AllergyPub Date : 2025-09-24DOI: 10.1111/all.70061
Marjolein S de Bruin-Weller,Celeste M Boesjes,Roselie A Achten,Lisa A Beck,Alan D Irvine,Christian Vestergaard,Marlies de Graaf,Femke van Wijk,Daphne S Bakker,Stephan Weidinger
{"title":"Biologics to Treat Atopic Dermatitis: Effectiveness, Safety, and Future Directions.","authors":"Marjolein S de Bruin-Weller,Celeste M Boesjes,Roselie A Achten,Lisa A Beck,Alan D Irvine,Christian Vestergaard,Marlies de Graaf,Femke van Wijk,Daphne S Bakker,Stephan Weidinger","doi":"10.1111/all.70061","DOIUrl":"https://doi.org/10.1111/all.70061","url":null,"abstract":"Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases worldwide. The clinical presentation of AD is heterogeneous and is characterized by a relapsing and remitting course. Most patients suffer from mild AD while approximately 5% to 20% experience severe disease activity, which often requires systemic treatment. Before 2017, systemic treatment options were limited to broad immunosuppressants, which often had significant toxicity and limited effectiveness. Advances in understanding AD pathophysiology have led to the development of targeted biologic therapies, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab. These monoclonal antibodies specifically block key pro-inflammatory cytokines involved in AD, improving disease control and symptom relief. Dupilumab, the first approved biologic, inhibits IL-4 and IL-13 signaling, while tralokinumab and lebrikizumab selectively block IL-13. Nemolizumab targets IL-31, which plays a crucial role in pruritus. This review summarizes primarily real-world data on the effectiveness and safety of these biologics, providing clinical guidance for their use and management of side effects. It also briefly discusses promising therapeutic targets currently in phase 3 trials.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"19 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-23DOI: 10.1111/all.70075
Yoshiyasu Takefuji
{"title":"Correspondence: Accuracy Is Not Enough: Stability‐Aware Feature Selection for Reproducible Biomarker Discovery","authors":"Yoshiyasu Takefuji","doi":"10.1111/all.70075","DOIUrl":"https://doi.org/10.1111/all.70075","url":null,"abstract":"Random forest (RF) models can achieve high predictive accuracy, yet their model‐specific feature importances may be unstable and misleading. Using an allergy benchmark dataset (10,000 instances, 11 features), we compared five selection strategies—RF, logistic regression, feature agglomeration (FA), highly variable gene selection (HVGS), and Spearman correlation—evaluating cross‐validated accuracy with the top five features and after removing the top two (reselecting the top three). RF attained 0.9999 accuracy with the top five but fell to 0.8836 and showed unstable rankings; logistic regression maintained 0.9116 but was also unstable. FA, HVGS, and Spearman achieved near‐perfect accuracy (0.9999) with the top five and modest declines (0.9076–0.9116) with stable rankings. Results underscore that accuracy does not imply reliable importance; stability‐aware, model‐agnostic, or unsupervised methods better support reproducible biomarker discovery.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"29 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of the Arg16Gly β2-Adrenergic Receptor Polymorphism on Long-Term Mepolizumab Response and Clinical Remission in Severe Eosinophilic Asthma: A Genotype-Stratified, Multicenter Study.","authors":"Santi Nolasco,Evelina Fagone,Raffaele Campisi,Andrea Portacci,Giulia Scioscia,Corrado Pelaia,Angelantonio Maglio,Claudio Candia,Vitaliano Nicola Quaranta,Isabella Carrieri,Alessandro Saglia,Alessandro Vatrella,Girolamo Pelaia,Carlo Vancheri,Maria Pia Foschino Barbaro,Maria D'Amato,Giovanna Elisiana Carpagnano,Nunzio Crimi,Claudia Crimi, ","doi":"10.1111/all.70071","DOIUrl":"https://doi.org/10.1111/all.70071","url":null,"abstract":"BACKGROUNDβ2-adrenergic signaling promotes airway smooth muscle relaxation and limits the release of pro-inflammatory mediators by immune cells. The rs1042713 polymorphism encodes a glycine-to-arginine substitution (Arg16Gly) that enhances β2-receptor downregulation. We investigated the association of this polymorphism