Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.anai.2025.11.014
Meera R. Gupta MD , Theresa A. Bingemann MD
{"title":"Who actually has asthma? The challenge of defining and diagnosing asthma","authors":"Meera R. Gupta MD , Theresa A. Bingemann MD","doi":"10.1016/j.anai.2025.11.014","DOIUrl":"10.1016/j.anai.2025.11.014","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 125-126"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-16DOI: 10.1016/j.anai.2025.11.007
Peter Olah PhD , Ulrike Raap MD , Bernhard Homey MD
Chronic pruritus is a debilitating symptom of several inflammatory skin conditions, presenting severe quality-of-life decreasing effects and major clinical challenges in terms of disease management. In the past decade, novel biological therapies have offered increasingly effective targeted interventions for the treatment of chronic pruritus, in which traditional approaches were often lacking or presented suboptimal safety profiles. However, recent advancements in the molecular characterization of sensory neuronal subsets helped to shed light on specific mechanisms of pruriception and thus have furthered our understanding of the peripheral nervous system and disease-relevant neuroimmune crosstalk. These developments have highlighted the targeting of interleukin-31, a major pruritus-associated cytokine, as a highly promising therapeutic target for chronic pruritus in inflammatory skin conditions. In this review, we therefore provide a focused overview of inflammatory conditions in which pruritus represents the major burden, the fundamental immune pathways, and sensory circuits involved, alongside the efficacies and safety profiles of novel therapies addressing chronic pruritus.
{"title":"Interleukin-31 targeting and other novel drugs in itch","authors":"Peter Olah PhD , Ulrike Raap MD , Bernhard Homey MD","doi":"10.1016/j.anai.2025.11.007","DOIUrl":"10.1016/j.anai.2025.11.007","url":null,"abstract":"<div><div>Chronic pruritus is a debilitating symptom of several inflammatory skin conditions, presenting severe quality-of-life decreasing effects and major clinical challenges in terms of disease management. In the past decade, novel biological therapies have offered increasingly effective targeted interventions for the treatment of chronic pruritus, in which traditional approaches were often lacking or presented suboptimal safety profiles. However, recent advancements in the molecular characterization of sensory neuronal subsets helped to shed light on specific mechanisms of pruriception and thus have furthered our understanding of the peripheral nervous system and disease-relevant neuroimmune crosstalk. These developments have highlighted the targeting of interleukin-31, a major pruritus-associated cytokine, as a highly promising therapeutic target for chronic pruritus in inflammatory skin conditions. In this review, we therefore provide a focused overview of inflammatory conditions in which pruritus represents the major burden, the fundamental immune pathways, and sensory circuits involved, alongside the efficacies and safety profiles of novel therapies addressing chronic pruritus.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 141-148"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.anai.2025.09.027
Steve L. Taylor PhD
{"title":"Pasta and bread wheats differ","authors":"Steve L. Taylor PhD","doi":"10.1016/j.anai.2025.09.027","DOIUrl":"10.1016/j.anai.2025.09.027","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 236-237"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.anai.2025.09.011
Dan Dalan MD
{"title":"Practicing allergists at the forefront","authors":"Dan Dalan MD","doi":"10.1016/j.anai.2025.09.011","DOIUrl":"10.1016/j.anai.2025.09.011","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Page 236"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-07-22DOI: 10.1016/j.anai.2025.07.015
Emily Campbell MD , Jenny Garkaby MD , Julia Upton MD , Nami Park PharmD , Mike Samad MD , Michelle Hogue MS , Joseph R. Harper PharmD , Anurag Relan MD , Heather McLaughlin PhD , Kelli W. Williams MD, MPH
Background
Inborn errors of immunity (IEIs), including activated phosphoinositide-3-kinase delta syndrome (APDS), are underdiagnosed due to factors including heterogenous clinical manifestations, lack of awareness, and limited genetic testing access. Genetic testing may establish the molecular diagnosis (MolDx) of numerous IEIs, which may result in management changes.
Objective
To investigate the clinical utility of the navigateAPDS sponsored program established to increase MolDx of APDS through broad genetic testing.
Methods
The eligibility criteria to receive sponsored testing included APDS clinical features.
