Diagnosing NSAID-Hypersensitivity/Allergy and NSAID-Exacerbated or Induced Food Allergy Phenotypes in Children and Adolescents

Valluzzi RL, Urbani S, Sciannamea M et al. J Allergy Clin Immunol Pract. 2026 Jul 8:S2213-2198(26)00582-9. doi: 10.1016/j.jaip.2026.06.044. 

Highlights Box

What is already known about this topic? Hypersensitivity reactions (HRs) to NSAIDs are common in children and adolescents, but in many of them NSAID hypersensitivity/allergy (NH/A) is excluded by testing.

What does this article add to our knowledge? NEFA/NIFA can be diagnosed in about 14% of children/adolescents reporting immediate HRs to NSAIDs, most of whom are sensitized to Pru p 3. Non-hypersensitive/allergic reactions to NSAIDs appear to be primarily related to infections with fever rather than to NSAID exposure itself.

How does this study impact current management guidelines? It supports the performance of targeted food allergy tests in children/adolescents reporting urticarial, angioedematous, and/or anaphylactic reactions to NSAIDs and highlights clinical predictors that help distinguish true NSAID HRs − diagnosed through drug challenges − from non-allergic/hypersensitive reactions in pediatric practice.

Graphical Abstract

Abstract

Ambulatory antibiotic prescribing for acute sinusitis: a multicenter, retrospective cohort study evaluating appropriateness

Arensman Hannan K, Ilges D, Le KT et al. Antimicrobial Stewardship & Healthcare Epidemiology. 2026;6(1):e193. doi:10.1017/ash.2026.10743

Abstract

Objective:

Antibiotics are frequently prescribed for acute sinusitis despite national guidelines recommending antibiotics only if specific symptom criteria are met. We aimed to define the proportion of acute sinusitis encounters meeting criteria for antibiotic prescribing, characterize prescribing practices, and identify factors associated with guideline-discordant prescribing.

Design:

This retrospective cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024 and March 31, 2024. Encounter notes were reviewed for appropriate antibiotic prescribing criteria as per national guidelines. Encounters were evaluated for drug selection and duration concordance based on local guidelines. A multivariable logistic regression analysis was performed to identify predictors of inappropriate antibiotic prescribing.

Setting:

Emergency departments, urgent care centers, and primary care clinics.

Results:

Antibiotic prescription characteristics

Antibiotic prescribing criteria were met for 67.6% of included encounters. Antibiotics were prescribed in 93.5% of encounters that met prescribing criteria, and 80.2% of encounters that did not. Both drug selection and duration were guideline-concordant in 49.2% of total encounters.

Effect of GLP-1RA on blood eosinophil levels in adults: a real-world study

Wu, Y., Lin, Y., Wu, J. et al.  BMC Pulm Med (2026). https://doi.org/10.1186/s12890-026-04469-8

Abstract

Background

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for glycemic control and weight management, especially semaglutide. Potential benefits of GLP-1RAs in asthma, especially in eosinophilic phenotypes, prompt growing scientific interest.

Objective

To investigate the impact of semaglutide on eosinophilic inflammation and to identify clinical and metabolic determinants of eosinophil reduction after treatment.

Methods

We conducted a retrospective, single-center study in Shanghai, China. Eligible subjects were those first prescribed semaglutide in our outpatient clinic. Demographic characteristics, complete blood counts, and lipid profiles before and after semaglutide treatment were collected from electronic medical records. Subgroup analyses were stratified using a blood eosinophil count (BEC) cut-off of 150/µL and a BMI threshold of 28 kg/m². Multiple linear regression analysis was employed to identify factors influencing the reduction in eosinophil counts.

Results

Among 371 participants included in the final analysis, BEC decreased significantly from 160(150)/µL at baseline to 110(100)/µL after semaglutide treatment (P < 0.001), and eosinophil percentage declined from 2.20(1.80)% to 1.60(1.40)% (P < 0.001).

Synergistic impacts of heat, pollen, and air pollution on allergic rhinitis and asthma under climate change: A 20-year time-series study

Ali EA, Aerts R, Vaes B et al. Environ Int. 2026 Jul;213:110330. doi: 10.1016/j.envint.2026.110330.

Abstract

Background: Climate changes are increasing the frequency of concurrent extremes in temperature, air pollution, and aeroallergens, yet evidence on their joint and synergistic health impacts remains limited. We aimed to quantify the independent, joint, and interactive short-term effects of temperature, air pollutants, and airborne pollen on allergic rhinitis and asthma using long-term general practitioner (GP) data.

 Methods: We conducted a population-based time-series study using 20 years of GP data. Daily maximum temperature, PM2.5, ozone, and pollen concentrations were linked to allergic rhinitis and asthma outcomes. We estimated cumulative relative risks (RR) over lag 0–14 days using distributed lag non-linear models, comparing high (95th percentile) versus median exposure levels. We evaluated effect modification through stratified analyses and quantified additive interaction for joint exposures at extreme levels (90th and 95th percentile) using relative excess risk due to interaction (RERI) and attributable proportion (AP).

