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

{"title":"Omalizumab enables bee venom desensitisation in patients with anaphylactic reactions to venom immunotherapy.","authors":"Kris Capper, Benjamin McGettigan, Cate Willis, Brittany Stevenson","doi":"10.1016/j.jaip.2025.09.038","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.038","url":null,"abstract":"<p><strong>Background: </strong>Venom immunotherapy (VIT) is the only treatment for honeybee venom allergy; however, some patients develop severe allergic reactions (SAR) during therapy. Omalizumab, an anti-IgE antibody, may improve VIT tolerance, though data in honeybee VIT remain limited.</p><p><strong>Objective: </strong>To evaluate the efficacy of adjuvant omalizumab in honeybee VIT, identify predictors of omalizumab requirement, and inform protocol selection.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of all adults undergoing honeybee VIT at Fiona Stanley Hospital, Perth, Western Australia, from 2015 to 2024. Baseline characteristics, biomarkers, protocols, and outcomes were analysed.</p><p><strong>Results: </strong>Among 354 VIT patients, 57 (16%) experienced SARs, with 36 (10%) receiving omalizumab. Predictors of omalizumab need included severe sting anaphylaxis, asthma, and elevated basal tryptase. One patient used omalizumab to escalate VIT dosing after already reaching maintenance. Of 35 patients using omalizumab during VIT up-titration, 22 (63%) achieved unsupported maintenance, 7 (20%) ceased due to SARs, and 5 (14%) remain on omalizumab. Excluding 5 patients who declined or lacked access to ongoing omalizumab, the success rate increases to 73%. The most common protocol involved a 12-week VIT up-titration to 100 μg with omalizumab 300 mg loading 2 weeks prior, followed by 150 mg fortnightly until maintenance VIT was reached. SARs most frequently occurred at omalizumab cessation. In 3 cases, these were overcome by resuming omalizumab with a higher VIT maintenance dose target.</p><p><strong>Conclusion: </strong>Omalizumab could be considered in patients experiencing recurrent SARs to standard VIT. A semi-rush protocol with omalizumab loading 1 to 2 weeks prior was well tolerated.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276855","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":"AI-Driven Wearable and Connected Technology for Allergy: Real-Time Monitoring and Predictive Management for Personalized Care.","authors":"George N Konstantinou, William C Anderson, Evangelos Bagkis, Zoe Brown, Kostas Karatzas, Theodosios Kassandros, Chrysanthi Sardeli, Ruchi Singla, Sharmilee M Nyenhuis","doi":"10.1016/j.jaip.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.013","url":null,"abstract":"<p><p>Allergic diseases are increasing worldwide, underscoring the need for innovative management strategies. Wearable and connected technologies combined with artificial intelligence (AI) can support real-time monitoring, personalized alerts, and proactive interventions. This review summarizes AI-enabled tools for allergy care spanning physiologic signals, environmental exposures (e.g., pollutant proxies such as particulates/VOCs), and patient behaviors, as well as connected medication-adherence technologies (e.g., digital inhalers) that integrate with the same analytics workflows. We also outline predictive algorithms that forecast exacerbations and briefly review therapeutic devices. Reported benefits include earlier warning of clinical deterioration, improved adherence/technique, and opportunities for tailored management. However, important limitations remain around data accuracy and reliability, user adoption, workflow integration, equity/fairness, privacy/cybersecurity, and evolving regulatory pathways. Critically, most devices and algorithms reviewed are investigational or early-phase, with evidence dominated by feasibility or short-term studies, and only a few show improvements in patient-centered outcomes in prospective trials. Realizing clinical value will require outcomes-focused validation (including external/pragmatic studies), safeguards for privacy and security, attention to bias and subgroup performance, and implementation models that fit clinical workflows and reimbursement. With these conditions met, AI-driven wearable and connected technologies could enable more proactive, personalized allergy care.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240235","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":"VAMPSS and the Future of Maternal Health.","authors":"Michael Schatz, Sonia Hernandez-Diaz, Christina D Chambers","doi":"10.1016/j.jaip.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.036","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240282","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":"Demographic and clinical variations in pediatric eosinophilic esophagitis: Insights from a multidisciplinary clinic.","authors":"Susan Wang, Amanda Troger, Pallavi Dwivedi, Suzanne Kochis","doi":"10.1016/j.jaip.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.022","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240274","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 Australian food anaphylaxis admission rates and updated allergy prevention guidelines: 2022 update.","authors":"Raymond James Mullins, Rachel L Peters, Mimi L K Tang","doi":"10.1016/j.jaip.