Journal of Allergy and Clinical Immunology-In Practice最新文献

{"title":"Alcohol-Induced Hypersensitivity: A Clinical and Mechanistic Overview.","authors":"Saheba Bhatnagar, Dayna Miyashiro, Ethan Canty, Katharine Woessner, Andrew White","doi":"10.1016/j.jaip.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.10.003","url":null,"abstract":"<p><p>Patients with reactions to alcohol pose a diagnostic challenge for allergists, since such symptoms can represent true hypersensitivity, alcohol as a cofactor for other allergens, or entirely separate mimicking conditions. The literature on this topic is limited, with much of the current understanding drawn from case reports, small case series, and mechanistic studies rather than large scale trials. Although the underlying mechanism is not fully understood, several pathways have been proposed to explain this cofactor effect, which this review will discuss in detail. Alcohol has also been identified as a direct trigger of IgE-mediated, non-IgE-mediated, and delayed hypersensitivity reactions, and can exacerbate pre-existing atopic and mast cell-related conditions, including aspirin-exacerbated disease, mastocytosis and urticaria. This review provides a comprehensive overview of these mechanisms and the clinical spectrum of alcohol-related reactions, highlights key mimickers relevant to the allergist, and provides a practical framework for diagnostic evaluation.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197805","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":"Second-line dupilumab after anti-IL5/Rα failure: remission rates and clinical outcomes in severe asthma.","authors":"Susanne Hansen, Kjell Erik Julius Håkansson, Marianne Baastrup Soendergaard, Asger Sverrild, Anna von Bülow, Ole Hilberg, Alexander Silberbrandt, Sofie Lock Johansson, Lycely Dongo, Roxana Vijdea, Linda Makowska Rasmussen, Johannes Martin Schmid, Charlotte Suppli Ulrik, Anne Sofie Bjerrum, Celeste Porsbjerg","doi":"10.1016/j.jaip.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>Switching biologic therapies occurs in 10-25% of severe asthma patients, yet remission rates after first-line biologic failure remain poorly characterised.</p><p><strong>Objective: </strong>To assess clinical remission after switching from anti-IL5/Rα to anti-IL4/13 therapy following treatment failure.</p><p><strong>Methods: </strong>This observational cohort study included all Danish adults with severe asthma switching to second-line anti-IL4/13 after failing to achieve remission on anti-IL5/Rα. Remission at 12 months was assessed by four domains: no exacerbations, no maintenance oral corticosteroid use (mOCS), ACQ-6 ≤1.5, and FEV₁ >80% predicted (FEV₁%pred).</p><p><strong>Results: </strong>A total of 173 patients were included (median age 55; 45% female), with 79% switching due to lack of treatment effect. The proportion of patients meeting each remission domain increased progressively from pre-biologic baseline to switching and follow-up. At 12 months, 66%, 75%, 54%, and 39% met the exacerbation, mOCS, ACQ-6, and FEV₁%pred criteria, respectively; 17% achieved full four-domain remission. Impaired lung function was the most persistent unmet criterion among non-remitters. Pre-biologic and pre-switch biomarkers did not predict remission, whereas atopic dermatitis (33% vs. 16%, p=0.05) and nasal polyps (75% vs. 49%, p=0.02) were associated with remission, and COPD with non-remission (4% vs. 34%, p=0.003).</p><p><strong>Conclusion: </strong>In severe asthma patients not achieving remission on first-line anti-IL5/Rα, nearly one in five achieved remission after switching to anti-IL4/13, suggesting that interclass switching is an effective strategy for patients with inadequate response. Impaired lung function and absence of broad T2 comorbidity predict a lower likelihood of remission.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185826","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":"Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease: Diagnosis and Treatment.","authors":"Dalan Smallwood, John W Jacobs, Richard F Lockey","doi":"10.1016/j.jaip.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.10.007","url":null,"abstract":"<p><p>Chronic cough, hoarseness, and other laryngopharyngeal symptoms (LPS) are common complaints that often prompt a referral to an allergist/immunologist. Laryngopharyngeal reflux disease (LPRD) can cause LPS, and due to its symptom overlap with many other conditions, it is critical to understand how to clinically evaluate and treat this disease. Assessing for the presence or absence of concomitant gastroesophageal reflux disease symptoms is critical. The importance of direct visualization via laryngoscopy, and in some cases endoscopic evaluation and pH testing, also highlight the importance of taking a multidisciplinary approach to evaluate suspected LPRD patients. This manuscript reviews LPS, the pathophysiology and diagnostic criteria of LPRD, and the often multidisciplinary approach required to best evaluate and manage this group of patients.