Pub Date : 2026-01-07DOI: 10.1016/j.jaip.2025.12.031
Marine Savouré, Émeline Lequy, Jean Bousquet, Marcel Goldberg, Kees de Hoogh, Danielle Vienneau, Céline Ribet, Marie Zins, Rachel Nadif, Bénédicte Jacquemin
Background: Rhinitis and asthma often co-occur; however, studies on their associations with air pollution have always considered them separately.
Objective: We investigated the association between long-term air pollution exposure and rhinitis and asthma multimorbidity in adults.
Methods: We used data at inclusion from Constances, a large French population-based adult cohort. Current rhinitis (CR) and current asthma (CA) were defined by questionnaire. Annual exposure to nitrogen dioxide (NO2), particulate matter 2.5 μm or less (PM2.5), and black carbon were estimated by linking participants' residential address to land-use regression models. We performed cross-sectional multinomial logistic regressions between each air pollutant and CR alone, CA alone, and CR+CA (no-CR/no-CA being the reference) adjusted for age, sex, smoking, education level, and French deprivation index.
Results: Among the 177,968 participants included in the analyses (mean age 47 years; 54% female), 111,108 were classified as no-CR/no-CA (62%), 49,971 CR alone (28%), 6,435 CA alone (4%), and 10,454 CR+CA (6%). One interquartile range (IQR) increase of black carbon and NO2 was significantly associated with the three phenotypes, with adjusted odds ratios from 1.04 to 1.13 for BC (IQR = 0.55-10-5·m-1), and from 1.06 to 1.14 for NO2 (IQR = 13.7 μg·m-3). For PM2.5, one IQR increase (4.09 μg·m-3) was significantly associated with CR alone and CR+CA. In all our analysis, the highest associations were observed for CR alone.
Conclusion: Our results show that long-term air pollution is more associated with rhinitis alone or with asthma multimorbidity than with asthma alone.
{"title":"PM<sub>2.5</sub>, Black Carbon, and NO<sub>2</sub> Associations With Rhinitis and Asthma Multimorbidity in Adults: The Constances Cohort.","authors":"Marine Savouré, Émeline Lequy, Jean Bousquet, Marcel Goldberg, Kees de Hoogh, Danielle Vienneau, Céline Ribet, Marie Zins, Rachel Nadif, Bénédicte Jacquemin","doi":"10.1016/j.jaip.2025.12.031","DOIUrl":"10.1016/j.jaip.2025.12.031","url":null,"abstract":"<p><strong>Background: </strong>Rhinitis and asthma often co-occur; however, studies on their associations with air pollution have always considered them separately.</p><p><strong>Objective: </strong>We investigated the association between long-term air pollution exposure and rhinitis and asthma multimorbidity in adults.</p><p><strong>Methods: </strong>We used data at inclusion from Constances, a large French population-based adult cohort. Current rhinitis (CR) and current asthma (CA) were defined by questionnaire. Annual exposure to nitrogen dioxide (NO<sub>2</sub>), particulate matter 2.5 μm or less (PM<sub>2.5</sub>), and black carbon were estimated by linking participants' residential address to land-use regression models. We performed cross-sectional multinomial logistic regressions between each air pollutant and CR alone, CA alone, and CR+CA (no-CR/no-CA being the reference) adjusted for age, sex, smoking, education level, and French deprivation index.</p><p><strong>Results: </strong>Among the 177,968 participants included in the analyses (mean age 47 years; 54% female), 111,108 were classified as no-CR/no-CA (62%), 49,971 CR alone (28%), 6,435 CA alone (4%), and 10,454 CR+CA (6%). One interquartile range (IQR) increase of black carbon and NO<sub>2</sub> was significantly associated with the three phenotypes, with adjusted odds ratios from 1.04 to 1.13 for BC (IQR = 0.55-10<sup>-5</sup>·m<sup>-1</sup>), and from 1.06 to 1.14 for NO<sub>2</sub> (IQR = 13.7 μg·m<sup>-3</sup>). For PM<sub>2.5</sub>, one IQR increase (4.09 μg·m<sup>-3</sup>) was significantly associated with CR alone and CR+CA. In all our analysis, the highest associations were observed for CR alone.</p><p><strong>Conclusion: </strong>Our results show that long-term air pollution is more associated with rhinitis alone or with asthma multimorbidity than with asthma alone.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946731","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 : 2026-01-02DOI: 10.1016/j.jaip.2025.12.029
Ana Maria Copaescu, Michael Ardern-Jones, Natalie K Hickerson, Ella Seccombe, Sherrie J Divito, Jonny Peter
Blistering drug eruptions represent a spectrum of severe cutaneous adverse reactions characterized by epidermal and mucosal detachment, which present clinically as vesiculobullous lesions. These conditions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous fixed drug eruptions, and other blistering mimickers, are rare but potentially life-threatening. Prompt recognition and management are critical to improving outcomes. This Grand Rounds Review describes two clinical cases of patients presenting with a blistering eruption, guiding the reader through the diagnostic approach, including differential diagnosis and acute management. The differential diagnosis and evaluation of blistering drug eruptions are central, with a focus on distinguishing among drug-, infection-, and autoimmune-induced diseases. A structured, clinical-based approach to these complex reactions can significantly improve patient safety and long-term outcomes.
