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

{"title":"Oscillometry may be used to detect bronchodilator reversibility in asthma patients with preserved spirometry.","authors":"Robert Greig, Philipp Suter, Rory Chan, Brian Lipworth","doi":"10.1016/j.jaip.2026.05.001","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.05.001","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864834","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":"Lessons Learned: Approaches to Delabeling Penicillin Allergy Population-level care - effective vs. ineffective strategies for delabeling penicillin allergy.","authors":"Ana Maria Copaescu, Ami P Belmont, Olajumoke O Fadugba, Monica T Kraft, Anna R Wolfson","doi":"10.1016/j.jaip.2026.04.023","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.04.023","url":null,"abstract":"<p><p>Penicillin allergy labels are a major barrier to optimal antimicrobial stewardship, yet most reported reactions are inaccurate and can be safely removed after evaluation. This Clinical Management Review Article summarizes lessons from population-level delabeling initiatives, highlighting the value of incorporating non-allergist perspectives and practical implementation tools. Effective strategies extend beyond specialist settings and rely on multidisciplinary engagement-including primary care, pharmacy, and nursing-to scale interventions. A practical toolkit offering standardized risk-stratification algorithms, oral challenge protocols, and communication templates supports safe and efficient delabeling across diverse clinical environments. Psychosocial and equity considerations are critical to delabeling success. Fear, misinformation, and cultural beliefs often shape patients' willingness to undergo evaluation, while systemic barriers-such as limited specialist access, language differences, and resource constraints-contribute to disparities. Programs that embed patient-centred education, shared decision-making, and flexible delivery models show improved uptake and long-term sustainability. Equity-focused approaches, including outreach to underserved communities and integration into routine care pathways, are essential to achieving broad impact. By combining evidence-based protocols with practical tools and inclusive stakeholder engagement, health systems can overcome logistical and psychosocial challenges to meaningfully reduce the number of inappropriate penicillin allergy labels. These lessons underscore the need for adaptable, equity-driven strategies to optimize antimicrobial use and improve patient outcomes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864827","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 relationship between maternal non-narcotic analgesics allergy labels and maternal and fetal outcomes: results from a large, administrative cohort.","authors":"Chang Su, Rebecca J Baer, Michael Schatz, Christina Chambers","doi":"10.1016/j.jaip.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.04.022","url":null,"abstract":"<p><strong>Background: </strong>Non-narcotic analgesics are the recommended first-line treatment for postpartum pain, and low-dose aspirin is recommended in ∼85% of pregnant patients who have preeclampsia risk factors. Timely evaluation of non-narcotic analgesics allergy labels (NNAALs) is essential for high-quality perinatal care.</p><p><strong>Objective: </strong>We aimed to address a knowledge gap on the relationship between maternal NNAALs and maternal and fetal outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the Study of Outcomes in Mothers and Infants, a population-based cohort of all births in California between 2016-2021. Maternal and fetal outcomes were examined by NNAAL status using Poisson log linear regression to calculate relative risks (aRRs), 95% confidence intervals (CIs), and p-values adjusted for maternal characteristics.</p><p><strong>Results: </strong>Maternal NNAALs were significantly associated with increased rates of preeclampsia (aRR 1.16, p < 0.0001) and eclampsia (aRR 1.64, p = 0.0047), Cesarean delivery (aRR 1.2, p < 0.0001), preterm birth (aRR 1.17, p < 0.0001), infants with neonatal intensive care unit admission (aRR 1.09, p = 0.0076), neonatal opioid withdrawal syndrome (aRR 1.49, p < 0.0001), infant long length of hospital stay (aRR 1.16, p < 0.0001), and a decreased rate of large for gestational age infants (aRR 0.92, p = 0.0092), but were not associated with small for gestational age infants, major structural birth defects, or 5-min APGAR score < 7.</p><p><strong>Conclusion: </strong>Maternal NNAALs were significantly associated with various maternal and fetal adverse outcomes. Our data suggest that proactive evaluations of patients with NNAALs may improve perinatal outcomes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845988","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":"Novel Approaches to Ambulatory Antibiotic Allergy Clinics","authors":"Fionnuala Cox PhD ,&nbsp;Amy Dowden MD ,&nbsp;Bernardo Sousa-Pinto PhD ,&nbsp;Philip H. Li MD","doi":"10.1016/j.jaip.2025.12.013","DOIUrl":"10.1016/j.jaip.2025.12.013","url":null,"abstract":"<div><div>Antibiotic allergy labels, especially to penicillins, are common but often inaccurate, with more than 90% disproven on formal evaluation. These unverified labels lead to suboptimal antibiotic use, increased health care costs, and worse clinical outcomes. Traditional allergist-led assessment models are not scalable due to global shortages of allergy specialists. Recent evidence supports a shift toward proactive, ambulatory, multidisciplinary delabeling strategies that integrate risk-stratified direct oral drug provocation testing into routine care. Validated point-of-care tools now enable nonallergists, including pharmacists, nurses, and physicians, to safely identify low-risk patients suitable for delabeling without skin testing. Successful programs in hospitals, outpatient clinics, and community settings demonstrate that ambulatory delabeling is safe, cost-effective, and scalable. High-yield populations such as pregnant women, immunocompromised individuals, and older adults benefit significantly from timely evaluation. Effective implementation requires structured training, standardized protocols, integration into electronic health records, and a Hub-and-Spoke model linking nonspecialist “spokes” to allergist-led “hubs” for oversight. Clear documentation, patient education, and postchallenge follow-up are essential to prevent relabeling. Future efforts must focus on equitable access, workforce development, and research to validate tools in underrepresented populations and quantify long-term antimicrobial stewardship benefits. Ambulatory delabeling is no longer the sole domain of allergists but a shared responsibility across health care systems to improve prescribing, patient safety, and global antimicrobial resistance outcomes.