Journal of Allergy and Clinical Immunology-In Practice最新文献

Background: Allergy-related misinformation proliferates across social media platforms, potentially compromising evidence-based patient care, yet comprehensive analyses remain limited.

Objective: To characterize dominant themes, engagement patterns, and public responses to allergy misinformation across major social media platforms.

Methods: We conducted cross-sectional qualitative content analysis of publicly available posts containing allergy misinformation from TikTok, Instagram, Facebook, and X between January and March 2025. Posts with 500 or more interactions were identified using systematic key word searches and coded for misinformation themes by independent reviewers. Public sentiment was assessed through analysis of top-ranked comments.

Results: Among 347 analyzed posts with 12.3 million combined views, natural cure promotion was most prevalent (31%), followed by IgG testing endorsement (24%), medication fearmongering (18%), food allergy misrepresentation (16%), and pharmaceutical conspiracy theories (11%). Natural cure content generated the highest engagement (median, 2,847 interactions; P < .001). Visual platforms (TikTok and Instagram) favored natural cures whereas text-based platforms emphasized conspiracy content. Of 3,470 analyzed comments, 62% were supportive or neutral toward misinformation, with only 38% providing challenged responses. Among corrective comments, only 23% included scientific evidence.

Conclusions: Allergy misinformation achieves high engagement with limited public correction across social media platforms. Health care providers must anticipate IgG testing and natural remedy narratives, integrate myth-busting into counseling, and leverage society-led digital strategies to counter misinformation's influence on clinical care.

Background: The concept of clinical remission in CRSwNP is gaining growing relevance in the era of biologic therapies. However, current definitions remain heterogeneous and lack standardized, operational criteria. This variability limits comparability across studies and hinders the implementation of remission as a therapeutic target in routine practice.

Objective: To develop a multidisciplinary, evidence-based, and clinically applicable definition of clinical remission in CRSwNP, integrating symptom-based, endoscopic, therapeutic, and timing-related criteria, and to evaluate expert consensus on the development of a composite remission score.

Methods: A three-round Delphi consensus was conducted among experts participating in the Rhinosinusitis Italian Network (RINET). Across the three rounds, experts rated the statements using a 5-point Likert scale. Positive or negative consensus was defined as ≥70% agreement or disagreement, respectively. Descriptive statistics assessed the convergence and stability of responses.

Results: Experts agreed that remission requires meeting concurrent criteria across four domains: timing (≥12 months), absence of systemic corticosteroid use or surgical indication, symptom thresholds (SNOT-22 <20 plus symptoms and hyposmia VAS ≤ 3), and endoscopic thresholds (Nasal Polyp Score and modified Lund-Kennedy score both 0 for complete remission; both ≤2 for partial remission). Consensus emerged on differentiating complete and partial remission, on introducing the concept of sustained remission (≥24 months), and on the need for a composite remission score with weighted components and category thresholds.

Conclusion: This Delphi consensus provides the first operational, multidomain definition of complete and partial clinical remission in CRSwNP, developed independently by a large multidisciplinary panel and informed by patient perspectives. The proposed criteria offer a practical framework to standardize remission assessment and support its adoption as a therapeutic goal.

Background: Poorly controlled asthma during pregnancy has been associated with adverse maternal and neonatal outcomes. Biologic medications, such as monoclonal antibodies, can improve control and reduce exacerbations in patients with moderate-severe asthma. However, there is limited data about the safety of biologics during pregnancy.

Objective: To determine the frequency of adverse pregnancy outcomes in patients with moderate-severe persistent asthma prescribed biologic therapies compared to an unexposed disease matched cohort.

Methods: This is a retrospective cohort study utilizing the TriNetX US Collaborative Network. Pregnant women ages 15 to 44 years old with moderate-severe asthma between January 2010 and July 2025 were identified. The study included two groups: asthma biologic prescription group and unexposed asthma controls which were 1:1 propensity score-matched by age, race, ethnicity, comorbidities, substance use, and obesity. Primary outcomes were defined as maternal and fetal complications that occurred in relation to the index event (pregnancy date). Odds ratios with 95% confidence intervals were calculated between matched groups for each outcome.

Results: After propensity score matching, there were 535 pregnant patients in each group. There was a decreased risk of any adverse pregnancy outcomes in the asthma biologic prescription group when compared to the disease matched controls (OR 0.609, CI 0.460-0.807, p=0.001).

Conclusion: Prescribed biologics for the treatment of moderate-severe asthma during pregnancy was not associated with an increased risk for adverse pregnancy outcomes when compared to disease matched controls, and may have a protective effect in reducing adverse pregnancy outcomes.