{"title":"Blistering Drug Eruptions: Diagnostic Challenges and Management in Clinical Practice: Unmasking the Cause: A Grand Rounds Review of Blistering Drug Eruption.","authors":"Ana Maria Copaescu, Michael Ardern-Jones, Natalie K Hickerson, Ella Seccombe, Sherrie J Divito, Jonny Peter","doi":"10.1016/j.jaip.2025.12.029","DOIUrl":"10.1016/j.jaip.2025.12.029","url":null,"abstract":"<p><p>Blistering drug eruptions represent a spectrum of severe cutaneous adverse reactions characterized by epidermal and mucosal detachment, which present clinically as vesiculobullous lesions. These conditions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous fixed drug eruptions, and other blistering mimickers, are rare but potentially life-threatening. Prompt recognition and management are critical to improving outcomes. This Grand Rounds Review describes two clinical cases of patients presenting with a blistering eruption, guiding the reader through the diagnostic approach, including differential diagnosis and acute management. The differential diagnosis and evaluation of blistering drug eruptions are central, with a focus on distinguishing among drug-, infection-, and autoimmune-induced diseases. A structured, clinical-based approach to these complex reactions can significantly improve patient safety and long-term outcomes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901646","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.11.020
Giovanni Simeone MD , Matteo Di Toro Mammarella MD , Stefano Miceli Sopo MD
{"title":"Some observations on systematic review of Phelan et al","authors":"Giovanni Simeone MD , Matteo Di Toro Mammarella MD , Stefano Miceli Sopo MD","doi":"10.1016/j.jaip.2025.11.020","DOIUrl":"10.1016/j.jaip.2025.11.020","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 321-322"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904154","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.12.016
{"title":"Impact of Molecular Evaluations in the Biology, Diagnosis, and Prognostication of Patients With Mastocytosis","authors":"","doi":"10.1016/j.jaip.2025.12.016","DOIUrl":"10.1016/j.jaip.2025.12.016","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 17-18"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903907","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.10.007
Julia E.M. Upton MD, MPH , Diana Toscano-Rivero MD , Danbing Ke PhD , Alireza Berenjy MD , Duncan Lejtenyi MSc , Liane Beaudette RN , Xiaojun Yin PhD , Carmen Hong Li MSc , Lucy Y. Duan MD , Casey G. Cohen PhD , Vy Kim MD, MScCH , Shireen Marzouk MD, MSc , Eyal Grunebaum MD , Christine T. McCusker MD, MSc , Bruce Mazer MD , Thomas Eiwegger MD , Moshe Ben-Shoshan MD
Background
The lowest dose of peanut oral immunotherapy (P-OIT) has not been determined.
Objective
To evaluate whether very low-dose oral immunotherapy (30 mg) may safely and effectively increase tolerated doses and induce immunologic changes.
Methods
We prospectively enrolled peanut-allergic children reactive to 444 mg peanut protein (PP) or less in double-blind placebo-controlled food challenges (DBPCFC) and randomly assigned them to three groups. Two were double-blinded P-OIT groups escalating to 30 mg (Group 30 mg) or 300 mg (Group 300 mg) PP maintenance doses. A third group followed open-label avoidance (Group Avoid). Cumulative tolerated doses of 443 mg or greater and 1,043 mg or greater PP were compared with Group Avoid by DBPCFC planned at 1 year. Safety and laboratory parameters (specific IgE and specific IgG4) were assessed.
