Current Opinion in Allergy and Clinical Immunology最新文献

Purpose of review: Air travel has now returned to prepandemic levels, with over 10.5 billion passengers in 2024. Many of these passengers have food allergies, and there is a perception that allergic reactions are common during commercial flights.

Recent findings: A recent systematic review and meta-analysis reported an incidence of in-flight medical events due to allergic reactions of 0.7 (95% CI 0.4-1.1) events per million passengers. For those with food allergies, the incidence of allergic reactions is around 10-100 times lower than that reported for reactions 'on the ground' - equivalent to one reaction per 3600 food-allergic passengers in any 1-year period. Reassuringly, there is no evidence that this rate had increased over the past 30 years, despite significant increases in both the prevalence of food allergy and passenger numbers.

Summary: Allergic reactions during commercial flights are uncommon; however, this is very likely to be confounded by the many precautions food-allergic passengers and their families take when flying. Nonetheless, the data confirm that flying can be safe for those with food allergies. While air travel continues to present numerous challenges to those with food allergy, this can be mitigated by consistent and helpful airline policies, which address the concerns of food-allergic individuals.

Purpose of review: Many new treatment options for chronic spontaneous urticaria have been clinically tested in recent years. This narrative review presents the current status of substances furthest along in development.

Recent findings: After decades in which only H1 antihistamines were available for treatment, omalizumab was approved as an add-on therapy in 2014. Meanwhile, the first omalizumab biosimilar, CT-P39, has been approved (EMA in March 2024, US FDA in March 2025). Moreover, dupilumab received approval in Japan since February 2024 and in the USA since April 2025. Following publication of two positive phase 3 trials, Remibrutinib was submitted for approval to the EMA and FDA in February 2025. Several anti-KIT mAbs are in clinical trials, the most advanced of which is barzolvolimab with two ongoing phase 3 trials. Ligelizumab, benralizumab and the MRGPRX2 antagonist EP-262 are not being further developed in the chronic spontaneous urticaria (CSU) indication.

Summary: The rapid increase in clinical trials in the field of CSU has already led to a significant improvement in treatment options beyond anti-IgE therapy with omalizumab in Japan and the USA, and further approvals of biologics and small molecules are expected shortly. It is expected that with a wider range of different approved therapeutic approaches, the treatment of CSU will have to be tailored to the urticaria subtype or patient profile in the future.

Purpose of review: Mast cell degranulation in anaphylaxis can result from both IgE-dependent and IgE-independent mechanisms. The two conditions differ in terms of phenotype, diagnosis and specific therapeutic targets.

Recent findings: Genetic factors and IgE-sialylation might enhance IgE-dependent degranulation. MRGPRX2-dependent signal might have a synergistic effect on IgE-dependent degranulation. The data on IgG-dependent anaphylaxis highlight the significance of histamine release from mast cells. Recent advances in the field have led to the development of novel targeting treatments for both IgE-dependent and IgE-independent mast cell degranulation.

Summary: In-vitro analysis of human mast cells offers the possibility of studying the mechanisms underlying mast cell degranulation in anaphylaxis. The implementation of this analysis in clinical practice can advance diagnosis. Moreover, mechanistic and preclinical studies support the development of targeted treatments for IgE-dependent and IgE-independent anaphylaxis.

Purpose of review: This review's objective is to give readers an update on recent and developing information about the function of the ocular surface microbiome in keratoconus.

Recent findings: The microbiome's function in the pathogenesis of keratoconus is supported by recent research. Numerous metabolites that are produced by the ocular surface bacteria can affect the host tissue. A shift in the microbiota may influence the composition of these metabolites, which could have an effect on keratoconus by altering the cornea's metabolic environment.

Summary: Gaining insight into the function of the ocular surface microbiota in keratoconus could open up new avenues for the creation of new therapeutic modalities.

Purpose of review: This review explores established risk factors for keratoconus and current insights into tear film immune biomarkers, with a focus on the role of chronic low-grade inflammation in disease pathogenesis and emerging targeted therapies.

Recent findings: Growing evidence supports immune dysregulation as a key driver in the onset and progression of keratoconus. Genetics establish a foundation for a dysregulated inflammatory response in the ocular surface and corneal microenvironment, which sustains and accelerates disease progression. Elevated tear levels of IL-1, IL-6, TNF-α, HMGB1, and MMP9 reflect these inflammatory changes. Chronic inflammation and repeated mechanical trauma from eye rubbing, especially in adolescents and young adults, are major risk factors for disease progression. Timely screening and regular corneal topography in adolescents with allergic or atopic disorders are essential for early diagnosis and prevention of vision loss.

