Allergy and asthma proceedings最新文献

{"title":"Food allergy, biologic therapies, and diagnostic precision: Expanding frontiers in allergy and immunology.","authors":"Joseph A Bellanti, Russell A Settipane","doi":"10.2500/aap.2026.47.260047","DOIUrl":"10.2500/aap.2026.47.260047","url":null,"abstract":"","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"233-236"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315358","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":"Safety of dupilumab use during pregnancy: A composite evaluation of pregnancy outcomes.","authors":"Frank L Ventura, Steven B Clayton","doi":"10.2500/aap.2026.47.260026","DOIUrl":"10.2500/aap.2026.47.260026","url":null,"abstract":"<p><p><b>Background:</b> Dupilumab is a monoclonal antibody that targets interleukin 4 and interleukin 13 pathways, increasingly used to treat asthma, eczema, and eosinophilic esophagitis (EoE). Currently, there is minimum literature that evaluated the safety of dupilumab during pregnancy. <b>Objective:</b> This study assessed whether dupilumab use is associated with increased pregnancy complications. <b>Methods:</b> We conducted a multicenter, retrospective study of pregnant patients exposed to dupilumab between 2017 and 2024 compared with age- and comorbidity-matched controls who were not receiving biologic therapy. The primary outcome was the composite rate of any pregnancy-related complication, analyzed <i>via</i> multivariate logistical regression. The data were analyzed both with no covariates and with four covariates (adjusted for age, race/ethnicity, hypertension, and parity). Statistical analyses were conducted by using statistical software, with a two-sided α level of 0.05 considered statistically significant. Secondary outcomes investigated complication rates by subgroups (maternal, labor, and fetal complications). Subgroup data were analyzed via the Wald test. <b>Results:</b> Of the 301 patients identified with both dupilumab exposure and a pregnancy classification of diseases code, 69 unique pregnancies met inclusion criteria for confirmed dupilumab exposure during pregnancy. Several patients carried more than one type 2 inflammatory diagnosis; therefore, diagnosis counts exceed the total number of patients. Among these 69 pregnancies, 39 involved asthma, 37 atopic dermatitis, and 3 EoE, with overlap across diagnoses. There was no significant difference in overall complication rates between the study and control groups (69.6% versus 65.2%; p = 0.5861). This held true in the adjusted model (n = 129) (odds ratio 1.131 [95% confidence interval, 0.505-2.533]; p = 0.7650). No significant differences were noted in the subgroups. The most prominent complications were gestational diabetes, gestational hypertension, preeclampsia, unplanned caesarean sections, and spontaneous abortion (SAB). Although SAB trended toward a higher frequency in the dupilumab group compared with the controls (14.0% versus 5.8%; p = 0.164), it remained within the expected general population rates (10-15%). <b>Conclusion:</b> Dupilumab exposure during pregnancy was not associated with an increased risk of pregnancy complications. These findings support the relative safety of dupilumab in pregnancy and provide reassurance to clinicians managing asthma, eczema, or EoE. Larger prospective studies are needed to confirm these results and assess long-term maternal and neonatal outcomes.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"291-296"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148314905","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":"Key factors in the diagnosis of sesame allergy in children.","authors":"Aymen Hismiogullari, Ozlem Sancakli, Melike Ocak, Soner Gunder, Berna Uzunoglu, Figen Celebi Celik, Canan Sule Karkiner, Demet Can","doi":"10.2500/aap.2026.47.260041","DOIUrl":"10.2500/aap.2026.47.260041","url":null,"abstract":"<p><p><b>Background:</b> Sesame allergy (SA) is diagnostically challenging in childhood, and data on its natural course and clinical nonreactivity development are limited. Although oral food challenge (OFC) remains the diagnostic criterion standard, the value of skin-prick tests (SPT) and sesame specific immunoglobulin E (sIgE) in diagnosis and clinical nonreactivity prediction is unclear. <b>Objective:</b> The objective was to assess the diagnostic accuracy of tahini SPT and sesame sIgE, and to determine the frequency of clinical nonreactivity and identify clinical and laboratory factors associated with clinical nonreactivity development in children undergoing tahini-based OFC. <b>Methods:</b> In this retrospective diagnostic accuracy