Allergy and asthma proceedings最新文献

{"title":"Follow-up after discontinuation of omalizumab in patients with moderate-to-severe asthma: A systematic review.","authors":"Qiu-Li Yan, Li-Yuan Zhang, Wen-Si Niu, Jin-Jin Shi, Ying-Qing Chen, Fang-Yuan Zhang, Lei Cheng","doi":"10.2500/aap.2026.47.260016","DOIUrl":"10.2500/aap.2026.47.260016","url":null,"abstract":"<p><p><b>Background:</b> Omalizumab is a well-established add-on therapy for patients with moderate-to-severe asthma. However, there is limited systematic evidence on the long-term outcomes after discontinuation of this treatment. <b>Objective:</b> To address this evidence gap, this review aimed to systematically evaluate the follow-up outcomes in patients with moderate-to-severe asthma after discontinuation of omalizumab treatment. <b>Methods:</b> The research was conducted in accordance with the systematic reviews and meta-analyses guidelines. We systematically searched medical literature data bases from December 2003 to August 2025 for observational studies (prospective or retrospective) on omalizumab discontinuation in moderate-to-severe asthma. Data extraction was conducted on key variables: omalizumab treatment regimens, postdiscontinuation long-term outcomes, asthma control status, relapse risk factors, asthma exacerbation rates, corticosteroid use, and patterns of omalizumab reinitiation. <b>Results:</b> A total of 11 eligible studies were included in the review. After discontinuation, most patients showed no remarkable changes in forced expiratory volume in 1 second, fractional exhaled nitric oxide level, total immunoglobulin E value, or absolute eosinophil count. Moreover, no obvious deterioration was observed in patient-reported quality of life. These findings confirm the sustained long-term benefits of previous omalizumab add-on therapy because the majority of patients maintained favorable disease control after discontinuation. Subgroup analyses further indicated that asthma exacerbations, when they occurred, predominantly occurred within the first year after discontinuation. <b>Conclusion:</b> This review indicates that, although most patients maintain stable objective indicators after omalizumab discontinuation, a significant proportion are at increased risk for exacerbations, deterioration in asthma control, and increased corticosteroid use, particularly within the first year.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 3","pages":"e24-e35"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and risk factors associated with breakthrough reactions in chemotherapy desensitization.","authors":"Hazal Kayikci, Ebru Damadoglu, Melek Cihanbeylerden, Cise Tuccar, Ayşegul Pehlivanlar Ustaoglu, Kerim Cayiroz, Elif Hatipoglu, Gul Karakaya, Ali Fuat Kalyoncu","doi":"10.2500/aap.2026.47.260018","DOIUrl":"10.2500/aap.2026.47.260018","url":null,"abstract":"<p><p><b>Background:</b> Rapid drug desensitization (RDD) is a safe and effective option for patients who are hypersensitive when no alternatives are available; however, breakthrough reactions (BTR) may still occur. <b>Objective:</b> This study aimed to evaluate chemotherapeutic RDD outcomes and identify risk factors for BTRs. <b>Methods:</b> This retrospective study included patients who underwent chemotherapeutic RDD between 2019 and 2023 at a tertiary adult allergy clinic. BTR rates and potential risk factors were assessed. <b>Results:</b> Among 197 patients with chemotherapy-induced immediate hypersensitivity reactions, 132 (95 women [72.0%]) were included in the final analysis. A total of 552 RDD procedures (range, 1-17) were performed, most frequently with carboplatin (43.1%), oxaliplatin (28.0%), and cisplatin (10.6%). Among these patients, 45 (34.0%) experienced a total of 72 BTRs (13.0%). BTRs occurred at a median of 2 cycles (range, 1-16 cycles) and the 16th step (range, 1-20 steps). Of all the procedures, 533 (96.6%) were successfully completed. Compared with the 16-step protocol, the 12-step protocol was associated with an increased BTR risk (odds ratio [OR] 4.05 [95% confidence interval {CI}, 1.7-9.5]; p = 0.001). Multivariate analysis revealed that the BTR risk increased with the total number of RDDs (OR 1.13 [95% CI, 1.0-1.2]; p = 0.026). Skin test positivity was identified as the strongest risk factor for BTRs (OR 2.767 [95% CI, 1.131-6.768]; p = 0.026). <b>Conclusion:</b> Chemotherapy RDD was effective and safe, achieving a 96.6% success rate. The total number of desensitization procedures and skin test positivities were significant predictors of BTRs, indicating that the risk may persist despite successful initial desensitization. Careful risk assessment and close monitoring are essential to ensure patient safety during repeated RDD cycles.