represent a dual benefit of barrier repair and immune rebalancing. Further studies are warranted to evaluate long-term infection outcomes in high-risk populations.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"15-20"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699893","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":"Moving towards asthma remission from mechanistic understanding to clinical practice.","authors":"J Christian Virchow, Giovanni Paoletti, Marek Lommatzsch, G Walter Canonica","doi":"10.1097/ACI.0000000000001123","DOIUrl":"10.1097/ACI.0000000000001123","url":null,"abstract":"<p><strong>Purpose of review: </strong>In the past, treatment of asthma aimed primarily at \"control\" of symptoms and a reduction of future risk. Recently, however, the concept of remission has been introduced which is broader than control and includes the concept of disease modification by using disease-modifying antiasthmatic drugs (DMAADs) that exclude the use of systemic corticosteroids. This review highlights the definitions as well as the clinical implications of the concept of remission in asthma.</p><p><strong>Recent findings: </strong>While in the past remission has been used mainly for the relatively rare event of spontaneous cessation of symptoms of asthma, a new definition has been proposed and included in several national guidelines and most recently also in international guidelines which include absence of symptoms, no exacerbations, stable pulmonary function, no need for systemic corticosteroids. In this review, novel definitions and their clinical implications are being discussed such as remission off treatment (e.g. following allergen immunotherapy) and remission on treatment (e.g. during treatment with a biologic). Furthermore, the concept of partial remission as well as the need to further investigate the interdependence of clinical and biological remission (reduction or normalization of inflammatory biomarkers) is discussed. This concept includes for the majority of patients the continuous use of a personalized treatment with DMAADs with a potentially lower treatment burden, provided patients are properly phenotyped and comorbidities are being recognized and treated.</p><p><strong>Summary: </strong>In contrast to previous guidelines, applying the concept of remission has the potential to improve asthma care with earlier interventions with DMAADs and broader treatment approaches to improve long-term outcomes.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"59-66"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602903","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":"WHIM syndrome: from mechanism to targeted therapy - advances shaping clinical care.","authors":"Rahim Z Miller, Christoph B Geier, Jacob R Bledsoe, Joao Pereira, Jolan E Walter","doi":"10.1097/ACI.0000000000001128","DOIUrl":"10.1097/ACI.0000000000001128","url":null,"abstract":"<p><strong>Purpose of review: </strong>Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is an autosomal dominant combined immunodeficiency (CID), often caused by increased CXCR4 pathway signaling. Against early-onset hallmark of neutropenia, diagnosis is delayed due to lack of awareness, incomplete penetrance, and requirement for specialized bone marrow evaluation to detect myelokathexis.</p><p><strong>Recent findings: </strong>Some infants with WHIM are identified via newborn screening for low thymic emigrant T cells. Early pediatric diagnosis is associated with improved outcomes. The genetic spectrum of CXCR4 expands beyond the canonical C-terminal hotspot, with N-terminal p.D84H variant. Recent trials of oral CXCR4 antagonist demonstrated increased circulating mature neutrophils and lymphocytes, reduced infection burden, and, in some cases, wart regression. Mechanistic studies in human and murine models contribute to the understanding of the combined immunodeficiency phenotype and highlight how CXCR4 hyperactivation impairs hematopoietic stem/progenitor cell egress, leukocyte trafficking and disrupts stromal niches critical for lymphocyte development and survival.</p><p><strong>Summary: </strong>Increased awareness, opportunities for screening at birth, improved pathological and genetic diagnostics, and 2024 FDA approval of the first oral CXCR4 antagonist create practical advance in targeting WHIM syndrome. As a CID with lifetime risk for humoral deficiency, impaired antiviral defense and malignancy, WHIM warrants long-term monitoring and further investigation into broader applications of CXCR4 antagonism.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"26 1","pages":"67-75"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833301","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":"Pregnancy complications in women with an inborn error of immunity: a systematic review.","authors":"Bengisu Yakut, Anna C R Knaapen, Xin Yu Cui, P Martin van Hagen, Virgil A S H Dalm, Annemarie G M G J Mulders, Saskia M Rombach","doi":"10.1097/ACI.0000000000001122","DOIUrl":"10.1097/ACI.0000000000001122","url":null,"abstract":"<p><strong>Purpose of review: </strong>Many patients with inborn errors of immunity (IEI) reach the reproductive age these days. This systematic review focuses on possible complications during pregnancy in women with IEI.</p><p><strong>Recent findings: </strong>The total number of pregnancies reported was 2531 in seven cohort studies. A total number of 97 pregnancies was described in case reports. Based on the cohort studies, there was an increased prevalence of preterm births (10.4-13%), caesarean sections (14-18%) and low neonatal weight at birth (4.5-16.5%) in women with IEI compared to control groups (P < 0.05). There was no difference in the prevalence of ectopic pregnancies, terminated pregnancies, gestational diabetes, spontaneous abortions and stillbirths in women with IEI compared to control populations based on the available cohort studies. Case reports showed infections in women with IEI were associated with premature delivery of the infant and an emergency caesarean section. Furthermore, women with IEI who previously experienced pregnancy complications, had uncomplicated pregnancies after immunoglobulin replacement therapy (IGRT).</p><p><strong>Summary: </strong>There was a higher prevalence of preterm births, caesarian sections and low neonatal birth weight in pregnant women with IEI compared to control groups. Treatment of antibody deficiencies may lower the risk of pregnancy complications.