study, 49 children with suspected SA were included. All participants underwent open tahini-based OFC. The diagnostic performance of tahini SPT and sesame sIgE was assessed by using receiver operating characteristic curve analysis. <b>Results:</b> Of the 49 children included in the study, 21 (42.9%) had a positive tahini-based OFC result. A tahini SPT demonstrated higher predictive performance for OFC positivity compared with sesame sIgE. An optimal cutoff value of 7.5 mm for a tahini SPT result yielded a sensitivity of 81% and a specificity of 85.7%. In contrast, sesame sIgE at a cutoff value of 2.60 kU/L demonstrated lower sensitivity (66.7%) and specificity (82.1%) for predicting OFC outcomes. The sesame sIgE to total IgE ratio was also significantly higher in patients with a positive outcome of OFC (p = 0.049). Patients with a negative outcome of OFC were significantly younger than those with a reactive outcome (p = 0.003). Atopic dermatitis was more prevalent in the negative outcome of the OFC group (p = 0.038), whereas a history of anaphylaxis was not associated with OFC outcomes (p = 0.084). <b>Conclusion:</b> Tahini SPT showed a trend toward better diagnostic performance than did sesame sIgE in predicting clinical reactivity in pediatric SA, although the difference did not reach statistical significance. Younger age and the presence of atopic dermatitis seemed to be associated with a higher likelihood of a negative OFC outcome. However, these findings should be interpreted with caution due to the retrospective design, limited sample size, and single-center setting. Further prospective studies are needed to confirm these observations.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"274-281"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315268","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":"Correlation of disease activity (Urticaria Activity Score over 7 Days) and quality of life (Chronic Urticaria Quality of Life Questionnaire) in patients with chronic spontaneous urticaria: A prospective observational study.","authors":"Mahashweta Dash, Afreen Ayub, Biju Vasudevan, Aradhana Sood","doi":"10.2500/aap.2026.47.260027","DOIUrl":"10.2500/aap.2026.47.260027","url":null,"abstract":"<p><p><b>Background:</b> Chronic spontaneous urticaria (CSU) significantly impairs patient quality of life (QoL) through recurrent wheals and pruritus. The urticaria activity score over 7 days (UAS7) and the chronic urticaria quality of life questionnaire (CU-Q2oL) are validated patient-reported outcome measures recommended by international guidelines for monitoring CSU. Whether these two measures track in parallel over a structured treatment course, particularly as disease activity diminishes, remains incompletely characterized, especially in South Asian populations. <b>Methods:</b> A 6-month prospective observational study was conducted at a tertiary-care dermatology center in India. Fifty adult patients with active CSU were enrolled. All received second-generation H1-antihistamines (cetirizine, levocetirizine, or fexofenadine) with dose up-titration up to fourfold as needed per international urticaria guideline recommendations guideline recommendations. No patients required omalizumab during the study period. The UAS7 and CU-Q2oL scores were recorded at baseline and monthly for 6 months. Baseline total serum immunoglobulin E (IgE) values and absolute eosinophil counts (AEC) were correlated with the clinical scores. Statistical analysis included Wilcoxon signed rank tests for longitudinal change and the Spearman rank correlation at each time point. The sample size was based on clinical feasibility; the study is considered exploratory. <b>Results:</b> The mean ± standard deviation baseline UAS7 score was 30.3 ± 9.1 (severe disease), and the mean ± standard deviation CU-Q2oL score was 51.4 ± 13.2. Both scores improved significantly by 6 months (UAS7 score: 5.1; CU-Q2oL score: 12.5; p < 0.0001 for both). The UAS7-CU-Q2oL correlation was moderate when the disease was active (Spearman r = 0.44, p = 0.002 at 1 month) but weakened substantially as disease activity declined (r ≈ 0.25, p = 0.08 at 3 months; r ≈ 0.08, p > 0.5 at 6 months). Baseline total IgE value and AEC did not correlate with disease severity or QoL at any time point. <b>Conclusion:</b> UAS7 and CU-Q2oL scores correlate during active CSU but diverge as disease is controlled. Even after symptom resolution, some patients retain residual QoL impairment. Routine use of both measures is recommended because UAS7 alone may underestimate the patient burden during remission. The total IgE value and AEC are not reliable surrogate markers of CSU severity or QoL in this exploratory cohort.