Results
We enrolled 51 children (26 male [51%], median age 10 years; interquartile range, 7-13 years) with initial cumulative-tolerated dose of 44 mg (interquartile range, 14-144 mg). In Group 30 mg, 15 of 17 patients completed DBPCFC (two of 17 withdrew). In Group 300 mg, 12 of 17 patients completed DBPCFC (five of 17 withdrew). In Group Avoid, 12 of 17 completed DBPCFC (five of 17 were lost to follow-up). By intention to treat, in Group 30 mg, 13 of 17 patients (P < .001 vs Group Avoid) tolerated 443 mg or greater PP, and seven of 17 (P = .007 vs Group Avoid) tolerated 1,043 or greater mg PP. In Group 300 mg, 10 of 17 patients (P ≤ .001 vs Group Avoid) tolerated 443 or greater mg PP, and eight of 17 (P = .003 vs Group Avoid) tolerated 1,043 mg PP. No patients in Group Avoid (0 of 17) tolerated 443 or greater mg PP or 1,043 or greater mg PP. Laboratory parameters (specific IgE and specific IgG4) were similar between Group 30 mg and Group 300 mg and significantly improved from Group Avoid. Systemic adverse events were fewer in Group 30 mg compared with Group 300 mg.
Conclusions
A 30 mg maintenance dose for P-OIT significantly increases the threshold over strict avoidance, clinically similarly to 300 mg, and may allow for a simplified and safer immunotherapy regimen and fewer treatment dropouts.
背景：花生口服免疫治疗（P-OIT）的最低剂量尚未确定。目的：评价极低剂量OIT （30mg）是否可以安全有效地增加耐受剂量并诱导免疫改变。方法：花生过敏儿童对/=443和>/=1043mg PP反应，并在1岁时计划DBPCFC与Group-Avoid进行比较。评估安全性和实验室参数（sIgE、sIgG4）。结果：我们招募了51名儿童（26名（51%）男性，中位年龄10岁（IQR 7-13）），初始累积耐受剂量为44mg （IQR 14-144）。在30mg组，15/17完成了DBPCFC（2/17退出）。在300mg组，12/17完成了DBPCFC（5/17退出）。在Group-Avoid中，12/17完成了DBPCFC（5/17失去了随访）。按治疗目的，30mg组、13/17组(p= 443和7/17组（p=0.007 vs. Group-Avoid）耐受>/=1043mg PP， 300mg组(p=/=443和8/17组（p=0.003 vs. Group-Avoid）耐受>/=1043mg PP，没有Group-Avoid组（0/17）耐受>/=443或>/=1043mg PP，实验室参数（sIgE、sIgG4）在30mg组和300mg组之间相似，与Group-Avoid组相比有显著改善。与300mg组相比，30mg组的全身不良事件较少。结论：30mg的P-OIT维持剂量显著增加了严格避免的阈值，在临床上与300mg相似，并且可能允许简化和更安全的OIT方案以及更少的治疗退出。NCT03532360。
{"title":"Peanut Oral Immunotherapy Using 30 and 300 mg Maintenance Doses","authors":"Julia E.M. Upton MD, MPH , Diana Toscano-Rivero MD , Danbing Ke PhD , Alireza Berenjy MD , Duncan Lejtenyi MSc , Liane Beaudette RN , Xiaojun Yin PhD , Carmen Hong Li MSc , Lucy Y. Duan MD , Casey G. Cohen PhD , Vy Kim MD, MScCH , Shireen Marzouk MD, MSc , Eyal Grunebaum MD , Christine T. McCusker MD, MSc , Bruce Mazer MD , Thomas Eiwegger MD , Moshe Ben-Shoshan MD","doi":"10.1016/j.jaip.2025.10.007","DOIUrl":"10.1016/j.jaip.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The lowest dose of peanut oral immunotherapy (P-OIT) has not been determined.</div></div><div><h3>Objective</h3><div>To evaluate whether very low-dose oral immunotherapy (30 mg) may safely and effectively increase tolerated doses and induce immunologic changes.</div></div><div><h3>Methods</h3><div>We prospectively enrolled peanut-allergic children reactive to 444 mg peanut protein (PP) or less in double-blind placebo-controlled food challenges (DBPCFC) and randomly assigned them to three groups. Two were double-blinded P-OIT groups escalating to 30 mg (Group 30 mg) or 300 mg (Group 300 mg) PP maintenance doses. A third group followed open-label avoidance (Group Avoid). Cumulative tolerated doses of 443 mg or greater and 1,043 mg or greater PP were compared with Group Avoid by DBPCFC planned at 1 year. Safety and laboratory parameters (specific IgE and specific IgG<sub>4</sub>) were assessed.