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 3","pages":"216-224"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of basophil activation tests in the diagnosis of cross-intolerance to nonsteroidal anti-inflammatory drug reactions.","authors":"Anh Quynh Nguyen, Ha Thi Ngoc Nguyen, Nhan Thi Ho, Mai Thi Vu, Yen Thi Hai Pham, Hien Thi Mai, Han Hoang Kim Nguyen, Oanh Thi Hoang, Nguyet Thi Minh Nguyen, Hieu Chi Chu, Sheryl van Nunen, Timothy John Craig, Tu Dac Nguyen, Dinh Van Nguyen","doi":"10.2500/aap.2026.47.260013","DOIUrl":"10.2500/aap.2026.47.260013","url":null,"abstract":"<p><p><b>Background:</b> Nonsteroidal anti-inflammatory drugs (NSAID) are the second most frequent cause of drug-induced hypersensitivity after β-lactam antibiotics. Diagnosing cross-intolerance reactions to NSAIDs remains challenging because conventional allergy tests are not useful and drug provocation tests (DPT), the current criterion standard, are resource-intensive and carry risk of severe reactions. Basophil activation testing (BAT) has emerged as a potential ex vivo diagnostic alternative. <b>Objective:</b> This study aimed to evaluate the diagnostic utility of the BAT for cross-intolerance reactions to NSAIDs among Vietnamese patients, including the identification of optimal drug type, concentration, and cutoff values. <b>Methods:</b> This validation study used a case-control design that involved 38 patients previously diagnosed with cross-intolerance to NSAIDs and 34 healthy controls. The diagnosis of NSAID cross-intolerance was established according to the international consensus guidelines, based on a detailed clinical history and, when indicated, a DPT. Both groups underwent BAT by using two NSAIDs at two concentrations each: acetylsalicylic acid (ASA) at 1.25 mg/mL and 0.5 mg/mL, and ketorolac at 1.25 mg/mL and 0.5 mg/mL. Flow cytometric analysis was performed to assess basophil activation based on CD63 and CD203c expression. <b>Results:</b> ASA 1.25 mg/mL showed the best BAT diagnostic performance for cross-intolerance, achieving 55.3% sensitivity and 91.2% specificity by using cutoffs of ≥4% activated basophils and stimulation index (SI) ≥ 1.5. <b>Conclusion:</b> BAT demonstrates moderate sensitivity but high specificity for NSAID cross-intolerance, particularly when ASA is used as the stimulant. These findings support BAT as a complementary confirmatory tool in selected patients at high risk, although negative results do not exclude hypersensitivity and DPT remains necessary when diagnostic confirmation is required. Further validation in clinically relevant populations is needed before routine clinical implementation.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 3","pages":"207-215"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we follow the penicillin allergy label trail in approaching patients with a sulfonamide allergy label?","authors":"Samantha R Horn, Gisoo Ghaffari, Taha Al-Shaikhly","doi":"10.2500/aap.2026.47.260019","DOIUrl":"10.2500/aap.2026.47.260019","url":null,"abstract":"<p><p><b>Background:</b> A penicillin allergy label increases the risk of hospitalization, length of hospital stays, and even mortality rate. This recognition has led to recommendations for proactive evaluation of penicillin allergy and de-labeling efforts. Less is known about the impact of the sulfonamide allergy label (SAL), the second-most-common antibiotic allergy label, on morbidity and mortality of patients and the impact on the health-care system. Further, the approach to patients with an SAL is not well characterized. <b>Objective:</b> We aimed to review recent evidence that examined the association between an SAL and clinical outcomes, including health-care utilization. We also aimed to review the evolving approach to an SAL, including the incorporation of decision tools and identifying patient populations that may benefit from proactive evaluation. <b>Methods:</b> We performed a narrative review of the literature. <b>Results:</b> There is increasing evidence that supports a negative impact for having an SAL on clinical outcomes. An SAL influences antibiotic prescription practices and is associated with an increased risk of opportunistic infections and urinary tract infections among recipients of solid organ transplantation and a small increase in the risk of complications from cystitis. The recent development and validation of the clinical decision tool, trimethoprim-sulfamethoxazole allergy clinical decision rule (SULF-FAST), and the proven feasibility and safety for direct oral challenge present an opportunity to offer proactive evaluation of individuals who might benefit from sulfonamide antibiotics such as individuals who are immunosuppressed, patients with recurrent urinary tract infections, or those with multiple antibiotic allergies. <b>Conclusion:</b> Proactive evaluation and de-labeling of sulfonamide allergy through direct oral challenge with trimethoprim-sulfamethoxazole could be considered in patients who are immunocompromised, patients with recurrent acute cystitis, and those with multiantibiotic allergy. Further research is needed to identify systematic hospital-wide interventions and to elucidate the benefit of such de-labeling on clinical outcomes.