Frontiers in allergy最新文献

{"title":"Nationwide epinephrine auto-injector dispensing in Greece: a drug-utilization study providing insights into anaphylaxis epidemiology and emergency-treatment preparedness.","authors":"George N Konstantinou","doi":"10.3389/falgy.2026.1906574","DOIUrl":"10.3389/falgy.2026.1906574","url":null,"abstract":"<p><strong>Background: </strong>Anaphylaxis is a serious systemic hypersensitivity reaction requiring prompt recognition and treatment, yet diagnosis-linked national surveillance is unavailable in many countries. Epinephrine auto-injector (EAI) dispensing cannot identify confirmed events or individual patients, but it is an epidemiologically relevant medication-use endpoint because EAIs are supplied to people with prior anaphylaxis or a clinically judged risk of future anaphylaxis.</p><p><strong>Objective: </strong>To quantify nationwide EAI dispensing in Greece as a drug-utilization and emergency-treatment-preparedness benchmark and, secondarily, derive scenario-based incidence-compatible and prevalence-equivalent indicators relevant to the epidemiology of anaphylaxis.</p><p><strong>Methods: </strong>This nationwide retrospective drug-utilization study analyzed aggregated net Anapen® DUO pack counts from reimbursed and non-reimbursed retail and hospital pharmacy channels during March 2015-March 2017, when it was the only EAI marketed nationally. Directly observed pack flow was primary, utilization by EAI strength was analyzed at the population level using age-equivalent denominators, expiry timing was examined conditionally, and scenario outputs were deterministic sensitivity analyses.</p><p><strong>Results: </strong>During 25 months, 33,986 twin-packs were recorded (153.2 packs per 100,000 person-years). The final 12-month rate was 154.0 per 100,000 population. Using age-equivalent population denominators, 150-microgram dispensing intensity was 5.8-fold higher than 300-microgram intensity. Reference scenarios yielded an incidence-compatible anaphylaxis indicator of 47.7-125.3 episodes per 100,000 person-years and prevalence-equivalent active EAI coverage of 51.7-133.0 persons per 100,000. Deliberately broader assumption ranges widened these to 17.0-229.8 and 19.7-177.3, respectively.</p><p><strong>Conclusion: </strong>Nationwide EAI dispensing provides the first all-age benchmark of access to community emergency epinephrine in Greece. By combining observed pack flow with transparent scenario-based analyses, this study introduces a reproducible approach for gaining insights into anaphylaxis epidemiology and emergency-treatment preparedness from national dispensing data, particularly where comprehensive registries are unavailable.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1906574"},"PeriodicalIF":3.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibroblast-centered mechanisms of chronic inflammation and airway remodeling in allergic bronchopulmonary aspergillosis.","authors":"Menglin Li, Chenxiao Qiao, Yun Pan, Jintao Zhang, Qian Chen, Ying Wang, Yinghui Qu, Ruichen Du, Shizhen Wang, Qian Qi","doi":"10.3389/falgy.2026.1952768","DOIUrl":"10.3389/falgy.2026.1952768","url":null,"abstract":"<p><p>Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity lung disease driven predominantly by type 2 immune responses. However, the classical immunological paradigm fails to adequately explain the persistent airway structural damage and frequent relapses observed even after inflammatory control is achieved. This review proposes a fibroblast-centered mechanistic framework that synthesizes evidence from ABPA, fungal-associated airway diseases, and pulmonary fibrosis to systematically delineate the mechanisms linking fibroblasts to chronic inflammation and airway remodeling. In the context of chronic inflammation and persistent epithelial injury, fibroblasts can be activated by various signals, including type 2 cytokines such as interleukin-4 (IL-4) and IL-13. Upon activation, fibroblasts exert their effects through functionally distinct subpopulations: they actively recruit eosinophils through chemokine secretion (e.g., CCL11), establishing a positive feedback loop of \"epithelial injury-fibroblast activation-eosinophil infiltration-tissue damage\" that sustains and amplifies inflammation. Prolonged activation further drives fibroblast-to-myofibroblast transition, characterized by expression of <i>α</i>-smooth muscle actin (<i>α</i>-SMA) and deposition of excessive extracellular matrix, resulting in irreversible airway remodeling and central bronchiectasis. Clinically, fibroblast-related markers such as periostin, transforming growth factor-<i>β</i>, and <i>α</i>-SMA show promise for future risk stratification. Biologics targeting fibrotic pathways have already demonstrated anti-remodeling potential. In the future, the integration of single-cell transcriptomics, spatial omics, and longitudinal clinical studies may clarify the roles of distinct fibroblast subpopulations in ABPA progression and treatment response. This integration could also enable the establishment of a comprehensive \"inflammation-remodeling\" assessment system-facilitating a therapeutic transition from pure immunosuppression toward combined modulation of tissue repair.