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

英文中文

Systemic Treatments for Chronic Spontaneous Urticaria: Anti-IgE and BeyondSystemic Treatments for Chronic Spontaneous Urticaria: Anti-IgE and Beyond 慢性自发性荨麻疹的全身治疗：抗ige及以上

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2026.01.006

引用次数: 0

Underpayment and Economic Harm in Aeroallergen Immunotherapy 空气过敏原免疫治疗的低支付和经济危害

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.12.014

Paul V. Williams MD , Lynda Kabbash MD

引用次数: 0

Omalizumab Enables Bee Venom Desensitization in Patients With Anaphylactic Reactions to Venom Immunotherapy Omalizumab使蜂毒脱敏患者对毒液免疫治疗的过敏反应。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.09.038

Kris Capper MD , Benjamin McGettigan MB ChB, FRACP, FRCPA , Cate Willis MBBS , Brittany Stevenson MBBS, FRACP, FRCPA

Background

Venom immunotherapy (VIT) is the only treatment for honeybee venom allergy; however, some patients develop severe allergic reactions (SARs) during therapy. Omalizumab, an anti-IgE antibody, may improve VIT tolerance, though data in honeybee VIT remain limited.

Objective

To evaluate the efficacy of adjuvant omalizumab in honeybee VIT, identify predictors of omalizumab requirement, and inform protocol selection.

Methods

A retrospective chart review was conducted of all adults undergoing honeybee VIT at Fiona Stanley Hospital, Perth, Western Australia, from 2015 to 2024. Baseline characteristics, biomarkers, protocols, and outcomes were analyzed.

Results

Among 354 VIT patients, 57 (16%) experienced SARs, with 36 (10%) receiving omalizumab. Predictors of omalizumab need included severe sting anaphylaxis, asthma, and elevated basal tryptase. One patient used omalizumab to escalate VIT dosing after already reaching maintenance. Of 35 patients using omalizumab during VIT uptitration, 22 (63%) achieved unsupported maintenance, 7 (20%) ceased because of SARs, and 5 (14%) remain on omalizumab. Excluding 5 patients who declined or lacked access to ongoing omalizumab, the success rate increases to 73%. The most common protocol involved a 12-week VIT uptitration to 100 μg with omalizumab 300 mg loading 2 weeks previously, followed by 150 mg fortnightly until maintenance VIT was reached. SARs most frequently occurred at omalizumab cessation. In 3 cases, these were overcome by resuming omalizumab with a higher VIT maintenance dose target.

Conclusions

Omalizumab could be considered in patients experiencing recurrent SARs to standard VIT. A semi-rush protocol with omalizumab loading 1 to 2 weeks previously was well tolerated.

背景：蜂毒免疫疗法（VIT）是治疗蜂毒过敏的唯一方法；然而，一些患者在治疗期间出现严重的过敏反应（SAR）。Omalizumab，一种抗ige抗体，可能改善VIT耐受性，尽管蜜蜂VIT的数据仍然有限。目的：评价omalizumab佐剂治疗蜜蜂VIT的疗效，确定omalizumab需求的预测因素，并为方案选择提供信息。方法：对2015年至2024年在西澳大利亚珀斯Fiona Stanley医院接受蜜蜂VIT治疗的所有成年人进行回顾性图表回顾。分析基线特征、生物标志物、方案和结果。结果：在354例VIT患者中，57例（16%）发生了SARs，其中36例（10%）接受了omalizumab治疗。omalizumab需求的预测因素包括严重的刺痛过敏反应、哮喘和基础胰蛋白酶升高。一名患者在达到维持剂量后使用omalizumab增加VIT剂量。在VIT上升滴定期间使用omalizumab的35例患者中，22例（63%）实现无支持维持，7例（20%）因SARs停止，5例（14%）继续使用omalizumab。排除5名拒绝或无法获得正在进行的omalizumab的患者，成功率增加到73%。最常见的治疗方案包括：将12周的VIT滴定至100 μg，奥玛珠单抗在2周前负荷300 mg，然后每两周增加150 mg，直到达到维持VIT。SARs最常见于停药时。在3例病例中，通过恢复使用更高的VIT维持剂量目标的omalizumab来克服这些问题。结论：奥玛单抗可用于复发性SARs患者的标准VIT。在1 - 2周之前使用omalizumab负荷的半匆忙方案耐受性良好。

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引用次数: 0

Comparative Effectiveness of Tezepelumab and Dupilumab in Asthma: A Multinational Retrospective Cohort Study Tezepelumab和Dupilumab治疗哮喘的比较疗效：一项跨国回顾性队列研究。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.11.024

Chun-Tse Hung MS, PharmD , Yu-Chien Hung MD , Chen-Yen An BPharm, RPh , Chi-Won Suk MD

Background

Although both dupilumab and tezepelumab are approved for severe asthma, real-world evidence comparing their effectiveness remains limited.

