Current Allergy and Asthma Reports最新文献

Purpose of review: This review aimed to summarize the inflammatory, microscopic, and histopathological features of inverted sinonasal papilloma (ISP) and to identify viral, molecular, and genetic predictors of recurrence and malignant transformation.

Recent findings: Recent studies describe a heterogeneous inflammatory microenvironment with mixed Th1/Th2/Th17 cytokine responses and epithelial neutrophilia as a defining hallmark. Considerable variability persists across studies evaluating viral and molecular markers. High-risk Human Papillomavirus type 18 (HR-HPV-18), Epidermal Growth Factor Receptor (EGFR) exon 20 mutations, p53 alterations, and p16 loss have been most consistently linked to recurrence and malignant progression. SNIP exhibits multifactorial biological behavior driven by inflammation, viral infection, and molecular dysregulation. These findings highlight the need for standardized histopathological and molecular criteria and prospective studies to refine recurrence prediction and early detection of malignant transformation.

Purpose of review: Monoclonal antibodies ("biologics") have increasingly been used to manage chronic sinusitis with nasal polyps (CRSwNP). The aim of this manuscript was to compare biologic outcomes to traditional management of CRSwNP with endoscopic sinus surgery (ESS).

Recent findings: There are now four approved biologics for the treatment of CRSwNP in the United States: dupilumab, mepolizumab, omalizumab, and tezepelumab. Cost analysis and comparison between phase 3 clinical trial results of biologics and ESS show ESS is at least as effective as biologics in controlling symptoms with significantly less cost to the healthcare system. Recent guidelines published by the European Position paper on Rhinosinusitis and Nasal Polyps (EPOS) and the American Academy of Otolaryngology continue to support ESS in the management of CRSwNP when traditional medical therapy has failed. Biologics may be considered an option for severe uncontrolled CRSwNP that has failed comprehensive ESS. Future studies are needed to assess long-term efficacy and cost of biologics compared to ESS in CRSwNP.

Purpose of review: This review synthesizes current evidence and expert consensus on the long-term management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with biologics, as established by the Italian CHRONOS project.

Recent findings: Accumulating real-world and clinical trial data confirm the sustained efficacy and safety of biologics targeting type 2 inflammation, enabling durable control and remission in a significant proportion of patients. Personalized dosing regimens, including dose-spacing strategies, appear feasible. The CHRONOS project provides practical guidance for optimizing long-term biologic therapy in severe CRSwNP. Response assessment should combine subjective and objective measures, especially for olfactory testing. Biologics may be considered before surgery only in selected complex cases. Dose-spacing strategies may be appropriate in stable patients but require multidisciplinary oversight in those with comorbid asthma. Adverse events are uncommon. The concept of disease modification is endorsed, recognizing biologics' potential to alter the natural history of CRSwNP.

Purpose of the review: With the continued increase in the prevalence of food allergy and its significant associated medical and financial burden, there is a need for safe and effective treatment options for patients. The goal of this review is to summarize published data on the safety and efficacy of peanut sublingual immunotherapy (SLIT) as a potential treatment option for children with food allergy.

Recent findings: Peanut SLIT has demonstrated clinically significant desensitization across 2 cohorts of children ages 1-11 years. In a study focused on 1-4-year-old peanut-allergic toddlers, even greater levels of desensitization as well as the potential for 3-month remission has been demonstrated. Small studies have also demonstrated potential efficacy with SLIT for other foods such as milk, hazelnut, and peach. Evidence to date supports SLIT as effective and safe and a potential future treatment option for children with food allergy.

Purpose of review: Adenosine deaminase 2 (ADA2) is predominantly expressed by and secreted from activated monocytes and macrophages into plasma. This review explores the utility of ADA2 as a biomarker of monocyte/macrophage activation in a range of conditions and suggests potential applications for its clinical use.

Recent findings: Elevated ADA2 activity has been observed in conditions associated with granulomatous inflammation and macrophage activation, including tuberculosis, sarcoidosis, and macrophage activation syndrome. This finding has also been reported in liver fibrosis, malignancy, infection, and autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Absent or near absent ADA2 activity is associated with deficiency of ADA2 (DADA2), an autosomal recessive inborn error of immunity. Increased ADA2 activity correlates with monocyte/macrophage activity, making it a potential biomarker in diseases characterized by excessive macrophage activation. Although ADA2 activity is relatively easy to measure in plasma and may assist with diagnosis when conventional approaches are unavailable, invasive, or carry additional risks, it lacks disease specificity. The absence of ADA2 activity in plasma combined with a characteristic clinical phenotype and biallelic genetic mutations inADA2 is diagnostic of DADA2.

Purpose of review: This review synthesizes interdisciplinary evidence on how environmental stressors-including climate change, urbanization, and air pollution-impact pollen dynamics and human health. We assess conventional and innovative monitoring methods to identify critical gaps in exposure evaluation and public health response.

Recent findings: Recent research confirms that climate change and urbanization are prolonging pollen seasons and increasing pollen potency. Pollutants such as O₃, NO_x, PM, SO₂, and elevated CO₂ along with urban heat island and vegetation changes further enhance pollen allergenicity. While monitoring technology is advancing, significant limitations persist, including poor spatial resolution, a lack of real-time capabilities, and severe underrepresentation of tropical regions. An integrated approach to pollen surveillance that combines climate, air quality, and health data is critically needed. Key challenges remain, including inadequate spatial coverage, a lack of standardized protocols, and poor integration with public health systems. The complex interactions between pollen as a bioaerosol and atmospheric processes represent a significant research gap, hindering our ability to predict and manage pollen-related health risks effectively.

Purpose of review: We aim to highlight recent advancements on the evolving chronic rhinosinusitis (CRS) phenotype: acute exacerbations of chronic rhinosinusitis (AECRS). We focused on studies that expanded the current understanding of its pathophysiology, patient characteristics, and disease burden.

Recent findings: Defining AECRS has been a topic of discussion for many years. A recent regulatory definition of AECRS in the literature incorporates a > 3 day requirement of worsened symptoms and an escalation of treatment. It is important not to rely on patient-reported rescue medication frequency as it was recently demonstrated these are only obtained for 1/3 of reported AECRS episodes. The pathophysiology behind AECRS is still being evaluated but it appears irritants such as viral insult to the sinonasal microbiome can create a dysbiosis and worsens host immune system breakdown, facilitating a subsequent bacterial infection. Many studies are using loose definitions of AECRS because no formal definition has existed until recently. Clinical trials and other studies are relying on patient-reported illnesses, CRS-related antibiotics, and CRS-related corticosteroids to determine an episode of AECRS. Formally defining AECRS is vital in order to conduct future literature on its etiology and clinical outcomes so results may be translatable. Additionally, our review demonstrates that CRS patients with asthma and/or concomitant allergic rhinitis appear to be at an increased risk for developing AECRS and future research should continue to investigate their interplay. Many patients are being overprescribed antibiotics and corticosteroids for reported AECRS episodes. This increases total healthcare spending and increases the risk for adverse effects from corticosteroids and antibiotic resistance. Future research should investigate methods to mitigate this practice.