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

{"title":"Lessons Learned: Approaches to Delabeling Penicillin Allergy—A Clinical Management Review of Population-Level Strategies","authors":"Ana Maria Copaescu MD, PhD,&nbsp;Ami P. Belmont MD, MHS,&nbsp;Olajumoke O. Fadugba MD,&nbsp;Monica T. Kraft MD,&nbsp;Anna R. Wolfson MD","doi":"10.1016/j.jaip.2026.04.023","DOIUrl":"10.1016/j.jaip.2026.04.023","url":null,"abstract":"<div><div>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 nonallergist 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-centered 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.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2227-2236"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","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":"Development and Validation of Clinical Scoring System to Estimate Mucus Plug Presence in Asthma","authors":"Tsuyoshi Sasada MD,&nbsp;Naoya Tanabe MD, PhD,&nbsp;Kaoruko Shimizu MD, PhD,&nbsp;Satoshi Marumo MD, PhD,&nbsp;Masataka Hirai MD,&nbsp;Yusuke Hayashi MD,&nbsp;Hirokazu Kimura MD, PhD,&nbsp;Atsuyasu Sato MD, PhD,&nbsp;Satoshi Morita PhD,&nbsp;Satoshi Konno MD, PhD,&nbsp;Toyohiro Hirai MD, PhD","doi":"10.1016/j.jaip.2026.06.017","DOIUrl":"10.1016/j.jaip.2026.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Airway mucus plugs on chest computed tomography (CT) are increasingly recognized for their impact and potential as treatable traits. However, radiation exposure warrants reasonable patient selection.</div></div><div><h3>Objective</h3><div>To develop and externally validate a practical clinical score to predict CT-detected mucus plug presence in 2 asthma cohorts and to evaluate its association with clinical outcomes.</div></div><div><h3>Methods</h3><div>This multicenter retrospective analysis used clinical and CT data from adult patients with stable asthma. The primary outcome was mucus plug presence on CT. We identified independent predictors using multivariable logistic regression, derived a practical scoring system in the exploratory cohort, and validated it in an independent cohort.</div></div><div><h3>Results</h3><div>The prevalence of mucus plugs was 50.8% (218 of 429) in the exploratory cohort and 76.5% (143 of 187) in the validation cohort. Age (A; maximum 2 points), body mass index (B; maximum 2 points), blood eosinophil count (E; maximum 2 points), fractional exhaled nitric oxide (N; maximum 1 point), and percent-predicted FEV₁ (F; maximum 2 points) were independently associated with the presence of mucus plugs. The derived score (ABENF score; maximum 9 points) showed good discrimination in both cohorts (cohort 1: area under the receiver-operating characteristic curve, 0.781, 95% CI, 0.742-0.820; cohort 2: area under the receiver-operating characteristic curve, 0.836, 95% CI, 0.783-0.889). The high-score group (ABENF score ≥4) had a shorter time to first exacerbation (<em>P</em> = .046) and higher sputum eosinophil percentage (<em>P</em> &lt; .001) in the validation cohort.</div></div><div><h3>Conclusions</h3><div>The ABENF score could be a practical tool to estimate mucus plug presence, potentially supporting more selective CT use.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2310-2318.e3"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310305","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":"Modification of Clinical Practice to Minimize Environmental Impact","authors":"","doi":"10.1016/j.jaip.2026.08.032","DOIUrl":"10.1016/j.jaip.2026.08.032","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Page 2188"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096375","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":"Early nutrition and the infant microbiome: Implications for atopy","authors":"Sonak Daulat MD","doi":"10.1016/j.jaip.2026.07.029","DOIUrl":"10.1016/j.jaip.2026.07.029","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Page 2437"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096492","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 “Underlying assumptions used in a network meta-analysis can alter the conclusions”","authors":"Jean Bousquet MD,&nbsp;Bernardo Sousa-Pinto MD,&nbsp;Rafael José Vieira MD,&nbsp;Mark S. Dykewicz MD,&nbsp;Ludger Klimek MD,&nbsp;Arunas Valiulis MD,&nbsp;Torsten Zuberbier