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185908","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":"Epinephrine-treated reactions and their severity in preschool children during oral immunotherapy.","authors":"Min Jung Kim, Lianne Soller, Alexandra Baaske, Melissa Braschel, Edmond S Chan, Raymond Mak, Tiffany Wong, Stephanie C Erdle, Scott B Cameron, Joanne Yeung, Victoria E Cook, Sandeep Kapur, Mary McHenry, Gregory A Rex, Sara Leo, Elissa M Abrams, Vicky Le Blanc","doi":"10.1016/j.jaip.2026.09.028","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.028","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149541","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":"Benefits and Harms of Dose Escalation of Inhaled Corticosteroids in Uncontrolled Asthma.","authors":"Arnaud Bourdin, Richard Beasley, Anju T Peters, Mario Castro, Njira L Lugogo, Olivier Ledanois, Antonio Martin, Yamo Deniz, Melissa Iammatteo, Mena Soliman, William W Busse","doi":"10.1016/j.jaip.2026.09.034","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.034","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149201","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":"Pharmacokinetics, pharmacodynamics, and safety of AQST-109 epinephrine 12mg sublingual film: A Phase I pediatric study.","authors":"David B K Golden, Douglas P Mack, S Shahzad Mustafa, H Henry Li, Aikaterini Anagnostou, Weily Soong, David M Fleischer, Elisabeth Kilroy, Karen Rance, Gary Slatko, Matthew Greenhawt","doi":"10.1016/j.jaip.2026.09.030","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.030","url":null,"abstract":"<p><strong>Background: </strong>Epinephrine auto-injectors (EAI) as anaphylaxis treatment are underutilized, and administration is sometimes delayed for myriad reasons. AQST-109 is a sublingual epinephrine film in late-stage clinical development, offering a potential needle-free and highly portable alternative to EAIs.</p><p><strong>Objective: </strong>To evaluate AQST-109's safety, pharmacokinetic (PK) and pharmacodynamic (PD) profile in pediatric participants, establishing a PK bridge to adult AQST-109 data.</p><p><strong>Methods: </strong>In this open-label Phase I study children aged 7-17 years, at-risk for a type 1 allergic reaction, received one 12mg AQST-109 film administered by healthcare provider. Primary PK endpoints included maximum plasma concentration (C_max) and area under the curve (AUC). Additional endpoints included time to maximum plasma concentration (T_max), heart rate (HR), systolic (SBP), diastolic blood pressure (DBP) and treatment-emergent adverse events (TEAEs).</p><p><strong>Results: </strong>Thirty-two patients received AQST-109, with 29 included in the PK analysis (n=3 with insufficient samples for analysis). Geometric mean (CV%) C_max was 568.6 (175.8) pg/mL (7-11 years, 449.1 [94.3] pg/mL; 12-17 years, 622.1 [213.9] pg/mL). Median T_max was 10 minutes. Geometric mean AUC_0-∞ (CV%) was 440.8 (84.6) h*pg/mL (7-11 years, 418.0 [51.1]; 12-17 years, 450.7 [99.4]). Mean maximum observed effect (E_max) (SD) for HR, SBP, and DBP was 12.5 (17.3) beats, 15.4 (12.3) mmHg and 9.8 (13.6) mmHg, respectively. No severe or serious TEAEs were reported.</p><p><strong>Conclusion: </strong>In children ages 7-17, a single 12-mg AQST-109 dose was well-tolerated, with rapid absorption and sustained exposure, supporting a PK bridge to adult data. AQST-109 has potential as a needle-free, sublingual alternative epinephrine treatment for severe allergic reactions in pediatric populations.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149568","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":"\"Bridging the Gap: Increasing Participation of Underrepresented Populations in Allergy and Immunology Research\".","authors":"Sharmilee M Nyenhuis, Ariel Callero, Juan Carlos Cardet, Bridgette L Jones, Lillian Nwanah, Aarti Pandya, Nicole B Ramsey, Christina Shincovich, Catherine Ye, Elliot Israel","doi":"10.1016/j.jaip.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.10.004","url":null,"abstract":"<p><p>Despite decades of national initiatives, racial, ethnic, socioeconomic, and historically underrepresented populations remain inadequately represented in allergy and immunology research. This limits the generalizability of findings, impedes identification of differences in treatment response and safety, and contributes to persistent disparities among populations disproportionately affected by allergic and immunologic diseases. Underrepresentation reflects patient-, provider-, investigator-, institutional-, and regulatory-level barriers: mistrust of research, financial and logistical burdens, restrictive eligibility criteria, language and health literacy challenges, limited community engagement, and inequitable recruitment practices. We summarize current evidence of barriers to participation in allergy and immunology clinical research and highlight practical, evidence-based strategies to improve equitable recruitment and retention. Key approaches include culturally and linguistically appropriate recruitment materials, community advisory boards and trusted community partners, collaboration with clinicians serving underserved populations, decentralized and hybrid designs that reduce participant burden, broader eligibility criteria when scientifically appropriate, improved investigator and staff training, and participant-centered retention strategies. Sustained partnerships and dissemination of findings to participating communities foster long-term trust. Increasing diversity requires a coordinated, systems-level approach that embeds equity throughout study design, recruitment, implementation, retention, and dissemination. Doing so strengthens the validity and generalizability of the evidence base and ensures that future advances benefit all populations equitably.