Pub Date : 2026-01-01DOI: 10.1016/S2213-2198(25)01169-9
{"title":"Continuing Medical Education Calendar","authors":"","doi":"10.1016/S2213-2198(25)01169-9","DOIUrl":"10.1016/S2213-2198(25)01169-9","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages A25-A26"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903906","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.2025.12.018
{"title":"Management of Mastocytosis and Mast Cell Activation in Children","authors":"","doi":"10.1016/j.jaip.2025.12.018","DOIUrl":"10.1016/j.jaip.2025.12.018","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Page 43"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903909","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.2025.10.004
Oluwatobi Olayiwola MD , Richard Yang MBI , David Stein PhD , Liqin Wang PhD , Dinah Foer MD
Background
Obesity is a well-known asthma risk factor, and weight loss benefits asthma outcomes. Asthma guidelines recommend weight reduction as part of care; however, provider practices are not known.
Objective
To evaluate whether weight management is integrated into routine asthma care for patients with comorbid obesity.
Methods
We analyzed outpatient encounter notes from patients with both asthma and obesity seen by primary care, allergy/immunology, or pulmonary providers at a large health system between January 1, 2020, and September 30, 2023. Notes were extracted from electronic health records for visits with a primary asthma diagnosis. Using Generative Pretrained Transformer-4 Omni (GPT-4o), a large language model (LLM), we assessed documentation of (1) asthma management, (2) obesity management, (3) integration of obesity management into asthma care, and (4) specific weight management strategies. Inclusion rates were compared across specialties, and encounter-level predictors were identified. Chart review evaluated the performance of GPT-4o.
Results
Of 17,658 encounters (N = 8992 patients), only 12.6% included obesity management as part of asthma care, more frequently in subspecialty (11.0%) than in primary care (1.6%) settings. In adjusted models, male sex, middle age, higher body mass index, higher education, and pulmonology care increased odds of an encounter with obesity management linked to asthma care; oral steroid use decreased the odds. Obesity management strategies differed by specialty, though exercise and general weight counseling was common. GPT-4o demonstrated robust performance.
Conclusions
LLM evaluation of >17,000 encounters demonstrate that, in contrast to guidelines, weight management is infrequently addressed in asthma care. These results highlight actionable opportunities to improve asthma outcomes.
{"title":"Management of Patients With Comorbid Asthma and Obesity: A Large Language Model Evaluation of Clinical Documentation","authors":"Oluwatobi Olayiwola MD , Richard Yang MBI , David Stein PhD , Liqin Wang PhD , Dinah Foer MD","doi":"10.1016/j.jaip.2025.10.004","DOIUrl":"10.1016/j.jaip.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a well-known asthma risk factor, and weight loss benefits asthma outcomes. Asthma guidelines recommend weight reduction as part of care; however, provider practices are not known.</div></div><div><h3>Objective</h3><div>To evaluate whether weight management is integrated into routine asthma care for patients with comorbid obesity.</div></div><div><h3>Methods</h3><div>We analyzed outpatient encounter notes from patients with both asthma and obesity seen by primary care, allergy/immunology, or pulmonary providers at a large health system between January 1, 2020, and September 30, 2023. Notes were extracted from electronic health records for visits with a primary asthma diagnosis. Using Generative Pretrained Transformer-4 Omni (GPT-4o), a large language model (LLM), we assessed documentation of (1) asthma management, (2) obesity management, (3) integration of obesity management into asthma care, and (4) specific weight management strategies. Inclusion rates were compared across specialties, and encounter-level predictors were identified. Chart review evaluated the performance of GPT-4o.</div></div><div><h3>Results</h3><div>Of 17,658 encounters (N = 8992 patients), only 12.6% included obesity management as part of asthma care, more frequently in subspecialty (11.0%) than in primary care (1.6%) settings. In adjusted models, male sex, middle age, higher body mass index, higher education, and pulmonology care increased odds of an encounter with obesity management linked to asthma care; oral steroid use decreased the odds. Obesity management strategies differed by specialty, though exercise and general weight counseling was common. GPT-4o demonstrated robust performance.</div></div><div><h3>Conclusions</h3><div>LLM evaluation of >17,000 encounters demonstrate that, in contrast to guidelines, weight management is infrequently addressed in asthma care. These results highlight actionable opportunities to improve asthma outcomes.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 138-150.e6"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314176","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.2025.10.008
Christine R.F. Rukasin MD , Timothy G. Chow MD , Payge Van Stechelman DO , Allison E. Norton MD , Cosby A. Stone Jr. MD, MPH , Caroline Hoelker APRN , Kimberly Risma MD, PhD , Grace Koo MD
{"title":"Direct challenges are safe and effective in children with low-risk allergies to oral cephalosporins","authors":"Christine R.F. Rukasin MD , Timothy G. Chow MD , Payge Van Stechelman DO , Allison E. Norton MD , Cosby A. Stone Jr. MD, MPH , Caroline Hoelker APRN , Kimberly Risma MD, PhD , Grace Koo MD","doi":"10.1016/j.jaip.2025.10.008","DOIUrl":"10.1016/j.jaip.2025.10.008","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 286-288.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330887","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.2025.10.026
Tolly G. Epstein MD, MS , Karen Berendts BS , David I. Bernstein MD
Background
Protocols for adjusting allergy injection doses after gaps in therapy, and optimal intervals for maintenance injections, are based on expert opinion only.
