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

{"title":"Information for Readers","authors":"","doi":"10.1016/S2213-2198(26)00290-4","DOIUrl":"10.1016/S2213-2198(26)00290-4","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Page A12"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826659","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":"Enhanced BDNF in Asthma: Does It Overrule Depression?","authors":"Marek Lommatzsch MD, Johann Christian Virchow MD","doi":"10.1016/j.jaip.2026.03.020","DOIUrl":"10.1016/j.jaip.2026.03.020","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1111-1112"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826662","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":"Courtney N. Andrews MSc ,&nbsp;Eric M. Mukherjee MD, PhD ,&nbsp;Andrew Gibson PhD ,&nbsp;Michael A. Postow MD ,&nbsp;Elizabeth J. Phillips MD ,&nbsp;Douglas B. Johnson MD, MCSI","doi":"10.1016/j.jaip.2026.02.027","DOIUrl":"10.1016/j.jaip.2026.02.027","url":null,"abstract":"<div><div>Immune checkpoint inhibitors are used in a wide range of cancers, offering durable responses for a substantial subset of patients. However, immune-related adverse events, the most clinically consequential checkpoint inhibitor–associated adverse reactions, pose a key challenge in practice, affecting virtually any organ system, resulting in treatment interruption, morbidity, or mortality. Patient education, early recognition, and effective management are essential to limit complications and maintain continuity of immunotherapy. Achieving this requires well-informed multidisciplinary teams who can identify, evaluate, and manage immune-related adverse events promptly. This review summarizes the most clinically significant immune-related adverse events and highlights the key principles of multidisciplinary diagnosis and management most relevant to the practicing allergist-immunologist to optimize patient outcomes.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1058-1072"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826725","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":"Evidence of a Therapeutic Window for TNF-α Inhibitor and Intravenous Immunoglobulin Benefits in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Treatment: A Multicenter 6-Year Retrospective Study","authors":"Haihui Yang MD ,&nbsp;Liyan Yuan MD ,&nbsp;Bolun Zhao MD ,&nbsp;Yitong Lin MD, PhD ,&nbsp;Mengyu Zhang MD ,&nbsp;Ting Feng BS ,&nbsp;Yao Qin MD ,&nbsp;Peizhen Zhao PhD ,&nbsp;Yue Zheng MD, PhD ,&nbsp;Guannan Zhu MD, PhD","doi":"10.1016/j.jaip.2026.01.004","DOIUrl":"10.1016/j.jaip.2026.01.004","url":null,"abstract":"<div><h3>Background</h3><div>TNF-α inhibitor and intravenous immunoglobulin (IVIG) are effective adjunctive therapies to glucocorticoids in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), but the optimal timing for this combination therapy remains unclear.</div></div><div><h3>Objective</h3><div>To compare the efficacy of different treatments in patients with SJS/TEN to identify the optimal timing.</div></div><div><h3>Method</h3><div>This multicenter retrospective study included patients with SJS/TEN treated with corticosteroids, with or without TNF-α inhibitors and/or IVIG, at three medical centers from July 2018 to January 2025. Patients were stratified into four treatment groups and compared for outcomes including cessation of new lesions, initiation of reepithelialization, and length of hospital stay.</div></div><div><h3>Results</h3><div>Among 139 patients with SJS/TEN, 40 received corticosteroid monotherapy, 30 received TNF-α inhibitors plus corticosteroids, 39 received IVIG plus corticosteroids, and 30 received triple combination with TNF-α inhibitors, IVIG, and corticosteroids. Compared with corticosteroid monotherapy, early initiation of TNF-α inhibitors within 13 days or IVIG within 7 days of rash onset was associated with significantly faster cessation of new lesion development and earlier reepithelialization, although no significant differences were observed in hospitalization. The triple combination with TNF-α inhibitors, IVIG, and corticosteroids was also associated with a significantly shorter time to cessation of new lesions and reduced reepithelialization time compared with corticosteroid monotherapy, but not with hospitalization. Notably, the triple combination group had the lowest cumulative and weight-adjusted corticosteroid doses.