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1952768"},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New advances in the treatment of chronic rhinosinusitis with nasal polyps from pathophysiology to biologic targeted therapy.","authors":"Baozhu Huang, Yue Xu, Ye Tian, Xiaoyu Liu, Xiaoyu Gao, Xue Wang, Yurong Zhang, Xiaoman Li, Ting Liu, Weibang Chen, Wenya Gao, Huikuan Chen, Feng Li, Danxian Jiang, Junfeng Hao, Chunjie Tian","doi":"10.3389/falgy.2026.1903649","DOIUrl":"https://doi.org/10.3389/falgy.2026.1903649","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic airway disease characterized mainly by type 2 inflammation, which seriously impairs patients' quality of life and imposes a huge economic burden. Traditional treatments cannot eradicate underlying immune disorders, leading to high postoperative recurrence. This review aims to summarize the pathophysiological basis of CRSwNP and the clinical application advances of biologics in its precision treatment.</p><p><strong>Methods: </strong>A narrative review was performed to synthesize key literature on the pathophysiology of CRSwNP, focusing on the core role of type 2 inflammatory molecules (IL-4, IL-13, IL-5, IgE, TSLP) and the clinical evidence of targeted biologics for refractory CRSwNP.</p><p><strong>Results: </strong>In-depth understanding of CRSwNP pathophysiology has promoted the shift to precision medicine. Biologics including dupilumab (anti-IL-4Rα), mepolizumab (anti-IL-5), omalizumab (anti-IgE) and tezepelumab (anti-TSLP) can precisely target key molecules in type 2 inflammatory pathways, achieving effective and long-lasting disease control, reducing polyp volume, improving nasal symptoms and olfactory function, decreasing reliance on oral corticosteroids and the need for reoperation, and exerting synergistic effects on comorbid asthma.</p><p><strong>Conclusions: </strong>Biologics mark a milestone in CRSwNP treatment, shifting clinical management from symptomatic treatment to individualized decision-making based on patient endotypes, comorbidities and treatment goals such as disease remission. Future research will focus on predictive biomarkers, head-to-head comparative studies and new targets for non-type 2 inflammation to optimize long-term management. By integrating recent biologic evidence with endotype-based recurrence mechanisms, this review provides a practical framework for biologic stewardship and remission-oriented management in CRSwNP.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1903649"},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Control first, tolerance second: biologics as enablers of allergen immunotherapy in severe allergic asthma.","authors":"B Jentzsch, A Hoheisel, K Gashynova, S Fähndrich, B C Frye, J A Alvarado Castillo, S Müller, I Cherrez-Ojeda, D Stolz","doi":"10.3389/falgy.2026.1942188","DOIUrl":"10.3389/falgy.2026.1942188","url":null,"abstract":"<p><p>Despite major advances in the treatment of severe asthma with biologics targeting IgE, IL-5/IL-5R<i>α</i>, IL-4R<i>α</i>, and thymic stromal lymphopoietin (TSLP), these agents suppress type 2 inflammation without reliably inducing durable allergen-specific tolerance. Allergen immunotherapy (AIT) remains the only disease-modifying option for IgE-mediated respiratory allergy, yet its use in severe asthma has historically been restricted by safety concerns in uncontrolled disease. We propose a \"control first, tolerance second\" framework, whereby biologic-induced disease control creates a window enabling safe initiation of subcutaneous or sublingual AIT. This narrative review synthesizes the immunological rationale and clinical evidence supporting sequential biologic-AIT combination, with emphasis on omalizumab as the best-studied adjunct and emerging data on dupilumab and tezepelumab. We address biomarker-guided patient selection, treatment sequencing, comorbid allergic rhinitis and chronic rhinosinusitis, corticosteroid-sparing effects, infection risk, airway antiviral immunity, and unresolved questions around long-term remission. The novelty of this framework lies in reframing biologics not merely as symptom-control agents but as facilitators that unlock a previously inaccessible disease-modifying intervention, potentially shifting severe allergic asthma management from control toward durable immunological remission. We conclude that biologic-enabled AIT is a promising but insufficiently defined strategy, and outline the prospective trials, standardized phenotyping, and safety registries needed to establish it as an evidence-based clinical pathway.