</div></div><div><h3>Results</h3><div>We enrolled 51 children (26 male [51%], median age 10 years; interquartile range, 7-13 years) with initial cumulative-tolerated dose of 44 mg (interquartile range, 14-144 mg). In Group 30 mg, 15 of 17 patients completed DBPCFC (two of 17 withdrew). In Group 300 mg, 12 of 17 patients completed DBPCFC (five of 17 withdrew). In Group Avoid, 12 of 17 completed DBPCFC (five of 17 were lost to follow-up). By intention to treat, in Group 30 mg, 13 of 17 patients (<em>P</em> < .001 vs Group Avoid) tolerated 443 mg or greater PP, and seven of 17 (<em>P</em> = .007 vs Group Avoid) tolerated 1,043 or greater mg PP. In Group 300 mg, 10 of 17 patients (<em>P</em> ≤ .001 vs Group Avoid) tolerated 443 or greater mg PP, and eight of 17 (<em>P</em> = .003 vs Group Avoid) tolerated 1,043 mg PP. No patients in Group Avoid (0 of 17) tolerated 443 or greater mg PP or 1,043 or greater mg PP. Laboratory parameters (specific IgE and specific IgG<sub>4</sub>) were similar between Group 30 mg and Group 300 mg and significantly improved from Group Avoid. Systemic adverse events were fewer in Group 30 mg compared with Group 300 mg.</div></div><div><h3>Conclusions</h3><div>A 30 mg maintenance dose for P-OIT significantly increases the threshold over strict avoidance, clinically similarly to 300 mg, and may allow for a simplified and safer immunotherapy regimen and fewer treatment dropouts.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 223-232.e7"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318769","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.10.034
Andreas Reiter MD , Julien Rossignol MD , Michael W. Deininger MD, PhD , Johannes Luebke MD , Olivier Hermine MD , Cem Akin MD , Jason Gotlib MD , Deepti H. Radia MD
Systemic mastocytosis (SM) is a rare hematological neoplasm driven by the KIT D816V mutation in up to 95% of cases. SM is classified into nonadvanced SM—comprising indolent SM (ISM), bone marrow (BM) mastocytosis, and smoldering SM—and advanced SM (AdvSM), with the subtypes aggressive SM, SM with an associated hematological neoplasm (SM-AHN according to the World Health Organization), and mast cell (MC) leukemia. Clinical presentations are heterogeneous, and careful evaluation of clinical and laboratory parameters is required to plan patient management. Here we discuss the diagnosis and treatment of 2 patients with KIT D816V positive SM, 1 with AdvSM and 1 with ISM, both of whom received KIT-targeted therapies. In addition to clinical presentations caused by a combination of MC mediator symptoms and consequences from MC infiltration of different organ systems, the diagnostic workup included qualitative and quantitative assessment of variably affected key parameters from (1) peripheral blood (eg, blood counts, serum tryptase, and other serum markers; variant allele frequency [VAF] of KIT D816V; and additional somatic mutations); (2) BM MC infiltration, KIT D816V VAF, presence/absence of an AHN/associated myeloid neoplasm, and cytogenetic analysis; and (3) organ infiltration/dysfunction (primarily affecting skin, bone/BM, and visceral organs).