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148789","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":"Inhaled, nasal and topical corticosteroid burden and association with corticosteroid-associated adverse events.","authors":"Kjell Erik Julius Håkansson, Inge Raadal Skov, Steven Arild Wuyts Andersen, Zarqa Ali, Simon Francis Thomsen, Anders Løkke, Rikke Ibsen, Ole Hilberg, Howraman Meteran, Claus R Johnsen, Peter Schwarz, Vibeke Backer, Charlotte Suppli Ulrik","doi":"10.1016/j.jaip.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.029","url":null,"abstract":"<p><strong>Background: </strong>Patients with type 2 inflammation-associated diseases are often treated with multiple formulations of corticosteroids. Long-term risks of using combinations of local corticosteroids are poorly characterised.</p><p><strong>Objective: </strong>Using Danish nationwide databases, investigate associations between local corticosteroid exposure and 11 corticosteroid exposure-associated conditions compared to non-users, and eventual dose-response relationship for exposed individuals.</p><p><strong>Methods: </strong>Systemic corticosteroid-naïve adults who redeemed inhaled, nasal and/or topical corticosteroids 2000-2012 were matched with non-initiators and followed for up to 23 years. Overall (inhaled, nasal and topical) exposure was calculated for 6-month periods as low (<1.25 daily prednisolone-equivalent mg), moderate (1.25-2.5 mg) or high (>2.5 mg). Competing risk Cox models with time-varying effects were used, presented as HR per additional 6-month period of exposure.</p><p><strong>Results: </strong>Overall, 292,393 local corticosteroid users were included (mean age 45, 47.7% female). Corticosteroid exposure-associated condition incidences were generally low, but all conditions had higher subdistribution-HRs in users, ranging from 1.4 to 3.8 for cataracts and obesity (p<0.001).For local corticosteroid users, increased risk per 6-month exposure was observed for osteoporosis (low-high dose: HRs 1.01-1.10), obesity (1.03-1.03) and pneumonia (1.03-1.15). Risk of cardiovascular disease, heart failure, cataract and gastroesophageal reflux disease increased with high-dose exposure only at HRs 1.03, 1.02, 1.04 and 1.04 per additional 6-month period of exposure, respectively.Stratified by formulation, high-dose inhaled and topical corticosteroids demonstrated the strongest associations.</p><p><strong>Conclusion: </strong>In individuals using local corticosteroids, the overall corticosteroid burden, including shorter periods of high-dose exposure, associates with corticosteroid exposure-associated adverse events albeit with generally low incidence and hazard.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148890","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":"The FAA's Proposed \"Performance-Based\" Approach to In-Flight Anaphylaxis Management.","authors":"Christopher Michael Warren, Lianne Mandelbaum, Anna Nowak Wegyrzn","doi":"10.1016/j.jaip.2026.09.027","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.027","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139221","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":"Biologic Injection-Related Pain in Severe Asthma, Its Impact on Treatment Aversion, and Pain-Relief Approach: A Multicenter Observational Study.","authors":"Takeshi Matsumoto, Megumi Aizawa-Abe, Naoki Yamamoto, Akiko Iri, Takahiro Fujiki, Yusuke Kusakabe, Emi Nakayama, Mayuko Tashima, Chikara Ito, Kodai Miyamoto, Reina Kitagawa, Yusei Fukushima, Akihiro Noda, Masanori Azuma, Tetsuya Ueda, Kensaku Aihara","doi":"10.1016/j.jaip.2026.09.023","DOIUrl":"10.1016/j.jaip.2026.09.023","url":null,"abstract":"<p><strong>Background: </strong>Although biologic therapies are essential for managing severe asthma, injection-related pain may be a frequently overlooked barrier to treatment persistence.</p><p><strong>Objective: </strong>To quantify biologic injection-related pain in asthma cases, identify clinical factors associated with such pain and treatment aversion, and explore practical pain-relief approaches.</p><p><strong>Methods: </strong>This multicenter observational study enrolled patients with asthma receiving biologics between May 2025 and March 2026. Insertion pain, injection pain, and treatment aversion attributable to injection-related pain were assessed using 0 to 10 visual analog scales. Associations between clinical factors, pain scores, and treatment aversion scores and the effects of local pressure and cooling at the injection site were evaluated. Patients with diabetes mellitus receiving tirzepatide served as a reference group.</p><p><strong>Results: </strong>In total, 122 biologic-treated and 27 tirzepatide-treated patient responses were analyzed. Mean insertion and injection pain scores for biologics were 3.00 ± 2.60 and 3.28 ± 2.91, respectively. Adjusted pain scores did not differ significantly across biologics and tirzepatide. Insertion pain was associated with anxiety and arm injection, whereas injection pain was associated with younger age and female sex. Both insertion and injection pain showed independent associations with log-transformed treatment aversion score (unstandardized regression coefficient [B] = 0.08, 95% CI, 0.03-0.12, and B = 0.07, 95% CI, 0.03-0.11, respectively). Injection-site cooling significantly reduced both pain types.</p><p><strong>Conclusions: </strong>Among patients receiving biologics for asthma, injection-related pain is common and independently associated with treatment aversion. Local cooling may offer a simple approach to reducing injection-related pain and addressing treatment aversion.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117643","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}