Safety of Dupilumab and Risk of Cutaneous T-Cell Lymphoma in Pediatric Patients With Atopic Dermatitis: A Data-Driven Guide to Counseling Patients and Families

M. G. Buethe, T. Sy, and L. F. Eichenfield. Pediatric Dermatology (2026): 1–7, https://doi.org/10.1111/pde.70285.

ABSTRACT

Features distinguishing CTCL from AD.

Recent publications reporting increased cutaneous T-cell lymphoma (CTCL) risk with dupilumab in atopic dermatitis (AD) have sparked debate, amplified by media coverage linking dupilumab to lymphoma. These concerns have reached pediatric populations, where we observe increasing parental hesitancy about initiating dupilumab for their children. This hesitancy is particularly acute given that dupilumab was only approved for infants aged 6 months and older in 2022—the first cohort now approaching 3–4 years of exposure.

Preventive Application of House Dust Mite-Sublingual Immunotherapy Induces Blocking Antibodies in Sensitized Preschool Children

V. Dwivedi, K. Schmidthaler, H. Demir, et al. Allergy (2026): 1–12, https://doi.org/10.1111/all.70387. 

ABSTRACT

Background

Sublingual allergen immunotherapy (SLIT) is an effective treatment for immunoglobulin (Ig)E-mediated allergies. Its success is associated with allergen-specific (s)IgG, which blocks IgE-mediated mechanisms. Preventive effects of SLIT in children before allergy-symptom onset remain largely unexplored.

Methods

Graphical Abstract: HDM-pSLIT induced IgG, IgG1, and IgG4 specific
to major HDM allergens in sensitized non-allergic preschool children
without increasing HDM-sIgE. It blunted the development of new
sensitizations and reduced HDM reactivity in skin and basophils.
HDM-pSLIT treated children displayed a blocking effect on
HDM-induced basophil activation.
HDM, house dust mite; Ig, immunoglobulin; pSLIT,
preventively administered sublingual immunotherapy.

A randomized trial was conducted between October 06, 2017 and December 15, 2022, which included house dust mite (HDM)-sensitized preschool children (aged 3–5 years) showing no allergy symptoms. They were randomized (2:2 blocks) to HDM-SLIT (300 index of reactivity/day, Staloral) or placebo solution for 2 years. Children receiving > 4 months of treatment were included in the analysis. Primary objective of the study was to compare the groups for change in major HDM allergen-Der p 1-sIgG levels from baseline to end of treatment (EOT).

Changes in the Use of Montelukast for Asthma After a US Food and Drug Administration Boxed Warning

Shanmugam H, Kesselheim AS, Liu ITT et al. JAMA Netw Open. 2026;9(5):e2614274. doi:10.1001/jamanetworkopen.2026.14274

Key Points

• Question  Did the use of montelukast to treat asthma change after an US Food and Drug Administration (FDA) boxed warning was announced in March 2020?
• Findings  In this cross-sectional study using national monthly cohorts of up to 614 637 patients with asthma from a national commercial claims dataset, the use of montelukast decreased after implementation of an FDA boxed warning.
• Meaning  These findings suggest that treatment patterns for patients with asthma changed after an FDA boxed warning.

Abstract

Importance  In March 2020, the US Food and Drug Administration (FDA) issued a boxed warning for montelukast amid reports of neuropsychiatric adverse effects.

A Multidisciplinary Approach to Checkpoint Inhibitor Adverse Reactions

Andrews C, Mukherjee E, Gibson A  et al. The Journal of Allergy and Clinical Immunology: In Practice, 14, 1058-1072

Abstract

Overlapping cellular and molecular mechanisms
of ICI efficacy and toxicities.

Immune checkpoint inhibitors are used in a wide range of cancers, offering durable responses for a substantial subset of patients. However, immune-related adverse events, the most clinically consequential checkpoint inhibitor–associated adverse reactions, pose a key challenge in practice, affecting virtually any organ system, resulting in treatment interruption, morbidity, or mortality. Patient education, early recognition, and effective management are essential to limit complications and maintain continuity of immunotherapy.