Eosinophilic lung diseases (ELDs) represent a heterogeneous group of airway and parenchymal disorders unified by eosinophilic inflammation but distinguished by diverse clinical features, mechanisms of persistence, and variable therapeutic responses. Traditional diagnostic tools-including blood eosinophil counts, bronchoalveolar lavage, sputum cytology, and exhaled nitric oxide predict the eosinophilic/T2 burden of the disease but often fail to distinguish IL-5-dependent from IL-5-independent pathways, overlook compartment-specific inflammation, and inadequately predict/monitor response to targeted biologics. The inconsistent efficacy of IL-5/IL-5R-directed monoclonal antibodies despite normalisation of blood eosinophils across the ELD spectrum, viz. robust clinical response in eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome, partial in asthma, and largely absent in COPD-underscores the limitations of current biomarkers and the need for refined precision endotyping. To address these gaps, emerging biomarker platforms move beyond eosinophil enumeration to define upstream drivers, activation states, tissue localization, and immune pathways sustaining persistent eosinophilia. These advances include non-invasive tools such as lateral-flow devices for assaying eosinophil peroxidase (eosinophil activity biomarker), breathomics and volatile organic compound profiling, cytokine-level inflammatory mapping, and composite biomarker models integrating airway, blood, and molecular signatures. In parallel, functional imaging modalities-including hyperpolarized gas MRI, phase-resolved functional lung MRI, and quantitative computed tomography (CT)-provide non-invasive, high-resolution visualization of regional ventilation, perfusion, and inflammation. This enables clinicians to "look into the lungs" and offer powerful stand-alone or complementary biomarker capability. Collectively, these innovations mark a shift toward mechanistically informed, tissue-specific, multimodal biomarker strategies that refine diagnosis, improve therapeutic selection, and enhance monitoring across the ELD spectrum, advancing the promise of precision medicine.

Oral immunotherapy (OIT) is effective for inducing desensitization to food allergens and continues to be investigated in many clinical trials, either alone or in combination with adjunct therapies. However, adverse events (AEs) such as gastrointestinal (GI) symptoms are common during OIT. These symptoms can pose a considerable management challenge for investigators adhering to clinical trial protocols with strict study windows where extended dosing interruptions are not feasible. GI symptom management practices in the previous clinical trials have usually been left to the discretion of each study site, resulting in a wide heterogeneity of management practices which could lead to substantial variability between sites. In the OUtMATCH randomized controlled clinical trial (NCT03881696) assessing omalizumab and multi-allergen OIT, a critical need for a unified approach for managing GI AEs was identified. To address this need, a subcommittee comprised of investigators, both allergists and gastroenterologists, within and outside of the Consortium of Food Allergy Research (CoFAR), developed a working definition for persistent GI AEs during OIT along with a management plan to be utilized within the ongoing OUtMATCH trial. We present here the definition and management plan, along with illustrative case-based scenarios encountered during the trial. Implementing a management plan for GI AEs during OIT clinical trials has the potential to create standardization, enhance symptom monitoring, improve outcome classification, allow for stratification of AEs related to GI symptoms, and improve safety outcomes for study participants.

Background: Early recognition of inborn errors of immunity (IEI), formerly primary immunodeficiencies, is crucial, yet the diagnostic accuracy of widely promoted clinical "warning signs" in children is uncertain.

Objective: To assess the diagnostic accuracy of clinical warning signs and established criteria for identifying paediatric IEI.

Methods: We searched MEDLINE and EMBASE (inception-May 2024) for studies reporting sensitivity and specificity of individual or combined warning signs in children (0-18 years) with suspected IEI. The reference standard was physician-confirmed IEI. Data were synthesised descriptively and, where appropriate, using bivariate random-effects models. Risk of bias was assessed with QUADAS-2.

Results: Twelve studies (∼7,000 participants, eight countries) met inclusion criteria. Diagnostic performance was highly heterogeneous, and pooled estimates are exploratory. Overall, most individual warning signs showed high specificity but low sensitivity; family history of IEI and signs such as persistent thrush, deep-seated abscesses and failure to thrive were generally highly specific but insensitive. Infection-based signs such as recurrent pneumonia or need for intravenous antibiotics provided a more balanced but still imperfect profile. Combinations of signs, including the Jeffrey Modell Foundation (JMF) threshold of ≥2 warning signs, improved sensitivity in some settings but with variable specificity, and up to one third of children with IEI did not meet any JMF warning-sign criteria.

Conclusions: Traditional warning signs have good rule-in but poor rule-out value for paediatric IEI. Reliance on these signs alone risks delayed or missed diagnoses, particularly for non-infectious IEI phenotypes. Context-specific criteria and decision-support tools are needed to better capture the breadth of IEI presentations and support timely referral.