{"title":"KIT-Targeting Drugs in the Management of Nonadvanced and Advanced Systemic Mastocytosis","authors":"Andreas Reiter MD , Julien Rossignol MD , Michael W. Deininger MD, PhD , Johannes Luebke MD , Olivier Hermine MD , Cem Akin MD , Jason Gotlib MD , Deepti H. Radia MD","doi":"10.1016/j.jaip.2025.10.034","DOIUrl":"10.1016/j.jaip.2025.10.034","url":null,"abstract":"<div><div>Systemic mastocytosis (SM) is a rare hematological neoplasm driven by the <em>KIT</em> D816V mutation in up to 95% of cases. SM is classified into nonadvanced SM—comprising indolent SM (ISM), bone marrow (BM) mastocytosis, and smoldering SM—and advanced SM (AdvSM), with the subtypes aggressive SM, SM with an associated hematological neoplasm (SM-AHN according to the World Health Organization), and mast cell (MC) leukemia. Clinical presentations are heterogeneous, and careful evaluation of clinical and laboratory parameters is required to plan patient management. Here we discuss the diagnosis and treatment of 2 patients with <em>KIT</em> D816V positive SM, 1 with AdvSM and 1 with ISM, both of whom received KIT-targeted therapies. In addition to clinical presentations caused by a combination of MC mediator symptoms and consequences from MC infiltration of different organ systems, the diagnostic workup included qualitative and quantitative assessment of variably affected key parameters from (1) peripheral blood (eg, blood counts, serum tryptase, and other serum markers; variant allele frequency [VAF] of <em>KIT</em> D816V; and additional somatic mutations); (2) BM MC infiltration, <em>KIT</em> D816V VAF, presence/absence of an AHN/associated myeloid neoplasm, and cytogenetic analysis; and (3) organ infiltration/dysfunction (primarily affecting skin, bone/BM, and visceral organs).</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 44-52"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446540","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.11.006
Princess U. Ogbogu MD , Donna Carstens MD , Fan Mu ScD , Erin E. Cook ScD , Yen Chung PharmD , Mu Cheng MPH , Elizabeth Judson MPH , Jingyi Chen MSc , Travis Wang MSc , Zhuo Chen MPH , Paneez Khoury MD
Background
There are limited real-world analyses of patients with hypereosinophilic syndrome (HES) in the United States.
Objective
To describe and compare treatment patterns and disease burden between patients with diagnosed or predicted HES and those without HES with elevated blood eosinophil count (BEC).
Methods
Open claims data were used to identify patients with 2 or more BECs greater than 1000 cells/μL, who were classified into 3 cohorts: patients with an HES diagnosis code (group 1), patients identified as having HES by a claims-based prediction model (group 2), and patients without HES with elevated BEC (group 3). HES-related treatments, disease manifestations, HES flares, and all-cause health care resource utilization were evaluated during the 12 months following a randomly selected elevated BEC. Group 3 was compared with groups 2 and 1, separately, using Wilcoxon rank-sum test for continuous variables and χ2 test for categorical variables.
Results
The study included 212 patients in group 1, 8089 in group 2, and 132,945 in group 3. Approximately 62.3% of group 1 patients received 1 or more HES-related treatment, with corticosteroids being the most common (59.0%). The most common disease manifestations were those related to the upper airway/pulmonary (61.8%), constitutional (46.2%), dermatologic (35.8%), and gastrointestinal systems (34.4%). Among patients in group 1, 22.2%, 97.2%, and 25.9% had 1 or more inpatient, outpatient, and emergency department visit, respectively. Compared with group 3, groups 1 and 2 had more corticosteroid use and health care resource utilization (all P < .05).
Conclusions
Patients with HES had a substantial clinical and health care resource utilization burden versus those without HES with elevated BEC.
