Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.01.022
Luis Pérez de Llano MD, PhD , David Dacal Rivas MD , Ian Pavord MA, DM, FRCP, FERS, FMedSci , Mian Muhammad Salman Aslam MBBS , Njira Lugogo MD, MS
Significant advances in the management of diseases driven by eosinophilic inflammation in the age of biologics provide us with an untapped opportunity to extend these highly effective treatments to other lung diseases that have eosinophils as a central effector cell. Currently, rare diseases such as chronic eosinophilic pneumonia and allergic bronchopulmonary aspergillosis (ABPA) are treated with oral corticosteroids (OCS) and often require long courses of exposure to high doses of OCS. In this era of increased awareness of OCS toxicity and a heightened interest in OCS stewardship, we are obligated to leverage our understanding of the pathophysiology of these diseases to implement strategies that include the use of biologics as therapeutic options. This review focuses on available literature on employing biologics to treat acute and chronic eosinophilic pneumonia, allergic bronchopulmonary aspergillosis, and hypereosinophilic syndrome.
{"title":"Biologics Use in Eosinophilic Lung Disease: Controversies and Consensus","authors":"Luis Pérez de Llano MD, PhD , David Dacal Rivas MD , Ian Pavord MA, DM, FRCP, FERS, FMedSci , Mian Muhammad Salman Aslam MBBS , Njira Lugogo MD, MS","doi":"10.1016/j.jaip.2026.01.022","DOIUrl":"10.1016/j.jaip.2026.01.022","url":null,"abstract":"<div><div>Significant advances in the management of diseases driven by eosinophilic inflammation in the age of biologics provide us with an untapped opportunity to extend these highly effective treatments to other lung diseases that have eosinophils as a central effector cell. Currently, rare diseases such as chronic eosinophilic pneumonia and allergic bronchopulmonary aspergillosis (ABPA) are treated with oral corticosteroids (OCS) and often require long courses of exposure to high doses of OCS. In this era of increased awareness of OCS toxicity and a heightened interest in OCS stewardship, we are obligated to leverage our understanding of the pathophysiology of these diseases to implement strategies that include the use of biologics as therapeutic options. This review focuses on available literature on employing biologics to treat acute and chronic eosinophilic pneumonia, allergic bronchopulmonary aspergillosis, and hypereosinophilic syndrome.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 583-596.e12"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367198","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.01.027
Giacomo Emmi MD, PhD , Jessica Bass DO , Elisa Baratella MD , Praveen Akuthota MD , Giuseppe G. Loscocco MD, PhD
Eosinophilic lung diseases encompass a heterogeneous spectrum of disorders characterized by the accumulation of eosinophils within the lung parenchyma. Etiologies range from primary eosinophilic syndromes to secondary causes such as parasitic and fungal infections, hematologic malignancies, allergic conditions, and systemic autoimmune diseases. Given their overlapping clinical and radiologic presentations, accurate and timely diagnosis is critical for guiding appropriate management and avoiding both overtreatment and delays in therapy. This review synthesizes current evidence and expert perspectives on the differential diagnosis of eosinophilic lung diseases, drawing on clinical, laboratory, radiologic, and histopathologic approaches. Key emphasis is placed on distinguishing primary eosinophilic syndromes from secondary causes, the role of molecular and immunologic testing, and the integration of multidisciplinary expertise. A comprehensive diagnostic algorithm is presented to assist clinicians in routine practice, with particular emphasis on addressing unmet needs such as biomarker development and the establishment of standardized definitions for disease activity. By elucidating diagnostic processes and minimizing common errors, this article seeks to enhance the precision of differential diagnosis and improve clinical outcomes for patients with eosinophilic lung involvement.