Objective

To compare the effectiveness of tezepelumab versus dupilumab in reducing asthma exacerbations among patients with asthma.

Methods

Data were obtained from the Global Collaborative Network of TriNetX. Adults aged ≥18 years who initiated dupilumab or tezepelumab between December 17, 2021, and September 1, 2024, were included. The primary outcome was time to first asthma exacerbation, and the secondary outcome was systemic corticosteroid use. Both outcomes were assessed over 1 year. Subgroup analyses were conducted by blood eosinophil counts, presence of chronic obstructive pulmonary disease (COPD), prior biologics use, and obesity. Propensity score matching was used to balance covariates between groups. Kaplan-Meier curves and Cox regression models were used to estimate comparative effectiveness.

Results

After 1:1 matching, 688 matched patients were included in each group. In the matched cohorts, the risk of asthma exacerbation did not differ between dupilumab and tezepelumab (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.83-1.10). This finding was consistent across sensitivity analyses. Both biologics showed similar benefits across all blood eosinophil levels and regardless of COPD, prior biologics use, or obesity. The risk of systemic corticosteroid use was also similar between both biologics (HR, 0.97; 95% CI, 0.85-1.10).

Conclusion

No significant difference in exacerbation risk was found between dupilumab and tezepelumab. Because residual confounding may exist, further investigation is warranted to guide the selection of biological therapies in clinical practice.

背景：虽然dupilumab和tezepelumab都被批准用于治疗严重哮喘，但比较其有效性的真实证据仍然有限。目的：比较tezepelumab与dupilumab在哮喘患者中减少哮喘加重的有效性。方法：数据来自TriNetX全球协作网络。纳入了在2021年12月17日至2024年9月1日期间接受dupilumab或tezepelumab治疗的年龄≥18岁的成年人。主要终点是首次哮喘发作的时间，次要终点是全身皮质类固醇的使用。这两项结果都是在一年内评估的。亚组分析根据血液嗜酸性粒细胞计数、慢性阻塞性肺疾病（COPD）的存在、既往生物制剂使用和肥胖进行。倾向评分匹配用于平衡组间协变量。Kaplan-Meier曲线和Cox回归模型用于估计比较有效性。结果：经1:1匹配，每组纳入688例匹配患者。在匹配的队列中，dupilumab和tezepelumab之间哮喘恶化的风险没有差异（HR, 0.96; 95% CI, 0.83-1.10）。这一发现在敏感性分析中是一致的。两种生物制剂在所有血液嗜酸性粒细胞水平和COPD、既往使用生物制剂或肥胖方面均显示出相似的益处。两种生物制剂中全身性使用皮质类固醇的风险也相似（HR, 0.97; 95% CI, 0.85-1.10）。结论：dupilumab与tezepelumab在加重风险方面无显著差异。由于可能存在残留的混杂因素，需要进一步的研究来指导临床实践中生物疗法的选择。

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引用次数: 0

Uncommon causal variants of the ADA2 gene in patients with reduced enzyme activity and nonconfirmatory genetic testing 酶活性降低和非确证性基因检测患者中ADA2基因不常见的因果变异。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.11.026

Alice Grossi PhD , Alessia Cafaro PhD , Marta Rusmini PhD , Francesca Rosamilia PhD , Michela Malacarne MSc , Barbara Testa MSc , Michela Lupia MSc , Maria Carla Giarratana MD , Maurizio Miano MD , Federica Barzaghi MD, PhD , Roberta Caorsi MD , Chiara Conti MD , Diego Vozzi MSc , Paolo Uva PhD , Giuliana Cangemi PhD , Carlo Dufour MD , Marco Gattorno MD , Isabella Ceccherini PhD

引用次数: 0

Uptake of oral immunotherapy and omalizumab for management of food allergy in clinical practice 口服免疫治疗和奥玛珠单抗在临床治疗食物过敏中的应用。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.12.006