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 3","pages":"177-183"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The medical management of chronic rhinosinusitis with nasal polyps and aspirin-exacerbated respiratory in the biologic age.","authors":"Kathleen M Buchheit","doi":"10.2500/aap.2026.47.260015","DOIUrl":"10.2500/aap.2026.47.260015","url":null,"abstract":"<p><p>The advent of biologic therapy for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) has allowed for substantial improvement in symptom control and reduction in medical resource utilization for patients with CRSwNP. CRSwNP is characterized by chronic symptoms (>12 weeks), including nasal congestion, hyposmia or anosmia, anterior or posterior mucopurulent drainage, and, in some patients, facial pain or pressure, with patients also having objective evidence of CRSwNP on nasal endoscopy or imaging. In Western countries, CRSwNP is most frequently marked by type 2 inflammatory cells and mediators, including tissue eosinophilia, T helper type 2 cells, group 2 innate lymphoid cells, locally produced immunoglobulin E, type 2 cytokines, and mast cell activation. Both CRSwNP and aspirin-exacerbated respiratory disease (AERD), an important, severe phenotype of CRSwNP, are associated with impairments in quality of life, medical resource consumption, and recurrent CRSwNP after functional endoscopic sinus surgery (FESS), with some patients requiring revision FESS. There are now four U.S. Food and Drug Administration approved biologics for treatment of CRSwNP, including dupilumab, omalizumab, mepolizumab, and tezepelumab, and more under investigation for the treatment of CRSwNP. Biologics have been shown to decrease nasal polyp size, improve sense of smell, reduce the need for systemic corticosteroids and FESS, and improve quality of life for patients with CRSwNP. In this review, I discuss guidelines for the treatment of CRSwNP and AERD in the biologic era, efficacy of biologic medications, and emerging real-world evidence for the use of biologic therapy for CRSwNP and AERD.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 3","pages":"162-169"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccinating patients on biologics for atopic disease: Clinical considerations and evidence-based recommendations.","authors":"Nicole M Chase","doi":"10.2500/aap.2026.47.260001","DOIUrl":"10.2500/aap.2026.47.260001","url":null,"abstract":"<p><p><b>Background:</b> Biologics that target type 2 inflammation have transformed the management of atopic diseases, but questions remain with regard to vaccine administration in these patients. Current product labeling recommends caution with vaccine administration in patients taking these medications, particularly live-attenuated vaccines, despite limited evidence of actual risk. <b>Objective:</b> The objective was to review clinical concerns and available evidence, and to provide practical recommendations for vaccination in patients receiving biologics for atopic diseases, with a focus on dupilumab. <b>Methods:</b> A comprehensive PubMed/MEDLINE literature search was conducted to identify relevant studies and clinical guidance with regard to vaccination strategies in patients receiving biologic therapy. The primary search terms included the following: \"biologic therapy\" or \"biologic therapy\" or \"monoclonal antibodies\" combined with \"vaccination\" or \"immunization\" or \"vaccine response\" or \"live vaccines\" or \"inactivated vaccines.\" Priority was given to randomized controlled trials, large observational studies, and registry data published within the past 10 years. <b>Results:</b> For non-live vaccines, evidence supports safety and efficacy, although results of some studies suggest moderately reduced responses. A randomized controlled trial found comparable antibody responses between dupilumab and placebo groups for tetanus (83.3% versus 83.7%) and meningococcal vaccines (86.7% versus 87.0%). Coronavirus disease 2019 (COVID-19) vaccine studies show mixed results, with some reporting lower antibody levels and neutralization capacity in patients on biologics. For live-attenuated vaccines, emerging evidence challenges traditional prohibitions. <b>Conclusion:</b> Current evidence supports the safety and efficacy of non-live vaccines in patients receiving biologics for atopic diseases, although responses may be moderately reduced. Analysis of emerging data suggests certain live-attenuated vaccines may be safer than previously thought, particularly in pediatric patients on dupilumab. Vaccination decisions should be individualized based on risk-benefit assessment. Further research is needed to establish definitive guidelines, particularly for live vaccines and long-term immunity.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 2","pages":"85-91"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From molecular pathways to meaningful patient management: Navigating complexity in allergy and immunology.","authors":"Joseph A Bellanti, Russell A Settipane","doi":"10.2500/aap.2026.47.260006","DOIUrl":"10.2500/aap.2026.47.260006","url":null,"abstract":"","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 2","pages":"75-77"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking barriers: A communication bundle for penicillin allergy label removal.","authors":"Katie Ray, Khaled Al-Zubaidi, Sarah Seward, Melodee Liegl, Amy Y Pan, Michelle L Mitchell","doi":"10.2500/aap.2026.47.250096","DOIUrl":"10.2500/aap.2026.47.250096","url":null,"abstract":"<p><p><b>Background:</b> Many barriers exist in disseminating the results of successful penicillin allergy delabels and preventing relabels. <b>Methods:</b> This study used electronic faxing to directly communicate the completion of successful direct oral challenges in children hospitalized or in the emergency department to outpatient pharmacies and out-of-network primary care providers. <b>Results:</b> This communication led to a decreased rate of the penicillin allergy label presence in pharmacy records, from 32% (36/112) to 12% (16/136) (p < 0.001). In conjunction with more conventional discharge communication mechanisms, allergy removal rates improved, from 61% (19/31) to 90% (18/20) (p = 0.029) for out-of-network primary care providers. <b>Conclusion:</b> This study demonstrated that the reliable, simple, and time-efficient direct communication between independent health-care systems and pharmacies can be successful when implemented in a streamlined bundled approach.