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

{"title":"The Importance of Disruptive Innovation in the Allergy Immunology Clinic","authors":"Marcus Shaker MD, MS ,&nbsp;David B.K. Golden MD ,&nbsp;Matthew Greenhawt MD, MBA, MSc ,&nbsp;John Oppenheimer MD ,&nbsp;Jonathan A. Bernstein MD ,&nbsp;Alexandra E. Conway MD ,&nbsp;Marylee Verdi APRN, MSN ,&nbsp;Aikaterini Anagnostou MD, PhD ,&nbsp;Elissa M. Abrams MD, MPH ,&nbsp;Karen S. Hsu Blatman MD, MBA ,&nbsp;Jason Sanders DO ,&nbsp;John J. Lee MD ,&nbsp;Lisa M. Bartnikas MD ,&nbsp;David M. Lang MD","doi":"10.1016/j.jaip.2025.05.057","DOIUrl":"10.1016/j.jaip.2025.05.057","url":null,"abstract":"<div><div>The field of allergy-immunology has been at the forefront of medical innovation, particularly innovations that are disruptive. A disruptive innovation (DI) represents a market change that meets some aspect of a consumer demand more successfully than a prior mainstream alternative but may be more limited in application. It is important for allergists-immunologists to recognize innovation, and DI in particular, both to better appreciate the contributions of our dynamic specialty and to critically evaluate the ever-changing landscape of health care delivery. This article highlights DIs—past, present, and future—within allergy-immunology and across sectors of the economy while discussing strategies for successful practice in an evolving world.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2306-2316"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250813","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 Proposed Framework for an Interdisciplinary Food Allergy Immunotherapy Program for Pediatric Patients Transitioning to Adult Care","authors":"Jennifer Y. Tong MD, CCFP, FCFP ,&nbsp;Brock A. Williams PhD, RD ,&nbsp;Scott B. Cameron MD, PhD, FRCPC ,&nbsp;Edmond S. Chan MD, FRCPC ,&nbsp;Victoria E. Cook MSc, MD, FRCPC ,&nbsp;Ravinder Dhaliwal RN, BScN ,&nbsp;Michael A. Golding MA ,&nbsp;Vicky Le Blanc MD, FRCPC ,&nbsp;Kelly Morrison RN, BScN ,&nbsp;Jennifer L.P. Protudjer PhD ,&nbsp;Lianne Soller PhD ,&nbsp;Timothy K. Vander Leek MD, FRCPC ,&nbsp;Tiffany Wong MD, FRCPC ,&nbsp;Kavya Yatham MD ,&nbsp;Raymond Mak MD, FRCPC","doi":"10.1016/j.jaip.2025.05.040","DOIUrl":"10.1016/j.jaip.2025.05.040","url":null,"abstract":"<div><div>Although established frameworks and guidelines are available to help transition pediatric patients successfully to adult care, patients receiving food allergy immunotherapy have a unique set of needs, and challenges that must be considered. We highlight these considerations for a research-based tertiary care center immunotherapy program. A proposed framework for an interdisciplinary food allergy immunotherapy team that includes not only pediatric allergists and nursing but also adult allergists, dietitians, researchers, and mental health team members working synergistically to address the needs of adolescents and young adults undergoing food allergy immunotherapy as they transition to adult care is presented. Collaborative frameworks such as the one proposed herein present a holistic strategy to transition pediatric patients undergoing food allergy immunotherapy to adult care. Future research activities within this framework will contribute invaluable insights into the broader landscape of food allergy management across the lifespan.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2298-2305"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227506","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":"Clinical and diagnostic features in 18 patients with vibratory urticaria: Is uvular edema a distinct entity?","authors":"Carolina Gómez Fariñas MD ,&nbsp;Manuel Rial Prado MD, PhD ,&nbsp;Olinda Pérez-Quintero MD ,&nbsp;Antonio Parra Arrondo MD, PhD ,&nbsp;Beatriz Veleiro Pérez MD","doi":"10.1016/j.jaip.2025.06.001","DOIUrl":"10.1016/j.jaip.2025.06.001","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2499-2502"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303552","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":"Differential Diagnosis of Chronic Spontaneous Urticaria","authors":"Dimitra Gialama MD ,&nbsp;Hanna Bonnekoh MD ,&nbsp;Nikolai Dario Rothermel MD ,&nbsp;Reid Oldenburg MD, PhD ,&nbsp;David A. Khan MD ,&nbsp;Hal M. Hoffman MD ,&nbsp;David Lang MD ,&nbsp;Pavel Kolkhir MD","doi":"10.1016/j.jaip.2025.06.019","DOIUrl":"10.1016/j.jaip.2025.06.019","url":null,"abstract":"<div><div>Patients with chronic recurrent wheals most commonly receive the diagnosis of chronic spontaneous urticaria, although a number of autoimmune, autoinflammatory, and malignant diseases can be suspected based on certain red flags. These warning signs are a wheal duration of more than 24 hours, post-inflammatory hyperpigmentation, and systemic symptoms such as arthralgia and fever and/or elevated inflammatory markers. Here, we detail the case of an adult patient who initially received the diagnosis of chronic spontaneous urticaria, discussing possible differential diagnoses and outlining options for treating the patient once a diagnosis has been established. We highlight the need for a careful examination of laboratory and histologic findings and other investigations, including serum immunofixation electrophoresis and genetic testing.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 9","pages":"Pages 2242-2250"},"PeriodicalIF":6.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499170","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":"Long-term Safety and Effectiveness of Sebetralstat: Interim Analysis of KONFIDENT-S Open-label Extension.","authors":"Henriette Farkas, John Anderson, Laurence Bouillet, Teresa Caballero, Mauro Cancian, Timothy Craig, Atsushi Fukunaga, Vesna Grivcheva-Panovska, Mar Guilarte, Daisuke Honda, Henry Kanarek, Sorena Kiani-Alikhan, Tamar Kinaciyan, Damia Leguevaques, Hilary J Longhurst, Markus Magerl, Michael E Manning, Inmaculada Martinez-Saguer, Isaac Melamed, Maeve E O'Connor, Jonny Peter, Sinisa Savic, Daniel F Soteres, Maria Staevska, Petra Staubach-Renz, Marcin Stobiecki, Raffi Tachdjian, Anna Valerieva, Patrick F K Yong, James Hao, Matthew Iverson, Michael D Smith, Christopher M Yea, Paul K Audhya, Emel Aygören-Pürsün, Jonathan A Bernstein, Danny M Cohn, William R Lumry, Marc A Riedl, Andrea Zanichelli, Marcus Maurer","doi":"10.1016/j.jaip.2025.08.020","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.08.020","url":null,"abstract":"<p><strong>Background: </strong>Poor compliance with hereditary angioedema guidelines for on-demand treatment is common due to challenges with parenteral administration. Sebetralstat, an oral plasma kallikrein inhibitor, demonstrated faster times to beginning of symptom relief, reduction in attack severity, and complete resolution than placebo in the phase 3 KONFIDENT trial (NCT05259917).</p><p><strong>Objective: </strong>This analysis evaluated long-term safety and effectiveness of sebetralstat in KONFIDENT-S (NCT05505916), an ongoing, 2-year, open-label extension study.</p><p><strong>Methods: </strong>Enrolled participants ≥12 years with hereditary angioedema with C1-inhibitor deficiency administered sebetralstat 600mg for each attack as early as possible, regardless of severity or location.</p><p><strong>Primary outcome: </strong>incidence of treatment-emergent adverse events (TEAE).</p><p><strong>Secondary outcomes: </strong>times to beginning of symptom relief, reduction in severity, and complete resolution.</p><p><strong>Results: </strong>At data cutoff (Jan 31, 2024), 84 participants (mean age: 35.9 years; 14.3% <18 years; 64.3% female) treated 640 attacks with sebetralstat (84% of total attacks); median (interquartile range, IQR) 5 (2-8) attacks per participant. Median time from attack onset to treatment: 9 minutes (1-69). Baseline severity: 30.0% mild, 43.3% moderate, 25.0% severe or very severe. Treatment-related TEAEs occurred in 8 participants (9.5%); none were serious. Median times to beginning of symptom relief (allowing for missing data entries between consecutive time points): 1.68h (0.76-5.05), reduction in severity: 6.57h (1.61->12), and complete attack resolution: 21.02h (7.22->24). No evidence of a diminished response over repeated treatments of attacks was observed.