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.032","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228604","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":"Penny-wise and Pound-foolish: A Cost-Effectiveness Analysis Of Unrealized Gains And Hidden Costs of 95165 Reimbursement.","authors":"Marcus Shaker, Weily Soong, Priya Bansal","doi":"10.1016/j.jaip.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.030","url":null,"abstract":"<p><strong>Background: </strong>Allergen immunotherapy (AIT) for aeroallergens can be an effective and cost-saving approach for patients with allergic disease. Dose definition limits reimbursement for the Current Procedural Terminology code 95165, which is used for the supervision of preparation and provision of antigens for allergen immunotherapy. The degree to which reduced reimbursement may impact health-economic outcomes is not well characterized.</p><p><strong>Objective: </strong>A cost-effectiveness model was developed to evaluate possible health and economic consequences of improper 95165 reimbursement as both a penalty and a potential subsidy in aeroallergen AIT.</p><p><strong>Methods: </strong>Cohort analyses were evaluated from societal and healthcare perspectives with an annual 95165 penalty alternatively considered as a subsidy or a cost-neutral lever causing variable impacts on subcutaneous AIT access. Probabilities and costs were derived from the medical literature and private practice estimates. Population level microsimulation was carried out to evaluate broader societal impacts of current 95165 reimbursement policy over a 5-year treatment course.</p><p><strong>Results: </strong>A non-penalized approach to AIT was preferred in all non-subsidized analyses. Even if the 95165 reimbursement penalty was modeled as a subsidy discount, an approach of withholding allergist-immunologist reimbursement based on a statutory volumetric definition of dose was not cost-effective if it limited access to therapy by more than 9.3% (societal perspective) or 11.1% (healthcare perspective excluding indirect costs) of individuals seeking therapy. With 85% of AIT services unaffected, assuming a 5% prevalence of moderate to severe AR, if only 1.2% of those with AR received subcutaneous immunotherapy, costs of incomplete allergist-immunologist reimbursement reached $353,946,504 (with subsidy) and $1,386,125,127 (without subsidy) over a 5-year course of AIT.</p><p><strong>Conclusion: </strong>Withholding allergist-immunologist reimbursement for mixing of allergen extracts has high potential of health-economic harm for patients and populations. Under highly conservative estimates, costs without subsidy could exceed $1.3 billion per treatment course.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214393","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":"Longitudinal associations between household use of \"green\" cleaning products and asthma symptoms.","authors":"Emilie Pacheco Da Silva, Raphaëlle Varraso, Léopold K Fezeu, Pilar Galan, Serge Hercberg, Mathilde Touvier, Christophe Paris, Nicole Le Moual, Orianne Dumas","doi":"10.1016/j.jaip.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.027","url":null,"abstract":"<p><strong>Background: </strong>The household use of irritant and sprayed cleaning products is an established asthma risk factor, which could motivate consumers to turn to \"green\" products. However, only two cross-sectional studies, with inconsistent results, evaluated the potential respiratory health impacts of \"green\" products.</p><p><strong>Objective: </strong>We investigated 2-years effects on asthma of household use of \"green\" products and irritants/sprays, using longitudinal data from the French NutriNet-Santé cohort.</p><p><strong>Methods: </strong>The asthma symptom score and household use of \"green\" products and irritants/sprays were evaluated using standardized questionnaires in 2018 and 2020. The evolution of weekly use (persistent, increased versus no weekly use) was studied in association with (i) the asthma symptom score in 2020; (ii) the incidence of asthma symptoms between 2018-2020 (incidence vs. asymptomatic); (iii) the evolution of asthma symptoms between 2018-2020 (improvement, deterioration vs. symptomatic stable) by logistic regressions. Models were adjusted for sex, age, smoking status, body mass index, educational level, and use of irritants/sprays (for \"green\" products).</p><p><strong>Results: </strong>Our study was based on 30,012 adults (mean age: 49 years(sd:14), 74% women). For irritants/sprays, a persistent (40%) and an increased (26%) use was associated with asthma symptoms (Mean Score Ratio(MSR)=1.26[1.18-1.34] & MSR=1.14[1.06-1.22], respectively), incidence (OR=1.30[1.16-1.45] & OR=1.07[0.95-1.20]), and deterioration (OR=1.48[1.19-1.85] & OR=1.28[1.01-1.64]). For green products, a persistent (20%) and an increased (12%) use was associated with symptoms in 2020 (MSR=1.08[1.01-1.16] & MSR=1.07[0.99-1.16]), and associations were suggested with incidence (OR=1.09[0.97-1.22] & OR=1.11[0.97-1.27]).</p><p><strong>Conclusion: </strong>Persistent and increased use of irritants/sprays but also \"green\" products was associated with deleterious effects on asthma over time.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214432","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":"Risk of self-harm and the use of leukotriene receptor antagonists and inhaled corticosteroids: a population-based study.","authors":"Boqing Chen, Andrew S C Yuen, Kenneth K C Man, Joseph F Hayes, David P J Osborn, Ian C K Wong, Adrienne Y L Chan, Lok Yin Cheng, Yogini H Jani, Wallis C Y Lau","doi":"10.1016/j.jaip.