Allergo Journal International最新文献

Background

Over the last 8 years, the treatment of atopic dermatitis (AD) has been revolutionized by the development and approval of novel systemic therapies. In addition to the biologics dupilumab, tralokinumab, lebrikizumab, and nemolizumab, the three Janus kinase inhibitors (JAKi) baricitinib, abrocitinib, and upadacitinib are now also available.

Methods and results

A selection of the most important publications on the approved JAKi for the systemic treatment of AD and their statements were used as the basis for this review.

Conclusion

Systemic JAKi have become established as a promising therapeutic option in the guidelines for the treatment of AD. They specifically block the JAK signaling pathways involved in the inflammatory response and provide rapid and effective relief of the inflammatory reaction as well as the symptoms such as itching and pain. Compared to the class of biologics, they have a broader effect on various cytokines. Despite very good efficacy, there are some safety concerns, which is why a careful risk–benefit assessment is required in accordance with European Medicines Agency recommendations.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and requires therapy that is individualized, yet also based on the current guidelines. This narrative review gives an update on the conventional therapy of AD depending on severity according to the German S3 guideline on AD. AD severity is graded as mild, moderate, and severe AD. Consequent topical basic therapy and avoidance of potential trigger factor is recommended for all patients. Basic therapy should be applied not only during a flare, but also to clear skin to prevent worsening; furthermore, mild/moderate eczema should receive anti-inflammatory therapy with topical corticosteroids/calcineurin inhibitors. Systemic therapy is indicated in moderate-to-severe AD with insufficient response to other measures, if applicable, also ultraviolet therapy. Systemic therapies are grouped into conventional and targeted therapies (biologics and Janus kinase inhibitors). Systemic corticosteroids should only be used as rescue therapy for 3 weeks maximum. Targeted therapies in AD have the highest recommendation grade for long-term therapy. Cyclosporin A (CsA), azathioprine (AZT), methotrexate (MTX), and mycophenolate mofetil (MMF) belong to the conventional steroid-sparing therapies. However, only CsA is licensed for AD. MTX should be and MMF might be considered for AD according to the German S3 guideline, while AZT may be considered in adults.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in industrialized countries and is characterized by heterogeneous (endo)phenotypes and a high disease burden. In Europe, four biologics and three oral Janus kinase (JAK) inhibitors are currently approved by the European Medicines Agency (EMA) for the treatment of moderate to severe AD in adolescents (≥ 12 years) and adults: dupilumab (anti-interleukin [IL]-4Rα; 2017), tralokinumab (anti-IL-13; 2021), lebrikizumab (anti-IL-13; 2023) and nemolizumab (anti-IL-31Rα; 2024) as well as the JAK inhibitors baricitinib (JAK 1/2; 2020), upadacitinib (JAK 1; 2021) and abrocitinib (JAK 1; 2022). Among the abovementioned therapies, baricitinib for moderate and severe AD from the second year of life and dupilumab for severe AD from the sixth month of life are already two approved systemic therapies for early childhood. This narrative review provides an update on the biologics currently approved for treatment of moderate and severe AD. It also provides a brief overview of monoclonal antibodies currently in phase III clinical trials and future issues and opportunities for immunomodulatory systemic therapies for AD.

Background

Aluminum hydroxide-adsorbed venom depot products are promoted for conventional build-up protocols and the maintenance phase of honeybee and Vespula venom immunotherapy (VIT) to improve treatment tolerability and support a sustained immune response. Published data regarding their off-label use during inpatient rush build-up of VIT are scarce.

Methods

During a recent supply shortage, an aluminum hydroxide-adsorbed depot product instead of the corresponding aqueous venom preparation was used for VIT build-up according to a standardized 3‑day rush protocol in 59 consecutive patients. Side effects during VIT build-up and subsequent transition to the maintenance phase of treatment were retrospectively evaluated.

Results

Local tolerability of the depot product was excellent; VIT-induced large local reactions exceeding 10 cm in diameter were documented in only 3 patients (5.1%). There was no indication of an increased rate of VIT-induced systemic reactions. One patient developing a moderately severe anaphylactic reaction on day 2 of honeybee VIT build-up promptly stabilized upon antiallergic treatment. No objective systemic reactions were observed during transition to outpatient VIT maintenance using the same depot product.

Conclusion

Due to their excellent local tolerability, depot preparations represent a promising option for VIT rush build-up.

This paper provides an overview of the various treatment options for food allergies, including the introduction of extensively heated foods, immunotherapies, food ladders, and pharmacological treatments.

Food allergies are associated with considerable psychosocial stress and restrictions in quality of life. While parents often report food allergies in their children, studies show that the perceived prevalence is often higher than the actual diagnosed prevalence. Epidemiological studies show an increasing prevalence worldwide, with significant regional differences. In Europe, self-reported prevalence varies widely, from less than 1% to over 10%, depending on region, age and foods analysed. In North America and Northern Europe, peanut and egg allergies are more common, while shellfish and fish allergies dominate in Asia. Environmental factors, ethnicity, genetic predisposition, dietary habits and socioeconomic conditions play a significant role in the development and distribution of food allergies. These factors must be taken into account when developing prevention and treatment strategies.

Purpose

Oral contact allergies (OCAs) are increasingly recognized in dental practice and commonly manifest as oral lichenoid reactions (OLRs), allergic contact stomatitis (ACS), and burning mouth syndrome (BMS). This narrative review aims to synthesize current knowledge on etiological factors, diagnostic challenges, and management strategies to enhance clinical guidance.

Methods

A comprehensive literature search was conducted across major medical and dental databases focusing on studies from 2000–2024 addressing OCAs related to dental materials, oral hygiene products, and food allergens. Emphasis was placed on clinical features, diagnostic methodologies—including patch testing and emerging biomarkers—and therapeutic approaches documented in recent literature.

Results

Common precipitants of OCAs include metals such as nickel, mercury, cobalt, and acrylates, with prevalence estimates ranging from 5 to 20%, predominantly affecting middle-aged women. Diagnosis primarily relies on clinical evaluation supported by patch testing, though emerging techniques such as salivary biomarkers and histopathological analyses show promise. Management centers on allergen avoidance and topical corticosteroids, with immunotherapy approaches such as sublingual immunotherapy (SLIT) gaining preliminary support despite a lack of comprehensive guidelines.

Conclusion

Enhanced detection and recognition of OCAs are critical to improving patient outcomes and quality of life. Dentists should incorporate OCAs into differential diagnoses for chronic oral mucosal disorders and remain informed about advances in diagnostics and therapeutics.