Efficacy and safety of oral antihistamines for allergic rhinitis: Network meta-analysis

Vieira RJ, Gil-Mata S, Ferreira A et al.  ARIA 2024-2025 guideline panel.  J Allergy Clin Immunol Pract. 2026 Feb 16:S2213-2198(26)00140-6. doi: 10.1016/j.jaip.2025.12.034. 

Highlights

• What is already known about this topic? Oral antihistamines are one of the mainstays of the pharmacological management of allergic rhinitis, being widely available and affordable.

• What does this article add to our knowledge? Oral antihistamines are effective in improving rhinitis symptoms and quality-of-life. Cetirizine, ebastine, bilastine and rupatadine were among the individual medications associated with the highest efficacy for improving nasal symptoms.

• How does this study impact current management guidelines? This systematic review will inform the Allergic Rhinitis and its Impact on Asthma (2024-2025) guidelines. In particular, it will provide evidence on the efficacy and safety of individual oral antihistamines.

Abstract

Background

Oral H1-antihistamines (OAH) are among the most frequently used medications for the treatment of allergic rhinitis (AR).

Objective

To perform a systematic review and network meta-analysis comparing the efficacy and safety of individual OAH in patients with AR.

Methods

We searched four electronic bibliographic databases and three clinical trial databases for randomized controlled trials assessing adults with perennial or seasonal AR, and comparing (i) OAH versus placebo or (ii) different individual OAH. We performed a network meta-analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality-of-Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence for comparisons involving the most clinically relevant second-generation OAH was assessed using GRADE-NMA.

Results

Summary of the network meta-analysis results of
the comparisons between each main oral
antihistaminewith placebo

We included 74 randomized controlled trials (21 on perennial AR and 53 on seasonal AR). Cetirizine, ebastine, bilastine and rupatadine were among the individual medications associated with the highest efficacy for improving nasal symptoms. For other efficacy outcomes, the most efficacious interventions varied.

Regulation of allergies across the body by microbial metabolites

Kim, C.H., Baker, J.R.  Exp Mol Med (2026). https://doi.org/10.1038/s12276-026-01642-1

Abstract

General impact of microbial metabolite dysbiosis on allergic pathogenesis.

Allergies are adverse immune responses to typically harmless substances, known as allergens. While allergies can involve diverse immune responses, type 2 immune responses that induce acute hypersensitivity mediated by mast cells, eosinophils and basophils are the major mechanisms underlying allergic disorders. Allergic diseases include atopic dermatitis, allergic rhinitis, food allergies and asthma. The onset and persistence of allergic disorders are influenced by genetic factors, pre-existing illnesses, age, environmental conditions and other lifestyle factors.

Beyond Algorithms: Clinical Judgement in the Management of Allergic Rhinitis

Di Lorenzo G, Melluso M, Seidita A. Clin Exp Allergy. 2026 Feb 17. doi: 10.1111/cea.70254.

From disease to illness in allergic rhinitis

Allergic rhinitis affects 10%–40% of the global population and represents one of the most frequently managed conditions in allergy and internal medicine practice. International guidelines, particularly ARIA (Allergic Rhinitis and its Impact on Asthma), have successfully standardised diagnosis and treatment through evidence-based algorithms that constitute an undeniable scientific advance. However, after 40 years of outpatient allergy practice, it becomes clear that daily clinical reality reveals a complexity that transcends standardised recommendations. This patient-centred perspective is not new—it echoes the Hippocratic emphasis on studying the patient rather than the disease, on careful observation and on allowing sufficient time to combine contradictory findings.

Artificial light at night extends pollen season and elevates allergen exposure

Brandt Geist, Lin Meng, Daniel S W Katz et al. PNAS Nexus, Volume 5, Issue 1, January 2026, pgaf405, https://doi.org/10.1093/pnasnexus/pgaf405

Abstract

Proportion of days in the pollen season under four exposure
severity levels for “No ALAN” and “ALAN” conditions.

