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

{"title":"How Airway Caliber Affects FeNO Thresholds Used to Identify Type 2 Inflammation in Asthma","authors":"Alain Michils PhD ,&nbsp;Amaryllis Haccuria PhD ,&nbsp;Myrna Virreira PhD ,&nbsp;Nathalie Grimaldi BS ,&nbsp;Nathalie Demaeyer MD ,&nbsp;Silvia Perez-Bogerd MD ,&nbsp;Andreï Malinovschi PhD ,&nbsp;Alain Van Muylem PhD","doi":"10.1016/j.jaip.2025.05.049","DOIUrl":"10.1016/j.jaip.2025.05.049","url":null,"abstract":"<div><h3>Background</h3><div><span>Fractional exhaled nitric oxide<span> (FeNO) has emerged as a biomarker of type 2 (T2) airway inflammation (AI), primarily reflecting IL-13 activity. Reducing airway caliber reduces FeNO levels, suggesting an impact of </span></span>airway obstruction.</div></div><div><h3>Objective</h3><div>This study compared the relative contributions of airway IL-13 and airway caliber to FeNO values in patients with asthma. We also investigated how airway caliber reduction affects FeNO thresholds for detecting active T2 AI.</div></div><div><h3>Methods</h3><div><span>FeNO and forced expiratory volume in 1 second (FEV</span>₁<span><span>) measurements as well as sputum<span> induction were performed in 120 patients with asthma and 13 controls. Elevated sputum IL-13, IL-5, or </span></span>eosinophils identified 100 patients with active T2 AI. The contributions of IL-13 and FEV</span>₁ to FeNO were assessed in asthmatics with clear evidence of T2 AI by multivariable linear models. Receiver operating characteristic (ROC) curve analysis was used to identify FeNO thresholds marking the presence of active T2 AI according to FEV₁.</div></div><div><h3>Results</h3><div>In T2 patients<em>,</em> IL-13 and FEV₁ contribute significantly (<em>P</em> = .005 and <em>P</em> = .008, respectively) to FeNO based on multivariable analysis. From the ROC curve analysis, the FeNO threshold corresponding to a specificity &gt;85% was 45 parts per billion (ppb) in the whole population and dropped to 22 ppb in patients with FEV₁ &lt;70%.</div></div><div><h3>Conclusions</h3><div>Airway caliber is a major determinant of FeNO values in asthma, as crucial as concomitant T2 AI. As a result, the optimal thresholds for FeNO to signal the presence of active T2 AI in asthmatics decrease significantly as FEV₁ decreases. New thresholds considering the impact of lung function should be established in larger cohorts.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2397-2404"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250796","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":"Strategic Directions for Advancing Equity in Food Allergy: Takeaways From CFAAR’s Summit for Advancing Equity in Food Allergy","authors":"Michael S. Yang MSc ,&nbsp;Christopher M. Warren PhD ,&nbsp;Melissa L. Engel PhD ,&nbsp;Waheeda Samady MD, MSCI ,&nbsp;Samantha R. Sansweet MPH ,&nbsp;Madeleine K. Kanaley MPH ,&nbsp;Elizabeth V.W. Folger MS ,&nbsp;Sanjana Shankar ,&nbsp;Ruchi S. Gupta MD, MPH ,&nbsp;Lucy A. Bilaver PhD","doi":"10.1016/j.jaip.2025.05.024","DOIUrl":"10.1016/j.jaip.2025.05.024","url":null,"abstract":"<div><div>In the United States, food allergy (FA) affects an estimated 10.6% of adults and 7.6% of children, totaling over 30 million individuals. Beyond their medical implications, FA places a substantial emotional, social, and economic burden on individuals, families, and caregivers. Disparities in FA education and access to clinical care have been found across socioeconomic and racial groups. To identify and address barriers to equity in FA, Northwestern’s Center for Food Allergy and Asthma Research hosted the Summit for Advancing Equity in Food Allergy (SAEFA), a conference bringing together 35 leading experts as panelists and over 5 dozen diverse FA stakeholders for 4 key FA panels: daily life, diagnosis, prevention, and daily treatment. Live transcription of the discussions by scribes and real-time projection of notes to the front of the conference room allowed attendees to actively review, contribute to, and refine insights as conversations evolved. The results from the SAEFA conference led to the creation of 5 strategic directions for advancing equity in the field: (1) enhance food allergy safety in public spaces, (2) expand community-based health initiatives, (3) increase equitable access to allergy care, (4) strengthen industry collaboration and policy reform, and (5) drive research innovation. Results from the SAEFA conference help underscore how tackling FA inequalities demands a comprehensive, multisector approach. Implementing strategies to expand access to care, patient education, and public awareness, while drawing from previously successful models and intiatives from other medical fields, can drive meaningful progress in advancing equity in the field of FA.