MD","doi":"10.1016/j.jaip.2026.07.026","DOIUrl":"10.1016/j.jaip.2026.07.026","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2434-2435"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096563","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":"Defining Minimal Clinical Disease Activity and Remission in Severe Asthma: A Modified Delphi Consensus","authors":"Simon Couillard MD,&nbsp;Arnaud Bourdin MD, PhD,&nbsp;Guy Brusselle MD, PhD,&nbsp;Delbert Dorscheid MD, PhD,&nbsp;Liam G. Heaney MD,&nbsp;Enrico Heffler MD, PhD,&nbsp;Flavia Hoyte MD,&nbsp;Erik Melén MD, PhD,&nbsp;Hiroyuki Nagase MD, PhD,&nbsp;Ian Pavord FMedSci,&nbsp;Luis Perez de Llano MD, PhD,&nbsp;Njira Lugogo MD","doi":"10.1016/j.jaip.2026.07.011","DOIUrl":"10.1016/j.jaip.2026.07.011","url":null,"abstract":"<div><div>The introduction of biologics in the treatment of severe asthma has led to improved patient outcomes and increased discussions around remission. Due to varying descriptions of remission, there is a clear need for a standardized definition of remission as a target for patients. Remission has stringent criteria to achieve the best possible outcomes for patients; however, not all patients achieve remission dependent on the disease severity and duration. Therefore, less stringent criteria should also be considered, such as a patient’s state of minimal clinical disease activity. To explore these definitions, a Steering Committee of respiratory healthcare professionals employed a systematic literature review and modified Delphi consensus. Outputs of the systematic literature review were used to draft consensus statements that underwent two rounds of review with the Steering Committee and one round of review with a wider group of healthcare professionals. Initial definitions of minimal clinical disease activity and remission were drafted based on the consensus statements and finalized in a Steering Committee meeting. The definitions include criteria for asthma exacerbations, steroid use, lung function, and quality of life. These definitions serve as a starting point for improving disease management in patients with severe asthma and should be validated in real-world settings.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2262-2275.e3"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474110","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":"Beyond the major determinant: Patterns of penicillin skin test positivity","authors":"Ingrid Salciccioli MBBS, MPH,&nbsp;Andrew J. King MS,&nbsp;John J.O. Accarino MD,&nbsp;Ami Belmont MD,&nbsp;Olajumoke O. Fadugba MD,&nbsp;Alexei Gonzalez-Estrada MD,&nbsp;David A. Khan MD,&nbsp;Anne Liu MD,&nbsp;Iris M. Otani MD,&nbsp;Elizabeth J. Phillips MD,&nbsp;Allison Ramsey MD,&nbsp;Cosby A. Stone Jr. MD, MPH,&nbsp;Aleena Banerji MD,&nbsp;Kimberly G. Blumenthal MD, MSc","doi":"10.1016/j.jaip.2026.07.021","DOIUrl":"10.1016/j.jaip.2026.07.021","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2417-2419.e1"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585882","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":"Continuing Medical Education Calendar","authors":"","doi":"10.1016/S2213-2198(26)00737-3","DOIUrl":"10.1016/S2213-2198(26)00737-3","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages A25-A26"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health in Eosinophilic Gastrointestinal Disorders: A Work Group Report of the AAAAI Eosinophilic Gastrointestinal Disorders Committee","authors":"Anupama Kewalramani MD,&nbsp;Gregory M. Constantine MD,&nbsp;Brandi Whitaker PhD,&nbsp;Mirna Chehade MD, MPH,&nbsp;Elizabeth T. Jensen MPH, PhD,&nbsp;Benjamin L. Wright MD,&nbsp;Peter Capucillig MD,&nbsp;Russell Hopp DO,&nbsp;Barry Pelz MD,&nbsp;Taha Al-Shaikhly MBChB,&nbsp;Robert Pesek MD","doi":"10.1016/j.jaip.2026.06.047","DOIUrl":"10.1016/j.jaip.2026.06.047","url":null,"abstract":"<div><div>Psychiatric comorbidities, including anxiety and depression, are increased in individuals with eosinophilic gastrointestinal disorder (EGID) compared with the general population. However, there are no established guidelines for screening and evaluating mental health disorders, and screening practices are unclear. We e-mailed an anonymous Web-based survey to members of the American Academy of Allergy, Asthma &amp; Immunology and the Consortium of Eosinophilic Gastrointestinal