{"title":"The Clinical Burden of Hypereosinophilic Syndrome in a Large United States Cohort","authors":"Princess U. Ogbogu MD , Donna Carstens MD , Fan Mu ScD , Erin E. Cook ScD , Yen Chung PharmD , Mu Cheng MPH , Elizabeth Judson MPH , Jingyi Chen MSc , Travis Wang MSc , Zhuo Chen MPH , Paneez Khoury MD","doi":"10.1016/j.jaip.2025.11.006","DOIUrl":"10.1016/j.jaip.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>There are limited real-world analyses of patients with hypereosinophilic syndrome (HES) in the United States.</div></div><div><h3>Objective</h3><div>To describe and compare treatment patterns and disease burden between patients with diagnosed or predicted HES and those without HES with elevated blood eosinophil count (BEC).</div></div><div><h3>Methods</h3><div>Open claims data were used to identify patients with 2 or more BECs greater than 1000 cells/μL, who were classified into 3 cohorts: patients with an HES diagnosis code (group 1), patients identified as having HES by a claims-based prediction model (group 2), and patients without HES with elevated BEC (group 3). HES-related treatments, disease manifestations, HES flares, and all-cause health care resource utilization were evaluated during the 12 months following a randomly selected elevated BEC. Group 3 was compared with groups 2 and 1, separately, using Wilcoxon rank-sum test for continuous variables and χ<sup>2</sup> test for categorical variables.</div></div><div><h3>Results</h3><div>The study included 212 patients in group 1, 8089 in group 2, and 132,945 in group 3. Approximately 62.3% of group 1 patients received 1 or more HES-related treatment, with corticosteroids being the most common (59.0%). The most common disease manifestations were those related to the upper airway/pulmonary (61.8%), constitutional (46.2%), dermatologic (35.8%), and gastrointestinal systems (34.4%). Among patients in group 1, 22.2%, 97.2%, and 25.9% had 1 or more inpatient, outpatient, and emergency department visit, respectively. Compared with group 3, groups 1 and 2 had more corticosteroid use and health care resource utilization (all <em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>Patients with HES had a substantial clinical and health care resource utilization burden versus those without HES with elevated BEC.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 205-214"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534859","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.10.046
Cem Akin MD, PhD , Theo Gülen MD , Mariana C. Castells MD, PhD , Hanneke Oude Elberink MD, PhD , Peter Valent MD
Over the past 15 years, the number of patients referred to specialized centers because of a suspected or known mast cell activation disorder (MCAD) has increased substantially in various countries. MCAD is an umbrella term encompassing a heterogeneous group of conditions in which inappropriate or excessive mast cell activation plays a central role. These include IgE-mediated allergic diseases, clonal mast cell disorders such as systemic mastocytosis, and mast cell activation syndrome (MCAS), a distinct clinical entity characterized by systemic symptoms, objective biochemical evidence of mast cell mediator release, and a response to targeted therapy. The increased referral rate is due to an increased awareness of MCAD, a high prevalence of IgE-dependent allergies where mast cell activation is a pathognomonic feature, and the growing access to internet and social media with unverified medical information resources, which may lead to incorrect self- or health care provider–suggested diagnoses. An additional challenge is that solid criteria for MCAS and other MCADs have been proposed but are not known, not applied, or not accepted by all providers. However, to confirm mast cell involvement with certainty in such disorders, which is an ultimate diagnostic prerequisite, stringent diagnostic criteria of MCAS or other MCADs have to be fulfilled. In this article, we provide an overview of available diagnostic standards, assays, and criteria used to diagnose MCAS and other forms of MCADs. In addition, we provide a state-of-the-art overview of therapeutic options. Finally, we review differential diagnoses that must be considered before MCAS is diagnosed.
{"title":"Diagnosis and Management of Patients With Mast Cell Activation Syndromes: Status 2026","authors":"Cem Akin MD, PhD , Theo Gülen MD , Mariana C. Castells MD, PhD , Hanneke Oude Elberink MD, PhD , Peter Valent MD","doi":"10.1016/j.jaip.2025.10.046","DOIUrl":"10.1016/j.jaip.2025.10.046","url":null,"abstract":"<div><div>Over the past 15 years, the number of patients referred to specialized centers because of a suspected or known mast cell activation disorder (MCAD) has increased substantially in various countries. MCAD is an umbrella term encompassing a heterogeneous group of conditions in which inappropriate or excessive mast cell activation plays a central role. These include IgE-mediated allergic diseases, clonal mast cell disorders such as systemic mastocytosis, and mast cell activation syndrome (MCAS), a distinct clinical entity characterized by systemic symptoms, objective biochemical evidence of mast cell mediator release, and a response to targeted therapy. The increased referral rate is due to an