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"e57-e64"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315278","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 impact of dietary patterns on the risk of asthma in children.","authors":"Lihui Liu, Yuxin Bai, Yanyan Huang, Jiaying Chen, Ruonan Su, Caihong Liu, Mengsi Zou, Wei Feng","doi":"10.2500/aap.2026.47.260017","DOIUrl":"10.2500/aap.2026.47.260017","url":null,"abstract":"<p><p><b>Background:</b> Previous research has predominantly focused on the relationship between individual nutrients and asthma. However, diet involves complex interactions among its various components. Dietary pattern analysis can more accurately reflect the impact of overall diet on disease. <b>Methods:</b> Based on the 2011-2020 National Health and Nutrition Examination Survey data base, this study included 7216 children ages 3-17 years. Principal component analysis was used to extract dietary features, and K-means clustering was used to identify typical dietary patterns. Multivariate weighted logistic regression was used to analyze the association between dietary patterns and the risk of asthma. Subgroup analyses were also conducted. Furthermore, ordinal logistic regression was used to explore the relationship between dietary patterns and asthma exacerbation levels. <b>Results:</b> Two primary dietary patterns were identified: a \"refined high red meat and high sugar diet pattern\" (characterized by high intake of refined grains, red meat, processed meats, solid fats, and added sugars) and a \"fruits and vegetables enrichment-balanced diet pattern\" (characterized by a balanced diet with adequate intake of fruits and vegetables). After adjusting for covariates, children who followed the refined high red meat and high sugar diet pattern had a 15% higher risk of asthma compared with those who followed the fruits and vegetables enrichment-balanced diet pattern (odds ratio [OR] 1.15; p = 0.04). Notably, in the 3-5-year-old subgroup, the fruits and vegetables enrichment-balanced diet pattern was associated with a 54% reduction in asthma risk (OR 0.46). However, no significant association was found between dietary patterns and asthma exacerbation severity levels (p > 0.05). <b>Conclusion:</b> The refined high red meat and high sugar diet pattern is a modifiable risk factor for childhood asthma, whereas the fruits and vegetables enrichment-balanced diet pattern seems to have a protective effect. Early childhood (ages 3-5 years) may be a critical period for dietary intervention. Analysis of these findings suggests that modifying dietary patterns could be an important strategy for the primary prevention of childhood asthma.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"e65-e72"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315103","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":"34-year-old female with cyclical abdominal pain and rash.","authors":"Janet Luu, Lily Tsai, Manisha Kumar, Andrew White","doi":"10.2500/aap.2026.47.260032","DOIUrl":"10.2500/aap.2026.47.260032","url":null,"abstract":"<p><p>A 34-year-old woman presented with recurrent, severe abdominal pain accompanied by nausea, vomiting, and rashes. A careful history revealed a cyclical monthly pattern of symptoms. Through a multidisciplinary approach, hormonal modulation led to symptom resolution. This case highlights the importance of recognizing a rare diagnosis characterized by cyclical cutaneous and systemic symptoms in women of reproductive age.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"309-311"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315292","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":"Social context factors and disparities in emergency department use in pediatric food allergy.","authors":"Cynthia A Esteban, Grace K Cushman, Saksham Chandra, Matthew M Scarpaci, Tao Zheng, David Barker, Elizabeth L Mcquaid","doi":"10.2500/aap.2026.47.260030","DOIUrl":"10.2500/aap.2026.47.260030","url":null,"abstract":"<p><p><b>Background:</b> Although disparities in food allergy (FA) related emergency department (ED) use exist, social context factors are understudied and may play an important role. <b>Objective:</b> We sought to evaluate the role of food security and community resources in explaining disparities in FA-related ED usage. <b>Methods:</b> Electronic medical record data from Hasbro Children's Hospital's FA clinic were extracted from January 1, 2016, to December 31, 2021, for children ages < 18 years. Diagnostic classification codes and chart reviews