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

{"title":"Occupational respiratory allergy caused by oyster mushroom (Pleurotus ostreatus)","authors":"Sabine Kespohl PhD, Virginie Doyen MD, PhD, Olivier Vandenplas MD, PhD, Ines Jadot PhD, Catherine Rifflart MSc, Joël Thimpont MD, Monika Raulf PhD","doi":"10.1016/j.jaip.2026.06.033","DOIUrl":"10.1016/j.jaip.2026.06.033","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2427-2428"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370728","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":"Lessons Learned From Fatal and Near-Fatal Perioperative IgE-Mediated Anaphylaxis","authors":"Pascale Dewachter MD, PhD,&nbsp;Claudie Mouton-Faivre MD,&nbsp;Agathe Vianey-Liaud MS,&nbsp;Eric Vicaut MD, PhD,&nbsp;Sadek Beloucif MD, PhD","doi":"10.1016/j.jaip.2026.07.006","DOIUrl":"10.1016/j.jaip.2026.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative anaphylaxis (POA), an acute circulatory failure usually IgE-mediated, remains a significant cause of anesthesia-related deaths. Because early recognition of this life-threatening condition is critical, we previously investigated the association of clinical characteristics with IgE-mediated allergy and showed that early cutaneous vasoconstriction was pathognomonic of IgE-mediated anaphylaxis.</div></div><div><h3>Objective</h3><div>To evaluate whether early cutaneous vasoconstriction phenotype is associated with an increased risk of fatal/near-fatal POA and analyze the mechanisms leading to poor outcomes.</div></div><div><h3>Methods</h3><div>This is a prespecified analysis of a retrospective observational cohort study conducted at 2 academic medical centers. Included in the study were adults diagnosed with IgE-mediated anaphylaxis (grades III and IV according to the modified Ring and Messmer scale) in the main analysis and those with a fatal or near-fatal outcome. IgE-mediated anaphylaxis successfully treated with mechanical circulatory support was defined as near-fatal.</div></div><div><h3>Results</h3><div>Of 72 included patients with IgE-mediated anaphylaxis (grade III: 65 [90.3%] and grade IV: 7 [9.7%]), 45 (62.5%) and 27 (37.5%) were, respectively, categorized in the miscellaneous (early or late cutaneous vasodilation or lack of cutaneous signs) and early cutaneous vasoconstriction groups. Six fatal or near-fatal cases (grade III: 4 and grade IV: 2) were exclusively reported in the early cutaneous vasoconstriction group. Early cutaneous vasoconstriction phenotype was associated with fatal/near-fatal outcomes. Fatal/near-fatal outcomes occurred in 22.2% of patients with cutaneous vasoconstriction (n = 6 of 27) while in none of those from the miscellaneous group (n = 0 of 45) (absolute risk difference: 22.2% [95% confidence interval: 8.2-40.8]). Fatal and near-fatal cases accounted for 18.5% (n = 5 of 27) and 3.7% (n = 1 of 27) of cases, respectively. Early cutaneous vasoconstriction was always associated with bradycardia (median [interquartile range]: 46 [38-57] beats/min) in the 6 fatal/near-fatal cases. A symptomatic treatment, disregarding the pathophysiological mechanisms of POA, might have contributed to poor outcomes.</div></div><div><h3>Conclusions</h3><div>POA exhibiting early cutaneous vasoconstriction was associated with an increased risk of fatal/near-fatal outcomes. Early cutaneous vasoconstriction and bradycardia likely reflect greater initial severity, owing to profound hypovolemia. This highlights the importance of recognizing this lesser-known phenotype. Further research is warranted.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2295-2309.e2"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766033","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":"Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline)","authors":"Timothy E. Dribin MD,&nbsp;Brad Sobolewski MD, MEd,&nbsp;Ronna L. Campbell MD, PhD,&nbsp;Paul J. Turner PhD,&nbsp;Lene H. Garvey MD, PhD,&nbsp;Jasmeet Soar MB, BChir,&nbsp;Julie Wang MD,&nbsp;Marcus S. Shaker MD, MS,&nbsp;Adam T. Fox MD,&nbsp;Sarayna S. McGuire MD, MS,&nbsp;Kenneth A. Michelson MD, MPH,&nbsp;David Schnadower MD, MPH,&nbsp;Graham Roberts DM,&nbsp;Waleed Alqurashi MD, MSc,&nbsp;Moshe Ben-Shoshan MD, MSc,&nbsp;David C. Brousseau MD, MS,&nbsp;Dianne E. Campbell MD, PhD,&nbsp;Andrew T. Clark MBBS, MD,&nbsp;Antoine Deschildre MD,&nbsp;Katie Frith MBBS,&nbsp;Hugh A. Sampson MD","doi":"10.1016/j.jaip.2026.07.004","DOIUrl":"10.1016/j.jaip.2026.07.004","url":null,"abstract":"<div><div>Health care providers across settings must be trained to manage anaphylaxis by (1) removing the offending allergen if still present; (2) positioning the patient with legs elevated, and if respiratory distress is present, allow the patient to sit upright with legs extended and elevated; (3) immediately administering epinephrine (adrenaline) intramuscularly (IM) or intranasally (IN) every 5 to 15 minutes for persistent anaphylaxis; and (4) optimizing airway, breathing, and cardiovascular (ABC) resuscitation. This may include