with the risk of severe eosinophilic asthma and its impact on the long-term effectiveness of mepolizumab and clinical remission.METHODSGenotypes from 102 patients with severe eosinophilic asthma receiving mepolizumab were compared with those from 31 individuals with mild asthma and 20 healthy controls. The severe-asthma cohort was followed for up to 24 months, and clinical data were collected at baseline and after 3, 6, 12, and 24 months of treatment. Analyses were stratified by Arg/Arg, Arg/Gly, and Gly/Gly genotypes.RESULTSEach additional Arg16 allele increased the odds of severe eosinophilic asthma by 2.61-fold (95% CI 1.48-4.59; p = 0.0001) relative to mild asthma and by 3.61-fold (95% CI 1.78-7.35; p < 0.0001) relative to healthy controls. Over 24 months of mepolizumab treatment, Arg/Arg patients had an increased risk of exacerbations (HR 2.3 [95% CI 1.03-5.20]; p = 0.0414) and poorer asthma control compared with Gly/Gly patients (ACT ≥ 20: 72.4% vs. 100%, p = 0.0308). Gly/Gly patients also experienced less decline in lung function. By month 24, each additional Gly16 allele increased the odds of achieving clinical remission by 2.86-fold (95% CI 1.20-6.81; p = 0.0170), defined as no annual exacerbations, no OCS, and ACT ≥ 20, and by 3.06-fold (95% CI 1.34-6.96; p = 0.0080) when including an FEV1 decline ≤ 5% from baseline.CONCLUSIONSThe Arg16 allele of the rs1042713 polymorphism increases the risk of severe eosinophilic asthma and may reduce the long-term efficacy of mepolizumab, whereas the Gly16 allele appears to confer better outcomes and higher remission rates.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"82 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-23DOI: 10.1111/all.70060
Paolo D'Avino,Juno Kim,Manru Li,Philipp Gessner,Patrick Westermann,Yagız Pat,Carina Beha,Claudia Traidl-Hoffmann,Jeremy Bost,Nicolas Gaudenzio,Christoph B Messner,Cezmi A Akdis,Yasutaka Mitamura
{"title":"Distinct Roles of IL-4, IL-13, and IL-22 in Human Skin Barrier Dysfunction and Atopic Dermatitis.","authors":"Paolo D'Avino,Juno Kim,Manru Li,Philipp Gessner,Patrick Westermann,Yagız Pat,Carina Beha,Claudia Traidl-Hoffmann,Jeremy Bost,Nicolas Gaudenzio,Christoph B Messner,Cezmi A Akdis,Yasutaka Mitamura","doi":"10.1111/all.70060","DOIUrl":"https://doi.org/10.1111/all.70060","url":null,"abstract":"BACKGROUNDAtopic dermatitis (AD) is a chronic type-2 inflammatory skin disease characterized by eczema and epithelial barrier dysfunction. Along with the type-2 cytokines IL-4 and IL-13, IL-22 contributes to AD pathogenesis. To date, most skin studies rely on reconstructed keratinocytes, which do not represent the real skin response.OBJECTIVEHere, we report the distinct effects of IL-4, IL-13, and IL-22 on bio-stabilized human skin with intact barriers and immune cells.METHODSSpatial transcriptomics on AD-lesions and non-lesional skin was performed. Ex vivo skin barrier integrity was evaluated using electrical impedance spectroscopy (EIS), RNA-sequencing, and untargeted proteomics, complemented by analyses of skin biopsies from dupilumab-treated AD patients.RESULTSSpatial transcriptomics demonstrated that AD lesions showed reduced expression of key barrier genes, including CLDN1, FLG, and FLG2. IL-4, IL-13, and IL-22 disrupted the skin barrier in the ex vivo human skin. Combining type-2 cytokines and IL-22 alone downregulated genes critical for barrier function and keratinization. In addition, IL-4 and IL-13 downregulated antimicrobial peptides, while IL-22 upregulated them. Interestingly, IL-4 and IL-13 reduced IL-22Rα1, and IL-22 upregulated IL-4Rα, suggesting immune cross-regulation. Proteomic analysis confirmed that all three cytokines (IL-4, IL-13, and IL-22) reduced the expression of key skin barrier proteins, particularly filaggrin and claudin-1. Dupilumab treatment of AD patients for 3 months restored IL-4/IL-13-dysregulated genes, whereas it had limited effect on IL22-associated pathways.CONCLUSIONThis comprehensive study provides insights into the distinct immune profiles following IL-4, IL-13, and IL-22 stimulation on human skin, highlighting their complex interplay in disrupting skin barrier function and modulating innate immune responses.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"9 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-23DOI: 10.1111/all.70067