Objective
To assess (1) incidences of systemic allergic reactions (SRs) to subcutaneous allergen immunotherapy (SCIT), (2) clinical practices that reduce the risk of SRs, (3) SCIT-related infections, and (4) risks associated with interruptions in SCIT.
Methods
From 2008 to 2023, members of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, & Immunology completed annual surveys of SCIT-related SRs; SCIT-related infections were assessed since 2014. Questions were added in 2020 regarding dose adjustment after gaps in immunotherapy, and maintenance intervals prescribed.
Results
Data were gathered on 84.1 million injection visits and 4.9 million patients (2008-2023). Four new SCIT-related fatalities were confirmed (2018-2023). One contaminated vial, resulting in 2 local skin infections, was identified (2014-2023). Practices reducing to 1 vial lower in patients who were more than 7 weeks late for maintenance vial injections had fewer grade 4 SRs (P = .02). Practices decreasing to the next lower vial in patients who were more than 28 days late during buildup had fewer grade 3 and 4 SRs (P = .03). For the period from 2021 to 2022, there was an increased rate of total (P < .0001), grade 2 (P < .0001), and grade 3 SRs (P = .0005) for practices that used a maintenance injection interval longer than 4 weeks.
Conclusions
Fatal reactions to SCIT still rarely occur. The risk of infections from SCIT is extremely low. Controlled studies are needed to define optimal dose adjustment strategies after gaps in therapy as well as the safest, most efficacious maintenance intervals for aeroallergen SCIT.
{"title":"Impact of Dose Adjustment After Gaps in Subcutaneous Immunotherapy: Update From the North American Immunotherapy Surveillance Study (2008-2023)","authors":"Tolly G. Epstein MD, MS , Karen Berendts BS , David I. Bernstein MD","doi":"10.1016/j.jaip.2025.10.026","DOIUrl":"10.1016/j.jaip.2025.10.026","url":null,"abstract":"<div><h3>Background</h3><div>Protocols for adjusting allergy injection doses after gaps in therapy, and optimal intervals for maintenance injections, are based on expert opinion only.</div></div><div><h3>Objective</h3><div>To assess (1) incidences of systemic allergic reactions (SRs) to subcutaneous allergen immunotherapy (SCIT), (2) clinical practices that reduce the risk of SRs, (3) SCIT-related infections, and (4) risks associated with interruptions in SCIT.</div></div><div><h3>Methods</h3><div>From 2008 to 2023, members of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, & Immunology completed annual surveys of SCIT-related SRs; SCIT-related infections were assessed since 2014. Questions were added in 2020 regarding dose adjustment after gaps in immunotherapy, and maintenance intervals prescribed.</div></div><div><h3>Results</h3><div>Data were gathered on 84.1 million injection visits and 4.9 million patients (2008-2023). Four new SCIT-related fatalities were confirmed (2018-2023). One contaminated vial, resulting in 2 local skin infections, was identified (2014-2023). Practices reducing to 1 vial lower in patients who were more than 7 weeks late for maintenance vial injections had fewer grade 4 SRs (<em>P</em> = .02). Practices decreasing to the next lower vial in patients who were more than 28 days late during buildup had fewer grade 3 and 4 SRs (<em>P</em> = .03). For the period from 2021 to 2022, there was an increased rate of total (<em>P</em> < .0001), grade 2 (<em>P</em> < .0001), and grade 3 SRs (<em>P</em> = .0005) for practices that used a maintenance injection interval longer than 4 weeks.</div></div><div><h3>Conclusions</h3><div>Fatal reactions to SCIT still rarely occur. The risk of infections from SCIT is extremely low. Controlled studies are needed to define optimal dose adjustment strategies after gaps in therapy as well as the safest, most efficacious maintenance intervals for aeroallergen SCIT.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 253-259.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423321","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.2025.10.037