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 2","pages":"120-123"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking the management of hereditary angioedema.","authors":"Paula Busse, Kim Wilson, Henriette Farkas, Shanna Fishel, Amod Athavale, Abigail Silber, Ellie Goldman, Catherine Miller, Shruti Nambiar","doi":"10.2500/aap.2026.47.260004","DOIUrl":"10.2500/aap.2026.47.260004","url":null,"abstract":"<p><p><b>Background:</b> Hereditary angioedema with C1INH deficiency (HAE-C1INH) is a rare, debilitating genetic disorder characterized by recurrent, unpredictable attacks. Although treatments exist, patients with HAE still alter their lives to avoid triggers and experience substantial physical, psychosocial, and financial burdens. <b>Objective:</b> To estimate the burden that HAE-C1INH patients experience despite currently approved therapies, aiming to identify unmet needs related to HAE, its therapies and the ability to achieve normalization of life. <b>Methods:</b> A web-based survey was conducted from March to April 2025 among 100 US adults with HAE-C1INH currently receiving long-term prophylaxis and/or on-demand therapies. Responses captured attack frequency, the impact of living with HAE, avoidance of attack triggers, and the patients' unmet needs. Descriptive statistical analysis was conducted. <b>Results:</b> Even with treatment, 80% of respondents reported ≥1 HAE attack in the past year and 61% thought about HAE at least weekly. Mental health was the aspect that respondents felt was most impacted by HAE (54% of respondents), and 73% reported taking ≥2 measures to avoid attack triggers. Several concerns impacted the ability to reach normalization; lifetime use of medication was the most commonly reported concern (68% of respondents). The greatest unmet needs associated with long-term prophylaxis were cost- and access-related. <b>Conclusion:</b> Substantial unmet needs related to disease control and achieving normalization remain for patients with HAE-C1INH, despite existing treatments. This study re-enforces the need to not only assess the frequency and severity of attacks, but also the psychosocial, mental, logistical, and financial burden of lifelong management of HAE-C1INH in clinical practice.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":" ","pages":"92-101"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What to do when your adult patient with severe asthma does not respond to a biologic.","authors":"Dennis K Ledford","doi":"10.2500/aap.2026.47.260003","DOIUrl":"10.2500/aap.2026.47.260003","url":null,"abstract":"<p><p><b>Background:</b> Asthma management has been revolutionized by the introduction and expansion of biologic therapies. Since the approval of omalizumab for allergic asthma in 2003, six additional biologics with an asthma indication have been FDA-approved, and several more are in late-phase development. The clinical challenge is that all of these therapies reduce exacerbations, but asthma exacerbations are difficult to predict. A subgroup of 20-40% of biologic-treated patients will achieve asthma remission, or near remission depending on the criteria used, during biologic therapy, an ideal outcome. For the remaining 60-80% of treated patients, the benefits are evident but usually less defined or quantifiable. Symptoms often improve, but patient-reported outcomes lack precision to verify efficacy. All biologic therapies reduce exacerbations by an average of 50%; they do not eliminate exacerbations for most patients. In long-term, unblinded, safety trials, the majority of treated subjects have zero to one exacerbation per year. Thus, for an individual patient, assessing response and predicting response can be problematic, and strategies for addressing suboptimal responses are not standardized. <b>Methods:</b> This article summarizes a potential approach to use when biologic therapy in adults with asthma is, or appears to be, insufficiently effective. <b>Results:</b> The major points are: 1) set expectations prior to therapy to facilitate decision making and do not expect remission or near remission depending on criteria used; 2) reassess the source of symptoms and findings with the possibility that the asthma diagnosis is not accurate or co-morbidities are the major contributors to the clinical presentation; 3) evaluate adherence with both small molecule therapy (i.e. inhaled controller therapy) and with the biologic regimen if administered in-home; 4) change the biologic to an alternative biologic, generally affecting a different pathway. <b>Conclusions:</b> This strategy is not a guarantee of success but may assist in clinical decision-making.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 2","pages":"78-84"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}