Sublingual allergen immunotherapy: evidence from randomized trials, real-world studies and meta-analyses

Paoletti G, Valli N, Di Bona D et al. (2026) Front. Allergy 7:1940709. doi: 10.3389/falgy.2026.1940709

Abstract

Background:

Allergen immunotherapy is the only potentially disease-modifying treatment for IgE-mediated respiratory allergy. Among the available routes, sublingual immunotherapy (SLIT) has gained prominence because of its favorable safety profile and greater patient acceptability. 

Objectives:

This narrative review critically appraises the clinical efficacy, real-world effectiveness, and long-term disease-modifying potential of SLIT for seasonal and perennial respiratory allergies by integrating evidence from randomized controlled trials, large observational cohorts, and meta-analyses, with attention to allergen- and product-specific outcomes and age-related differences. 

Schematic overview of the effects of SLIT on allergic disease.
Evidence from randomized controlled trials and real-world studies
indicates reduced symptoms and medication use in allergic rhinitis,
 improved quality of life, and increased IgG4, secretory IgA (sIgA)/
IgE-blocking activity.
In asthma, SLIT is associated with fewer exacerbations and reduced
use of asthma medications. Sustained clinical benefits after treatment
 discontinuation have been demonstrated in both adults and children,
with evidence reported for pollen and house dust mite allergens.
Created with BioRender.com.

Results:

Robust RCT evidence supports clinically meaningful reductions in symptoms and medication use with grass and HDM SLIT tablets, with sustained benefits observed up to 1–2 years after a 3-year treatment course in key trials.

Planetary Health in Health Guidelines: Expert Workshop Report 2024

Saadat P, Herrmann A, Sousa-Pinto B et al.  Clin Public Health Guidel. 2026 Apr 15;3(2):e70072. doi: 10.1002/gin2.70072.

ABSTRACT

Health systems contribute to environmental degradation while simultaneously being affected by its consequences. Yet, planetary health considerations are largely absent from health guidelines. On November 6–7, 2024, the Planetary Health Expert Workshop convened over 50 experts from the GRADE Planetary Health Project Group at Humanitas University, Italy, to explore methods for embedding planetary health into health guideline development. Through presentations, case studies, and group discussions, participants identified key methodological gaps and proposed processes and tools to advance the integration of planetary health in health guidelines.

Occupational Allergic Contact Dermatitis From Over-Ear Headphones: Chemical Analysis Reveals Octylisothiazolinone and Other Potential Skin Sensitizers

G. Fenech, E. Langlois, E. Pelletier et al.  Contact Dermatitis (2026): 1–9, https://doi.org/10.1111/cod.70246.

ABSTRACT

Background

Over-ear headphones are a growing source of allergic contact dermatitis (ACD). Identifying well-known and new culprit sensitizers in such products is challenging because of a lack of labelling and limited cooperation from manufacturers.

Objectives

To report potential skin sensitizers in occupationally-used headphones from patients attending an occupational allergy clinic.

Patients and Methods

The over-ear headphones from two octylisothiazolinone (OIT)-allergic patients with ear ACD were chemically analysed using ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS).

Results

Different parts of the culprit over-ear headphones of Patient 1,
chemically analysed using UPLC–MS/MS.

UPLC–MS/MS confirmed the presence of OIT, but also other biocides (1,2-benzisothiazolin-3-one, cetylpyridinium chloride), rubber accelerators (zinc dibenzyldithiocarbamate, 1,3 diphenyl guanidine, 1,3 di-O-tolyguanidine, tetramethylthiuram disulfide,

As-Needed Versus Regular Medication Use in the Treatment of Allergic Rhinitis in the Pollen Season: A MASK-air Study

B. Sousa-Pinto, R. J. Vieira, A. Bognanni, et al.,  Allergy (2026): 1–18, https://doi.org/10.1111/all.70508.

ABSTRACT

Background

Patients with allergic rhinitis often use as-needed medication instead of regular treatment. Using data from the MASK-air mHealth app, we compared weeks with use of as-needed versus regular medication on treatment satisfaction and symptom control.

Methods

We assessed data from the MASK-air app. We compared weeks in the pollen season in which patients reported the use of one same medication during all the days in the week (“regular treatment”) versus those in which patients reported the use of the same single medication (and no other treatments) in at most 4 days per week (“as-needed treatment”). We built mixed-effects linear regression models, evaluating the differences between regular and as-needed treatments on visual analogue scales for symptom control and treatment satisfaction. We performed sensitivity analyses (i) considering a different definition of as-needed treatment (use of medication ≤ 2 days per week), and (ii) evaluating treatment days preceded by non-treatment days.