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1942188"},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between severity of different body regions and inadequate control of atopic dermatitis: results from a cross-sectional and longitudinal study.","authors":"Zifan Li, Ruoxi Yu, Ying Lin","doi":"10.3389/falgy.2026.1888094","DOIUrl":"10.3389/falgy.2026.1888094","url":null,"abstract":"<p><strong>Background: </strong>The Atopic Dermatitis Control Tool (ADCT) serves as a key metric for assessing atopic dermatitis (AD) management. However, the relationship between eczema severity in different body regions and inadequate control in AD patients has not been extensively researched. This study aimed to examine this association in both children and adults with AD and to further explore temporality and treatment effects through longitudinal follow-up.</p><p><strong>Methods: </strong>A cross-sectional questionnaire survey was conducted on pediatric and adult patients with AD in Guangzhou, China. The questionnaires were completed by the AD patients attending the Department of Dermatology at Guangdong Provincial Hospital of Chinese Medicine between March, 2024 and December, 2025. Additionally, a longitudinal sub-cohort of 96 AD patients with 24-week follow-up data was retrospectively analyzed.</p><p><strong>Results: </strong>A total of 713 AD patients completed the survey, including 175 children (aged 12-17 years old) and 538 adults. In the pediatric group, the severity of the head and neck and lower limbs was independently associated with inadequate disease control. In the adult group, the severity of the lower limbs was independently associated with poor disease control. In the longitudinal cohort, improvements in disease severity of the head and neck and lower limbs from baseline to week 24 were independently associated with ADCT-defined clinical improvement.</p><p><strong>Conclusion: </strong>The AD control status exhibits age-specific regional associations. Longitudinal data further demonstrate that reductions in disease severity in the head and neck and lower limbs were independently associated with clinical improvement. These findings are exploratory and require prospective validation before they can inform treatment prioritization.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1888094"},"PeriodicalIF":3.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epigenetics in asthma: implications for treatable traits.","authors":"Vasiliki Apollonatou, Argyro Vrouvaki, Marina Moustaka Christodoulou, Athanasios Fengas, Stelios Loukides, Evangelia Fouka","doi":"10.3389/falgy.2026.1929559","DOIUrl":"10.3389/falgy.2026.1929559","url":null,"abstract":"<p><p>Epigenetic mechanisms refer to heritable and potentially reversible modifications that regulate chromatin architecture and gene expression without altering the underlying DNA sequence. In asthma, these mechanisms provide a molecular interface between genetic susceptibility, environmental exposures, and immune dysregulation, contributing to disease heterogeneity and treatment response. The treatable traits paradigm, which focuses on the identification of specific modifiable biological and clinical characteristics, offers a clinically relevant framework for linking epigenetic changes to distinct molecular endotypes, enhancing mechanistic stratification beyond traditional phenotyping, thereby supporting precision medicine approaches. Emerging evidence suggests that epigenetic signatures have considerable potential as biomarkers for inflammatory endotyping and therapeutic stratification, although further validation is required before routine clinical implementation. In this mini review we will discuss epigenetic mechanisms involved in the development and maintenance of asthma processes, such as DNA methylation, histone modifications, and noncoding RNAs, focusing on their relevance to key treatable traits, including type 2 inflammation, corticosteroid responsiveness, airway remodeling, and exposure-driven disease.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1929559"},"PeriodicalIF":3.