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2290-2297"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121335","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":"Validation of the Urticaria Activity Score for Cold Urticaria","authors":"Eva Grekowitz MD ,&nbsp;Pascale Salameh PhD ,&nbsp;Sabine Altrichter MD ,&nbsp;Dalia M. Ahsan MD ,&nbsp;Karsten Weller MD ,&nbsp;Martin Metz MD ,&nbsp;Manuel P. Pereira MD, PhD ,&nbsp;Dorothea Terhorst-Molawi MD","doi":"10.1016/j.jaip.2025.04.012","DOIUrl":"10.1016/j.jaip.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Cold urticaria (ColdU) is characterized by the appearance of wheals and/or angioedema and itch after exposure to cold stimuli. The Cold Urticaria Activity score (ColdUAS) is a newly devised patient-reported outcome measure (PROM) assessing disease activity in ColdU.</div></div><div><h3>Objectives</h3><div>We aimed to validate the ColdUAS according to PROM guidelines, assess the optimal documentation period, and develop a scoring computation algorithm.</div></div><div><h3>Methods</h3><div>We instructed 71 patients with typical and atypical ColdU to complete the ColdUAS questionnaire over 4 consecutive weeks and asked to fill out additional anchor instruments including global assessment tools and validated quality of life measures. The scoring computation for the ColdUAS was developed by an expert group and the questionnaire was tested for its construct, structural, convergent, and known-groups validity as well as for its reliability including internal consistency and test-retest reliability.</div></div><div><h3>Results</h3><div>The ColdUAS is calculated from the first three questions in the ColdUAS questionnaire, and the optimal assessment period was 2 weeks. We developed a calculation sheet to facilitate its use. The score demonstrates robust construct, structural, and convergent validity, as well as validity among known groups. It exhibits high reliability, including internal consistency and test-retest reliability.</div></div><div><h3>Conclusions</h3><div>The ColdUAS is a newly developed PROM to assess disease activity in adolescent and adult patients with typical or atypical ColdU, tailored to the specific symptoms of these patients. The validation study confirmed its validity and reliability as a valuable tool in routine care and clinical research.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2329-2337.e3"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058250","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":"Parameters Linked With Higher Itch Severity in Chronic Spontaneous Urticaria—Chronic Urticaria Registry Results","authors":"Jules Stolz Cand Med ,&nbsp;Pascale Salameh PhD ,&nbsp;Riccardo Asero MD ,&nbsp;Emek Kocatürk MD ,&nbsp;Jonny Peter MD, PhD ,&nbsp;Clive Grattan MD ,&nbsp;Leonie Shirin Herzog MD ,&nbsp;Melba Muñoz MD, PhD ,&nbsp;Joachim Dissemond MD ,&nbsp;Petra Staubach-Renz MD ,&nbsp;Andrea Bauer MD ,&nbsp;Simon Francis Thomsen MD, PhD ,&nbsp;Ana M. Giménez-Arnau MD ,&nbsp;Maria Puertolas MD ,&nbsp;Alexis Bocquet MD ,&nbsp;Michael Makris MD, PhD ,&nbsp;Stamatios Gregoriou MD ,&nbsp;Maryam Khoshkhui MD ,&nbsp;Samaneh Kouzegaran MD ,&nbsp;Martijn Bastiaan Adriaan van Doorn MD, PhD ,&nbsp;Manuel Pedro Pereira MD, PhD","doi":"10.1016/j.jaip.2025.05.033","DOIUrl":"10.1016/j.jaip.2025.05.033","url":null,"abstract":"<div><h3>Background</h3><div>Itch is the most bothersome symptom in chronic spontaneous urticaria (CSU) and severely affects quality of life.</div></div><div><h3>Objective</h3><div>To analyze factors associated with itch severity, and how itch is associated with quality of life and health care use in CSU.