Meera Patel BS , Chen Wang MD , Amanda Urban DNP , Iris Martin BS , Jean Ulrick RN , Susan Roy RN , Kirsten Zambell PhD , Anjali Rai MD , David E. Kleiner MD, PhD , Jatin Raj Matta DHSc , Nader S. Metwalli PhD , Ronald Ouwerkerk PhD , Ami Makadia BS , Theo Heller MD , Ahmed M. Gharib MD , Alexandra F. Freeman MD
{"title":"Obesity and hepatic steatosis in STAT3 hyper-IgE syndrome","authors":"Meera Patel BS , Chen Wang MD , Amanda Urban DNP , Iris Martin BS , Jean Ulrick RN , Susan Roy RN , Kirsten Zambell PhD , Anjali Rai MD , David E. Kleiner MD, PhD , Jatin Raj Matta DHSc , Nader S. Metwalli PhD , Ronald Ouwerkerk PhD , Ami Makadia BS , Theo Heller MD , Ahmed M. Gharib MD , Alexandra F. Freeman MD","doi":"10.1016/j.jaip.2025.10.037","DOIUrl":"10.1016/j.jaip.2025.10.037","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 303-305.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453884","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.2025.10.043
Natasha Correa MD , Jennifer Namazy MD
{"title":"Pharmacological Management of Severe Asthma in Pregnancy","authors":"Natasha Correa MD , Jennifer Namazy MD","doi":"10.1016/j.jaip.2025.10.043","DOIUrl":"10.1016/j.jaip.2025.10.043","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 313-314.e22"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903930","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.2025.10.001
Nyla Thyara Melo Lobão MD, PhD , Maine Luellah Demaret Bardou MD , Shirley Yajaira Cerinza Vila MD , Lucas Salomão de Sousa Ferreira MSc , Luisa Karla Arruda MD, PhD , José Eduardo Seneda Lemos MD , Mariana Paes Leme Ferriani MD, PhD , Marina Mendonça Dias MSc , Eliana Cristina Toledo MD, PhD , Faradiba Sarquis Serpa MD, PhD , Therezinha Ribeiro Moyses MD , Herberto J. Chong-Neto MD, PhD , Nelson Augusto Rosário Filho MD, PhD , Caroline Guth de Freitas Batista de Moraes MSc , Fernanda Casares Marcelino MD , Eli Mansour MD, PhD , Caroline Rosa Emergente Coutinho MD , Ronney Corrêa Mendes MD , Rozana de Fátima Gonçalves MD , Solange Oliveira Rodrigues Valle MD, PhD , Anete Sevciovic Grumach MD, PhD
Background
Hereditary angioedema (HAE) with normal C1 inhibitor (HAE-nC1INH) is a rare and heterogeneous group of bradykinin-mediated disorders, characterized by diagnostic challenges and limited evidence-based recommendations.
Objective
To describe the clinical features and therapeutic strategies of Brazilian patients with HAE-nC1INH, supporting individualized, subtype-oriented management. Methods: This multicenter, cross-sectional analytical study was conducted through the Brazilian Group for the Study of Hereditary Angioedema (GEBRAEH). Data were collected in December 2024 using a standardized online questionnaire and analyzed descriptively and inferentially.
Results
A total of 116 symptomatic patients were included: 92 with HAE with mutation in coagulation factor XII, 21 with HAE of unknown genetic cause, and 3 with HAE with mutation in angiopoietin-1. Females accounted for 96%. Abdominal symptoms were predominant, and diagnostic delay decreased in more recent generations. Initial interventions most often involved isolated combined estrogen-progestin oral contraceptive (COC) withdrawal (33 of 116; 28%) or combined with progestins (35 of 116; 30%). In HAE with mutation in coagulation factor XII, COC withdrawal was effective in 97% (29 of 30), further enhanced with progestins (30 of 30; 100%). COC withdrawal reduced median attack days (4.5 to 1; P < .001) and prolonged attack-free intervals (P < .001). Four patients relapsed after more than 10 years of remission, associated with hormonal changes. Tranexamic acid demonstrated variable efficacy (2 of 10 achieved complete cessation, 5 of 10 partial reduction, and 3 of 10 no response). Lanadelumab showed clinical efficacy in HAE of unknown genetic cause (2 of 2) and HAE with mutation in angiopoietin-1 (1 of 1). Androgens showed only limited benefit (7 of 7; all partial reduction).