Alicia Martinek,Andrea Deinzer,Roman G Gerlach,Jana Petzold,Lea Semmler,Christof Vorsatz,Padraic G Fallon,Christian Schwartz
{"title":"Obesity Impairs Skin Barrier Function and Facilitates Allergic Sensitization in Mice.","authors":"Alicia Martinek,Andrea Deinzer,Roman G Gerlach,Jana Petzold,Lea Semmler,Christof Vorsatz,Padraic G Fallon,Christian Schwartz","doi":"10.1111/all.70067","DOIUrl":"https://doi.org/10.1111/all.70067","url":null,"abstract":"Atopic dermatitis is a chronic inflammatory skin condition marked by intense itching and a weakened skin barrier. The compromised skin barrier often leads to exaggerated immune responses and greater sensitivity to allergens. Previous studies have already implicated a link between obesity and atopic dermatitis; however, the mechanisms linking obesity to atopy are not yet well understood. We propose that obesity impairs skin barrier function, facilitating allergen penetration in the skin and triggering systemic and local allergic sensitization. We used a diet-induced obesity mouse model to examine skin barrier integrity and immune responses in both steady-state and inflammatory conditions. In order to induce dermatitis or food allergy, we epicutaneously applied MC903 or ovalbumin, respectively. We observed that obesity significantly alters skin barrier physiology, as indicated by increased transepidermal water loss in obese animals. Over time, we observed a decrease in key skin barrier proteins-preceding overt cutaneous inflammation, further indicating a loss of barrier integrity during obesity. Interestingly, skin barrier breakdown was independent of changes to the microbiome. On a cellular level, immune profiling revealed a shift towards a type 17 helper T-cell response bias, although this shift did not coincide with an increase in cytokine production under steady-state conditions. Topical application of MC903 in obese animals led to increased ear swelling and a pronounced Th17-biased inflammatory response compared to lean counterparts. Our findings show that obesity weakens the skin barrier, facilitating increased allergen penetration and allergic sensitization. The Th17-skewed immune environment in obese animals may also amplify inflammatory responses to allergens and act as a feed-forward loop to further disintegrate the skin barrier. This study highlights how obesity-induced skin barrier dysfunction contributes to allergic conditions like atopic dermatitis and may be therapeutically targeted by barrier restoration.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"88 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-19DOI: 10.1111/all.70058
William P M Worrall,Nadine Serhan,Julien J Karrich,Céline El Samrout,Ruchan Ekren,Jasper B J Kamphuis,Charlotte Hateb,Edouard Leveque,Alexia Loste,Pol Andre Apoil,Nicolas Gaudenzio,Laurent L Reber
{"title":"Tissue Distribution and Phenotype of Human Mast Cells in BRGSF and NSG-SGM3-IL15 Humanized Mice.","authors":"William P M Worrall,Nadine Serhan,Julien J Karrich,Céline El Samrout,Ruchan Ekren,Jasper B J Kamphuis,Charlotte Hateb,Edouard Leveque,Alexia Loste,Pol Andre Apoil,Nicolas Gaudenzio,Laurent L Reber","doi":"10.1111/all.70058","DOIUrl":"https://doi.org/10.1111/all.70058","url":null,"abstract":"","PeriodicalId":122,"journal":{"name":"Allergy","volume":"16 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-18DOI: 10.1111/all.70063
Claus Bachert,Hans Hoogeveen,Rimko Ten Have,Donghui Yu,Margitta Worm,Oliver Pfaar,Marek Jutel,Andreas Distler,Andrzej Bozek,Dirk-Jan Opstelten,Annemie Narkus,Ronald van Ree