</div></div><div><h3>Conclusions</h3><div>For treating SJS/TEN, adding TNF-α inhibitors within 13 days of the onset of rash or IVIG within 7 days was associated with a significantly shorter time to new lesion cessation and reepithelialization, but later use provided no additional benefit.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1087-1093.e3"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020432","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 Practical Clinical Model for Diagnosing Occupational Asthma in Workers Exposed to Low-Molecular-Weight Agents: Model Development and Validation","authors":"Hormoz Nassiri Kigloo MD, MSc ,&nbsp;Christopher Carlsten MD ,&nbsp;Susan M. Tarlo MB, BS ,&nbsp;Mohsen Sadatsafavi MD, PhD ,&nbsp;Hille Suojalehto MD, PhD ,&nbsp;Catherine Lemiere MD, MSc ,&nbsp;Jolanta Walusiak-Skorupa MD, PhD ,&nbsp;Bilge Akgündüz MD ,&nbsp;Jacques A. Pralong MD, MSc ,&nbsp;Gareth Walters MD ,&nbsp;Samuel Wallbanks MSc ,&nbsp;Kevin Soon-Keen Lau MSc ,&nbsp;Eva Suarthana MD, PhD","doi":"10.1016/j.jaip.2026.02.014","DOIUrl":"10.1016/j.jaip.2026.02.014","url":null,"abstract":"<div><h3>Background</h3><div>The specific inhalation challenge (SIC) is the reference standard for diagnosing occupational asthma (OA) but is not widely used globally.</div></div><div><h3>Objective</h3><div>We aimed to develop a more practical clinical model to diagnose OA in workers exposed to low-molecular-weight (LMW) agents.</div></div><div><h3>Methods</h3><div>We conducted a diagnostic study using clinical interview variables and non-SIC tests as predictors. OA was defined by positive SIC. Retrospective data from Quebec and British Columbia were used to develop logistic models. External validation included centers with routine SIC (Finland, Poland) and expert-confirmed OA (Ontario, Turkey, England).</div></div><div><h3>Results</h3><div>The clinical interview model included male sex, isocyanate exposure, work-related rhinoconjunctivitis, smoking status, and exposure duration &lt;10 years. The clinical interview model can correctly discriminate a positive from a negative SIC in 65% of the cases (area under the receiver operating characteristic curve [AUC] = 0.65). Adding diagnostic tests to the clinical interview model improved the AUC to 0.73 for the nonspecific bronchial hyperreactivity (NSBHR), 0.80 for the serial peak expiratory flow (PEF), and 0.81 for NSBHR plus serial PEF. Combining the clinical interview with serial PEF was the model of choice, showing strong internal validity (shrinkage 0.93) and adequate calibration (Hosmer-Lemeshow <em>P</em> &gt; .05). In Finland/Poland, AUCs were 0.61 for the clinical interview alone and 0.72 with serial PEF; in England, 0.73 and 0.81; and in Ontario/Turkey, 0.60 and 0.68, respectively. Calibration was adequate in all centers.</div></div><div><h3>Conclusion</h3><div>A novel model, comprising clinical features and serial PEFs, can predict positive SIC caused by LMW agents. It can guide referrals or diagnosis when SIC is unavailable or unnecessary.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1121-1132.e7"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312229","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":"Redefining Diagnostic and Management Approaches to Vancomycin Adverse Drug Reactions","authors":"Santiago Alvarez-Arango MD, PhD ,&nbsp;Katherine C. Konvinse MD, PhD ,&nbsp;Manaswini Pujar BS ,&nbsp;Ingrid P. Salciccioli MBBS, MPH ,&nbsp;Christopher M. Bland PharmD ,&nbsp;Kimberly G. Blumenthal MD, MSc","doi":"10.1016/j.jaip.2026.02.008","DOIUrl":"10.1016/j.jaip.2026.02.008","url":null,"abstract":"<div><div>Vancomycin remains a cornerstone therapy for resistant gram-positive infections, yet adverse drug reactions are common and often mislabeled, leading to unnecessary avoidance and downstream negative consequences. This review summarizes the epidemiology, mechanisms, diagnostic tools, and management strategies to support mechanism-based care. Vancomycin infusion reaction, likely driven by Mas-related G-protein coupled receptor X2, is the most common vancomycin-induced hypersensitivity phenotype, whereas IgE-mediated reactions are rare and remain mechanistically unproven. Diagnostic limitations are substantial, because reactions can be clinically identical and distinguishing biomarkers or diagnostic tools are lacking. Dose–response intradermal testing for vancomycin infusion reaction evaluation is an emerging approach. Vancomycin infusion reaction management focuses on supportive therapy and adjustment of the infusion rate, whereas recurrent or severe reactions should prompt allergy evaluation for a possible IgE-mediated mechanism. Delayed reactions are less well characterized and span a spectrum from benign morbilliform eruptions to severe cutaneous adverse reactions, most notably drug reaction with eosinophilia and systemic symptoms. Diagnostic testing for delayed reactions remains limited, with no validated skin testing methods and <em>in vitro</em> assays restricted to research settings. Continued advances in understanding immunologic mechanisms, together with standardized electronic health record terminology and delabeling pathways, are essential to improve diagnostic accuracy and strengthen antimicrobial stewardship.