</div></div><div><h3>Methods</h3><div>We retrieved patient data from the Chronic Urticaria Registry. Patients were categorized by self-reported itch severity (recall period of 7 days). We used ordinal logistic regressions as well as negative binomial and gamma regressions with log link to investigate possible associations.</div></div><div><h3>Results</h3><div>A total of 3,045 patients, 74.3% female, mean age 44.4 years, with no, mild, moderate, or intense itch (16.4%, 25.2%, 32.5%, and 25.9%, respectively) were included. A higher itch rating was associated with symptomatic dermographism (odds ratio [OR] = 1.25; <em>P</em> = .027), malaise (OR = 1.43; <em>P</em> &lt; .001), depression (OR = 1.46; <em>P</em> = .008), and laboratory signs of inflammation (ie, elevated erythrocyte sedimentation rate (OR = 1.57; <em>P</em> = .031) and leukocyte counts (OR = 2.37; <em>P</em> = .004)). Intense itch was associated with worse quality of life (Chronic Urticaria Quality of Life Questionnaire; <em>P</em> &lt; .001) and more patients visiting a general practitioner, allergologist or dermatologist, and the emergency room (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Higher itch levels are associated with inflammation and depression and are linked to worse quality of life and increased health care demand. Addressing itch is crucial to reducing the humanistic and societal burden in CSU.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2349-2360.e3"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188523","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":"Direct oral challenges safely reduce the burden of low-risk cephalosporin allergy labels","authors":"Jason Moraczewski MD ,&nbsp;Rebecca Lee MPH ,&nbsp;Grace Koo MD ,&nbsp;Matthew S. Krantz MD ,&nbsp;Christine Allocco APRN ,&nbsp;Elizabeth J. Phillips MD ,&nbsp;Cosby A. Stone Jr. MD, MPH","doi":"10.1016/j.jaip.2025.05.054","DOIUrl":"10.1016/j.jaip.2025.05.054","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2522-2525.e1"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250795","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":"Baked Milk Modulates Cow’s Milk Allergy in Children: Impact of Phenotype, Age, and Intake","authors":"Olga Domínguez MD, MSc ,&nbsp;Elisabet Poyatos MD, MSc ,&nbsp;Carmen Riggioni MD, MSc ,&nbsp;Guillermo Salamanca PhD ,&nbsp;Rosa Jiménez-Feijoo MD, PhD, MSc ,&nbsp;Jaime Lozano MD, MSc ,&nbsp;Monica Piquer MD, PhD, MSc ,&nbsp;Adrianna Machinena MD, MSc ,&nbsp;M. Mar Folqué MD, MSc ,&nbsp;Iñaki Ortiz de Landazuri BS ,&nbsp;Maria Lasa RPh ,&nbsp;Laia Alsina MD, PhD ,&nbsp;Mariona Pascal PhD ,&nbsp;Montserrat Alvaro-Lozano MD, PhD, MSc","doi":"10.1016/j.jaip.2025.06.011","DOIUrl":"10.1016/j.jaip.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Limited evidence indicates that baked milk (BM) intake accelerates cow's milk allergy (CMA) resolution or modulates immunity in BM tolerant (BMT) and BM-allergic (BMA) phenotypes.</div></div><div><h3>Objective</h3><div>This study evaluates the efficacy, safety, and immunological effects of BM introduction, focusing on regular intake in BMT and low-dose intake in BMA, and their impact on tolerance development.</div></div><div><h3>Methods</h3><div>A prospective study including children 12 to 72 months of age with an oral food challenge (OFC) confirmed CMA. Children with CMA were categorized into BMT or BMA phenotypes based on BM-OFC results. BMT children were randomized into 2 groups: B2 (daily intake of 0.55 g of BM protein [BMP]) and C2 (strict avoidance of BM). BMA children who tolerated the minimal dose were similarly randomized: B1 (daily intake of 0.0375 g of BMP) and C1 (strict avoidance of BM). Assessments at baseline (T0) and 12 months (T1) included skin prick tests (SPT), specific-IgE (sIgE), specific-IgG4 (sIgG4), basophil activation test (BAT), and T-cell cytokine profile. BM doses doubled at 6 months, and CM-OFC confirmed outcomes at T1.</div></div><div><h3>Results</h3><div>A total of 50 participants with confirmed CMA were included, of whom 32 were BMT and 18 BMA. Daily BM intake in the B2 group significantly enhanced tolerance to CM (77.2% vs 40% in C2, <em>P</em> &lt; .05), with improved safety and marked reductions in SPT and sIgE markers. Reactivity thresholds increased 9-fold (0.9 g vs 0.05 g). No significant increase in tolerance was seen in the B1 group. Mild home reactions occurred in 9.3%. Predictors of tolerance included early age (&lt;24 months), BM consumption, absence of asthma, immunological markers (sIgE, SPT, and sIgG4/sIgE), and reduced BAT reactivity.