Summary: The tear film and corneal microenvironment contain valuable immune markers that shed light on keratoconus pathophysiology. Advances in precision and predictive medicine hold promise for safer, more effective strategies to halt disease progression.

Purpose of review: Recurrences of anaphylaxis is a concern due to its unpredictability and long-term burden to patients and healthcare systems. This review examines recurrence rates, associated risk factors, and gaps in current knowledge to guide improved clinical management.

Recent findings: From 1240 initial records, 11 studies fulfilled the inclusion criteria of our systematic review. Recurrences of anaphylaxis rates range from 2.6 to 17.6% of patients after a first episode of anaphylaxis, with a rising trend over time. Personal history of food allergy is the most consistent associated risk factor, followed by the presence of atopic comorbidities such as asthma and atopic dermatitis. Other potential factors include socioeconomic deprivation, and seasonal variations. There is lack of evidence on contributing factors to volve to more severe episodes and on how etiology may change between episodes.

Summary: Recurrences of anaphylaxis is multifactorial, with personal history of food allergy and allergic comorbidities as primary risk factors. Inconsistencies across studies underscore the need for standardized research. Limited data on severity and etiology progression highlight areas for future investigation to improve long-term outcomes.

Purpose of review: Epinephrine is universally considered the standard of care for the treatment of severe allergic reactions, including anaphylaxis, and, until recently, was preferentially recommended to be given intramuscularly in the thigh. However, newer routes of administration have been studied, with the intranasal route recently approved by regulatory agencies.

Recent findings: Pharmacokinetic and pharmacodynamic studies suggest that noninjectable epinephrine routes (e.g., intranasal and sublingual) can achieve epinephrine levels on par with intramuscular administration via autoinjector.

Summary: With new routes of epinephrine delivery being studied and approved for use, a new frontier of anaphylaxis management is emerging. There is potential that these routes may change how epinephrine is administered and severe reactions, including anaphylaxis, are treated.

Purpose of review: This review compares the T-cell-mediated pathways of atopic dermatitis and atopic keratoconjunctivitis (AKC), as well as allergic asthma and vernal conjunctivitis (VKC).These chronic, T cell-mediated conditions frequently coexist and are unified by Th2-driven inflammation, epithelial barrier dysfunction, and tissue remodeling. By comparing their epidemiology, pathogenesis, genetic contributors, and therapeutic approaches, this review examines how skin, airway, and ocular allergic pathways intersect and diverge.

Recent findings: Barrier dysfunction and Th2-driven inflammation contribute to disease persistence across atopic dermatitis, AKC, allergic asthma, and VKC, with structural remodeling evident in chronic stages. In atopic dermatitis and allergic asthma, genetic studies implicate type 2 immune pathways, while in VKC, unfolded protein response genes are implicated; epigenetic changes, including DNA methylation and histone regulation, are emerging as shared contributors. Topical calcineurin inhibitors improve symptoms in both atopic dermatitis and AKC, though biologics like dupilumab may induce conjunctivitis in atopic dermatitis patients. Inhaled corticosteroids and anti-type 2 biologics remain mainstays for allergic asthma, while mast cell stabilizers and topical corticosteroids are used in VKC. New therapies, including JAK inhibitors and novel anti-inflammatory agents, offer additional options across these interconnected allergic diseases.

Summary: By highlighting immunologic convergence and divergence across these allergic conditions, this review underscores the importance of cross-specialty awareness and tailored treatments. Integrating ocular findings into broader allergy care may improve outcomes for patients with multicompartment involvement.

Purpose of review: Among patients with hymenoptera venom allergy (HVA), a high proportion have an underlying systemic mastocytosis. It is essential to identify them for an adequate management.

Recent findings: The clinical presentation of anaphylaxis after stinging -cardiovascular symptoms and absence of cutaneous- may point to a clonal mast cell disease (MCD). In addition, these patients usually have low mast cell burden, so highly sensitive techniques are needed to detect clonality.

Summary: It is important to recognize patients with HVA associated with a clonal MCD since the handling of immunotherapy and the duration of such treatment differs from the general population. Identifying these patients with predictive scores and providing the appropriate techniques to reach the diagnosis may avoid unnecessary studies. Moreover, patients with clonal MCDs, in addition to typical mast cell-mediator release symptomatology may have other complications, such as bone mass loss, that need to be treated.