Evaluating montelukast-second-generation antihistamine combinations versus monotherapy in allergic rhinitis: A network meta-analysis

Wandana A, Tanely JC, Sudrajat RMC et al.  Asia Pac Allergy. 2026 May;16(3):152-166. doi: 10.5415/apallergy.0000000000000236. 

Abstract

Background: 

Allergic rhinitis (AR) is an atopic condition affecting over 400 million people worldwide, impairing quality of life and often leading to complications such as asthma and sinusitis. Montelukast, a leukotriene receptor antagonist, is often used in combination with second-generation antihistamines (sgAHs) to enhance symptom control. However, the relative efficacy of different montelukast-sgAH combinations remains unclear.

Objective: 

To evaluate and compare the efficacy of montelukast combined with various sgAHs versus montelukast monotherapy in patients with AR.

Methods: 

Randomized controlled trials (RCTs) comparing montelukast-sgAH combinations to montelukast alone were identified from 5 electronic databases up to 2025. Outcomes included Total Nasal Symptom Score (TNSS; 0–12), Daytime and Nighttime Nasal Symptom Scores (DNSS, NNSS; 0–3), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; 0–6).

Gold and Nickel Release From Gold-Plated Earrings Under Cysteine-Modified Artificial Sweat Conditions

Jensen MB, Ahlström MG, Jellesen MS et al. Contact Dermatitis. 2026 May 17. doi: 10.1111/cod.70187. 

ABSTRACT

Background

Contact allergy to gold is frequently observed in patch testing, although with low clinical relevance. Nickel allergy, in contrast, is common, clinically relevant, and nickel release from jewellery remains a regulatory concern. Standardised artificial sweat tests show no detectable gold release from gold-containing jewellery.

Objectives

To assess surface composition and the release of nickel and gold from gold-plated earrings under clinically relevant biochemical conditions.

Methods

Ten pairs of low-cost gold-plated earrings were analysed by scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS) and X-ray fluorescence. Metal release was assessed using a cysteine-modified artificial sweat solution at 30°C for 168 h. Gold and nickel concentrations were quantified by inductively coupled plasma mass spectrometry.

Results

Results of nickel and gold release after 168 h in the artificial
sweat solution at 30°C.

Nickel release was detected in 10/10 earrings (median: 2.1 μg/cm2, range: 0.00032–10.0) frequently exceeding the EU regulatory limit.

Systemic IgE promotes allergic rhinitis by licensing Th2-to-Tfh conversion and local IgE production

 Nakai T, Tezuka S, Adachi T et al. Mucosal Immunol. 2026 May 23:100351. doi: 10.1016/j.mucimm.2026.100351.

Highlights

• Systemic IgE and local Th2 cells cooperate to drive AR development.
• Systemic IgE facilitates Th2-to-Tfh differentiation to trigger local IgE response.
• MC/basophil activation potentiates antigen-induced local type-2 responses.

Abstract

Graphical abstract

Although systemic allergen-specific IgE is an essential biomarker for allergic rhinitis (AR), its mechanistic contribution to symptom development remains unclear. Here, using mouse models, we investigated how systemic antigen-specific IgE influences AR symptoms and local type 2 inflammation. Mice were adoptively sensitized with ovalbumin (OVA)-specific IgE (OVA-IgE) and/or in vitro–differentiated OVA-specific Th2 (OVA-Th2) cells, followed by repeated intranasal OVA exposure.

Th2 cytokine-induced mucociliary remodeling in chronic rhinosinusitis: implications for antiviral defense and epithelial function

Theorell, J., Drnevich, J., Jovanovic Gasovic, S. et al.  Respir Res (2026). https://doi.org/10.1186/s12931-026-03734-y

Abstract

Chronic rhinosinusitis (CRS) is a sinonasal inflammatory disease, often complicated by aberrant Th2-driven immunologic responses and increased susceptibility to viral infections. Th2-induced epithelial remodeling has been proposed to facilitate viral entry and replication, thereby increasing susceptibility to infection and exacerbating inflammation in CRS. This exploratory study investigated if chronic Th2-mediated remodeling alters the transcriptional response to rhinoviral infection between individuals with and without CRS. We hypothesized that Th2 cytokine exposure of human primary nasal epithelial cells during their differentiation disrupts mucociliary function, impairing the antiviral response to rhinovirus. 