Artificial light at night (ALAN), a growing environmental stressor in urban ecosystems, disrupts natural light–dark cycles and alters plant phenological events such as leaf-out and flowering. However, the extent to which ALAN influences airborne pollen season timing and exacerbates allergy-related health risks remains largely understudied. This study investigates how ALAN influences the timing and duration of the airborne pollen season across the Northeastern United States from 2012 to 2023 and the consequences of allergenic pollen exposure. Using daily pollen concentrations from the National Allergy Bureau, ALAN data from the Visible Infrared Imaging Radiometer Suite product, and gridded Daymet climate data, we derived three key pollen season metrics: start of season, end of season, and season length, and examined their relationship with environmental conditions.

ARIA 2024-2025 guideline panel. Efficacy and safety of oral antihistamines for allergic rhinitis: Network meta-analysis.

Vieira RJ, Gil-Mata S, Ferreira A et al. J Allergy Clin Immunol Pract. 2026 Feb 16:S2213-2198(26)00140-6. doi: 10.1016/j.jaip.2025.12.034. 

Highlights

• What is already known about this topic? Oral antihistamines are one of the mainstays of the pharmacological management of allergic rhinitis, being widely available and affordable.

• What does this article add to our knowledge? Oral antihistamines are effective in improving rhinitis symptoms and quality-of-life. Cetirizine, ebastine, bilastine and rupatadine were among the individual medications associated with the highest efficacy for improving nasal symptoms.

• How does this study impact current management guidelines? This systematic review will inform the Allergic Rhinitis and its Impact on Asthma (2024-2025) guidelines. In particular, it will provide evidence on the efficacy and safety of individual oral antihistamines.

Abstract

Background

Oral H1-antihistamines (OAH) are among the most frequently used medications for the treatment of allergic rhinitis (AR).

Perceived Acquired Resistance to Omalizumab in Obese Patients With Chronic Spontaneous Urticaria

Martins F, Trave I, Pereira S, Gonçalo M.  Clin Exp Allergy. 2026 Feb 8. doi: 10.1111/cea.70236. 

Summary

• Obese patients with chronic spontaneous urticaria often require progressively increasing omalizumab doses to maintain previous disease control.

Frey’s syndrome in an infant misdiagnosed as food allergy

Semaan, M., Alkhuder, S. & Jeimy, S. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01015-3

Abstract

Background

Frey’s syndrome (auriculotemporal syndrome) is characterized by gustatory flushing and sweating in the distribution of the auriculotemporal nerve. Although classically described after parotid surgery in adults, congenital and idiopathic forms are increasingly recognized in infants. Because symptoms occur during feeding, the condition can closely mimic IgE-mediated food allergy, leading to unnecessary dietary restrictions and anxiety.

Case presentation

We report an 8-month-old boy referred for evaluation of suspected multiple food allergies after several emergency department visits for feeding-associated facial redness, interpreted by caregivers as “hives”, and accompanied by significant parental anxiety and progressive dietary avoidance.

Evaluating the concordance of pollen forecasting apps against automated pollen monitoring: A single-site experience

Gonzalez F, Ciaccio CE, Nyenhuis SM. J Allergy Clin Immunol Glob. 2026 Jan 12;5(2):100639. doi: 10.1016/j.jacig.2026.100639.

Abstract

Background

Individuals with allergic rhinitis and asthma rely on accurate pollen forecasts to avoid allergen exposure and manage symptoms. However, many widely used weather and health applications (apps) use manual pollen counting methods, which may vary in accuracy.

Objective

This study aimed to evaluate the concordance between popular pollen forecasting apps and real-time data collected from an automated pollen monitoring device at a single site in the Chicago area.

Methods

We compared daily pollen forecasts from 2 commonly used consumer apps (The Weather Channel app and the AccuWeather app) with pollen data recorded by the PollenSense automated monitoring device over 2 months. To assess daily concordance, forecasted pollen levels and automated counts were categorized as being in the low, moderate, or high ranges. Descriptive and inferential assessment of accuracy and reliability of consumer-facing pollen forecasts were performed.

Results

Concordance between the AccuWeather app and PollenSense.

Across the study period, concordance between the consumer apps and the PollenSense counts was low