Impact of IL-4/IL-13 Blockade with Dupilumab on the Microbiome in Type 2 Inflammatory Diseases: A Systematic Review

Mari, PV., Carriera, L., Saviano, A. et al.  Curr Allergy Asthma Rep 26, 37 (2026). https://doi.org/10.1007/s11882-026-01281-6

Abstract

Purpose of Review

To systematically review current evidence on microbiota changes associated with dupilumab treatment across different anatomical sites in type 2 inflammatory diseases.

Recent Findings

Compartment-specific microbiome changes associated with dupilumab.
Dupilumab blocks IL-4Rα signaling, inhibiting IL-4 and IL-13 pathways
and promoting site-specific microbiome modulation.

Fifteen studies were included, comprising two randomized trials and thirteen observational studies, mostly in atopic dermatitis, with fewer data in chronic rhinosinusitis with nasal polyps and NSAID-exacerbated respiratory disease. The skin was the most frequently investigated site, followed by the sinonasal tract and gut.

Evaluating montelukast-second-generation antihistamine combinations versus monotherapy in allergic rhinitis: A network meta-analysis

Wandana A, Tanely JC, Sudrajat RMC et al.  Asia Pac Allergy. 2026 May;16(3):152-166. doi: 10.5415/apallergy.0000000000000236. 

Abstract

Background: 

Allergic rhinitis (AR) is an atopic condition affecting over 400 million people worldwide, impairing quality of life and often leading to complications such as asthma and sinusitis. Montelukast, a leukotriene receptor antagonist, is often used in combination with second-generation antihistamines (sgAHs) to enhance symptom control. However, the relative efficacy of different montelukast-sgAH combinations remains unclear.

Objective: 

To evaluate and compare the efficacy of montelukast combined with various sgAHs versus montelukast monotherapy in patients with AR.

Methods: 

Randomized controlled trials (RCTs) comparing montelukast-sgAH combinations to montelukast alone were identified from 5 electronic databases up to 2025. Outcomes included Total Nasal Symptom Score (TNSS; 0–12), Daytime and Nighttime Nasal Symptom Scores (DNSS, NNSS; 0–3), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; 0–6).

Gold and Nickel Release From Gold-Plated Earrings Under Cysteine-Modified Artificial Sweat Conditions

Jensen MB, Ahlström MG, Jellesen MS et al. Contact Dermatitis. 2026 May 17. doi: 10.1111/cod.70187. 

ABSTRACT

Background

Contact allergy to gold is frequently observed in patch testing, although with low clinical relevance. Nickel allergy, in contrast, is common, clinically relevant, and nickel release from jewellery remains a regulatory concern. Standardised artificial sweat tests show no detectable gold release from gold-containing jewellery.

Objectives

To assess surface composition and the release of nickel and gold from gold-plated earrings under clinically relevant biochemical conditions.

Methods

Ten pairs of low-cost gold-plated earrings were analysed by scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS) and X-ray fluorescence. Metal release was assessed using a cysteine-modified artificial sweat solution at 30°C for 168 h. Gold and nickel concentrations were quantified by inductively coupled plasma mass spectrometry.

Results

Results of nickel and gold release after 168 h in the artificial
sweat solution at 30°C.

Nickel release was detected in 10/10 earrings (median: 2.1 μg/cm2, range: 0.00032–10.0) frequently exceeding the EU regulatory limit.

Systemic IgE promotes allergic rhinitis by licensing Th2-to-Tfh conversion and local IgE production

 Nakai T, Tezuka S, Adachi T et al. Mucosal Immunol. 2026 May 23:100351. doi: 10.1016/j.mucimm.2026.100351.

Highlights

• Systemic IgE and local Th2 cells cooperate to drive AR development.
• Systemic IgE facilitates Th2-to-Tfh differentiation to trigger local IgE response.
• MC/basophil activation potentiates antigen-induced local type-2 responses.

Abstract

Graphical abstract

Although systemic allergen-specific IgE is an essential biomarker for allergic rhinitis (AR), its mechanistic contribution to symptom development remains unclear. Here, using mouse models, we investigated how systemic antigen-specific IgE influences AR symptoms and local type 2 inflammation. Mice were adoptively sensitized with ovalbumin (OVA)-specific IgE (OVA-IgE) and/or in vitro–differentiated OVA-specific Th2 (OVA-Th2) cells, followed by repeated intranasal OVA exposure.