{"title":"Differential Diagnosis of Eosinophilic Lung Diseases","authors":"Giacomo Emmi MD, PhD , Jessica Bass DO , Elisa Baratella MD , Praveen Akuthota MD , Giuseppe G. Loscocco MD, PhD","doi":"10.1016/j.jaip.2026.01.027","DOIUrl":"10.1016/j.jaip.2026.01.027","url":null,"abstract":"<div><div>Eosinophilic lung diseases encompass a heterogeneous spectrum of disorders characterized by the accumulation of eosinophils within the lung parenchyma. Etiologies range from primary eosinophilic syndromes to secondary causes such as parasitic and fungal infections, hematologic malignancies, allergic conditions, and systemic autoimmune diseases. Given their overlapping clinical and radiologic presentations, accurate and timely diagnosis is critical for guiding appropriate management and avoiding both overtreatment and delays in therapy. This review synthesizes current evidence and expert perspectives on the differential diagnosis of eosinophilic lung diseases, drawing on clinical, laboratory, radiologic, and histopathologic approaches. Key emphasis is placed on distinguishing primary eosinophilic syndromes from secondary causes, the role of molecular and immunologic testing, and the integration of multidisciplinary expertise. A comprehensive diagnostic algorithm is presented to assist clinicians in routine practice, with particular emphasis on addressing unmet needs such as biomarker development and the establishment of standardized definitions for disease activity. By elucidating diagnostic processes and minimizing common errors, this article seeks to enhance the precision of differential diagnosis and improve clinical outcomes for patients with eosinophilic lung involvement.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 542-557"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367214","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2025.12.025
John Allen Meadows MD
{"title":"Clarification regarding terminology in “Guidance for the evaluation by payors of claims submitted using Current Procedural Terminology codes 95165, 95115, and 95117”","authors":"John Allen Meadows MD","doi":"10.1016/j.jaip.2025.12.025","DOIUrl":"10.1016/j.jaip.2025.12.025","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Page 729"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367247","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.01.028
Amy D. Klion MD , Elliot Israel MD
{"title":"More Than One Way to Be Guilty: Eosinophils as Culprits and Messengers in Lung Disease","authors":"Amy D. Klion MD , Elliot Israel MD","doi":"10.1016/j.jaip.2026.01.028","DOIUrl":"10.1016/j.jaip.2026.01.028","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 619-620"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367327","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 : 2026-03-01Epub Date: 2025-11-21DOI: 10.1016/j.jaip.2025.11.015
Lianne ten Have MSc , Karin B. Fieten PhD , Fleur.L. Meulmeester MSc , Els J.M. Weersink MD, PhD , Pieter-Paul Hekking MD, PhD , Sarah A. van Nederveen-Bendien MD, PhD , Arnoud F. Aldenkamp MD , Kornelis W. Patberg MD, PhD , Marjo J.T. van de Ven MD, PhD , Ilonka H. van Veen MD , PhD , Astrid van Huisstede MD, PhD , Annelies Beukert MD , Thomas Macken MD , Karen T.M. Oud MD , Lennart Conemans MD , Edwin van Velzen MD, PhD , Marijke Amelink MD, PhD , Jeroen M.A.M. Retera MD , Lotte van Ruitenbeek MD , Gert-Jan Braunstahl MD, PhD , Kim de Jong PhD
Background
Severe asthma greatly impacts daily life. Although biologics such as dupilumab improve clinical outcomes, their effects on patient-reported outcome measures prioritized by patients remain largely unexplored.
Objective
(1) To evaluate changes in fatigue, quality of life (QoL), and work and activity impairment over 12 months following dupilumab initiation in a large severe asthma cohort. (2) To explore differences between biologic-naive patients and switchers and assess the relationship with asthma symptom control.
Methods
Dutch severe asthma registry data were used, measuring fatigue (Checklist for Individual Strength – Subjective Fatigue), QoL (Asthma Quality of Life Questionnaire), work and activity impairment (Work Productivity and Activity Impairment – General Health), and asthma symptom control (6-item Asthma Control Questionnaire) at baseline and at 3, 6, 9, and 12 months. Changes over time and mean improvement “on dupilumab” (baseline vs 3-12 months) were explored using linear mixed models.
Results
Among 236 patients (45% biologic-naive), median (interquartile range) baseline scores were 38 (29 to 47) for fatigue, 5.1 (4.4 to 5.9) for QoL, 35% (10 to 70) for work impairment, and 50% (20 to 70) for activity impairment. Mean improvement “on dupilumab” was −3.3 (95% CI, −4.7 to −1.9) for fatigue, 0.4 (0.3 to 0.5) for QoL, −9% (−15 to −2) for work impairment, and −6% (−10 to −3) for activity impairment. Improvements were greater in patients with larger asthma symptom control improvement. Minimal clinically important differences were achieved by 50% for the 6-item Asthma Control Questionnaire, 46% for QoL, and 30% or less for fatigue and work and activity impairment, with higher rates among those impaired at baseline.