Density distributions of environmental exposure values
restricted to days exceeding the 90th percentile of each
exposure-specific study-period distribution.

Findings: Pollen exposure was strongly associated with allergic rhinitis (RR=2.54, 95% CI: 2.40–2.69) and with asthma (RR=1.49, 95% CI: 1.38–1.61). In joint-effects analyses, co-exposure to extreme heat and high pollen concentrations was associated with an increased risk of allergic rhinitis (RR= 2.07, 95% CI: 1.77–2.41), with clear evidence of synergistic interaction on the additive scale (RERI=0.48, 95% CI: 0.32–0.64, AP=0.23, 95% CI: 0.17–0.30).

COVID-19 vaccination induces cross-neutralisation of sarbecoviruses related to SARS-CoV-2

West, G.E., Morse, R.B., Sievers, B.L. et al.  npj Vaccines 11, 125 (2026). https://doi.org/10.1038/s41541-026-01469-x

Abstract

Multi-dose vaccine schedules in a cohort of older individuals
with mixed infection histories induce strong humoral responses
against SARS-CoV-2 Wu-1 and early Omicron lineages.

The combined threats of future sarbecovirus zoonosis and continually emerging SARS-CoV-2 VOCs highlight the need to assess the breadth of existing SARS-CoV-2 vaccine-mediated protection. Here, we investigate a cohort of older individuals who received four COVID-19 vaccine doses, for potential cross-neutralisation against lentiviral particles bearing spikes from either Omicron VOCs or other sarbecoviruses. Despite recent fourth bivalent mRNA vaccine doses (encoding SARS-CoV-2 Wu-1 and Omicron spikes), neutralisation of Omicron lineage VOCs was reduced compared to Wu-1, consistent with an imprinted immune response.

P014 Remibrutinib improves dermatology-related quality of life in patients with chronic spontaneous urticaria regardless of baseline disease severity in the phase III REMIX-1 and REMIX-2 studies

Michael R Ardern-Jones, John Reed, Sinisa Savicet al.  British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.041, https://doi.org/10.1093/bjd/ljag086.041

Abstract

Mean change from baseline in DLQI (observed data, full analysis set).

Many patients with chronic spontaneous urticaria (CSU) experience inadequate disease control and impaired quality of life despite treatment. Remibrutinib, a highly selective Bruton’s tyrosine kinase inhibitor, reduced CSU disease activity and improved quality of life, sleep, and daily activity vs. placebo in the REMIX-1 and REMIX-2 studies. Here, we evaluate the impact of remibrutinib on Dermatology Life Quality Index (DLQI) in the REMIX-1 and REMIX-2 data (pooled), stratified by baseline disease severity per weekly Urticaria Activity Score (UAS7; moderate: 16 ≤ UAS7 < 28, severe: 28 ≤ UAS7 ≤ 42). REMIX-1 and REMIX-2 were randomized, double-blind, placebo-controlled studies of oral remibrutinib 25 mg twice daily in adults with CSU who remained symptomatic with second-generation H₁-antihistamines.

Prevention and Treatment of Peanut Allergy

George Du Toit, M.B., B.Ch., and Gideon Lack, M.B., B.Ch. Published June 24, 2026 N Engl J Med 2026;394:2449-2458 DOI: 10.1056/NEJMcp2314424

Summary

Modeled Effect of Delayed Peanut Introduction
on the Development of Peanut Allergy

Early introduction of peanut protein reduces allergy prevalence by approximately 80%, with efficacy diminishing as introduction is delayed. Appropriate prevention involves ingestion of approximately 2 g of peanut protein weekly for infants at low risk and 4 to 6 g weekly for infants at high risk. Population-level implementation that targets all infants achieves greater reduction in disease burden than approaches that target only high-risk groups, although disparities exist among some ethnic groups and groups with restricted access to care.

Mepolizumab reduces healthcare resource utilization in patients with chronic rhinosinusitis with nasal polyps: a linked EMR and claims-based pre-post study

Swenson, A., Ahmed, W., Silver, J. et al. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01038-w

Abstract

Background

Real-world evidence on the effectiveness of mepolizumab at reducing healthcare resource utilization (HCRU) and clinical symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is limited.

Methods

This real-world study used linked electronic medical record and claims data from the OM1 Real-World Data Cloud of clinician networks in the US, including an ear, nose and throat physician registry. CRSwNP-related HCRU, procedures, concomitant medications, and sign and symptom outcomes were assessed in adult patients with CRSwNP who initiated mepolizumab on/after July 29, 2021 (index date), with ≥1 mepolizumab record, data available for ≥12 months pre- and ≥6 months post-index (follow-up/post-mepolizumab period).

Results

There was a significant difference in CRSwNP-related HCRU 6-months post- versus pre-mepolizumab initiation (N = 245), mean difference in outpatient visits (95% confidence interval): −0.82(−1.10, −0.53), p < 0.0001; otolaryngologist visits: −0.35(−0.54, −0.16), p = 0.0004; allergist visits: −0.28(−0.43, −0.14), p = 0.0001.