</p><p><strong>Conclusion: </strong>Oral sebetralstat enabled compliance with treatment guidelines. No new safety signals were observed, and effectiveness for repeated attacks was consistent with the KONFIDENT trial results.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976639","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":"Idiopathic Anaphylaxis Grand Rounds.","authors":"Moshe Ben-Shoshan, Cem Akin, Victoria E Cook, Roy Khalaf, George Freigeh","doi":"10.1016/j.jaip.2025.08.019","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.08.019","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Idiopathic anaphylaxis (IA) refers to recurrent, life-threatening hypersensitivity reactions without identifiable triggers, representing a diagnostic and therapeutic challenge. We describe a 17-year-old girl presenting with recurrent episodes of flushing, pruritus, and respiratory symptoms, without consistent allergen exposure or cofactor involvement. Evaluation revealed elevated acute tryptase levels with a normal baseline, negative skin testing, and negative alpha-gal and KIT mutation analysis. The patient improved on daily cetirizine with no further reactions. IA remains a diagnosis of exclusion, requiring careful consideration of IgE-mediated allergies, cofactor-dependent anaphylaxis, clonal mast cell disorders, and systemic mimics such as neuroendocrine tumors or vasovagal syncope. We summarize current evidence on IA pathogenesis, epidemiology, differential diagnosis, and management. While antihistamines and corticosteroids are commonly used prophylactically, emerging data suggest anti-IgE therapy with omalizumab may offer benefit in refractory cases. Diagnostic workup should include serum tryptase measurement, trigger identification, and consideration of underlying mast cell disorders. Future research is needed to clarify the natural history, standardize diagnostic pathways, and evaluate long-term treatment strategies for this heterogeneous condition. CASE DESCRIPTION: A 17-year-old girl presented to the emergency department (ED) with a two-hour history of flushing, pruritus, and wheezing. The symptoms began after eating dinner, which included shepherd's pie and macadamia nuts, foods she had previously tolerated. There were no preceding exposures to medications, alcohol, or insect stings, and she did not engage in exercise prior to symptom onset. She reported three additional similar episodes. These were not consistently associated with eating, and there were no common foods or additives identified between episodes. There was no history of tick bite. There was no correlation between reactions and stage of her menstrual cycle. She did not have a personal or family history of atopy (atopic dermatitis, allergic rhinitis, asthma, IgE-mediated food allergy) or anaphylaxis. There was no history of spontaneous or inducible urticaria. She did not have a history of spontaneous flushing, pruritus, abdominal pain, diarrhea, presyncopal or syncopal episodes. She did not have a history of bony pain or fractures. At the time of the medical assessment in the ED, the patient's examination was notable for facial erythema and diffuse hives. Respiratory symptoms had resolved by the time of assessment. There were no cutaneous lesions suggestive of cutaneous mastocytosis. (Figure 1) The examination was otherwise unremarkable. She was given 2&lt;sup&gt;nd&lt;/sup&gt; generation antihistamines, and symptoms gradually resolved over several hours. The serum tryptase drawn two hours following symptom initiation was 17.2 mcg/L. A repeat level five days later was 3.2 mcg/L.","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977887","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":"From General Intelligence to Specialized Support: AIDUS as a Blueprint for Artificial Intelligence in Chronic Urticaria.","authors":"Sujani Kakumanu, Jay Portnoy","doi":"10.1016/j.jaip.2025.08.018","DOIUrl":"10.1016/j.jaip.2025.08.018","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977942","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":"How Infections and Immune Development Relate to Preschool Recurrent Wheezing and Asthma.","authors":"Kirsten M Kloepfer, Daniel J Jackson, Tuomas Jartti, Andrew H Liu, James E