Conclusions
Fatigue, QoL, and work and activity impairment improved following dupilumab initiation, though most patients did not achieve clinically relevant improvements. Effects on fatigue and work and activity impairment appear less pronounced compared with asthma symptom control, possibly due to irreversible impairments in some patients.
{"title":"Impact of Dupilumab for Severe Asthma on Fatigue, Quality of Life, Work Productivity, and Activity","authors":"Lianne ten Have MSc , Karin B. Fieten PhD , Fleur.L. Meulmeester MSc , Els J.M. Weersink MD, PhD , Pieter-Paul Hekking MD, PhD , Sarah A. van Nederveen-Bendien MD, PhD , Arnoud F. Aldenkamp MD , Kornelis W. Patberg MD, PhD , Marjo J.T. van de Ven MD, PhD , Ilonka H. van Veen MD , PhD , Astrid van Huisstede MD, PhD , Annelies Beukert MD , Thomas Macken MD , Karen T.M. Oud MD , Lennart Conemans MD , Edwin van Velzen MD, PhD , Marijke Amelink MD, PhD , Jeroen M.A.M. Retera MD , Lotte van Ruitenbeek MD , Gert-Jan Braunstahl MD, PhD , Kim de Jong PhD","doi":"10.1016/j.jaip.2025.11.015","DOIUrl":"10.1016/j.jaip.2025.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Severe asthma greatly impacts daily life. Although biologics such as dupilumab improve clinical outcomes, their effects on patient-reported outcome measures prioritized by patients remain largely unexplored.</div></div><div><h3>Objective</h3><div>(1) To evaluate changes in fatigue, quality of life (QoL), and work and activity impairment over 12 months following dupilumab initiation in a large severe asthma cohort. (2) To explore differences between biologic-naive patients and switchers and assess the relationship with asthma symptom control.</div></div><div><h3>Methods</h3><div>Dutch severe asthma registry data were used, measuring fatigue (Checklist for Individual Strength – Subjective Fatigue), QoL (Asthma Quality of Life Questionnaire), work and activity impairment (Work Productivity and Activity Impairment – General Health), and asthma symptom control (6-item Asthma Control Questionnaire) at baseline and at 3, 6, 9, and 12 months. Changes over time and mean improvement “on dupilumab” (baseline vs 3-12 months) were explored using linear mixed models.</div></div><div><h3>Results</h3><div>Among 236 patients (45% biologic-naive), median (interquartile range) baseline scores were 38 (29 to 47) for fatigue, 5.1 (4.4 to 5.9) for QoL, 35% (10 to 70) for work impairment, and 50% (20 to 70) for activity impairment. Mean improvement “on dupilumab” was −3.3 (95% CI, −4.7 to −1.9) for fatigue, 0.4 (0.3 to 0.5) for QoL, −9% (−15 to −2) for work impairment, and −6% (−10 to −3) for activity impairment. Improvements were greater in patients with larger asthma symptom control improvement. Minimal clinically important differences were achieved by 50% for the 6-item Asthma Control Questionnaire, 46% for QoL, and 30% or less for fatigue and work and activity impairment, with higher rates among those impaired at baseline.</div></div><div><h3>Conclusions</h3><div>Fatigue, QoL, and work and activity impairment improved following dupilumab initiation, though most patients did not achieve clinically relevant improvements. Effects on fatigue and work and activity impairment appear less pronounced compared with asthma symptom control, possibly due to irreversible impairments in some patients.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 656-665.e9"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589857","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 : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.jaip.2026.01.002
Seong-Dae Woo MD, PhD , Jieun Seo MS , Yoo Seob Shin MD, PhD , Rae Woong Park MD, PhD , Hae-Sim Park MD, PhD
Background
Chronic rhinosinusitis (CRS) is a common comorbidity affecting clinical outcomes in adults with asthma.
Objective
To assess the impact of CRS on long-term asthma outcomes in a real-world clinical setting.
Methods
This retrospective cohort study analyzed the medical records of 16,153 adults with asthma at the Ajou University Medical Center, Korea. Patients were classified into those with and without comorbid CRS. The CRS group was further stratified into the type 2 (T2)-high and T2-low CRS subgroups based on blood eosinophil counts. Over a 10-year follow-up, long-term clinical outcomes, including asthma exacerbation (AE), hospitalization or emergency department (ED) visits, and systemic corticosteroid use, were estimated using Kaplan-Meier curves and Cox proportional hazards models. We analyzed longitudinal laboratory and lung function measures using adjusted linear mixed-effects models.