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergen-specific IgE sensitization spectrum in 4,166 children with allergic diseases at a county-level hospital in eastern China: a retrospective cross-sectional study.","authors":"Yan Teng, Shouling Ding, Baoqin Zhang","doi":"10.3389/falgy.2026.1893168","DOIUrl":"10.3389/falgy.2026.1893168","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize the serum specific IgE sensitization spectrum in children with allergic diseases at a county-level tertiary hospital and to evaluate age-, sex-, and co-sensitization patterns.</p><p><strong>Methods: </strong>This single-center retrospective cross-sectional study included 4,166 children aged <18 years with allergic diseases who underwent serum specific IgE (sIgE) testing at the First People's Hospital of Taicang City between 2019 and 2024. Twenty allergens (10 inhalant and 10 ingested) were measured by enzyme immunoassay, with sensitization defined as sIgE ≥0.35 kU/L. Sensitization patterns by sex and age were assessed using <i>χ</i> ²/Fisher's exact tests and multivariable logistic regression, and co-sensitization was evaluated using the <i>φ</i> coefficient.</p><p><strong>Results: </strong>The overall sensitization rate was 75.85%, with higher positivity in boys than girls (77.46% vs. 73.49%, <i>P</i> = 0.004); polysensitization was present in 57.35% of children (33.20%, 65.80%, and 56.99% in the <3, 3 to <12, and 12 to <18 years groups, respectively). The most common allergens were egg, <i>Dermatophagoides farinae</i>, house dust, <i>Dermatophagoides pteronyssinus</i>, and cow's milk. Sensitization showed a clear age-related shift from food allergens in children <3 years to inhalant allergens in adolescents. Male sex independently increased the risk of overall sensitization (aOR 1.26, 95% CI 1.09-1.46). Sensitization to mites and cat epithelium increased with age, whereas sensitization to egg and cow's milk declined. Co-sensitization analysis identified a strong mite cluster (<i>D. farinae</i> and <i>D. pteronyssinus</i>, <i>φ</i> = 0.888), a mite-related house-dust cluster, and a moderate early-food cluster involving egg, cow's milk, and wheat flour.</p><p><strong>Conclusion: </strong>In this county-level cohort from the northern Yangtze River Delta, pediatric allergen sensitization was dominated by house dust mites and early food allergens, with sex- and age-related differences and distinct co-sensitization patterns. These findings may inform allergen screening and pediatric allergy management in similar regional settings.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1893168"},"PeriodicalIF":3.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe anaphylactic shock suspectedly induced by injection of recombinant humanized type III collagen lyophilized fiber for facial skin improvement: a case report.","authors":"Junjie Liu, Wenjing Yan, Jing Liu, Bowen Yang, Yong Du","doi":"10.3389/falgy.2026.1901705","DOIUrl":"10.3389/falgy.2026.1901705","url":null,"abstract":"<p><p>Recombinant humanized type III collagen is widely used in facial rejuvenation due to its excellent biocompatibility and overall favorable safety profile; however, severe systemic hypersensitivity reactions are exceedingly rare. We report a case of a 47-year-old woman with no prior history of allergy who received topical lidocaine to the face, followed by injection of recombinant humanized type III collagen lyophilized fibers for skin texture improvement. Immediately after the injection, she developed suspectedly severe anaphylactic shock temporally associated with the recombinant collagen injectionpresenting with confusion, respiratory distress, followed by marked bradycardia (33 beats/min), and loss of palpable arterial pulse. Emergency protocols were activated immediately, including cardiopulmonary resuscitation, intravenous adrenaline, corticosteroids, and fluid resuscitation. The patient's vital signs gradually recovered, and she was discharged after complete recovery two days later after complete recovery. This case suggests that recombinant humanized collagen, as a macromolecular protein, inherently carries the risk of triggering immediate-type anaphylactic shock despite its favorable safety profile. Clinicians should perform rigorous preoperative assessment, adhere to standardized procedures, and be proficient in the emergency management of anaphylactic shock to minimize the risk of severe adverse reactions and ensure medical safety.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1901705"},"PeriodicalIF":3.