Results
Between March 2021 and September 2024, a total of 7811 patients across the United States and Canada underwent genetic testing. The median age at time of testing was 33 (range, 0-89) years, and the most selected eligibility criterion was severe, recurrent sinopulmonary infections. Of the 630 patients who received a positive MolDx, 377 (60%) had disorder-associated clinical actionability; 73 (12%) had Food and Drug Administration–approved treatments available. The most identified IEIs included genetically defined common variable immune deficiency and APDS. Of the patients with variants in PIK3CD or PIK3R1, 35 received an APDS MolDx and 131 received a variant of uncertain significance (VUS). Patients with APDS had a median age at time of symptom onset of 3 (range, 0-44) years and a median diagnostic delay of 13 (range, 0-50) years. Of the 13 APDS-causing variants identified, 5 were novel for APDS.
Conclusion
These findings demonstrate that broad genetic testing for IEIs is useful and may contribute to disease management changes and improved health outcomes. Variant identification and VUS resolution are crucial in elucidating the genetic contribution to the clinical spectrum of IEIs and APDS.
{"title":"Clinical and genetic findings of individuals tested using the navigateAPDS genetic testing program","authors":"Emily Campbell MD , Jenny Garkaby MD , Julia Upton MD , Nami Park PharmD , Mike Samad MD , Michelle Hogue MS , Joseph R. Harper PharmD , Anurag Relan MD , Heather McLaughlin PhD , Kelli W. Williams MD, MPH","doi":"10.1016/j.anai.2025.07.015","DOIUrl":"10.1016/j.anai.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Inborn errors of immunity (IEIs), including activated phosphoinositide-3-kinase delta syndrome (APDS), are underdiagnosed due to factors including heterogenous clinical manifestations, lack of awareness, and limited genetic testing access. Genetic testing may establish the molecular diagnosis (MolDx) of numerous IEIs, which may result in management changes.</div></div><div><h3>Objective</h3><div>To investigate the clinical utility of the navigateAPDS sponsored program established to increase MolDx of APDS through broad genetic testing.</div></div><div><h3>Methods</h3><div>The eligibility criteria to receive sponsored testing included APDS clinical features.</div></div><div><h3>Results</h3><div>Between March 2021 and September 2024, a total of 7811 patients across the United States and Canada underwent genetic testing. The median age at time of testing was 33 (range, 0-89) years, and the most selected eligibility criterion was severe, recurrent sinopulmonary infections. Of the 630 patients who received a positive MolDx, 377 (60%) had disorder-associated clinical actionability; 73 (12%) had Food and Drug Administration–approved treatments available. The most identified IEIs included genetically defined common variable immune deficiency and APDS. Of the patients with variants in <em>PIK3CD</em> or <em>PIK3R1</em>, 35 received an APDS MolDx and 131 received a variant of uncertain significance (VUS). Patients with APDS had a median age at time of symptom onset of 3 (range, 0-44) years and a median diagnostic delay of 13 (range, 0-50) years. Of the 13 APDS-causing variants identified, 5 were novel for APDS.</div></div><div><h3>Conclusion</h3><div>These findings demonstrate that broad genetic testing for IEIs is useful and may contribute to disease management changes and improved health outcomes. Variant identification and VUS resolution are crucial in elucidating the genetic contribution to the clinical spectrum of IEIs and APDS.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 213-220.e5"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.anai.2025.11.021
Xiao P. Peng MD, PhD , Jahnavi Aluri PhD , Keith Sacco MD , Roshini S. Abraham PhD
{"title":"“Ask and you shall receive”: Implications of sponsored genetic testing programs for inborn errors of immunity (IEIs)","authors":"Xiao P. Peng MD, PhD , Jahnavi Aluri PhD , Keith Sacco MD , Roshini S. Abraham PhD","doi":"10.1016/j.anai.2025.11.021","DOIUrl":"10.1016/j.anai.2025.11.021","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 129-130"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-08-14DOI: 10.1016/j.anai.2025.08.006
Amir Ghabousian MD, Gisele N. Bezerra MD, Zhaozhong Zhu SCD, Janice A. Espinola MPH, Ashley F. Sullivan MS, MPH, Carlos A. Camargo Jr MD, DrPH
Background
The absence of a standardized asthma definition in epidemiologic studies undermines the consistency of incidence estimates and the comparability of clinical outcomes.
