Clinical Reviews in Allergy & Immunology最新文献

Diseases associated with hypersensitivity reactions (HRs) are extremely common and can affect the quality of life of millions of people, sometimes with life-threatening severity. In order to diagnose, treat, cure, or potentially prevent these diseases, clinicians and scientists need a better understanding of the entire immune process, from its initiation through the central mechanism to the effector phase. A new classification is needed, primarily because earlier classifications defined HRs almost exclusively by their effector mechanisms. However, outstanding achievements in immunological science over the past decades have revealed the critical, decision-making roles of initiation and central mechanisms in shaping the well-known effector phases. In addition, a crucially important group of HRs consists of small-molecule drug-induced reactions, which include both immunological and non-immunological pharmacological processes; therefore, the incorporation of these entities represents a key aspect of the revised classification. This review article provides a historical overview of the evolution of the main HR classifications, and proposes a new, expanded classification that (a) considers the initiation, central, and effector phases of HRs as interconnected, equally important processes; (b) highlights the role of peripheral barrier tissues in the breakdown of tolerance, thereby contributing to the development of HRs, and (c) distinguishes between classic and non-classic HRs (e.g., pharmacological interaction with immune receptors [p-i] reactions and pseudoallergies). Adoption of this new classification may expand the possibilities for developing preventive and causal therapies and help physicians appropriately interpret and thus effectively treat the heterogeneous phenotypes of hypersensitivity diseases.

Plant food allergy (FA) is a major global health problem, being peanut one of the most studied allergenic foods worldwide. Biomarkers (Bms) are essential tools for precision medicine, guiding diagnosis, risk stratification, and treatment. However, evidence on their clinical applicability in plant FA remains limited and fragmented. Therefore, we aim to systematically review the Bms identified in plant FA related to several aspects of the pathology. This systematic review was performed in accordance with the PRISMA guidelines. A comprehensive search was conducted in three databases (PubMed, Web of Sciences and Cochrane Library) between July 2019 and July 2024. Articles were screened using predefined inclusion and exclusion criteria, and categorized into five thematic sections: sensitization, tolerance, threshold, severity and follow-up treatment. Risk-of-bias and certainty of evidence were assessed using validated tools and the GRADE approach. From the 733 articles found, 71 studies met inclusion criteria and were selected for data extraction. A majority of them were high-quality publications and predominantly involved pediatric cohorts from Europe and North America. Peanut was the most studied food, followed by nuts and wheat, while fruits and seeds were rarely represented. Across all sections, most of the studies were related to severity and tolerance. Specific IgE to whole extracts or molecular components were the most frequent Bms, followed by skin prick test. Emerging Bms were identified, although they remain in early validation stages. Risk-of-bias and certainty of evidence were primarily moderate, reflecting the exploratory nature of most of the included studies. This review highlights the predominance of classical Bms and the promise of novel candidates for future clinical integration. However, research remains allergen-, age- and region-restricted, underscoring the need for multicenter studies, representative patient samples, and validation of emerging Bms to achieve globally applicable precision medicine in plant FA.

Autoimmune hepatitis (AIH) is typically a chronic, inflammatory, and progressive liver disease of autoimmune origin. Currently, two recognized types are identified in clinical practice: type 1 and type 2. The disease can occur in all geographic regions and racial/ethnic groups worldwide, but shows marked variations. This pattern reflects a complex interplay between genetic factors and environmental triggers. In this review, we aim to examine the geoepidemiological features of AIH and explore how these features relate to its etiopathogenesis, providing an integrated analysis of this complex condition. Our work may shed light on the initiation and progression of AIH, as well as its treatment and prevention.

Airway remodeling, a hallmark of asthma, involves structural and functional changes in the airways including extracellular matrix (ECM) deposition, airway smooth muscle (ASM) cell hypertrophy and hyperplasia, epithelial and fibroblasts remodeling, and mitochondrial dysfunction driven by chronic inflammation. The aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor commonly known for mediating xenobiotic responses, has recently emerged as a key regulator of cellular processes implicated in airway remodeling. This review explores the multifaceted role of AhR in modulating proliferation, migration, ECM remodeling, contraction, and mitochondrial homeostasis across various airway structural cell types. Based on recent studies, we highlight how AhR exerts anti-proliferative effects in ASM, epithelial, and fibroblasts, modulates calcium signaling to influence contraction, and regulates ECM turnover via transforming growth factor-β and matrix metallopeptidase pathways. Additionally, the dual, ligand- and context-dependent nature of AhR activation is emphasized, with both protective and detrimental outcomes observed depending on the specific agonist and disease conditions. Collectively, this review underscores the therapeutic potential of targeting AhR in airway remodeling.

Advances in the understanding of atopic dermatitis (AD) pathogenesis have driven the development of innovative systemic therapies targeting key immunologic pathways. This systematic review summarizes current evidence on the impact of biologic agents, Janus kinase (JAK) inhibitors, and other emerging treatments on AD-related biomarkers and their correlation with clinical outcomes. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published between 2014 and 2024. Eighty studies met the inclusion criteria. Dupilumab was the most extensively investigated therapy, followed by tralokinumab, JAK inhibitors, and novel agents such as amlitelimab, stapokibart, and tezepelumab. Across drug classes, consistent reductions in CCL17/TARC, LDH, and total IgE levels were observed, generally paralleling clinical improvement in EASI and SCORAD scores. Transcriptomic and proteomic analyses revealed normalization of Th2/Th22 inflammatory signatures and restoration of barrier-related gene expression, while microbiome studies showed a reduction in Staphylococcus aureus colonization. Despite these advances, the heterogeneity of study designs and analytical techniques limits the comparability of results. CCL17 and LDH currently represent the most reliable biomarkers associated with disease severity and treatment response, although their limited specificity restricts clinical applicability. Future research should aim to validate integrated biomarker panels combining immunologic, transcriptomic, and microbiomic data to enable precision medicine approaches in atopic dermatitis management.