Beyond red meat: fish roe-associated reactions in patients with alpha-gal syndrome—a case series from Sri Lanka

Badanasinghe, C.N., Suriapperuma, T., de Silva, S.R. et al. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01059-5

Abstract

Background

Alpha-gal syndrome (AGS) is an IgE-mediated allergy to galactose-α-1,3-galactose (α-Gal), classically presenting with delayed allergic reactions after ingestion of mammalian-derived foods. Fish roe has recently emerged as a potential but under-recognized trigger in α-Gal-sensitized individuals. We describe the first South Asian case series of three patients with AGS who developed anaphylaxis following fish roe ingestion, highlighting this atypical trigger as a possible emerging cause of anaphylaxis associated with AGS in the region.

Case presentation

We retrospectively reviewed patients evaluated at a tertiary allergy clinic in Sri Lanka between January 2025 and May 2026 who developed allergic reactions following fish roe ingestion and fulfilled the diagnostic criteria for AGS based on a compatible clinical history, positive skin prick testing, elevated serum α-Gal-specific IgE, and symptom resolution following dietary avoidance.

Exhalation Delivery System with Fluticasone in Chronic Rhinosinusitis by Eosinophil, Asthma, and Allergy Status

 Peters AT, Adappa ND, Chandra RK et al. Ann Allergy Asthma Immunol. 2026 Sep 3:S1081-1206(26)00423-0. doi: 10.1016/j.anai.2026.08.024. 

Abstract

Background

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses. Comorbid asthma, environmental allergies, and eosinophilia are associated with CRS. Exhalation delivery system with fluticasone (EDS-FLU) is approved for CRS; however, the influence of these features on treatment response remains unclear.

Objective

To evaluate whether baseline blood eosinophil (EOS) count, asthma, or allergies affect response to EDS-FLU in patients with CRS.

Methods

ReOpen1 and ReOpen2 were randomized, EDS-placebo–controlled studies. Patients with CRS were assigned (1:1:1) to EDS-FLU 186 μg, EDS-FLU 372 μg, or EDS-placebo, administered twice daily for 24 weeks.

Eosinophilia and Hypereosinophilia: A Practical Approach to Navigating a Broad Differential Diagnosis

S. Wigerinck and P. Vandenberghe, European Journal of Haematology (2026): 1–15, https://doi.org/10.1111/ejh.70299.

Abstract

Eosinophilia, defined as an absolute eosinophil count (AEC) of ≥ 0.5 × 109/L, is a frequently encountered finding with a vast spectrum of potential underlying etiologies. Hypereosinophilia (HE) is defined as AEC > 1.5 × 109/L and may become life-threatening when eosinophil-induced organ damage occurs, defining the hypereosinophilic syndrome (HES). Among the many causes of HE, rare hematological malignancies, in particular the “myeloid/lymphoid neoplasms (MLN) with eosinophilia and tyrosine kinase (TK) gene fusions,” represent phenotypically and prognostically heterogeneous and challenging entities.

For this reason, the evaluation of HE constitutes a diagnostic and therapeutic challenge. In this review, we provide a concise overview of eosinophil biology, highlight their physiological role as regulators of immunity, tissue homeostasis, and inflammation, their involvement in diseases affecting nearly all organ systems, and in hematological malignancies in particular. Furthermore, we present a practical, stepwise diagnostic approach to HE, emphasizing early recognition of eosinophil-mediated organ dysfunction to initiate timely treatment, as well as red flags that should raise further hematologic evaluation, including molecular and cytogenetic investigations to identify an underlying clonal disorder. Treatment strategies depend on the underlying etiology and range from supportive care, over corticosteroids to targeted biological therapies and tyrosine kinase inhibitors (TKIs).

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Efficacy of Biological and Steroid Therapies in Adolescent and Adult Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis With Meta-Regression

Al Hayek M, Lucendo AJ, Savarino E et al. Clin Gastroenterol Hepatol. 2026 Sep;24(9):2374-2386. doi: 10.1016/j.cgh.2026.04.003.

Abstract

Background & Aims

The therapeutic hierarchy of current pharmacologic options for eosinophilic esophagitis (EoE) has not been established. We performed a network meta-analysis to evaluate the comparative efficacy of pharmacological therapies for EoE.

Methods

PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to May 25, 2025, for randomized controlled trials (RCTs) ≥12 weeks in duration comparing corticosteroids, biologics, or proton pump inhibitors with placebo or active comparators in participants aged ≥12 years. Key outcomes included changes in dysphagia from baseline and histologic remission (≤6 eosinophils/high-power field) at 12, 24, and 48 weeks. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results

Graphical Abstract

Thirteen RCTs were included. For dysphagia improvement compared with placebo and active comparators, dupilumab 300 mg and cendakimab 360 mg demonstrated moderate-to-high-certainty benefit at 12 and 24 weeks, whereas budesonide oral suspension (BOS) 2 mg demonstrated moderate-to-high-certainty benefit at 12 weeks; no 24-week data were available for BOS. At 48 weeks, budesonide orodispersible tablets (BOT) 0.5 and 1 mg demonstrated high certainty benefits for dysphagia improvement compared with placebo and active comparators.