S. Shahzad Mustafa MD , Richard Kraude PhD , Sara Patrawala MD , Peter Capucilli MD , Linh-An Tuong MD, MSc , Denise Sanchez-Tejera MD , Allison Ramsey MD

引用次数: 0

Reply to “Association of Asthma and Rheumatoid Arthritis: Conundrum Still Unsolved” 回复“哮喘与类风湿关节炎的关联：尚未解决的难题”

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.11.037

Richard P. Ramonell MD , Patricia Choi MD , Marc C. Gauthier MD , Merritt L. Fajt MD , Anuradha Ray PhD , Sally E. Wenzel MD

引用次数: 0

Updates on Kinase Inhibitors in Allergy 激酶抑制剂在过敏中的最新进展。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.10.047

Melanie C. Dispenza MD, PhD , Brian S. Kim MD

Kinase inhibitors are emerging as transformative therapeutic agents in allergy. Advances in drug design have produced highly selective inhibitors with improved safety and efficacy, extending their clinical use beyond oncologic indications to the treatment of immune-mediated and hypersensitivity disorders. Bruton’s tyrosine kinase inhibitors offer rapid, on-demand control of IgE-mediated reactivity and are approved for use in chronic urticaria. Janus kinase inhibitors demonstrate potent anti-inflammatory and anti-pruritic effects in atopic dermatitis and may expand into other chronic itch disorders. KIT inhibitors, both mutant- and wild type–specific, are redefining treatment possibilities for mastocytosis and chronic urticaria through mast cell suppression. This review highlights recent progress in the development and application of these drugs in allergic diseases. We summarize the mechanistic rationale for targeting each pathway, review pivotal clinical trial findings, and discuss safety profiles and practical considerations for clinical use. Collectively, these inhibitors are important additions to the therapeutic options in immune-mediated disorders.

激酶抑制剂正在成为变革性的过敏症治疗药物。药物设计的进步产生了安全性和有效性更高的高选择性抑制剂，从而将其临床应用范围从肿瘤适应症扩展到免疫介导和超敏性疾病的治疗。Bruton的酪氨酸激酶（BTK）抑制剂提供快速，按需控制ige介导的反应性，现在被批准用于慢性荨麻疹。Janus激酶（JAK）抑制剂在特应性皮炎中显示出有效的抗炎和抗瘙痒作用，并可能扩展到其他慢性瘙痒疾病。KIT抑制剂，无论是突变型还是野生型特异性，都通过肥大细胞抑制来重新定义肥大细胞增多症和慢性荨麻疹的治疗可能性。本文综述了近年来这些药物在变态反应性疾病中的开发和应用进展。我们总结了针对每个途径的机制原理，回顾了关键的临床试验结果，并讨论了临床使用的安全性和实际考虑因素。总的来说，这些抑制剂是免疫介导性疾病治疗选择的重要补充。

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引用次数: 0

The Skin Tells the Story: Early Signs of Inborn Errors of Immunity 皮肤能说明问题：先天免疫缺陷的早期迹象。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.11.014

Zeynep Meric MD , Betul Kosa MD , Betul Gemici Karaaslan MD , Sezin Aydemir MD , Muhammed Aydin MD , Dilan Demir Gumus MD , Nergis Akay MD , Emre Ozer MD , Ahmet Kan MD , Sevgi Sipahi Çimen MD , Muhlis Cem Ar MD , Ayse Deniz Yucelten MD , Ozgur Kasapcopur MD , Tugba Kevser Uzuncakmak MD , Esra Yucel MD , Ayca Kiykim MD

Background

Inborn errors of immunity (IEIs) comprise a heterogeneous group of more than 500 genetic disorders, often presenting with recurrent infections, autoimmunity, malignancies, allergic inflammation, and various skin manifestations.

Objective

To evaluate the prevalence, phenotypes, and treatment responses of skin manifestations in IEIs.

Methods

Patient data from 2018 to 2024 were retrospectively analyzed in a single-center cohort from Turkey and classified according to the 2024 report of the International Union of Immunological Societies. Recorded skin manifestations included atopic dermatitis–like lesions, infections, granulomas, pigmentary abnormalities, vascular changes, and autoimmune lesions.