{"title":"Subcutaneous Allergen Immunotherapy in Adults Allergic to House Dust Mites: A Phase 3 Randomized Controlled Trial.","authors":"Claus Bachert,Hans Hoogeveen,Rimko Ten Have,Donghui Yu,Margitta Worm,Oliver Pfaar,Marek Jutel,Andreas Distler,Andrzej Bozek,Dirk-Jan Opstelten,Annemie Narkus,Ronald van Ree","doi":"10.1111/all.70063","DOIUrl":"https://doi.org/10.1111/all.70063","url":null,"abstract":"BACKGROUNDSubcutaneous allergen immunotherapy (SCIT) has a longstanding history as a safe and effective treatment. Nevertheless, to meet the European Medicines Agency's regulatory requirements for continued market authorization, its efficacy and safety must be confirmed in a pivotal Phase III trial.OBJECTIVEBased on a successful Phase II dose-finding study, the aim was to confirm the safety and efficacy of a subcutaneous house dust mites (HDM) preparation in a randomized controlled trial using an optimal higher dose than the current maintenance dose.METHODSeven hundred sixty-seven subjects were randomized in a 1:1 ratio to 1-year treatment with SCIT-product at a dose of 50,000 AUeq/mL or placebo. Out of these, 682 subjects completed the study. The primary endpoint was assessed using the combined symptom and medication score (CSMS(n)), which focuses on nasal symptoms, as specified by the European Academy of Allergy and Clinical Immunology (EAACI).RESULTSThe primary endpoint showed a trend (p = 0.0767) with a mean treatment effect of -0.12 (95% CI, -0.3 to 0) toward a favorable change in mean CSMS(n) for active compared to placebo treatment. This treatment effect of 0.12 points did however not meet the prespecified minimal clinically relevant difference of 0.25 points. Among the 767 randomized patients, 539 had mild symptoms and 228 patients had moderate to severe HDM allergic symptoms, defined by a mean baseline daily symptom score (dSS(n)) of at least 2. Post hoc analysis of the clinical data, focusing on this subgroup of patients with moderate to severe symptoms, revealed a significant treatment effect for the primary endpoint, with a clinically meaningful reduction of -0.39 points (95% CI, -0.64 to -0.13; p = 0.0031) thereby surpassing the minimal prespecified difference of 0.25 points. No additional safety concerns were observed in the moderate to severe symptom group compared with the minor symptom group.CONCLUSIONTreatment with the tested SCIT-product at a dose of 50,000 AUeq/mL was safe and well tolerated. The primary outcome was not met, with no significant difference observed between the active and placebo groups. A likely explanation might be the inclusion of mainly patients with mild symptoms of rhino conjunctivitis (539 of in total 767 randomized subjects). Post hoc analysis, however, indicated that SCIT was effective in the subgroup of patients with moderate to severe disease, suggesting that the overall study outcome may have been influenced by the inclusion of a large proportion of patients with only mild symptoms of HDM-induced rhino-conjunctivitis. As a consequence, reconfirming efficacy requires adequate baseline symptom severity, especially in HDM allergic patients.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"9 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AllergyPub Date : 2025-09-18DOI: 10.1111/all.70043
Maheshwar Bhasin,Matthew Cooper,Patricia Macchiaverni,Ravisha Srinivas Joys,Therese A O'Sullivan,Jeffrey A Keelan,Carina Venter,Debra J Palmer,Adrian J Lowe,Susan L Prescott,Desiree Silva,Valerie Verhasselt
{"title":"Colostrum as a Protective Factor Against Peanut Allergy: Evidence From a Birth Cohort.","authors":"Maheshwar Bhasin,Matthew Cooper,Patricia Macchiaverni,Ravisha Srinivas Joys,Therese A O'Sullivan,Jeffrey A Keelan,Carina Venter,Debra J Palmer,Adrian J Lowe,Susan L Prescott,Desiree Silva,Valerie Verhasselt","doi":"10.1111/all.70043","DOIUrl":"https://doi.org/10.1111/all.70043","url":null,"abstract":"BACKGROUNDFood allergy affects families' quality of life, can be lifelong and life-threatening, urging the identification of early modifiable risk factors. Formula feeding in the first days of life may increase the risk of cow's milk allergy, a risk often attributed to cow's milk allergens exposure. Early formula feeding also reduces the colostrum intake, the first 3 days' milk, which is rich in bioactive compounds critical for immune and gut health. This study investigates whether partial colostrum feeding increases the risk of food allergy beyond cow's milk.METHODSData from 666 mother-infant pairs in the Australian ORIGINS cohort categorised neonates as exclusive colostrum-fed (ECF, only breastmilk) or partial colostrum-fed (PCF, formula plus breastmilk) within the first 3 days. IgE-mediated food allergy (egg, peanut, cow's milk, cashew) at 12-18 months was determined by skin prick tests and