</div></div><div><h3>Conclusions</h3><div>Early BM introduction appears to support CMA resolution in BMT and may enhance safety, particularly in young children. Regular BM consumption could contribute to better outcomes, while biomarkers offer valuable insights for personalized management.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2437-2448.e3"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337235","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 Randomized Trial Comparing Direct Challenges to Penicillin Skin Testing for Outpatient Low-Risk Penicillin Allergy Evaluations in Pregnancy","authors":"Sara Patrawala MD ,&nbsp;S. Shahzad Mustafa MD ,&nbsp;Richard Kraude PhD ,&nbsp;Allison Ramsey MD","doi":"10.1016/j.jaip.2025.07.003","DOIUrl":"10.1016/j.jaip.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>The importance of penicillin allergy de-labeling in the general population is well known. Its significance is further highlighted in pregnancy because penicillin-based antibiotics are first-line therapy for most infections at the time of delivery, particularly group B <em>Streptococcus</em>.</div></div><div><h3>Objective</h3><div>To evaluate the safety of a two-step direct challenge (DC) to amoxicillin without preceding skin testing in pregnant patients with a low-risk penicillin allergy label, regardless of trimester.</div></div><div><h3>Methods</h3><div>We performed a prospective, randomized controlled trial comparing penicillin skin testing (PST) followed by an oral amoxicillin challenge versus a two-step DC to amoxicillin without preceding skin testing in pregnant patients regardless of trimester with a low-risk penicillin allergy label.</div></div><div><h3>Results</h3><div>A total of 144 women were included in this study, 73 of whom underwent PST and 70 of whom underwent DC. Of those women, 68 (93.2%) undergoing PST had a negative evaluation for penicillin allergy compared with 70 (100%) who underwent DC. No reactions in either PST or DC groups required medical treatment or, notably, administration of epinephrine. Direct challenge took significantly less time compared with PST. Median time for PST was 75 minutes (interquartile range, 75-80 minutes) compared with 65 minutes (interquartile range, 65-70 minutes) for DCs.</div></div><div><h3>Conclusion</h3><div>For evaluation of penicillin allergy in pregnancy, we demonstrate that a DC is as safe as PST in low-risk pregnant patients.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2405-2410.e1"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621057","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":"Artificial Intelligence–Generated Answers to Patients’ Questions on Asthma: The Artificial Intelligence Responses on Asthma Study","authors":"Mattia Nigro MD ,&nbsp;Andrea Aliverti PhD ,&nbsp;Alessandra Angelucci PhD ,&nbsp;Fulvio Braido MD, PhD ,&nbsp;Giorgio W. Canonica MD ,&nbsp;Apostolos Bossios MD, PhD ,&nbsp;Hilary Pinnock MD ,&nbsp;Jeanette Boyd PhD ,&nbsp;Pippa Powell PhD ,&nbsp;Stefano Aliberti MD ,&nbsp;Artificial Intelligence Responses on Asthma Study Task Force","doi":"10.1016/j.jaip.2025.04.051","DOIUrl":"10.1016/j.jaip.2025.04.051","url":null,"abstract":"<div><h3>Background</h3><div>Asthma is a prevalent chronic respiratory disease requiring ongoing patient education and individualized management. The increasing reliance on digital tools, particularly generative artificial intelligence (AI), to answer health-related questions has raised concerns about the accuracy, reliability, and comprehensibility of AI-generated information for people living with asthma.</div></div><div><h3>Objective</h3><div>To evaluate systematically the reliability, accuracy, comprehensiveness, and understandability of responses generated by three widely used artificial intelligence–based chatbots (ChatGPT, Bard, and Copilot) to common questions formulated by people with asthma.