Respiratory mucosal vaccines for emerging viruses: promise and challenges

Beeton K, Case JB.  J Virol. 2026 Jul 23:e0174825. doi: 10.1128/jvi.01748-25.

ABSTRACT

Mediators of respiratory mucosal immunity. 

Systemically administered vaccines were instrumental in reducing severe disease, hospitalizations, and deaths during the SARS-CoV-2 pandemic. However, they often failed to consistently elicit robust immunity at mucosal sites. This minireview examines a central role for respiratory mucosal immunity in protection against emerging viral pathogens and highlights key takeaways from the SARS-CoV-2 pandemic. Evidence from SARS-CoV-2 and influenza studies demonstrates that mucosal vaccination uniquely induces secretory IgA, as well as resident memory B and T cells within the upper and lower airways, thereby promoting broader and more potent protection.

Proportion of Antiepileptic Drug–Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis

Lee EY, Knox C, Sugumar C, Phillips EJ. JAMA Dermatol. Published online July 22, 2026. doi:10.1001/jamadermatol.2026.2473

Key Points

Question  What is the global proportion of antiepileptic drug–associated Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Findings  In this systematic review and meta-analysis of 50 studies including 4403 patients, 23% of SJS/TEN cases were attributed to antiepileptic drugs. Nearly all antiepileptic drug–associated cases involved aromatic agents (96%), most commonly carbamazepine (39%), phenytoin (19%), and lamotrigine (15%).

Meaning  These findings support the view that antiepileptic drugs are a major cause of SJS/TEN worldwide and reinforce the preferential use of nonaromatic alternatives when clinically appropriate.

Abstract

Importance  Antiepileptic drugs (AEDs) are frequently implicated in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are the most severe type of drug hypersensitivity reaction, with a mortality rate up to 50%. However, the overall proportion of these cases attributed to AEDs has not been systematically reviewed.

REACH Study: Broncho-Vaxom (OM-85) Cuts Recurrent Respiratory Tract Infections

 

Symptom probability increases at low pollen exposure in adolescents with allergic rhinitis findings from the GINIplus and LISA birth cohorts

Schmid J, Grill P, Flexeder C et al.  Pediatr Allergy Immunol. 2026 Jul;37(7):e70429. doi: 10.1111/pai.70429.

Abstract

Background

Pollen-induced allergic rhinitis increases significantly with age among children and adolescents and is associated with reduced quality of life due to symptom severity, social impacts, and decreased school performance. This study examines associations between pollen exposure and allergic rhinitis symptoms in German adolescents.

Methods

In the 15-year follow-up of the GINIplus and LISA birth cohorts at the Munich study area, monthly occurrence of nasal symptoms was assessed in 1594 participants. Pollen concentrations of birch, grass, ragweed, and mugwort between January 2010 and March 2014 were considered. Monthly individual pollen exposures (grains/m3) were assigned as the sum of all pollen types to which participants were sensitized. Associations between pollen exposure and monthly nasal symptoms were analyzed using adjusted generalized additive mixed-effect models.

Results

GAMM curves of the partial association of mean individual
pollen exposure on probability of nasal symptom occurrence
in the total study period.

A non-linear association between individual pollen exposure and nasal symptoms was observed, with symptom probability increasing significantly at low pollen concentrations and plateauing around 24 grains/m3 (birch) and 14 grains/m3 (grass).

Efficacy of probiotics on immunological and clinical outcomes in allergic rhinitis: an umbrella review and updated meta-analysis of RCTs in children and adults

Wang, Z., Lu, Y.  BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00873-1

Abstract

Background

Allergic rhinitis (AR) is a prevalent inflammatory condition with limited long-term treatment options. Probiotics have been investigated as immunomodulatory agents, yet evidence remains inconsistent. This umbrella review with updated meta-analysis evaluated probiotic efficacy on immunological and clinical outcomes in children and adults with AR.

Methods

We systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase through May 2026. Randomized controlled trials assessing probiotics effects on IgE, antigen-specific IgE, eosinophil count, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Total Rhinitis Symptom Score (RTSS) were included. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using random-effects models with REML estimation; Hartung-Knapp-Sidik-Jonkman (HKSJ) was used for outcomes with ≤ 5 studies.