were used to identify encounters with immunoglobulin E (IgE) mediated FA-related diagnoses. We evaluated the differences in FA-related ED use by age, race and/or ethnicity, community resources (Child Opportunity Index [COI]), and the percentage of households in the census tract that receive Supplemental Nutrition Assistance Program (SNAP) benefits. Logistic regression was performed to identify predictors of FA-related ED use. <b>Results:</b> A total of 1,512 children were seen at the FA clinic for IgE-mediated FA. Those who used the ED for FA were non-Latino White (NLW) (16.1%), Black (22.0%), Latino (23.1%), and Other (23.5%) (standardized mean difference [SMD], 0.10; p < 0.05). The risk of FA-related ED visits differed by age, with fewer visits for older children (odds ratio [OR], 0.7), and by social economic and neighborhood environment variables, with a lower risk of ED visits for more resourced environments (ORs for public insurance, 1.57; OR for SNAP, 1.19; and OR for COI, 0.80). Disparities in ED usage became negligible for patients already connected to routine allergist care, which demonstrated a potential protective factor. <b>Conclusion:</b> Black and Latino children have an increased risk for FA-related ED visits compared with NLW children, although social contextual factors explained most of the disparities. Analysis of the findings demonstrates the need to consider the social economic and neighborhood environment in FA management to inform place-based interventions.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"253-263"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148314889","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":"Local anesthetic hypersensitivity: Frequently suspected, rarely proven: A retrospective study of 101 patients.","authors":"Zuleyha Galata, Ozlem Limoncu, Ceyda Tunakan Dalgıc, Reyhan Gumusburun, Nihal Mete Gokmen, Ali Kokuludag, Aytul Zerrin Sin","doi":"10.2500/aap.2026.47.260038","DOIUrl":"10.2500/aap.2026.47.260038","url":null,"abstract":"<p><p><b>Introduction:</b> Local anesthetics (LAs) are commonly used to provide regional insensitivity in dentistry, minor surgical procedures, and general anesthesia but may rarely cause allergic reactions. <b>Methods:</b> The file data of 101 patients who were referred to the Department of Allergy and Immunology, Ege University Faculty of Medicine, with a suspected LA allergy between February 2020 and August 2024 were retrospectively reviewed. Patients included in the study were contacted by phone and asked whether they had used LAs after the test and whether any reactions had developed. <b>Results:</b> Female patients comprised 81% (n = 82) of the study cohort. Patients were predominantly referred from the departments of dentistry (45% [n = 46]) and anesthesiology (22% [n = 22]). Patients were referred due to reactions related to LAs alone (n = 51) and both LAs and other drugs (n = 50). The severity of LA reactions was mild (n = 47), moderate (n = 36), or severe (n = 18), with dyspnea being the most common symptom (n = 47). Prick-intradermal (P-ID) and provocation tests were performed on all the patients (suspected LAs [n = 32], alternative LAs [n = 23], random [n = 46]). Only one patient tested positive in the P-ID test, and a provocation test was performed on this patient with an alternative agent, with a negative result. Of the 80 patients reached by phone, 41 received LAs based on test results and did not develop an allergic reaction, whereas the other 39 patients did not receive LAs. <b>Conclusion:</b> Immunologically mediated reactions to LAs were exceedingly rare in this study. These findings highlight that most suspected reactions are not attributable to confirmed allergic mechanisms and underscore the importance of a careful clinical history and guideline-based evaluation to avoid unnecessary drug avoidance.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"297-303"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315323","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":"Patterns of epinephrine prescribing at discharge and length of stay for adult anaphylaxis in U.S. emergency departments.","authors":"Esther Y Liu, Cancan Zhang, Trisha Ray, Kari C Nadeau, Laura Valenzuela-Vallejo, Kadija Salifu, Elizabeth J Samelson, Kenneth J Mukamal","doi":"10.2500/aap.2026.47.260039","DOIUrl":"10.2500/aap.2026.47.260039","url":null,"abstract":"<p><p><b>Background:</b> Anaphylaxis is a life-threatening allergic reaction that requires prompt epinephrine and post-treatment management. Guidelines recommend prescribing epinephrine at discharge from the emergency