Disease Researchers to examine mental health screening practices among clinicians caring for patients with EGIDs in the United States. Literature examining the association between mental health disorders and EGID was reviewed, best practices for anxiety and depression screening were discussed, and recommendations for implementing successful screening programs were formulated. Most survey respondents (62%; n = 31 of 50) indicated screening for anxiety and depression was important; however, only 18.6% (n = 11 of 59) conducted screening as part of standard clinical care for these patients. The most cited barriers to screening included a lack of time, limited expertise, and inadequate screening resources. This report provides recommendations and resources to facilitate the implementation of anxiety and depression screening in patients with EGIDs.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2244-2253"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096384","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 Spectrum of Eosinophilic Cellulitis (Wells’ Syndrome): New Insights Based on 114 Cases","authors":"Aloïs Castro MD,&nbsp;Amélie Osio MD,&nbsp;Cécile Landais MSc,&nbsp;Jason Shourick MD,&nbsp;Achille Aouba MD, PhD,&nbsp;Hélène Aubert MD,&nbsp;Michèle Bernier MD,&nbsp;Sofia Bogiatzi MD,&nbsp;Gérôme Bohelay MD, PhD,&nbsp;Estelle Charvet MD,&nbsp;Marine Chastagner MD,&nbsp;Olivier Chosidow MD, PhD,&nbsp;François Comoz MD,&nbsp;Anastasia Delmotte MD,&nbsp;Marie Denis-Musquer MD,&nbsp;Vincent Descamps MD, PhD,&nbsp;Lydia Deschamps MD,&nbsp;Frédéric Dezoteux MD, PhD,&nbsp;Nicolas Dupin MD, PhD,&nbsp;Jean-François Emile MD, PhD,&nbsp;Matthieu Groh MD, MSc","doi":"10.1016/j.jaip.2026.07.033","DOIUrl":"10.1016/j.jaip.2026.07.033","url":null,"abstract":"<div><h3>Background</h3><div>Eosinophilic cellulitis (EC), also known as Wells’ syndrome, is a rare, poorly studied inflammatory dermatosis.</div></div><div><h3>Objective</h3><div>To describe the clinical and histopathological spectrum, associated conditions, outcomes of EC, and treatment response rates.</div></div><div><h3>Methods</h3><div>Retrospective multicenter study including patients with biopsy-proven EC. Risk factors for unfavorable clinical course (defined as recurrence or persistent disease &gt;6 months) were assessed using univariable and multivariable logistic regression models.</div></div><div><h3>Results</h3><div>A total of 114 patients (53% females; median age, 52 years) were included. The most frequent clinical presentation was papulonodular (52%), with lesions predominantly on the legs (69%). Disabling pruritus was common (83%), whereas systemic symptoms were rare. Histological findings did not differ between patients with or without triggering factors or associated diseases, or between those with or without blood eosinophilia. Triggering factors and associated conditions were identified in 30 (26%) and 24 (21%) patients, respectively. Arthropod bites or stings were the most common triggering factor, whereas hematological malignancies, antineutrophil cytoplasmic antibody–negative eosinophilic granulomatosis with polyangiitis, and idiopathic hypereosinophilic syndrome were the most frequently associated conditions. Most frequently used treatments were topical (54%) and oral corticosteroids (35%), with complete response rates of 67% and 82%, respectively. Conventional synthetic disease-modifying antirheumatic drugs showed moderate efficacy (complete response ≤31%), whereas biologics targeting type 2 inflammation yielded promising results. In multivariable analysis, lesion size higher than 5 cm was the only variable independently associated with unfavorable clinical course (odds ratio, 3.79; 95% CI 1.42-10.10; <em>P</em> = .008).</div></div><div><h3>Conclusions</h3><div>EC likely represents a disease spectrum encompassing conditions leading to eosinophil-mediated dermal toxicity. Lesion size larger than 5 cm is associated with unfavorable clinical course. Although corticosteroids achieve high remission rates, biologics targeting type 2 inflammation appear promising second-line options warranting further evaluation.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2368-2378.e4"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702792","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}