Results

Among 389 patients with IEIs, 155 (39.8%) exhibited skin manifestations, with 48.3% presenting as an initial symptom. The median (interquartile range) age at onset of skin manifestations was 8.5 (2.2-84) months, whereas the median age at referral was 84 (19-174) months. The predominant IEI categories were combined immunodeficiencies with associated or syndromic features (21%) and immunodeficiencies affecting cellular and humoral immunity (20.5%). Cutaneous manifestations were most frequent in congenital phagocyte defects (56.8%). Predominant skin manifestations included infections (59.3%), atopic dermatitis–like lesions (37.4%), and chronic mucocutaneous candidiasis (16.7%). During the median follow-up period of 44 (17-68) months, the most common comorbidities were recurrent sinopulmonary infections (67.3%) and growth delay (50.6%). Biological agents were administered to 11.6% of patients, whereas 20% underwent hematopoietic stem cell transplantation.

Conclusions

Skin manifestations are common and often early indicators of IEIs. Their coexistence with recurrent infections or growth delay should prompt immunologic evaluation. Early recognition may facilitate timely diagnosis, targeted treatment, and improved long-term outcomes.

背景：先天性免疫错误（IEIs）由500多种遗传性疾病组成，通常表现为复发性感染、自身免疫、恶性肿瘤、过敏性炎症和各种皮肤表现。目的：本研究旨在评估IEI患者皮肤表现的患病率、表型和治疗反应。方法：回顾性分析2018-2024年土耳其单中心队列患者数据，并根据国际免疫学会联合会（IUIS） 2024年报告进行分类。记录的皮肤表现包括ad样病变、感染、肉芽肿、色素异常、血管改变和自身免疫性病变。结果：389例IEI患者中，155例（39.8%）有皮肤表现，其中48.3%为首发症状。出现皮肤症状的中位年龄（IQR）为8.5（2.2-84）个月，而转诊时的中位年龄为84（19-174）个月。主要的IEI类别是合并免疫缺陷与相关或综合征特征（21%）和影响细胞和体液免疫的免疫缺陷（20.5%）。先天性吞噬细胞缺陷以皮肤表现最为常见（56.8%）。主要的皮肤表现包括感染（59.3%）、ad样病变（37.4%）和慢性皮肤粘膜念珠菌病（16.7%）。在44（17-68）个月的中位随访期间，最常见的合并症是复发性肺感染（67.3%）和生长迟缓（50.6%）。11.6%的患者接受了生物制剂治疗，20%的患者接受了造血干细胞移植。结论：皮肤表现是IEI常见的早期症状。它们与复发性感染或生长迟缓共存时应进行免疫学评估。早期识别可能有助于及时诊断，有针对性的治疗和改善长期结果。

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Systemic Therapy for Atopic Dermatitis: Choosing Biologics or Janus Kinase Inhibitors for Children and Adults 特应性皮炎的全身治疗：儿童和成人选择生物制剂或Janus激酶抑制剂。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-02-01 DOI: 10.1016/j.jaip.2025.10.052

Irene M. Scholl MD , Aaron M. Drucker MD, PhD , Carsten Flohr MD, PhD , Louise A.A. Gerbens MD, PhD

Atopic dermatitis is a highly prevalent chronic inflammatory skin disease worldwide, with a significant burden on patients’ quality of life. Although most patients with atopic dermatitis are effectively managed with topical treatments, a significant minority requires systemic therapy. In recent years, the therapeutic landscape for this patient population has expanded beyond conventional treatments, introducing novel targeted therapies such as biologic agents and Janus kinase inhibitors. These novel therapies vary in aspects such as efficacy, safety profile, route of administration, monitoring requirements, and impact on comorbidities, necessitating individualized treatment decision-making. As a result, selecting the most appropriate therapy can be challenging. This article provides a practical overview of the current targeted therapies to support informed clinical decision-making regarding treatment selection, monitoring, and dosing considerations.

特应性皮炎（AD）是一种全球高度流行的慢性炎症性皮肤病，严重影响患者的生活质量。虽然大多数AD患者可以通过局部治疗得到有效治疗，但也有少数患者需要全身治疗。近年来，针对该患者群体的治疗方案已经扩展到传统治疗之外，引入了新的靶向治疗，如生物制剂和Janus激酶（JAK）抑制剂。这些新疗法在疗效、安全性、给药途径、监测要求和对合并症的影响等方面各不相同，需要个性化的治疗决策。因此，选择最合适的治疗方法是具有挑战性的。本文提供了当前靶向治疗的实用概述，以支持关于治疗选择、监测和剂量考虑的知情临床决策。

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