department (ED), yet results of studies show lower-than-recommended prescribing rates and variable ED lengths of stay (LOS). Large-scale analyses of adult anaphylaxis care in U.S. EDs remain limited. <b>Objective:</b> The objective was to estimate the proportion of adults discharged from U.S. EDs with an epinephrine prescription, characterize ED LOS, and identify predictors of these outcomes. <b>Methods:</b> We analyzed 2013-2015 and 2018-2022 National Hospital Ambulatory Medical Care Survey-ED visits for adults ages ≥ 18 years diagnosed with anaphylaxis who were discharged home. Outcomes were (1) epinephrine prescription at discharge and (2) ED LOS < 4 hours. Patients who arrived by emergency medical services (EMS) were excluded for LOS analysis. Multivariable log-binomial regression estimated risk ratios (RR) between outcomes and clinical predictors. <b>Results:</b> Among 609 ED visits, 14% resulted in an epinephrine prescription at discharge (95% confidence interval [CI], 10%-18%). The median (interquartile range) LOS was 138 minutes (80-199 minutes), with 83% discharged within 4 hours (95% CI, 78%-87%). Older adults (≥42 years) and Hispanic patients were less likely to receive an epinephrine prescription (RR 0.47 [95% CI, 0.25-0.90]; RR 0.34 [95% CI, 0.12-0.95], respectively). Rural visits were more likely to have LOS < 4 hours (RR 1.12 [95% CI, 1.02-1.23]). <b>Conclusion:</b> Epinephrine prescribing at discharge was infrequent across the full cohort, whereas ED LOS was typically brief among the patients who did not arrive by EMS. Older adults and Hispanic patients were less likely to receive epinephrine, and rural visits had shorter LOS. These findings highlight potential disparities in discharge prescribing and ED management of adult anaphylaxis in U.S. EDs.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"264-273"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315328","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":"Predictors of delayed treatment-free remission with omalizumab in chronic spontaneous urticaria.","authors":"Sukran Aslan Savas, Fatih Colkesen, Mehmet Emin Gerek, Ummugulsum Yilmaz Ergun, Emrah Harman, Secim Kolak, Ferhat Sagun, Ismail Yigitdol, Sevket Arslan","doi":"10.2500/aap.2026.47.260037","DOIUrl":"10.2500/aap.2026.47.260037","url":null,"abstract":"<p><p><b>Background:</b> Reliable biomarkers that predict delayed treatment-free remission with omalizumab in chronic spontaneous urticaria (CSU) remain unclear. <b>Objective:</b> The objective was to identify independent predictors of delayed treatment-free remission with omalizumab by comparing patients who achieved treatment-free remission with ≤ 12 doses with those who required > 12 doses. <b>Methods:</b> This single-center retrospective study included 163 adult patients with antihistamine-refractory CSU who were treated with omalizumab (300 mg every 4 weeks) between January 2018 and October 2025. Treatment discontinuation was considered only after at least six consecutive doses and complete disease control, defined as a urticaria control test (UCT) score of 16 with no wheals or angioedema. Treatment-free remission was defined as a symptom-free period of at least 6 months without pharmacotherapy after discontinuation. Patients were classified as having early remission (≤12 doses) or delayed remission (>12 doses). Demographic, clinical, and laboratory variables were compared, and multivariable logistic regression was performed. <b>Results:</b> Of the 163 patients (median age, 41 years; 60.1% women), 99 (60.7%) had delayed remission and 64 (39.3%) had early remission. Delayed remission was associated with a higher prevalence of autoimmune disease in the delayed remission group than in the early remission group (27.3% versus 12.5%; p = 0.025) longer symptom duration before omalizumab initiation (p < 0.001), and higher baseline total immunoglobulin E (IgE) levels (p < 0.001). In multivariable analysis, longer pretreatment symptom duration (odds ratio [OR] 1.023 [95% confidence interval {CI}, 1.009-1.038]; p = 0.002) and autoimmune disease (OR 2.984 [95% CI, 1.130-7.882]; p = 0.027) independently predicted delayed remission, whereas the total IgE value did not (p = 0.070). <b>Conclusion:</b> Longer pretreatment symptom duration and coexisting autoimmune disease were the strongest independent predictors of delayed treatment-free remission with omalizumab in CSU.</p>","PeriodicalId":7646,"journal":{"name":"Allergy and asthma proceedings","volume":"47 4","pages":"282-290"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315364","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}