Effect of Th2 cytokine exposure on sinonasal epithelial cells

on cytokine secretion

Primary nasal epithelial cells from patients with and without CRS were differentiated at air-liquid interface while being exposed to Th2 cytokines (IL-4, IL-13, or IL-4/13; 10 ng/mL) followed by a rhinovirus (RV-A16) infection. RNA sequencing and inflammatory cytokine profiling revealed significant downregulation of pathways involved in cilia structure, development, and function, as well as lower rhinovirus reads in Th2 cytokine-exposed cultures, with similar trends observed in CRS and non-CRS samples.

Correlation of Patient-Reported Symptoms With Rhinogram Features Beyond Simple Airway Resistance.

Darbari Kaul R, Alvarado R, Choy C, et al. Annals of Otology, Rhinology & Laryngology. 2026;0(0). doi:10.1177/00034894261454654

Abstract

Introduction:

Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance.

Methods:

Image of rhinomanometry testing conducted on a patient
with placement of the sealed pressure sensing
tube and anaesthetic style mask.

A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman’s rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals.

Cytokines and immunologic checkpoint molecules in predicting success of allergen immunotherapy

Berge, M., Hultgren, O., Hugosson, S. et al.  Sci Rep 16, 15356 (2026). https://doi.org/10.1038/s41598-026-53894-6.                                                                                                                                                                                                                                                        

Abstract

Differential expression of immune checkpoint
molecule proteins between consensus clusters.

There are large variations in how individual patients respond to allergen immunotherapy (AIT) against grass and/or birch allergy. There are currently no reliable biomarkers to predict which patients are likely to benefit from the treatment. The purpose of this study was to examine the potential of cytokine and soluble immunologic checkpoint molecule (ICM) levels as biomarkers for AIT success. Blood samples collected before starting AIT were analyzed for concentration of 92 different cytokines and 14 different ICMs. Traditional univariable statistical analysis was performed to evaluate differences between responders and non-responders. Furthermore, both unsupervised and supervised machine learning algorithms were used for multivariable analysis of differences between the responders and non-responders and to try to identify clusters within the subjects which could potentially be linked to endotypes of allergic rhinitis.

Sustained on/off-treatment disease control with abrocitinib for moderate-to-severe atopic dermatitis

Guttman-Yassky E, Bieber T, Kabashima K et al.  J Dermatolog Treat. 2026 Dec;37(1):2672328. doi: 10.1080/09546634.2026.2672328. 

Abstract

Purpose

Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to placebo following 12 weeks of abrocitinib 200 mg.

Materials and methods

In the phase 3 JADE REGIMEN study, patients with moderate-to-severe AD who achieved Investigator’s Global Assessment (IGA) of 0/1 (with ≥2 grades of improvement) and ≥75% improvement in Eczema Area and Severity Index (EASI) after 12 weeks of abrocitinib 200 mg were randomized (1:1:1) to placebo, abrocitinib 100 mg, or abrocitinib 200 mg for 40 weeks.

Characterizing the Nasal Microbiome Using a Nasal Allergen Challenge Model

Linton S, Sjaarda C, Hossenbaccus L et al. J Allergy Clin Immunol. 2026 May 14:S0091-6749(26)00339-8. doi: 10.1016/j.jaci.2026.05.003.

Abstract

Graphical Abstract

Background: The role of the nasal microbiome in allergic rhinitis (AR), particularly following direct allergen exposure using a controlled model, remains incompletely understood. Understanding microbiome dynamics after allergen challenge could provide insights into AR pathophysiology.

Objective: To evaluate nasal microbiome changes following a nasal allergen challenge (NAC) with ragweed pollen extract in individuals with ragweed-induced AR compared to non-allergic controls.

Methods: Nineteen ragweed-allergic and twelve non-allergic participants completed an out-of-season NAC. Middle meatus and the adjacent nasal cavity secretions were collected at baseline and 6, 24, and 48 hours post-challenge.