Objective
To evaluate the impact of integrating bronchodilator response (BDR) into parent-reported asthma definitions by comparing incidence, disease severity, control, and diagnostic performance across these definitions, and to assess the individual diagnostic performance of BDR and fractional exhaled nitric oxide in identifying asthma cases.
Methods
We used data from a prospective cohort of 919 infants with severe (hospitalized) bronchiolitis to explore 4 asthma definitions: (1) broad, any physician diagnosis of asthma by age 6 years, as reported by parents; (2) epidemiologic, definition 1 plus either asthma medication use (eg, inhaled bronchodilator, inhaled corticosteroid, systemic corticosteroid, and montelukast) or asthma-related symptoms between ages 5.0 and 5.9 years; (3) alternative strict, definition 2 plus a post-BDR increase of 8% or greater in predicted forced expiratory volume in 1 second; and (4) strict, definition 2 plus a post-bronchodilator increase of more than 10% in predicted forced expiratory volume in 1 second. Outcomes were assessed across these definitions, and their diagnostic performance was compared with a physician reviewer’s asthma diagnosis (reference standard).
Results
The incidence rates for the 4 definitions were 37.2%, 27.7%, 13.2%, and 9.3%, respectively, with intermittent asthma severity classification following a similar pattern (72.4%, 65.5%, 56.0%, and 52.8%). Transitioning from the first to the fourth definition improved specificity and positive predictive value but reduced sensitivity, with no consistent trends being observed for asthma control across definitions.
Conclusion
These findings suggest that incorporating BDR into parent-reported asthma definitions underestimates asthma incidence and identifies cases with worse clinical outcomes.
{"title":"Impact of varying childhood asthma definitions on incidence and clinical outcomes","authors":"Amir Ghabousian MD, Gisele N. Bezerra MD, Zhaozhong Zhu SCD, Janice A. Espinola MPH, Ashley F. Sullivan MS, MPH, Carlos A. Camargo Jr MD, DrPH","doi":"10.1016/j.anai.2025.08.006","DOIUrl":"10.1016/j.anai.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>The absence of a standardized asthma definition in epidemiologic studies undermines the consistency of incidence estimates and the comparability of clinical outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the impact of integrating bronchodilator response (BDR) into parent-reported asthma definitions by comparing incidence, disease severity, control, and diagnostic performance across these definitions, and to assess the individual diagnostic performance of BDR and fractional exhaled nitric oxide in identifying asthma cases.</div></div><div><h3>Methods</h3><div>We used data from a prospective cohort of 919 infants with severe (hospitalized) bronchiolitis to explore 4 asthma definitions: (1) broad, any physician diagnosis of asthma by age 6 years, as reported by parents; (2) epidemiologic, definition 1 plus either asthma medication use (eg, inhaled bronchodilator, inhaled corticosteroid, systemic corticosteroid, and montelukast) or asthma-related symptoms between ages 5.0 and 5.9 years; (3) alternative strict, definition 2 plus a post-BDR increase of 8% or greater in predicted forced expiratory volume in 1 second; and (4) strict, definition 2 plus a post-bronchodilator increase of more than 10% in predicted forced expiratory volume in 1 second. Outcomes were assessed across these definitions, and their diagnostic performance was compared with a physician reviewer’s asthma diagnosis (reference standard).</div></div><div><h3>Results</h3><div>The incidence rates for the 4 definitions were 37.2%, 27.7%, 13.2%, and 9.3%, respectively, with intermittent asthma severity classification following a similar pattern (72.4%, 65.5%, 56.0%, and 52.8%). Transitioning from the first to the fourth definition improved specificity and positive predictive value but reduced sensitivity, with no consistent trends being observed for asthma control across definitions.</div></div><div><h3>Conclusion</h3><div>These findings suggest that incorporating BDR into parent-reported asthma definitions underestimates asthma incidence and identifies cases with worse clinical outcomes.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 168-172"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.anai.2025.10.012
Ricardo J. Estrada-Mendizabal MD , Payge Moraca DO , Alfonso J. Castillo-Ivon , Jennifer Priessnitz MD , Ebram N. Labib MD , Saiyara S. Shama MBBS , Nisha B. Patel MD , Lisa A. Marks MLS, AHIP , Sergio E. Chiarella MD , Vito Sabato MD , Christine R.F. Rukasin MD , Gerald W. Volcheck MD , Alexei Gonzalez-Estrada MD
Background
Perioperative hypersensitivity (POH) is a rare, immediate hypersensitivity reaction. Its more severe form, perioperative anaphylaxis, has a 2% mortality rate. Sex is a biological variable that can affect the immune response, but its role in POH remains unclear. We aimed to assess sex-based differences in POH and explore potential differences by age, culprit drugs, and reaction severity.
