Current Opinion in Allergy and Clinical Immunology最新文献

Purpose of review: This review provides an updated overview of the association between chronic urticaria (CU) and autoinflammatory syndromes (AS), underlining the diagnostic and therapeutic implications of identifying CU as an initial manifestation of systemic autoinflammatory disorders.

Recent findings: emerging evidence has reinforced the role of innate immune dysregulation in the pathogenesis of CU associated with AS, with particular involvement of the pro-inflammatory cytokines such as interleukin (IL)-1β. Several monogenic and multifactorial autoinflammatory diseases, including cryopyrin-associated periodic syndromes (CAPS), Schnitzler syndrome (SchS), Still's disease (SD), and others, may present with CU. Neutrophilic urticarial dermatosis (NUD) has been recognized as a histopathological hallmark. Early diagnosis remains challenging but is crucial, as targeted therapies, especially IL-1 inhibitors, have demonstrated significant efficacy in controlling systemic inflammation and preventing disease progression.

Summary: CU refractory to conventional treatment, particularly when associated with systemic symptoms, should prompt suspicion of an underlying autoinflammatory syndrome. A comprehensive diagnostic approach, including clinical assessment, inflammatory markers evaluation, histopathological examination, and genetic testing, is essential. Recognition of the autoinflammatory nature of CU allows for timely initiation of personalized therapies, improving patient prognosis and reducing long-term morbidity.

Purpose of review: Among the various manifestations of perioperative hypersensitivity (POH), skin reactions are often the first and most visible signs of an allergic or hypersensitivity response to drugs, antiseptics, or other agents in the perioperative setting. This review aims to examine the range and significance of skin manifestations associated with POH reactions, particularly their diagnostic value and clinical presentation in the perioperative setting.

Recent findings: Cutaneous signs such as urticaria, angioedema, flushing, and erythema are common in POH and may present alone or alongside systemic symptoms. While these manifestations are frequently observed, they are not universally present, especially in life-threatening reactions like anaphylaxis. The timing, distribution, and morphology of these skin changes can provide diagnostic clues, although intraoperative factors like draping, lighting, and hypotension may hinder their identification. Cutaneous vasoconstriction signs such as pallor, piloerection, sweating, and cyanosis are strong indicators of life-threatening IgE-mediated allergic reactions compared to early vasodilation signs like erythema or urticaria.

Summary: Skin manifestations play a crucial role in the early recognition and management of POH, but their absence should not lead to false reassurance. A thorough understanding of these signs is essential for accurate diagnosis and safe management in the perioperative environment.

Purpose of review: Anterior ocular inflammatory surface diseases (AOISDs), including dry eye disease (DED), allergic conjunctivitis (AC), and infectious conjunctivitis (IC), are highly prevalent, but frequently underdiagnosed. This review examined the current landscape of AOISD diagnostics, emphasizing emerging technologies, diagnostic disparities, and implementation challenges across global health systems.

Recent findings: While conventional diagnosis relies heavily on clinical judgment, newer approaches - such as tear-based biomarkers (e.g., tear IgE, MMP-9), artificial intelligence (AI)-assisted imaging, and telemedicine - offer improved diagnostic precision. Despite their promise, their clinical application faces barriers to adoption, including limited cost-effectiveness data, a lack of reimbursement, and insufficient integration into primary care. Diagnostic capacity remains particularly constrained in low-resource settings owing to workforce shortages and equipment limitations. Public awareness and patient education also affect care-seeking behaviors and appropriate treatment use.

Summary: AOISD diagnostics are evolving, but many remain inaccessible due to systemic, economic, and infrastructural barriers. Future progress depends on policy integration, cross-sector collaboration, and the context-specific implementation of diagnostic innovations. Strengthening primary care engagement and aligning investments with the disease burden will be critical to advancing equitable AOISD detection and improving patient outcomes globally.

Purpose of review: Anaphylaxis in elderly is a little-known topic, despite the worldwide growth of this part of the population. In this review, the main elicitors are discussed, with a particular regard for risk factors, clinical manifestation and management of anaphylaxis in people over 65 years of age.

Recent findings: Available data report age-dependent differences regarding elicitors, cofactors and symptoms of anaphylaxis. In the last years, few studies have focused on anaphylaxis in the elderly, highlighting drugs and insect venom as main triggers.

Summary: Drugs and insect venom represent the main triggers of anaphylaxis in individuals over 65 years of age. In addition, idiopathic anaphylaxis is seen more frequently in adults and older adults, and recent studies show an increasing rate of food-related anaphylaxis in this population.Elderly patients are at a greater risk of severe or fatal reactions because they often have multiple comorbidities requiring the concomitant use of several drugs. This may complicate anaphylaxis management, leading to poor outcomes, increased hospitalization and higher admission to intensive care unit.The clinical presentation of anaphylaxis in older adults is most often characterized by cardiovascular symptoms, with syncope as the most frequent one.The injection of adrenaline is the most important treatment of anaphylaxis at any age, and no absolute contraindications are reported. Despite this, its use still remains suboptimal.

Purpose of review: Atopic dermatitis (AD) is a chronic inflammatory skin disease involving Th2 cytokine-driven inflammation. AD patients are at risk of developing conjunctivitis, including atopic keratoconjunctivitis (AKC), a sight-threatening chronic allergic eye disease involving both Th2 and Th1/17 cytokine-driven inflammation.In AD, dupilumab is highly effective by inhibiting interleukin (IL)-4 and IL-13. However, some AD patients develop dupilumab-associated ocular surface disease (DAOSD), an AKC-like disease. There are no biomarkers to predict who will develop DAOSD. The purpose of this review is to highlight recent findings in AD and AKC suggesting different immunopathogenic mechanisms are involved.

