Current Opinion in Allergy and Clinical Immunology

PURPOSE OF REVIEW: The full understanding of the long-term effectiveness and safety of allergen immunotherapy (AIT) for allergic respiratory diseases cannot be achieved through randomized controlled trials (RCTs) alone. However, real-world studies designed as registries can complement RCTs. RECENT FINDINGS: The significance of registries is highlighted by their potential to reassess contraindications and collect data on adult and pediatric patients with multiple comorbidities who are often excluded from RCTs...

PURPOSE OF REVIEW: Ocular surface disorders (OSDs) are a prevalent and often debilitating condition encountered in clinical practice, particularly by allergists and clinical immunologists. RECENT FINDINGS: A comprehensive guide to office procedures for evaluating and managing OSDs, with a specific focus on ocular allergies, would assist in the evaluation process that begins with an initial patient assessment utilizing standardized forms to systematically gather detailed medical history, symptomatology, and environmental exposure data...

PURPOSE OF REVIEW: This review will identify and summarize the published existing data pertaining specifically to Hymenoptera venom allergy in children and adolescents, highlighting the major studies currently available on venom immunotherapy (VIT) and its prognosis in children. RECENT FINDINGS: The current review covers the incidence and prevalence of Hymenoptera venom allergy (HVA) in children, factors influencing occurrence and severity of reactions (age, sex, comorbidities, etc...

PURPOSE OF REVIEW: Recognition of the importance of innate lymphoid cells (ILCs) in the immune mechanisms of food allergy has grown in recent years. This review summarizes recent findings of ILCs in immunoglobulin E (IgE)-mediated food allergy. New research on ILCs in the context of the microbiome and other atopic diseases are also considered with respect to how they can inform understanding of the role of ILCs in food allergy. RECENT FINDINGS: ILCs can mediate allergic and tolerogenic responses through multiple pathways...

PURPOSE OF REVIEW: To resume the current literature about vaccination and the onset of chronic urticaria. RECENT FINDINGS: The recent large-scale vaccination against SARS-CoV-2 targeting elderly, adult and children, has highlighted how vaccines can trigger onset or exacerbation of chronic urticaria. SUMMARY: COVID-19 vaccines may act as triggers in the development of chronic spontaneous urticaria. More data regarding the other vaccines are necessary to evaluate a similar potential role...

PURPOSE OF REVIEW: Epinephrine is the first line treatment for anaphylaxis, however, there are limited data to support this. This review examines data surrounding evidence for the use of epinephrine in anaphylaxis, data on prescription for and use of epinephrine autoinjectors, and data examining newer routes of delivery of epinephrine; with a focus on recent publications over the past few years. RECENT FINDINGS: With recent epidemiologic studies of anaphylaxis and new forms of epinephrine being studied, new data on the effects of epinephrine are aiding in the understanding of epinephrine's effects and the shortcomings of epinephrine both in its effect and utility in the real world...

PURPOSE OF REVIEW: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires rapid identification and intervention. Current management includes early recognition, prompt administration of epinephrine, and immediate medical attention. However, challenges remain in accurate diagnosis, timely treatment, and personalized care. This article reviews the integration of artificial intelligence and machine learning in enhancing anaphylaxis management. RECENT FINDINGS: Artificial intelligence and machine learning can analyze vast datasets to identify patterns and predict anaphylactic episodes, improve diagnostic accuracy through image and biomarker analysis, and personalize treatment plans...

PURPOSE OF REVIEW: The purpose of this narrative review was to summarize data and official recommendations purporting to paired tryptase determination in patients experiencing drug-induced anaphylaxis, published between January 1, 2023 and June 1, 2024. RECENT FINDINGS: Three main lines of evidence obtained through paired acute and baseline tryptase determination were identified: diagnostic criterion for hypersensitivity reactions involving systemic mast cell activation; differential diagnostic criterion for hypersensitivity reactions involving other mechanisms of immediate reactions; and added value of acute and baseline tryptase levels for personalized management following drug-induced anaphylaxis: cause, risk of recurrence, underlying mast cell conditions including hereditary α-tryptasemia, familial clusters...

