Pub Date : 2026-02-01DOI: 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
{"title":"Reply to “Association of Asthma and Rheumatoid Arthritis: Conundrum Still Unsolved”","authors":"Richard P. Ramonell MD , Patricia Choi MD , Marc C. Gauthier MD , Merritt L. Fajt MD , Anuradha Ray PhD , Sally E. Wenzel MD","doi":"10.1016/j.jaip.2025.11.037","DOIUrl":"10.1016/j.jaip.2025.11.037","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Page 535"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 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.
{"title":"Updates on Kinase Inhibitors in Allergy","authors":"Melanie C. Dispenza MD, PhD , Brian S. Kim MD","doi":"10.1016/j.jaip.2025.10.047","DOIUrl":"10.1016/j.jaip.2025.10.047","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Pages 336-343"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 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.
{"title":"The Skin Tells the Story: Early Signs of Inborn Errors of Immunity","authors":"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","doi":"10.1016/j.jaip.2025.11.014","DOIUrl":"10.1016/j.jaip.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To evaluate the prevalence, phenotypes, and treatment responses of skin manifestations in IEIs.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Pages 464-474.e4"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 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.
{"title":"Systemic Therapy for Atopic Dermatitis: Choosing Biologics or Janus Kinase Inhibitors for Children and Adults","authors":"Irene M. Scholl MD , Aaron M. Drucker MD, PhD , Carsten Flohr MD, PhD , Louise A.A. Gerbens MD, PhD","doi":"10.1016/j.jaip.2025.10.052","DOIUrl":"10.1016/j.jaip.2025.10.052","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Pages 344-359"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jaip.2025.12.011
Whitney W. Stevens MD, PhD , Michael E. Wechsler MD , Tara F. Carr MD
The development, introduction, and widespread use of type 2–targeting biologics for respiratory disease has been of dramatic and unprecedented benefit to patients, improving disease control, reducing morbidity, and allowing for avoidance of more toxic therapies such as reliance on chronic systemic corticosteroids. Developed to treat more severe forms of asthma, the available biologics—benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab—have been successfully applied to treat other diseases of the upper and lower airways. Indeed, multiple different biologics are now approved by the Food and Drug Administration for each general clinical indication: severe asthma, chronic obstructive pulmonary disease, eosinophilic granulomatosis with polyangiitis, and chronic rhinosinusitis with nasal polyposis. Clinically, the selection of a type 2–targeting biologic for respiratory disease starts with the confirmation of a specific diagnosis, assessment of responsiveness to previous medical (and surgical) therapies, and determination whether underlying type 2 inflammation is present. Other critical considerations include route of administration, accessibility, insurance coverage, and patient preference. In some cases, there may be only 1 biologic available for a patient. However, as often is the case, patients may indeed qualify for, or potentially benefit from, more than 1 treatment. Selecting the right treatment—that which is most effective—can be a challenge. In this review, we provide practical and evidence-based recommendations about selecting a type 2 biologic across the spectrum of respiratory diseases.
{"title":"Overview of Biologics Targeting Type 2 Inflammation in Respiratory Disease","authors":"Whitney W. Stevens MD, PhD , Michael E. Wechsler MD , Tara F. Carr MD","doi":"10.1016/j.jaip.2025.12.011","DOIUrl":"10.1016/j.jaip.2025.12.011","url":null,"abstract":"<div><div>The development, introduction, and widespread use of type 2–targeting biologics for respiratory disease has been of dramatic and unprecedented benefit to patients, improving disease control, reducing morbidity, and allowing for avoidance of more toxic therapies such as reliance on chronic systemic corticosteroids. Developed to treat more severe forms of asthma, the available biologics—benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab—have been successfully applied to treat other diseases of the upper and lower airways. Indeed, multiple different biologics are now approved by the Food and Drug Administration for each general clinical indication: severe asthma, chronic obstructive pulmonary disease, eosinophilic granulomatosis with polyangiitis, and chronic rhinosinusitis with nasal polyposis. Clinically, the selection of a type 2–targeting biologic for respiratory disease starts with the confirmation of a specific diagnosis, assessment of responsiveness to previous medical (and surgical) therapies, and determination whether underlying type 2 inflammation is present. Other critical considerations include route of administration, accessibility, insurance coverage, and patient preference. In some cases, there may be only 1 biologic available for a patient. However, as often is the case, patients may indeed qualify for, or potentially benefit from, more than 1 treatment. Selecting the right treatment—that which is most effective—can be a challenge. In this review, we provide practical and evidence-based recommendations about selecting a type 2 biologic across the spectrum of respiratory diseases.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Pages 385-394"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jaip.2025.12.009
Yifei Cao MM , Yunhui Zhang PhD
{"title":"Menopause and Asthma Unlinked? It’s More Complicated","authors":"Yifei Cao MM , Yunhui Zhang PhD","doi":"10.1016/j.jaip.2025.12.009","DOIUrl":"10.1016/j.jaip.2025.12.009","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Pages 535-536"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jaip.2026.01.007
{"title":"Updates on the Current and Evolving Treatment for Hereditary Angioedema","authors":"","doi":"10.1016/j.jaip.2026.01.007","DOIUrl":"10.1016/j.jaip.2026.01.007","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 2","pages":"Page 384"},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jaip.2026.01.024
Simonne L Horwitz, Lianne Soller, Victoria E Cook, Scott B Cameron, Joanne Yeung, Sandeep Kapur, Mary McHenry, Edmond S Chan, Raymond Mak, Gregory A Rex, Tiffany Wong, Stephanie C Erdle
Clinical implications: In a real-world setting, 81.4% of preschoolers who received cashew and/or walnut OIT successfully tolerated a 4000mg follow-up oral food challenge, enabling dietary liberalization. Real-world cashew and walnut OIT should be considered as an alternative to avoidance in preschoolers.
{"title":"Real-World Effectiveness Analysis of Preschool Cashew and Walnut Oral Immunotherapy.","authors":"Simonne L Horwitz, Lianne Soller, Victoria E Cook, Scott B Cameron, Joanne Yeung, Sandeep Kapur, Mary McHenry, Edmond S Chan, Raymond Mak, Gregory A Rex, Tiffany Wong, Stephanie C Erdle","doi":"10.1016/j.jaip.2026.01.024","DOIUrl":"https://doi.org/10.1016/j.jaip.2026.01.024","url":null,"abstract":"<p><strong>Clinical implications: </strong>In a real-world setting, 81.4% of preschoolers who received cashew and/or walnut OIT successfully tolerated a 4000mg follow-up oral food challenge, enabling dietary liberalization. Real-world cashew and walnut OIT should be considered as an alternative to avoidance in preschoolers.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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