supplemental oxygen, noninvasive or invasive positive-pressure ventilation, and intravenous fluid resuscitation. For life-threatening or refractory presentations, (5) IM/IN epinephrine should be administered every 5 minutes while addressing ABC derangements; this includes aggressive intravenous fluid resuscitation for patients in anaphylactic shock. Providers may continue IM or IN epinephrine or switch to the other, as both routes are considered equally efficacious based on pharmacokinetic data. An intravenous epinephrine infusion should be prepared for patients with persistent anaphylaxis after 2 doses of IM/IN epinephrine and initiated after the third dose, or earlier at the provider’s discretion. In settings without epinephrine infusions, repeat IM/IN epinephrine should be administered every 5 minutes, along with other ABC interventions, and the patient should be transferred quickly to a setting equipped to provide advanced resuscitative care.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2254-2261"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450478","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":"Genetic Testing in Clinical Immunology: What to Know and How to Do It","authors":"Rui Yang MD, PhD,&nbsp;Ivan K. Chinn MD,&nbsp;Jordan S. Orange MD, PhD,&nbsp;Xiao P. Peng MD, PhD","doi":"10.1016/j.jaip.2026.06.034","DOIUrl":"10.1016/j.jaip.2026.06.034","url":null,"abstract":"<div><div>Genetically driven immune diseases are immune-mediated disorders involving germline and/or somatic host genetic changes that make a major contribution to disease pathogenesis. These conditions, which include the inborn errors of immunity, may predispose patients to the development of immunodeficiency, immune dysregulation, atopy, autoinflammation or hyperinflammation, and malignancy. Since the development of massively parallel sequencing, also known as next-generation sequencing, and its introduction into clinical use, clinical genetic testing has expanded exponentially across medical specialties, including clinical immunology, with approximately 28% of patients with suspected genetically driven immune diseases undergoing genetic testing in the United States. Despite rapid uptake, knowledge gaps persist regarding when to order genetic testing, how to choose the appropriate assay, and how to interpret the results in clinical context. In this review, we provide a practical framework for genetic testing strategy and interpretation and discuss current limitations, as well as emerging advances that may help further enhance diagnostic yield and clinical impact.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2200-2208.e6"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096264","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":"Original Article Highlights From This Issue","authors":"","doi":"10.1016/S2213-2198(26)00732-4","DOIUrl":"10.1016/S2213-2198(26)00732-4","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages A13-A16"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096372","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":"Practice Notes","authors":"","doi":"10.1016/S2213-2198(26)00736-1","DOIUrl":"10.1016/S2213-2198(26)00736-1","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages A23-A24"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096362","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 basal serum tryptase trajectories in patients with systemic mastocytosis and baseline levels <20 ng/mL.","authors":"Kevin Y Tse, Benjamin Lampson, Botao Zhou, Matt Zhou, Robert S Zeiger, Erin Sullivan, Fagen Xie, Dakota Powell, Chris Yuen, Wansu Chen","doi":"10.1016/j.jaip.2026.09.011","DOIUrl":"10.1016/j.jaip.2026.09.011","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065848","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":"Functional evaluation of the DNA double-strand break repair pathway to characterize a novel NBN variant associated with Nijmegen breakage syndrome.","authors":"Aviva Beleck, Sudarshan Iyer, Amrita Basu, Hemalatha G Rangarajan, Eunkyung Song, Margaret Redmond, Roshini S Abraham","doi":"10.1016/j.jaip.2026.09.013","DOIUrl":"10.1016/j.jaip.2026.09.013","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065795","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 a 12-Week Threshold: Interpreting Pulmonary Rehabilitation Duration in Adults With Asthma.","authors":"Jiaqi Wu, Jiage Niu","doi":"10.1016/j.jaip.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.001","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041598","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 \"Beyond a 12-Week Threshold: Interpreting Pulmonary Rehabilitation Duration in Adults With Asthma\".","authors":"Paula Regalado-Cabello, Beatriz Brea-Gómez, Laura Pérez-Gisbert, María Teresa Soriano-Gómez, Irene Torres-Sánchez","doi":"10.1016/j.jaip.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.09.002","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041696","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}