maternal-reported immediate reactions to allergens.RESULTSPCF prevalence was 46%. PCF infants showed an increased risk of peanut allergy [aOR (95% CI) 4.47 (1.04-19.12)] and multiple food allergies [aOR 11.44 (1.48-88.55)] compared to ECF infants. Risk was greater in PCF infants with later (> 7 M) peanut introduction [aOR 5.45 (1.18-25.11)], while ECF infants maintained a low risk regardless of timing. To disentangle the effect of reduced colostrum intake from formula feeding in PCF infants, we analysed the association between the number of colostrum feeds and allergic outcomes. No peanut allergy cases occurred in infants receiving nine or more colostrum feeds per day within their first 72 h, regardless of formula feeding.CONCLUSIONPartial colostrum feeding may be an overlooked risk factor for peanut and multiple food allergies. With over a third of neonates globally partially colostrum-fed, findings highlight the importance of promoting colostrum feeding and exploring colostrum-based therapies for high-risk infants.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"73 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Live Zoster Vaccination and the Reduced Risk of Chronic Respiratory Diseases: An Emulated Target Trial.","authors":"Tae Hyeon Kim,Kyeongmin Lee,Jaehyeong Cho,Jiyeon Oh,Sooji Lee,Lee Smith,Francesco Branda,Junyang Jung,Jinseok Lee,Hayeon Lee,Dong Keon Yon","doi":"10.1111/all.70056","DOIUrl":"https://doi.org/10.1111/all.70056","url":null,"abstract":"BACKGROUNDRecent previous study suggests that live zoster vaccination may reduce the risk of diseases like dementia and cardiovascular diseases, through prevention of herpes zoster. Thus, this study aims to evaluate whether live zoster vaccination can reduce the risk of chronic respiratory disease including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD).METHODSThis target trial emulation study utilized a nationwide, population-based cohort of 2,519,582 individuals aged ≥ 50 years in South Korea. The cohort was constructed by integrating health insurance data from the Korea Health Insurance Review and Assessment Service, national health examination data from the Korean National Health Insurance Service, and vaccination records from the Korea Disease Control and Prevention Agency. The exposure was receipt of at least one dose of live zoster vaccination between January 1, 2012, and December 31, 2021. Outcomes included the incidence of newly diagnosed COPD, asthma, and ILD, as well as hospitalizations associated with these conditions. Following stabilized inverse probability of treatment weighting, we employed the Cox proportional hazards model to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and calculated restricted mean survival time (RMST) for the risk of outcomes associated with live zoster vaccination. The observation period extends from the index date to January 31, 2024.MEASUREMENTS AND MAIN RESULTSAfter stabilized inverse probability of treatment weighting, 745,644 individuals were assigned to the vaccinated group and 1,069,230 to the unvaccinated group, with a mean age of 62.12 years (SD, 3.45) and 49.18% were male. Live zoster vaccination significantly reduced the risk of COPD (aHR, 0.70 [95% CI, 0.69-0.71]; RMST difference, 23.22 days [95% CI, 21.72-24.71]), asthma (0.68 [0.67-0.69]; 25.96 days [24.52-27.40]) and ILD (0.78 [0.73-0.82]; 2.39 days [2.05-2.74]). Additionally, the vaccination significantly reduced the risk of hospital admissions due to these conditions: COPD (0.59 [0.53-0.65]), asthma (0.54 [0.49-0.59]), and ILD (0.68 [0.58-0.79]). The observed protective benefit was more pronounced in non-smokers compared to current smokers. The time-attenuated effect was strongest during 1 to 2 years following live zoster vaccination and remained evident for up to 6 years.CONCLUSIONSLive zoster vaccination significantly reduced the incidence of chronic respiratory disease and related hospitalizations. These findings suggest that live zoster vaccination may provide public health benefits beyond preventing herpes zoster in adults aged ≥ 50 years.","PeriodicalId":122,"journal":{"name":"Allergy","volume":"22 1","pages":""},"PeriodicalIF":12.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}