Results
Twenty-nine RCTs comprising 2,078 participants were included. Probiotic supplementation was associated with significant reductions in total IgE (WMD: -198.35, 95%CI: -291.10 to -105.61), global RQLQ (WMD: -9.43, 95%CI: -11.71 to -7.15), nasal-RQLQ (WMD: -1.52, 95%CI: -2.89 to -0.15), and nasal-RTSS (WMD: -1.97, 95%CI: -3.61 to -0.32). No significant effects were observed for antigen-specific IgE, eosinophil count, eye-RQLQ, global-RTSS, or eye-RTSS. The umbrella review of seven meta-analyses (2008–2025) confirmed consistent benefits for quality of life and nasal symptoms.


Conclusions

Probiotic supplementation may improve quality of life and nasal symptoms while reducing IgE in AR patients, but evidence is limited by high heterogeneity, fragility of the IgE finding, and pooling of diverse strains. Routine clinical recommendation is not supported by high‑certainty evidence; further strain‑specific RCTs are needed.

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Insights into Pathogenesis of Chronic Spontaneous Urticaria

Torsten Zuberbier, Hanna Bonnekoh, Emek Kocatürk, et al.  British Journal of Dermatology, 2026, ljag277, https://doi.org/10.1093/bjd/ljag277

Abstract

Molecular mechanisms of CSU

Chronic spontaneous urticaria (CSU) is a mast cell–mediated inflammatory disease marked by recurrent wheals and/or angioedema in the absence of identifiable external triggers. Once considered idiopathic, CSU is now recognized as a heterogeneous immunological disorder that results in mast cell activation. Two major endotypes have been described: autoallergic (type I) CSU, mediated by IgE autoantibodies directed against self-antigens, and autoimmune (type IIb) CSU, mediated by IgG autoantibodies targeting IgE or FcεRI on mast cells and basophils. Type IIb CSU is associated with higher disease severity, autoimmune comorbidities, low total IgE levels, and reduced responsiveness to antihistamines and omalizumab.

Efficacy and Safety of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Roy Khalaf, Alexandre Ton That, Natacha Tardioet al.  Int Arch Allergy Immunol 2026

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus driven by type-2 inflammation. Dupilumab, a monoclonal antibody targeting the IL-4Ra subunit shared by the IL-4 and IL-13 receptor complexes , has recently emerged as a targeted biologic therapy for EoE. This systematic review evaluates the evidence for dupilumab in EoE across pediatric and adult populations, focusing on efficacy, safety, and symptom improvement. 

Methods: MEDLINE and Embase were searched from inception to June 30, 2025. Eligible studies included randomized controlled trials, cohort studies, case-control studies, and case reports reporting dupilumab use in confirmed EoE. Study screening and quality assessment were performed in duplicate. . Data on demographics, atopic comorbidities, dosing regimens, histologic outcomes, symptom improvement, and adverse events were extracted and summarized descriptively. 

Forest plot of histological remission rates with dupilumab
across included randomized controlled trials

Results: Nineteen studies (three randomized trials, nine cohorts, seven case reports) comprising 760 patients were included.

Asthma-related Pediatric Healthcare Utilization after Hospitalization for RSV and Other Viral Lower Respiratory Tract Infections

Guy Hazan, Mai Ofri, Lital Hertz et al.  Open Forum Infectious Diseases, Volume 13, Issue 7, July 2026, ofag402, https://doi.org/10.1093/ofid/ofag402

Abstract

Background

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) in infants. Although influenza, parainfluenza, and human metapneumovirus also contribute to LRTI-related hospitalizations, their comparative population-level healthcare burden is not well defined. This study compared population-level healthcare utilization (HCU) associated with RSV-LRTI and LRTI caused by other respiratory viruses (ORspV-LRTI).

Methods

This nationwide retrospective cohort study used electronic health records from Clalit Health Services (CHS), covering more than 5 million individuals in Israel. Infants born in 2015–2023 and hospitalized before 12 months of age with PCR-confirmed viral LRTI during the RSV season were included. Acute healthcare utilization (HCU) was assessed within 30 days following hospital discharge, and long-term respiratory HCU was evaluated through 6 years of age.