Gern","doi":"10.1016/j.jaip.2025.08.017","DOIUrl":"10.1016/j.jaip.2025.08.017","url":null,"abstract":"<p><p>The relationship between infections, immune development, and preschool recurrent wheezing and asthma is complex and multifaceted. Respiratory syncytial virus (RSV) and rhinovirus (RV) are significant early-life triggers for wheezing, with differing immunologic and genetic associations. RV, especially RV-C, has been closely linked to asthma development, particularly allergic asthma. RSV wheezing illnesses can identify susceptible children and are linked to nonallergic asthma. Ongoing studies using broader RSV prevention (vaccines, mAbs) in full-term infants may further clarify these relationships. Both RSV and RV infections are associated with changes in bacterial abundance. The timing of these changes and the bacterial strains that are altered are likely important factors in asthma development that are continually being investigated. Beyond viral triggers, asthma and recurrent wheeze in preschoolers result from a complex interplay of microbial (urban vs rural living), environmental (eg, air pollution levels and diet) and host immune factors. Strategies focusing on microbiome modulation (eg, bacterial lysate ingestion), pollution reduction, increasing biodiversity, and nutritional support (eg, vitamin D) may offer promising paths for prevention and improved management.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977939","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":"Effects of Oral Immunotherapy on the Growth Trajectories of Food-Allergic Children.","authors":"Matan Elkan, Liat Nachshon, Ortal Cohen, Michael B Levy, Yael Koren, Naama Epstein-Rigby, Arnon Elizur, Michael R Goldberg","doi":"10.1016/j.jaip.2025.08.016","DOIUrl":"10.1016/j.jaip.2025.08.016","url":null,"abstract":"<p><strong>Background: </strong>Children with IgE-mediated food allergies, particularly milk, are at risk for hampered growth. Limited data are available regarding the benefit of oral immunotherapy (OIT) on growth outcomes.</p><p><strong>Objective: </strong>To evaluate the impact of OIT on growth metrics in this population.</p><p><strong>Methods: </strong>We retrospectively analyzed data from patients (aged 4-15 [females] and 4-16.5 [males] years) who successfully completed OIT. Pre- and post-OIT height-for-age and weight-for-age z-scores (HAZ and WAZ, respectively) were calculated using World Health Organization standards.</p><p><strong>Results: </strong>Patients (n = 458, mean age 8.0 ± 2.7 years) successfully treated for tree nut (33.4%), peanut (29.7%), milk (17.2%), sesame (14.6%), and egg (4.8%) allergy were analyzed. Baseline mean HAZ -0.19 ± 1.05 improved to -0.10 ± 1.05 (P < .001) after OIT (median duration, 19.4 months). This was positively correlated with the mean change in WAZ (r = 0.44, P < .001). Milk-allergic patients had lower baseline HAZ than non-milk-allergic patients (-0.45 ± 0.91 vs -0.14 ± 1.07, P = .016). Patients beginning OIT before age 6 had the greatest HAZ improvement (0.16 ± 0.42), whereas those starting after age 12 experienced a decrease (-0.11 ± 0.49). In 113 patients with a median 34-month follow-up, HAZ improved by 0.30 ± 0.73 (P < .001). This effect was not observed at long-term follow-up in a group of patients who did not achieve successful OIT (n = 21). Using a linear regression model, significant predictors of follow-up HAZ were younger age at baseline (B = -0.09, 95% confidence interval [CI] [-0.15, -0.03], P = .002) and lower baseline HAZ (B = 0.83, 95% CI [0.69, 0.97], P < .001).</p><p><strong>Conclusions: </strong>OIT may enhance long-term growth in allergic children, especially in younger patients and those with a lower baseline HAZ. Effects on their final stature remain to be determined.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977928","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":"Blanching Erythema in Intraoperative Anaphylaxis.","authors":"Terrique Pinnock, Steven B Porter, Alexei Gonzalez-Estrada, J Ross Renew","doi":"10.1016/j.jaip.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.07.010","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977768","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}