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.025","url":null,"abstract":"<p><strong>Background: </strong>Whether leukotriene receptor antagonists (LTRAs) or inhaled corticosteroids (ICS) use can increase the risk of self-harm remains unclear.</p><p><strong>Objective: </strong>To evaluate the association between self-harm and use of LTRA and ICS among patients with asthma.</p><p><strong>Methods: </strong>This self-controlled case series (SCCS) study used data from the UK Clinical Practice Research Datalink linked to hospital and mortality records. We included patients with asthma aged ≥10 years who had at least one prescription of LTRA, one prescription of ICS, and an incident self-harm during 2005-2020. Incidence rate ratios (IRRs) of self-harm during periods of (presented in order of precedence if they overlapped): pre-LTRA, pre-ICS, LTRA-alone, ICS-alone, and combination use of LTRA and ICS, versus non-use, were calculated using conditional Poisson regression model. Additional analyses using SCCS extension, case-case-time-control, and cohort study designs were used to examine robustness of results.</p><p><strong>Results: </strong>Among 313,943 individuals prescribed LTRA and ICS, 2,900 had incident self-harm. IRRs were 0.77 (95%CI=0.58-1.01) during pre-LTRA, 0.68 (95%CI=0.57-0.82) during LTRA-alone, and 0.70 (95%CI=0.56-0.86) during combination use. Further analysis suggested the self-harm incidence was lower during the first 90 days of LTRA use (IRR=0.74; 95%CI=0.58-0.95), before returning to non-use level (IRR=0.93; 95%CI=0.74-1.17). Comparable incidence to non-use was observed during pre-ICS (IRR=0.99; 95%CI=0.71-1.39) and ICS-alone (IRR=0.88; 95%CI=0.75-1.04). The results were robust across sensitivity analyses and study designs, which did not suggest increased risk of self-harm with LTRA/ICS use.</p><p><strong>Conclusion: </strong>Using the SCCS design, which was based on comparisons within a population with both the outcome and exposure of interest, our study does not support an association between self-harm and LTRA or ICS in patients with asthma.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193860","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":"Allergic Lymphangitis after Hymenoptera Sting.","authors":"Jyotsna Mullur","doi":"10.1016/j.jaip.2025.08.030","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.08.030","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150601","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":"Efficacy, Safety, and Quality-of-Life Outcomes of Remibrutinib in Chronic Spontaneous Urticaria: A Systematic Review and Meta-Analysis.","authors":"Ahmed Ali Khan, Abdul Ahad Riaz, Faisal Naseer, Noor Fatima, Zuhair Abrar, Linta Malik, Jumana Khan, Raza Aslam, Ahmed Abdul Rab, Allahdad Khan","doi":"10.1016/j.jaip.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.09.023","url":null,"abstract":"<p><strong>Background: </strong>Chronic spontaneous urticaria (CSU) is a mast cell-mediated condition affecting ∼1% of the population and is often refractory to antihistamines and omalizumab. Remibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, prevents mast cell activation independent of the IgE pathway.</p><p><strong>Objective: </strong>To assess the efficacy, safety, and quality-of-life outcomes (QoL) of remibrutinib compared to placebo in adults with refractory CSU.</p><p><strong>Methods: </strong>A systematic review was conducted per PRISMA guidelines. Three RCTs (n=997) and two single-arm studies (n=280) evaluating remibrutinib in CSU were included. Specific disease activity endpoints assessed included changes in Urticaria Activity Score (UAS7), Hives Severity Score (HSS7), Itch Severity Score (ISS7), Angioedema Activity Score (AAS7), and Dermatology Life Quality Index (DLQI). The risk of bias was evaluated using the Cochrane RoB-2 tool for RCTs and ROBINS-I for single-arm studies. Meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>In the pooled analysis of RCTs, remibrutinib effectively decreased UAS7 at Week 12 compared to placebo (MD -7.81, 95% CI: -10.29 to -5.33), with improvements in itch and hives severity scores (MD -2.94, 95% CI: -3.73 to -2.15, and MD -4.05, 95% CI: -4.98 to -3.12, respectively). Remibrutinib increased the likelihood of achieving complete response (UAS7=0; RR 3.32, 95% CI: 2.34 to 4.71), controlled disease (UAS7≤6; RR 2.13, 95% CI: 1.73 to 2.62), and minimal quality-of-life impact (DLQI ≤ 1; RR 1.84, 95% CI: 1.47 to 2.30). REMIX-1 and REMIX-2 trials showed significantly better disease control (UAS7≤6) by week 2 (RR 6.81, 95% CI: 3.45 to 13.42). Adverse event rates with remibrutinib were similar to placebo, except for increased nasopharyngitis, upper respiratory tract infection, and petechiae (RR 1.88, 95% CI: 1.11 to 3.19; RR 2.88, 95% CI: 1.30 to 6.41; and RR=7.52, 95% Cl: 1.44 to 39.20, respectively) Evidence from single-arm studies (BISCUIT at 24 weeks and Jain 2024 at 52 weeks) suggested sustained long-term efficacy and tolerability.</p><p><strong>Conclusion: </strong>Remibrutinib shows rapid symptom improvement with an acceptable safety profile in refractory CSU and appears to be a promising oral option for antihistamine-refractory CSU based on short-term data.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180343","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}