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 15 questions regarding asthma management were formulated by patients and categorized by difficulty. Responses from ChatGPT, Bard, and Copilot were evaluated by international experts for accuracy and comprehensiveness, and by patient representatives for understandability. Reliability was assessed through consistency testing across devices. We conducted a blinded evaluation.</div></div><div><h3>Results</h3><div>A total of 21 experts and 16 patient representatives participated in the evaluation. ChatGPT demonstrated the highest reliability (15 of 15 responses), accuracy (median score, 9.0; interquartile range [IQR], 7.0-9.0), and comprehensiveness (median score, 8.0; IQR, 8.0-9.0) compared with Bard and Copilot (<em>P</em> &lt; .0001). Bard achieved superior scores in understandability (median score, 9.0; IQR, 8.0-10.0; <em>P</em> &lt; .0001). Performance differences were consistent across question difficulty levels.</div></div><div><h3>Conclusions</h3><div>Artificial intelligence–driven chatbots can provide generally accurate and understandable responses to asthma-related questions. Variability in reliability and accuracy underscores the need for caution in clinical contexts. Artificial intelligence tools may complement but cannot replace professional medical advice in asthma management.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2390-2396"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063241","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":"Familial mast cell–mediated angioedema: Description of 4 families","authors":"Marina Sabaté-Brescó PhD ,&nbsp;Mar Guilarte MD, PhD ,&nbsp;Gorka Alkorta-Aranburu PhD ,&nbsp;Anna Sala-Cunill MD, PhD ,&nbsp;Carmen Diaz Donado MD, PhD ,&nbsp;Maria Luisa Baeza MD, PhD ,&nbsp;Julian Azofra MD, PhD ,&nbsp;Pere Gaig MD ,&nbsp;Valeria Herrera-Lasso MD, PhD ,&nbsp;Beatriz Veleiro MD ,&nbsp;Patricia Cueto Pruneda MsC ,&nbsp;Nuria Rodriguez-Garijo MD, PhD ,&nbsp;Maria Pilar Gil MD, PhD ,&nbsp;Moisés Labrador-Horrillo MD, PhD ,&nbsp;Marta Ferrer Puga MD, PhD","doi":"10.1016/j.jaip.2025.06.021","DOIUrl":"10.1016/j.jaip.2025.06.021","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2506-2508.e2"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509349","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":"Pathogenesis of Chronic Spontaneous Urticaria With or Without Angioedema","authors":"Sarbjit S. Saini MD ,&nbsp;Ricardo Asero MD ,&nbsp;Massimo Cugno MD ,&nbsp;Hae-Sim Park MD, PhD ,&nbsp;Eric T. Oliver MD","doi":"10.1016/j.jaip.2025.07.025","DOIUrl":"10.1016/j.jaip.2025.07.025","url":null,"abstract":"<div><div>Chronic spontaneous urticaria (CSU) is a complex, immune-mediated skin disorder characterized by the appearance of wheals and/or angioedema. Histopathologic analysis reveals skin mast cell degranulation and a perivascular infiltrate composed of lymphocytes, eosinophils, neutrophils, and basophils. Mast cells and basophils are key effector cells in the pathogenesis and severity of CSU, and both cells can be activated by IgE-dependent and independent mechanisms. The pathogenesis of CSU remains incompletely understood, though recent studies have highlighted autoimmune mechanisms involving both IgG and IgE autoantibodies. Two major autoimmune endotypes have emerged: type I (autoallergic), involving IgE autoantibodies to autoantigens like thyroid peroxidase, and type IIb (autoimmune), characterized by IgG autoantibodies targeting IgE or its high-affinity receptor (FcεRI). Recently, it has been found that patients can co-express both endotypes and the disease implications are unclear. Diagnostic tools such as the autologous serum skin test, basophil histamine release assay, and detection of circulating autoantibodies aid in identifying these endotypes but lack standardized assays. In addition to IgE-dependent pathways, recent evidence implicates complement and mas-related G protein–coupled receptor X2 in non–IgE-mediated mast cell activation. Notably, endotype classification has been shown to predict therapeutic response, with type IIb patients often exhibiting lower responsiveness to antihistamines and omalizumab treatments.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2221-2228"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735182","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}