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1034-1047"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826729","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":"Penicillin Allergy Decision & Mobile Empowerment (PADME)—Ideation and design of a novel delabeling program for children","authors":"Nonie Arora MD, MBA ,&nbsp;Kimberly Risma MD, PhD ,&nbsp;Mildred Kwan MD, PhD ,&nbsp;Andrew Winslow MD","doi":"10.1016/j.jaip.2025.12.020","DOIUrl":"10.1016/j.jaip.2025.12.020","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1192-1195.e3"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829161","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":"Predictive value of serial peak expiratory flow and clinical interview for diagnosing occupational asthma in high-molecular-weight exposure","authors":"Hormoz Nassiri Kigloo MD, MSc ,&nbsp;Cathrine Lemiere MD ,&nbsp;Hille Suojalehto MD, PhD ,&nbsp;Jolanta Walusiak-Skorupa MD, PhD ,&nbsp;Eva Suarthana MD, PhD","doi":"10.1016/j.jaip.2026.02.035","DOIUrl":"10.1016/j.jaip.2026.02.035","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1203-1205"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437128","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":"Oral Food Challenges After Treatment With Omalizumab in the Clinical Setting","authors":"Hao Tseng MD, MSc,&nbsp;Robert A. Wood MD,&nbsp;Jackie Isola RN, MS, CPNP,&nbsp;Nicholas Anania BA,&nbsp;Jennifer Dantzer MD, MHS","doi":"10.1016/j.jaip.2026.02.033","DOIUrl":"10.1016/j.jaip.2026.02.033","url":null,"abstract":"<div><h3>Background</h3><div>Although omalizumab is now approved for the treatment of food allergy, little is known about its use in the clinical setting.</div></div><div><h3>Objective</h3><div>To examine the outcome of oral food challenges (OFCs) after treatment with omalizumab.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of clinic patients who underwent OFCs after treatment with omalizumab, including cumulative tolerated doses and all adverse events.</div></div><div><h3>Results</h3><div>A total of 51 patients (45% female; median age, 9 [range, 1-23] years; median total IgE, 512 [interquartile range, 285 to 1080] IU/mL) underwent 73 OFCs, with milk (n = 27), egg (n = 23), and wheat (n = 9) accounting for 81% of the OFCs. A reaction history was documented for 95% and all challenged foods had a positive allergen-specific IgE (median, 34 [interquartile range, 12 to &gt;100] kUA/L). OFCs were performed at a median of 7 (range, 4-14) months after starting omalizumab. Among OFCs to any food with a goal dose ≥6000 mg (n = 56), 89% successfully consumed ≥1000 mg, 86% ≥2000 mg, 75% ≥4000 mg, and 66% ≥6000 mg. Allergic reactions occurred in 45% (n = 33) of all OFCs, with 21 treated with antihistamines and 2 treated with epinephrine. Dietary introduction of allergenic foods was permitted following 92% of OFCs. Omalizumab treatment response was associated with higher baseline total IgE, every 2-week dosing versus every 4-week dosing, higher total omalizumab dose per 4 weeks per weight, and lower allergen-specific IgE to total IgE ratio.</div></div><div><h3>Conclusions</h3><div>Omalizumab can be effectively used for the treatment of food allergy in the clinical setting and may enable the introduction of allergenic foods into the diet for most patients.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1142-1152.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391706","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":"Tacrolimus therapy in omalizumab-refractory chronic spontaneous urticaria","authors":"Anna M. Cheng MD ,&nbsp;Areli Flores-Camargo MD ,&nbsp;David A. Khan MD","doi":"10.1016/j.jaip.2026.02.036","DOIUrl":"10.1016/j.jaip.2026.02.036","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 5","pages":"Pages 1206-1208.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460991","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}