Conclusions
COC withdrawal is the most effective first-line intervention in HAE with mutation in coagulation factor XII, with greater efficacy when combined with progestins. Tranexamic acid and lanadelumab may serve as complementary options in selected cases. Late relapse highlights the need for long-term follow-up, with intensified monitoring during periods of hormonal fluctuation.
{"title":"Real-World Evidence on the Management of Hereditary Angioedema With Normal C1 Inhibitor","authors":"Nyla Thyara Melo Lobão MD, PhD , Maine Luellah Demaret Bardou MD , Shirley Yajaira Cerinza Vila MD , Lucas Salomão de Sousa Ferreira MSc , Luisa Karla Arruda MD, PhD , José Eduardo Seneda Lemos MD , Mariana Paes Leme Ferriani MD, PhD , Marina Mendonça Dias MSc , Eliana Cristina Toledo MD, PhD , Faradiba Sarquis Serpa MD, PhD , Therezinha Ribeiro Moyses MD , Herberto J. Chong-Neto MD, PhD , Nelson Augusto Rosário Filho MD, PhD , Caroline Guth de Freitas Batista de Moraes MSc , Fernanda Casares Marcelino MD , Eli Mansour MD, PhD , Caroline Rosa Emergente Coutinho MD , Ronney Corrêa Mendes MD , Rozana de Fátima Gonçalves MD , Solange Oliveira Rodrigues Valle MD, PhD , Anete Sevciovic Grumach MD, PhD","doi":"10.1016/j.jaip.2025.10.001","DOIUrl":"10.1016/j.jaip.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary angioedema (HAE) with normal C1 inhibitor (HAE-nC1INH) is a rare and heterogeneous group of bradykinin-mediated disorders, characterized by diagnostic challenges and limited evidence-based recommendations.</div></div><div><h3>Objective</h3><div>To describe the clinical features and therapeutic strategies of Brazilian patients with HAE-nC1INH, supporting individualized, subtype-oriented management. Methods: This multicenter, cross-sectional analytical study was conducted through the Brazilian Group for the Study of Hereditary Angioedema (GEBRAEH). Data were collected in December 2024 using a standardized online questionnaire and analyzed descriptively and inferentially.</div></div><div><h3>Results</h3><div>A total of 116 symptomatic patients were included: 92 with HAE with mutation in coagulation factor XII, 21 with HAE of unknown genetic cause, and 3 with HAE with mutation in angiopoietin-1. Females accounted for 96%. Abdominal symptoms were predominant, and diagnostic delay decreased in more recent generations. Initial interventions most often involved isolated combined estrogen-progestin oral contraceptive (COC) withdrawal (33 of 116; 28%) or combined with progestins (35 of 116; 30%). In HAE with mutation in coagulation factor XII, COC withdrawal was effective in 97% (29 of 30), further enhanced with progestins (30 of 30; 100%). COC withdrawal reduced median attack days (4.5 to 1; <em>P</em> < .001) and prolonged attack-free intervals (<em>P</em> < .001). Four patients relapsed after more than 10 years of remission, associated with hormonal changes. Tranexamic acid demonstrated variable efficacy (2 of 10 achieved complete cessation, 5 of 10 partial reduction, and 3 of 10 no response). Lanadelumab showed clinical efficacy in HAE of unknown genetic cause (2 of 2) and HAE with mutation in angiopoietin-1 (1 of 1). Androgens showed only limited benefit (7 of 7; all partial reduction).</div></div><div><h3>Conclusions</h3><div>COC withdrawal is the most effective first-line intervention in HAE with mutation in coagulation factor XII, with greater efficacy when combined with progestins. Tranexamic acid and lanadelumab may serve as complementary options in selected cases. Late relapse highlights the need for long-term follow-up, with intensified monitoring during periods of hormonal fluctuation.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 233-242.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281692","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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