increased awareness of MCAD, a high prevalence of IgE-dependent allergies where mast cell activation is a pathognomonic feature, and the growing access to internet and social media with unverified medical information resources, which may lead to incorrect self- or health care provider–suggested diagnoses. An additional challenge is that solid criteria for MCAS and other MCADs have been proposed but are not known, not applied, or not accepted by all providers. However, to confirm mast cell involvement with certainty in such disorders, which is an ultimate diagnostic prerequisite, stringent diagnostic criteria of MCAS or other MCADs have to be fulfilled. In this article, we provide an overview of available diagnostic standards, assays, and criteria used to diagnose MCAS and other forms of MCADs. In addition, we provide a state-of-the-art overview of therapeutic options. Finally, we review differential diagnoses that must be considered before MCAS is diagnosed.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 19-28"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598087","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 : 2026-01-01DOI: 10.1016/j.jaip.2025.10.002
Melba Muñoz MD, PhD , Pascale Salameh PhD , Sabine Altrichter MD , Leslie Durner MD , Clara Geppert-Steidl MD , Petra Staubach MD , Jonathan A. Bernstein MD , Karsten Weller MD
Background
Symptomatic dermographism (SD) is the most common subtype of chronic inducible urticaria. It is characterized by the recurrent appearance of itch and subsequent strip-shaped wheals induced by applying shear forces on the skin, such as stroking or rubbing. The impossibility to avoid symptom’s occurrence in most cases leads to a marked quality-of-life (QoL) impairment. As of yet, a validated and disease-specific instrument to adequately assess QoL in patients with SD is not available.
Objective
To validate the first disease-specific patient-reported outcome measure to assess health-related QoL impairment in patients with SD, the Symptomatic Dermographism Quality-of-Life Questionnaire (SD-QoL).
Methods
A 13-item QoL questionnaire had been previously generated and published. Now, the SD-QoL was analyzed regarding its domain structure and tested for its reliability and validity by evaluating its internal consistency, test-retest reliability, and convergent and known-groups validity.
Results
In total, 106 patients with SD participated in the SD-QoL validation study. The results suggest a 3-domain structure (“symptoms,” “functioning,” and “emotions”/“appearance”) with an excellent internal consistency of the domains as well as the overall instrument. Furthermore, the analyses indicated high levels of convergent validity and known-groups validity as well as an excellent test-retest reliability.
Conclusions
The SD-QoL is the first validated disease-specific QoL instrument for SD that allows assessing QoL of patients with SD in clinical trials as well as in routine patient care.
{"title":"Validation of the Symptomatic Dermographism Quality of Life Questionnaire (SD-QoL)","authors":"Melba Muñoz MD, PhD , Pascale Salameh PhD , Sabine Altrichter MD , Leslie Durner MD , Clara Geppert-Steidl MD , Petra Staubach MD , Jonathan A. Bernstein MD , Karsten Weller MD","doi":"10.1016/j.jaip.2025.10.002","DOIUrl":"10.1016/j.jaip.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Symptomatic dermographism (SD) is the most common subtype of chronic inducible urticaria. It is characterized by the recurrent appearance of itch and subsequent strip-shaped wheals induced by applying shear forces on the skin, such as stroking or rubbing. The impossibility to avoid symptom’s occurrence in most cases leads to a marked quality-of-life (QoL) impairment. As of yet, a validated and disease-specific instrument to adequately assess QoL in patients with SD is not available.</div></div><div><h3>Objective</h3><div>To validate the first disease-specific patient-reported outcome measure to assess health-related QoL impairment in patients with SD, the Symptomatic Dermographism Quality-of-Life Questionnaire (SD-QoL).</div></div><div><h3>Methods</h3><div>A 13-item QoL questionnaire had been previously generated and published. Now, the SD-QoL was analyzed regarding its domain structure and tested for its reliability and validity by evaluating its internal consistency, test-retest reliability, and convergent and known-groups validity.</div></div><div><h3>Results</h3><div>In total, 106 patients with SD participated in the SD-QoL validation study. The results suggest a 3-domain structure (“symptoms,” “functioning,” and “emotions”/“appearance”) with an excellent internal consistency of the domains as well as the overall instrument. Furthermore, the analyses indicated high levels of convergent validity and known-groups validity as well as an excellent test-retest reliability.</div></div><div><h3>Conclusions</h3><div>The SD-QoL is the first validated disease-specific QoL instrument for SD that allows assessing QoL of patients with SD in clinical trials as well as in routine patient care.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 274-282.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281705","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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