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"25 6","pages":"464-477"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12573678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387691","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":"Patients' perspective on allergen immunotherapy for respiratory allergy.","authors":"Francesco Catamerò, Simona Barbaglia, Enrico Heffler, Mattia Giovannini, Giovanni Paoletti","doi":"10.1097/ACI.0000000000001110","DOIUrl":"10.1097/ACI.0000000000001110","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores patients' perspective on allergen immunotherapy (AIT) for respiratory allergy, addressing awareness, motivations, adherence challenges, perceived benefits and risks, and the importance of education and shared decision-making. It also summarizes the data on patient-reported outcomes, considers the role of patient associations, and outlines future directions for enhancing adherence and advancing patient-centered care.</p><p><strong>Recent findings: </strong>AIT is the only treatment capable of modifying the natural course of allergic diseases, providing lasting benefits in terms of symptom reduction, quality of life (QoL), and asthma control. Despite its efficacy and safety, AIT remains underused due to several factors, including cost, misinformation, patient skepticism, and adherence challenges. Limited reimbursements further restrict access.</p><p><strong>Summary: </strong>The patient's perspective is crucial in AIT, as it directly impacts adherence and treatment outcomes. Allergic rhinitis and asthma significantly reduce the QoL, especially when poorly controlled, but their burdens are often underestimated. Adherence to AIT depends on multiple factors including age, physician engagement, perceived efficacy, convenience, education, and socioeconomic status. Effective communication, shared decision-making, and tailored education enhance long-term compliance, while financial barriers and lack of reimbursement remain significant obstacles. Patient-reported outcome measures (PROMs) are essential tools for assessing symptom burden, disease control, and QoL, supporting clinical decisions and research. Validated PROMs, as well as combined symptom-medication scores, help personalize care and are increasingly integrated into digital platforms for real-time monitoring. Respiratory patient associations play a vital role in promoting education, empowerment, and advocacy, enhancing adherence and access to care.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"500-510"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130253","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":"Epinephrine nasal spray for the treatment of anaphylaxis: perspectives in pediatrics.","authors":"Giada Crescioli, Mattia Giovannini, Benedetta Pessina, Simona Barni, Antonella Muraro, Alfredo Vannacci, Francesca Mori","doi":"10.1097/ACI.0000000000001109","DOIUrl":"10.1097/ACI.0000000000001109","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anaphylaxis is a severe allergic reaction characterized by a rapid onset and can be potentially life-threatening. Epinephrine is considered the first-line treatment, and until recently, it was available only for intramuscular injection. A new intranasal epinephrine delivery device has now been approved for use in adults and children, offering a needle-free option for emergency treatment of allergic reactions. This narrative review explores its technical characteristics, along with its pharmacokinetic, pharmacodynamic, and safety profiles based on the results of the most recent clinical trials.</p><p><strong>Recent findings: </strong>The key advantages of the intranasal route, including the elimination of needle-length variability, reduced risk of administration errors in obese or underweight patients, and simplified storage requirements, are also discussed. According to recent research, intranasal epinephrine represents an easy-to-use, effective, and well tolerated treatment for severe allergic reactions. Intranasal delivery may offer a painless, easy-to-use, and reliable solution suitable for healthcare professionals, age-appropriate patients and caregivers.</p><p><strong>Summary: </strong>Based on the current evidence, intranasal epinephrine appears to be a promising, well tolerated option that could significantly improve the accessibility and effectiveness of anaphylaxis management in the pediatric setting.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"511-517"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091285","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":"Depemokimab: a new long-acting anti-IL5 treatment for severe asthma and chronic rhinosinusitis with nasal polyps.","authors":"David I Bernstein","doi":"10.1097/ACI.0000000000001112","DOIUrl":"https://doi.org/10.1097/ACI.0000000000001112","url":null,"abstract":"<p><strong>Purpose of review: </strong>Clinical data are reviewed pertaining to depemokimab, the first extended life anti-IL5 mAb, for treating severe eosinophilic asthma. This molecule was engineered through amino acid modification (YTE mutation) of the Fc region. This modification increases Fc receptor affinity and enables antibody recycling, thereby greatly extending serum half-life and will allow a dosing duration of 26 weeks.</p><p><strong>Recent findings: </strong>Phase 1 and 3 clinical studies have demonstrated that depemokimab maintains drug concentrations and reduces peripheral eosinophils over a single 26-week dosing interval. A 52-week double-blinded, placebo-controlled (DBPC) Phase 3 study of patients with severe eosinophilic asthma demonstrated that depemokimab reduced annualized asthma exacerbations by 54% compared with placebo, the primary efficacy outcome. No significant differences between active and placebo arms were detected for secondary endpoints (e.g., symptoms, FEV1 and quality of life). Results of a noninferiority study comparing depemokimab, benralizumab and mepolizumab are pending. In a DBPC trial of chronic rhinosinusitis with nasal polyps (CRSwNP), depemokimab was also effective in reducing nasal polyp endoscopy scores and nasal obstruction.</p><p><strong>Summary: </strong>Depemokimab could offer patients with severe persistent asthma a more convenient add-on treatment option than existing shorter acting biologics and thereby improve overall adherence.</p>","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"25 6","pages":"488-492"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387733","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}