Results
After propensity score matching, we performed between-group comparisons. The CRS group had higher risks of severe AE (hazard ratio [HR] = 2.07; 95% CI, 1.51-2.87), overall AE (HR = 1.59; 95% CI, 1.36-1.86), hospitalization or ED visits (HR = 1.38; 95% CI, 1.08-1.78), and systemic corticosteroid use (HR = 1.44; 95% CI, 1.25-1.66). Further, these risks were persistently higher in the T2-high CRS subgroup than in the T2-low CRS subgroup (P < .001 for all). Throughout the follow-up, the CRS group, particularly the T2-high subgroup, exhibited elevated blood or sputum eosinophils and FeNO levels, with greater lung function decline than in the non-CRS or T2-low CRS subgroups.
Conclusion
Comorbid CRS, particularly a T2-high CRS endotype, is associated with increased 10-year risk of AEs, hospitalizations or ED visits, and systemic corticosteroid use, as well as greater lung function decline in adults with asthma.
{"title":"Impact of Chronic Rhinosinusitis on Long-Term Clinical Outcomes in Adults With Asthma","authors":"Seong-Dae Woo MD, PhD , Jieun Seo MS , Yoo Seob Shin MD, PhD , Rae Woong Park MD, PhD , Hae-Sim Park MD, PhD","doi":"10.1016/j.jaip.2026.01.002","DOIUrl":"10.1016/j.jaip.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Chronic rhinosinusitis (CRS) is a common comorbidity affecting clinical outcomes in adults with asthma.</div></div><div><h3>Objective</h3><div>To assess the impact of CRS on long-term asthma outcomes in a real-world clinical setting.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed the medical records of 16,153 adults with asthma at the Ajou University Medical Center, Korea. Patients were classified into those with and without comorbid CRS. The CRS group was further stratified into the type 2 (T2)-high and T2-low CRS subgroups based on blood eosinophil counts. Over a 10-year follow-up, long-term clinical outcomes, including asthma exacerbation (AE), hospitalization or emergency department (ED) visits, and systemic corticosteroid use, were estimated using Kaplan-Meier curves and Cox proportional hazards models. We analyzed longitudinal laboratory and lung function measures using adjusted linear mixed-effects models.</div></div><div><h3>Results</h3><div>After propensity score matching, we performed between-group comparisons. The CRS group had higher risks of severe AE (hazard ratio [HR] = 2.07; 95% CI, 1.51-2.87), overall AE (HR = 1.59; 95% CI, 1.36-1.86), hospitalization or ED visits (HR = 1.38; 95% CI, 1.08-1.78), and systemic corticosteroid use (HR = 1.44; 95% CI, 1.25-1.66). Further, these risks were persistently higher in the T2-high CRS subgroup than in the T2-low CRS subgroup (<em>P</em> < .001 for all). Throughout the follow-up, the CRS group, particularly the T2-high subgroup, exhibited elevated blood or sputum eosinophils and FeNO levels, with greater lung function decline than in the non-CRS or T2-low CRS subgroups.</div></div><div><h3>Conclusion</h3><div>Comorbid CRS, particularly a T2-high CRS endotype, is associated with increased 10-year risk of AEs, hospitalizations or ED visits, and systemic corticosteroid use, as well as greater lung function decline in adults with asthma.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 704-712.e9"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991803","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.02.002
{"title":"Biologics Use in Eosinophilic Lung Disease: Controversies and Consensus","authors":"","doi":"10.1016/j.jaip.2026.02.002","DOIUrl":"10.1016/j.jaip.2026.02.002","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 597-598"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417235","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.01.029
{"title":"A Special Thank-You to Our Reviewers","authors":"","doi":"10.1016/j.jaip.2026.01.029","DOIUrl":"10.1016/j.jaip.2026.01.029","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 539-541"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417862","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 : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/S2213-2198(26)00097-8
{"title":"Original Article Highlights From This Issue","authors":"","doi":"10.1016/S2213-2198(26)00097-8","DOIUrl":"10.1016/S2213-2198(26)00097-8","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages A9-A11"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417863","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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