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1014-1022.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806289","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":"Persistent Long-Term Hypothalamic-Pituitary-Adrenal-Axis Suppression After Maintenance Oral Corticosteroid Withdrawal in Severe Asthma: Biochemical Assessment Is Essential","authors":"Liam Michael Coyle MB, BCh, BAO ,&nbsp;Christian Schnier PhD ,&nbsp;Pamela Jane McDowell PhD ,&nbsp;Charlene Redmond PhD ,&nbsp;Claire Ann Butler PhD ,&nbsp;Liam Gabriel Heaney MD","doi":"10.1016/j.jaip.2026.02.013","DOIUrl":"10.1016/j.jaip.2026.02.013","url":null,"abstract":"<div><h3>Background</h3><div>There is no consensus on the approach to maintenance oral corticosteroid (mOCS) withdrawal in severe asthma (SA) in the presence of hypothalamic-pituitary-adrenal-axis (HPA-axis) suppression.</div></div><div><h3>Objectives</h3><div>The objective of this study is identify the prevalence of persistent HPA-axis suppression after long-term follow-up and factors that predictively correlate to persistent HPA-axis suppression. The secondary objective is to validate the morning cortisol cut points using short Synacthen test results and evaluate the use of dynamic testing.</div></div><div><h3>Methods</h3><div>Retrospective analysis was carried out on data from Northern Ireland patients registered to the United Kingdom Severe Asthma Registry.</div></div><div><h3>Results</h3><div>At baseline, 83% (149 of 180, 95% confidence interval [CI]: 76%-88%) of the cohort demonstrated adrenal insufficiency. After a median test time of 58.5 (33.5-78.5) months, 48 of 180 (27%) had persistent adrenal insufficiency, and of these, 32 (66.7%) had complete adrenal insufficiency. Of those with adrenal insufficiency at baseline, 68% (101 of 149, 95% CI: 60%-75%) achieved HPA-axis recovery. The median time from baseline to the most recent test in those who recovered was 21 (6-40) months. Those with persistent adrenal insufficiency had a significantly lower baseline cortisol than those who achieved HPA-axis recovery (43 nmol/L [1.56 μg/dL] [interquartile range (IQR): 21.5-105 nmol/L] vs 165 nmol/L [5.98 μg/dL] [IQR: 77-222 nmol/L], <em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>A proportion of patients with SA withdrawing from mOCS will have persistent adrenal insufficiency. These patients are asymptomatic and, if not identified through serial biochemical assessment, will be at risk of harm. These data also have implications for other diseases treated with long-term OCS.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1113-1120.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312280","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":"Charting the Seas of Drug Allergy","authors":"Cosby A. Stone Jr. MD, MPH ,&nbsp;Jason A. Trubiano MBBS, PhD","doi":"10.1016/j.jaip.2026.03.018","DOIUrl":"10.1016/j.jaip.2026.03.018","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1081-1082"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826727","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":"Feed the Good Wolf: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindset","authors":"Marylee Verdi APRN, MSN ,&nbsp;Juliette Madan MD, MS ,&nbsp;Dominic Candido PhD ,&nbsp;Marcus Shaker MD, MS ,&nbsp;Andrew A. White MD","doi":"10.1016/j.jaip.2026.01.037","DOIUrl":"10.1016/j.jaip.2026.01.037","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1083-1086"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826728","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":"Novel Uses of Digital Health and the Electronic Medical Record in Drug Allergy","authors":"Morgan Rose BA, BSc, MBBS, DTM&HFRACP, PhD ,&nbsp;Eric Macy MD, MS ,&nbsp;Allison Ramsey MD ,&nbsp;Christine R.F. Rukasin MD","doi":"10.1016/j.jaip.2025.12.028","DOIUrl":"10.1016/j.jaip.2025.12.028","url":null,"abstract":"<div><div>Modern drug allergy practice is witnessing the steady expansion of electronic health records and digital health applications. This creates both obstacles and opportunities for optimizing allergy care. In this review we describe ways in which novel technology is being used with regard to immunologically mediated drug hypersensitivity research and clinical practice. We propose future directions to strengthen drug allergy diagnostic accuracy, clinical decision-making, and patient safety.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1007-1013"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893447","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":"A Multidisciplinary Approach to Checkpoint Inhibitor Adverse Reactions","authors":"","doi":"10.1016/j.jaip.2026.04.003","DOIUrl":"10.1016/j.jaip.2026.04.003","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Page 1073"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826726","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":"Reply to “Stepping up ICS doses in asthma: the crucial roles of relievers, triple therapy, and biomarkers” and “Methodological challenges in evaluating high-dose ICS escalation”","authors":"Trung N. Tran MD, PhD ,&nbsp;Marjan Kerkhof MD, PhD ,&nbsp;Tham T. Le PhD ,&nbsp;Mina Khezrian PharmD, PhD ,&nbsp;Nicole Zubizarreta MPH ,&nbsp;Joshua Enxing MS ,&nbsp;Kirsty Rhodes PhD ,&nbsp;Jonatan Hedberg MSc ,&nbsp;Bill Cook PhD ,&nbsp;Tianshi David Wu MD, MHS ,&nbsp;Tim W. Harrison MD","doi":"10.1016/j.jaip.2026.03.007","DOIUrl":"10.1016/j.jaip.2026.03.007","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1212-1214"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826730","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}