Frequency and severity of systemic reactions during beta-lactam skin testing in adults with immediate hypersensitivity allergy

Letón-Cabanillas, P., Noguerado-Mellado, B., Quijada-Morales, P. et al.  Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01032-2

Abstract

Diagnostic workflow for beta-lactam immediate hypersensitivity skin 

testing

Hypersensitivity to beta-lactams (BL) is the most frequent drug allergy, and skin testing (ST) remains the first-line diagnostic tool. Although generally safe, systemic reactions (SR) during ST are a concern. We conducted a 7-year ambispective study (2018–2025) including 216 adults with confirmed immediate hypersensitivity reactions (HSR) to BL, established by positive skin tests (ST) or drug challenge tests (DCT). Among them, 138 (63.9%) had positive ST, predominantly intradermal tests (IDT; 93.5%). Five patients (3.6% of ST-positive; 2.3% of the entire cohort) developed SR during ST, all after IDT following negative skin prick tests (SPT).

Prediction of allergic disease trajectories from birth up to adolescence

Leskien M, Scheerer M, Thiering E e al. Pediatr Allergy Immunol. 2026 Apr;37(4):e70341. doi: 10.1111/pai.70341.

Abstract

Background

Allergic diseases often develop jointly during early childhood. Potential disease trajectories and relevant early-life factors have been described, yet existing prediction approaches mostly focus on single allergic diseases cross-sectionally. Models addressing allergic multimorbidity and disease trajectories are lacking. We aim to predict allergic disease trajectories from birth up to adolescence using early-life factors.

Methods

Preceding research using data from 4646 adolescents of the German birth cohorts GINIplus and LISA identified seven allergic disease trajectories up to the age of 15 years. A set of predictors comprising parental and perinatal factors, early allergic or respiratory symptoms, lifestyle and environmental factors was used with an XGBoost machine learning approach to perform multiclass classification. In a subsample (N = 2109), polygenic risk scores (PRS) for asthma, allergic rhinitis, atopic dermatitis, and any allergy were added to the predictor set.

Results

Sankey Plot illustrating the distributions of observed and predicted
trajectories and their overlaps.

Our approach revealed moderate classification success (multiclass area under the curve (AUC) = 0.69). A macro-averaged sensitivity of 0.26 and specificity of 0.89 were obtained. The most important predictors were early-life skin rash, respiratory symptoms, and air pollution.

Loss of symbiotic gut bacteria in children at diagnosis of food protein–induced enterocolitis syndrome

Winberg A, Simonyté Sjödin K, Öhlund M, West CE. J Allergy Clin Immunol. 2026 Mar 11:S0091-6749(26)00184-3. doi: 10.1016/j.jaci.2026.02.043.

Abstract
Background

Gut microbial composition has been proposed to influence disease onset in children with food protein–induced enterocolitis syndrome (FPIES).

Objective
We sought to investigate differences in gut microbiota profiles in children with newly diagnosed FPIES and healthy control subjects.

Methods
Fecal samples were collected at FPIES diagnosis from 56 children stratified into 3 age groups: mean (SD) age 4.6 (0.5) months, 6.5 (0.6) months, and 11.7 (7.8) months. Gut microbiota profiles were analyzed using 16S ribosomal RNA gene amplicon sequencing and compared between children with FPIES and 43 age-matched control subjects.

Graphical Abstract

Results
Age was the strongest determinant of gut microbiota composition, followed by FPIES status. β-diversity differed significantly between children with FPIES and control subjects (P < .01), primarily driven by shifts in Bacteroidota, Proteobacteria, Actinobacteriota, and Verrucomicrobiota.

Hypersensitivity to Excipients in Drugs: An EAACI Position Paper

L. H.Garvey, K.Brockow, A.Barbaud, et al.  Allergy (2026): 1–26, https://doi.org/10.1111/all.70324.

ABSTRACT

Characteristics of immediate drug hypersensitivity

reactions (DHR) caused by excipients.

Drugs contain active pharmaceutical ingredients and excipients, compounds which enhance the pharmacokinetics, stability and palatability of the pharmaceutical formulation. While most drug hypersensitivity reactions (DHR) are caused by active ingredients, excipients may also be involved. Excipient-related DHR are easily overlooked and may lead to repeated anaphylaxis in patients exposed to pharmaceutical formulations containing different active ingredients.

Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis

Islam N, Chu AWL, Sheriff F, et al. JAMA Pediatr. Published online February 09, 2026. doi:10.1001/jamapediatrics.2025.6105

Key Points

Question  What are the risk factors associated with the development of food allergy in children?

Findings  This systematic review and meta-analysis of 2.8 million participants in 190 studies identified the following largest and most certain risk factors associated with the development of food allergies in children: prior allergic conditions (atopic march/diathesis), atopic dermatitis, increased skin transepidermal water loss, filaggrin gene sequence variations, delayed solid food introduction, infant and intrapartum antibiotic exposure, male sex, being first born, family history of allergy, parental migration, self-identification as Black, and cesarean delivery.

Meaning  This systematic review and meta-analysis clarifies the major and minor risk factors associated with developing early-onset food allergy to inform optimal prevention clinical practice, policy, and research.

Abstract

Importance  The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Broad-Spectrum Grass Pollen Immunotherapy: Revisiting the Role of Species Diversity in Allergy Treatment

Feindor, M., Hewings, S., Goodman, J. et al. Curr Treat Options Allergy 13, 4 (2026). https://doi.org/10.1007/s40521-026-00412-8

Abstract

Purpose of Review

This review examines whether allergen immunotherapy (AIT) for grass pollen allergy should expand beyond the recent trend towards a mono-species approach based on Phleum pratense. It explores whether multi-species formulations better reflect natural exposure and could improve clinical outcomes.

Recent Findings

Group 5 homologues identified in individual extracts and
a mixed extract of 13 species of Poaceae family grasses,
using a monoclonal antibody

Research from aerobiology and immunology shows that grass pollen exposure involves diverse species with distinct flowering periods, influenced by climate and geography.

Adverse Events of Biologics in Severe Asthma

Sánchez, J., Caraballo, A. & Álvarez, L.  Curr Treat Options Allergy 13, 3 (2026). https://doi.org/10.1007/s40521-026-00411-9

Abstract

Purpose of Review

To summarize current evidence on the immediate and long-term safety profile of the available monoclonal biological therapy (MBT) approved for the treatment of severe asthma.

Recent Findings

Risk of serious adverse events

Clinical trials and real-world studies have shown that MBT are generally well tolerated, although certain adverse effects such as local reactions, anaphylaxis, parasitic or viral infections, malignancy, and cerebrovascular events are of special concern in these therapies or have already been reported.

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.

• What is already known about this topic? Oral antihistamines are one of the mainstays of the pharmacologic 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