Recent findings: A recent proteomics study of tear fluids identified raised inflammatory markers ( n  = 31) in AD patients with DAOSD ( n  = 22) and a shift towards a Th1/17 profile. Alternative biologics have been investigated for treating moderate-to-severe AD which have fewer ocular side-effects. The inhibitory effects of dupilumab cause an associated upregulation of IL-33 which could lead to an AKC-like disease. A recent therapeutic approach in AD via regulatory T cells suggests a novel treatment for those at risk of DAOSD.

Summary: Ocular side-effects of dupilumab suggest that the immunopathogenic pathways in moderate-to-severe AD and AKC are not the same and, for DAOSD, might require different treatment approaches.

Purpose of review: The rising incidence of anaphylaxis and reports of cases unresponsive to standard epinephrine treatment highlight the relevance of refractory anaphylaxis. There is a lack of standardized management protocols, and clinicians across specialties need guidance to handle this rare but life-threatening condition.

Recent findings: There is a lack of a universally accepted definition, with most studies describing it as anaphylaxis unresponsive to several doses of intramuscular epinephrine. It emphasizes the pathophysiological complexity, including potential mechanisms like delayed epinephrine absorption, atypical mediator release, or underlying comorbidities. Management relies on recommendations ranging from intravenous epinephrine to adjunctive treatments. We call attention to gaps in clinical guidelines and research, advocating for more data on incidence, risk factors, and effective interventions, especially in emergency settings.

Summary: There is a need for clear protocols to help recognize and manage cases of refractory anaphylaxis. This includes awareness of when to escalate care, use intravenous epinephrine or adjunctive agents. For research, the variability in definitions and treatment approaches points to the need for standardized diagnostic criteria and prospective studies to better understand risk factors, outcomes, and optimal management strategies. Additionally, there is a strong case for exploring biomarkers and therapies that may improve early identification and treatment of high-risk cases.

Purpose of review: This review explores the shared immunologic mechanisms and clinical distinctions between seasonal and perennial allergic rhinitis (SAR, PAR) and their ocular counterparts, seasonal and perennial allergic conjunctivitis (SAC, PAC). These IgE-mediated diseases often coexist, reflecting overlapping triggers, mast cell activation, and mucosal immune responses. By comparing their epidemiology, pathophysiology, genetics, and treatments, this review highlights how nasal and ocular allergic pathways intersect and diverge.

Recent findings: SAC and SAR frequently co-occur, with up to 71% of SAR patients reporting conjunctival symptoms and 75% of SAC patients experiencing rhinitis; in children, 42% with allergic rhinitis also have PAC. Recent studies suggest possible shared genetic and metabolic contributors across these conditions. Therapeutically, oral and intranasal antihistamines remain a mainstay for SAR, while combination intranasal corticosteroid-antihistamine regimens offer enhanced control in PAR. Topical dual-action antihistamine-mast cell stabilizers are commonly used in SAC and serve as first-line therapy for PAC. Novel ocular delivery systems, such as dexamethasone intracanalicular inserts, show promise for PAC.

Summary: These findings emphasize the overlap in episodic and chronic nasal and ocular allergies, with shared mechanisms, genetics, and treatment approaches, yet with site-specific nuances. Ongoing research into genetic and therapeutic differentiation remains crucial to advancing personalized allergy care.

Purpose of review: Dry eye disease (DED), allergic conjunctivitis (AC), and infectious conjunctivitis (IC) are anterior ocular inflammatory surface diseases (AOISD) that remain overlooked, particularly in low-resource settings. This review explores the policy and health system factors driving inequities in AOISD diagnosis and highlights strategic pathways for scaling up access through global public health integration.

Recent findings: While diagnostic innovations such as tear-based biomarkers, artificial intelligence (AI) tools, and teleophthalmology platforms offer promising solutions, implementation remains hindered by cost, workforce limitations, and fragmented infrastructure. Epidemiological data gaps persist, particularly in Africa and Europe. Emerging evidence supports the cost-effectiveness of integrated diagnostics, task-shifting strategies, and multisectoral partnerships, including national programs and non-governmental organization-led initiatives, to expand diagnostic capacity.

Summary: Advancing AOISD diagnosis requires a coordinated approach that bridges innovation and policy. Integrating AOISDs into broader global eye health strategies, strengthening primary care systems, and aligning diagnostics with public health goals is essential to ensure equitable care. Public-private partnerships, investment in workforce training, and targeted education campaigns will be central to closing diagnostic gaps sustainably.

Purpose of review: Pathogenesis of severe cutaneous adverse reaction (SCAR) including Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) has been identified by recent studies. This review provides recent understanding of pathomechanisms of SCAR and how to manage the patients with SCAR.

Recent findings: Recent studies, including single-cell data, identified key signaling pathways and immune phenotypes in SCAR. These studies have highlighted potential treatments, such as TNF-α inhibitors and JAK inhibitors. Moreover, severity score of DIHS/DRESS and many biomarkers for SCAR are provided.

Summary: The pathogenesis of SCAR remains unclear, and most effective therapeutic strategy has not yet been established. However, the pathogenesis of keratinocyte cell death in SJS/TEN, which is the most critical phenomenon, has been established. The difference of immune profile between early and late stage have been suggested in DIHS/DRESS. Although new therapeutic options have been identified by resent studies, there is a lack of trial data for the efficiency of them. Further trials and studies of SCAR is expected to lead to the development of general effective treatment options for SCAR.