Objective
To systematically assess sex-based differences in the proportion of POH and assess variations by age group, suspected culprit drugs, and reaction severity.
Methods
A systematic search was conducted in MEDLINE, EMBASE, Scopus, and Web of Science. Cohort, retrospective, prospective, and cross-sectional studies reporting the female-to-male ratio of POH patients were included. A proportional meta-analysis using an inverse-variance method with logit transformation was performed to calculate pooled sex proportions. Subgroup analyses were conducted based on age, culprit drugs, and severity grading.
Results
A total of 62 studies comprising 19,944 patients (63% female) were included. The pooled proportion of female-to-male patients with POH was 0.60 (95% CI: 0.57-0.63; 95% prediction interval: 0.40-0.78). Subgroup analysis revealed a higher female predominance in adults, 0.59 (95% CI: 0.55-0.62), whereas males predominated in pediatric studies (0.41; 95% CI: 0.36-0.47).
Conclusion
We found a female predominance of POH overall, though males had a higher proportion in pediatric studies, possibly due to chromosomal factors influencing POH rates before adolescence. In adulthood, hormonal changes may contribute to the observed female predominance. Further research is needed to explore the mechanisms behind the observed differences.
{"title":"Sex-based differences in perioperative hypersensitivity","authors":"Ricardo J. Estrada-Mendizabal MD , Payge Moraca DO , Alfonso J. Castillo-Ivon , Jennifer Priessnitz MD , Ebram N. Labib MD , Saiyara S. Shama MBBS , Nisha B. Patel MD , Lisa A. Marks MLS, AHIP , Sergio E. Chiarella MD , Vito Sabato MD , Christine R.F. Rukasin MD , Gerald W. Volcheck MD , Alexei Gonzalez-Estrada MD","doi":"10.1016/j.anai.2025.10.012","DOIUrl":"10.1016/j.anai.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative hypersensitivity (POH) is a rare, immediate hypersensitivity reaction. Its more severe form, perioperative anaphylaxis, has a 2% mortality rate. Sex is a biological variable that can affect the immune response, but its role in POH remains unclear. We aimed to assess sex-based differences in POH and explore potential differences by age, culprit drugs, and reaction severity.</div></div><div><h3>Objective</h3><div>To systematically assess sex-based differences in the proportion of POH and assess variations by age group, suspected culprit drugs, and reaction severity.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in MEDLINE, EMBASE, Scopus, and Web of Science. Cohort, retrospective, prospective, and cross-sectional studies reporting the female-to-male ratio of POH patients were included. A proportional meta-analysis using an inverse-variance method with logit transformation was performed to calculate pooled sex proportions. Subgroup analyses were conducted based on age, culprit drugs, and severity grading.</div></div><div><h3>Results</h3><div>A total of 62 studies comprising 19,944 patients (63% female) were included. The pooled proportion of female-to-male patients with POH was 0.60 (95% CI: 0.57-0.63; 95% prediction interval: 0.40-0.78). Subgroup analysis revealed a higher female predominance in adults, 0.59 (95% CI: 0.55-0.62), whereas males predominated in pediatric studies (0.41; 95% CI: 0.36-0.47).</div></div><div><h3>Conclusion</h3><div>We found a female predominance of POH overall, though males had a higher proportion in pediatric studies, possibly due to chromosomal factors influencing POH rates before adolescence. In adulthood, hormonal changes may contribute to the observed female predominance. Further research is needed to explore the mechanisms behind the observed differences.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"136 2","pages":"Pages 195-203.e4"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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