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genes and cells associated with sublingual allergen immunotherapy revealed by integrated transcriptome analysis in allergic rhinitis patients.","authors":"Zhengqi Li, Yilin Hou, Hang Li, Ding Ji, Yi Wei, Renqiang Ma","doi":"10.3389/falgy.2026.1855863","DOIUrl":"10.3389/falgy.2026.1855863","url":null,"abstract":"<p><strong>Background: </strong>Sublingual allergen immunotherapy (SLIT) is known as an effective therapy for allergic rhinitis (AR), although its efficacy varies across different treatment duration and individuals. The factors associated with the duration and response of SLIT need to be explored.</p><p><strong>Methods: </strong>Twenty-seven AR patients undergoing SLIT and three healthy volunteers were recruited. Peripheral blood mononuclear cells were isolated for RNA sequencing, and key results were further examined by quantitative PCR (qPCR) in available PBMC samples. Time-correlated and response-associated genes were identified and analyzed using bioinformatic tools. The data were further integrated with single-cell transcriptome.</p><p><strong>Results: </strong>We first identified 164 genes significantly correlated with SLIT duration. The expressions of genes associated with immunoregulation, nitric oxide and serotonin transportation were regulated as the treatment proceeded. qPCR validation further showed a significant positive correlation between SLC6A4 expression and SLIT duration, while SH2D1B and ARG1 showed positive trends. Then, we identified 257 up-regulated and 349 down-regulated genes in SLIT responders. Several pathways were enriched in these genes, including interferon signaling (up-regulated in responders) and granulocytes migration (down-regulated in responders). Single-cell and deconvolution analyses suggested that natural killer cell-associated signals may associate with SLIT efficacy, potentially in relation to T-cell-regulatory and eosinophil-migration-related transcriptional programs.</p><p><strong>Conclusions: </strong>This study revealed potential genes and cells associated with SLIT duration and response. Regulation of T cells and NK cells may play a crucial role in the successful treatment responses. Further studies are required to validate these findings and assess their clinical relevance.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1855863"},"PeriodicalIF":3.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical phenotypes, endotypes, and biomarker profiles of immediate rituximab hypersensitivity reactions: a prospective pharmacovigilance study.","authors":"Narapong Yotinnoratham, Wannada Laisuan, Kumutnart Chanprapaph, Silada Kanokrungsee, Chavachol Setthaudom, Supornchai Onpun, Pungjai Mongkolpathumrat, Supranee Buranapraditkun, Apinya Chungcharoenpanich, Nichapha Dechapaphapitak, Supa Oncham, Nattakirana Tongdee, Sananya Khamkaew, Ratchaya Lertnawapan, Jettanong Klaewsongkram","doi":"10.3389/falgy.2026.1903523","DOIUrl":"10.3389/falgy.2026.1903523","url":null,"abstract":"<p><strong>Background: </strong>Rituximab (RTX) has been associated with immediate hypersensitivity reactions (HSRs) involving multiple phenotypes and endotypes.</p><p><strong>Objective: </strong>To characterize the clinical phenotypes and endotypes of immediate RTX HSRs.</p><p><strong>Methods: </strong>A prospective study was conducted as part of a pharmacovigilance program from July 2020 to December 2021. Participants who experienced immediate RTX HSRs were enrolled. Skin testing, basophil activation testing (BAT), IFN-<i>γ</i> ELISpot assays, and IgG anti-drug antibody (ADA) ELISA assays were performed.</p><p><strong>Results: </strong>Seventeen patients with immediate RTX reaction were enrolled, including 9 with infusion-related reactions (IRRs) and 8 with immediate RTX HSRs. Among 13 patients who underwent biomarkers testing, all 5 patients with IRRs showed negative result for all biomarkers. Among the eight patients with immediate RTX HSRs, elevated serum tryptase levels during acute reaction onset were observed in four patients, suggesting possible type I reaction, although definite classification was limited by the reaction. Two of the 8 patients demonstrated elevated IL-6 levels together with increased serum tryptase levels, suggesting mixed reactions (type I/CRS). The remaining 4 patients could not be assigned to a specific endotype and were therefore categorized as unclassified. BAT results were negative in all cases.</p><p><strong>Conclusion: </strong>Immediate RTX HSRs demonstrated heterogeneous phenotypes and endotypes. IRRs were the most common phenotype and occurred exclusively during the first RTX cycle. Skin testing, ADA detection, and serum IL-6 measurement may contribute to endotype characterization, although larger prospective studies are needed to establish their diagnostic utility.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"7 ","pages":"1903523"},"PeriodicalIF":3.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}