PURPOSE OF REVIEW: Anaphylaxis is a severe, and potentially life-threatening hypersensitivity reaction whose diagnosis is based on clinical signs and symptoms and their prompt recognition. The presence of mimics and unusual presentations necessitate a careful evaluation and expertise in the field, due to potential diagnostic errors and hence a delay in the treatment.The aim of this review is to analyze and make an overview of the potential differential diagnosis of anaphylaxis, focusing on the clinical challenges of recognizing these conditions effectively among similar others...

PURPOSE OF REVIEW: Cyclosporine is a versatile immunomodulatory drug commonly employed in modern medicine. Although cyclosporine was initially used to prevent solid organ transplant rejection, its indications have extended to treat many inflammatory or autoimmune diseases. Cyclosporin is available for use in oral, intravenous, and topical forms, including eye drops to treat corneal and ocular surface conditions. It is naturally advantageous to administer cyclosporin directly into the eye, avoiding potential and dose limiting systemic adverse effects...

PURPOSE OF REVIEW: The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations. RECENT FINDINGS: A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis. SUMMARY: This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i...

PURPOSE OF REVIEW: Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children. RECENT FINDINGS: Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others...

PURPOSE OF REVIEW: Allergic conjunctivitis is characterized by the development of pathophysiological changes to the ocular surface, which occurs when pro-allergic and pro-inflammatory mediators interact with their cognate receptors expressed on immune and nonimmune cells. Traditional treatments with antihistamines and corticosteroids provide relief, but there is a need for more efficacious and tolerable long-term therapy with a better safety profile. This article aims to provide an overview of the mode of action and clinical application of agonist therapies targeting glucocorticoid, melanocortin, and toll-like receptors, as well as antagonist therapies targeting cytokine, chemokine, integrin, and histamine receptors...

PURPOSE OF REVIEW: This review aims to identify phenotypes at-risk of Hymenoptera venom-induced anaphylaxis (HVA), focusing on different perspectives (epidemiological, clinical, and therapeutic) in order to adapt future preventive strategies. RECENT FINDINGS: HVA remains one of the leading causes of anaphylaxis, with a broad pattern of symptoms. Although most cases occur outside healthcare settings, data indicate a high emergency admission rate due to insect stings...

PURPOSE OF REVIEW: Cancer immunotherapy is one of the most emerging and rapidly growing fields.Ocular side effects associated with these therapies are common and can be present in up to 70% of patients.The cornea may be involved in different pathogenic mechanisms triggered by different immunotherapeutic agents, and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss.We aimed to review the incidence, mechanism, and management of ocular surface side effects in cancer patients receiving immunotherapy...

PURPOSE OF REVIEW: This review summarizes recent advances in identifying genetic risk factors for atopic dermatitis and how these genetic associations are being used to explore the causal relationships between atopic dermatitis and potential risk factors and downstream outcomes. RECENT FINDINGS: A recent large-scale GWAS meta-analysis has identified 91 genetic loci associated with atopic dermatitis. Rare variant studies have also identified new gain-of-function or loss-of-function variants implicated in atopic dermatitis, particularly for FLG and STAT6/JAK1...

PURPOSE OF REVIEW: The ocular surface is prone to inflammation due to exposure to environmental irritants and pathogens. Inflammasomes are intracellular, multiprotein complexes that communicate potentially dangerous signals to the immune system. The identification of inflammasomes in various inflammatory ocular surface conditions can aid in the development of therapeutics to treat these chronic inflammatory conditions. RECENT FINDINGS: Several inflammasomes have been associated with ocular surface disorders including dry eye disease, keratitis, and allergies...

PURPOSE OF REVIEW: Chronic spontaneous urticaria (CSU) patients sometimes do not respond to second-generation antihistamine, and 10-50% patients do not even respond to four-fold the usual dose of nonsedating H1 antihistamine, which further leads to repeated courses of oral corticosteroids to abate the symptoms. There are third-line agents approved by EAACI guidelines, which include omalizumab and cyclosporine. Certain patients are even resistant to the third-line agents. In this review, various other treatment options will be discussed in patients of refractory CSU...

PURPOSE OF REVIEW: To understand the current global scale of drug hypersensitivity (DH) and drug allergy (DA), and to identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS: Global patterns of DH/DA seem to be changing and increasing worldwide, but there are still great challenges in capturing quality DH/DA mortality and morbidity statistics (MMS). DH/DA MMS may gain new perspectives with the global implementation of the International Classification of Diseases (ICD)-11...

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