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.

Regulatory T cells: master orchestrators of immune tolerance and tissue homeostasis.

Bluestone JA, Levings MK, Ramsdell FJ et al. (2026)  Front Sci 4:1792210. doi: 10.3389/fsci.2026.1792210

Abstract

Key features of regulatory T cell (Treg) function in
maintaining immune and tissue homeostasis. 

Harnessing the biology of regulatory T cells (Tregs) for therapeutic development is one of medicine’s most promising opportunities to transform disease treatment. Initially viewed simply as guardians against destructive immune responses, we now understand that Tregs are adaptive and highly specialized coordinators of immune tolerance and tissue repair. This strategic roadmap examines how evolving insights into their central role in maintaining tolerance and health can transform therapeutic development across medical specialties. Early efforts to evaluate Treg therapies have proven safe and shown some clinical benefit. The convergence of biological insights and technological advances has the potential to harness and exploit this specialized tolerogenic population by augmenting function through environmental cues and reinforcing tissue-repair capabilities.

Evidence on the Role of Biologics in Chronic Rhinosinusitis with Nasal Polyposis

Kilgore, K.M., Marino, G.A., Lee, J.T. et al.  Curr Treat Options Allergy 13, 16 (2026). https://doi.org/10.1007/s40521-026-00423-5

Abstract

Purpose of Review

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease that may be refractory to conventional medical and surgical therapies. Advances in the understanding of type 2 inflammatory mechanisms have led to the development of targeted biologic therapies. This review examines clinical trial evidence, and real-world data supporting biologic use in CRSwNP.

Recent Findings

Four biologics (dupilumab, omalizumab, mepolizumab, tezepelumab) are FDA approved in the United States for the management of refractory CRSwNP. Randomized controlled trials and multiple additional studies have demonstrated the efficacy of biologics in reducing nasal polyp burden and nasal congestion in patients who are refractory to traditional medical/surgical therapy or are poor surgical candidates.

Relationship of NSAID-hypersensitivity and Chronic Urticaria. Clinical Implications

Sánchez, J., Caraballo, A. & Diez, S.  Curr Treat Options Allergy 13, 15 (2026). https://doi.org/10.1007/s40521-026-00419-1

Abstract

Purpose of Review

In this review, we conducted a literature search seeking to better understand the relationship between chronic spontaneous urticaria (CSU) and nonsteroidal anti-inflammatory drugs hypersensitivity (NSAID-hypersensitivity) associated with NSAID exacerbated cutaneous diseases (NECD), its clinical course, and gain insight into the answers to clinical questions.

Recent Findings

CSU and NSAID cutaneous reaction interaction

The coexistence of CSU and NSAID-hypersensitivity specially NECD has been well documented. However, many questions remain unanswered: Why does this coexistence occur?

IL-37a facilitates allergen immunotherapy in a house dust mite-induced mouse model of allergic asthma

Jin, Z., Jing, X., Zeng, J. et al.  BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00869-x

Abstract

Serum allergen-specific immunoglobulin levels measured by ELISA. 

In recent years, the incidence of allergic asthma has increased dramatically. Allergen immunotherapy (AIT) is an effective approach to achieve long-term remission of allergic asthma and has gained widespread attention. However, current AIT suffers from low efficacy and long treatment duration. In this study, we found that IL-37a transgenic mice with allergic asthma exhibited reduced pulmonary inflammation, decreased Th2 cytokines, and lower allergen-specific IgE following AIT.

In vitro IgE diagnostics in inhalant allergy: Plant and mold allergens

Regina Treudler. Allergologie select. 2026; 10: 151-157. doi: 10.5414/ALX02616E.

Abstract

Respiratory allergies represent one of the most prevalent immune-mediated disorders worldwide, such as allergic rhinitis and asthma. The advent of in vitro diagnostic methods, particularly those based on molecular allergology, has revolutionized the diagnostic approach to inhalant allergies by enabling precise identification of sensitizing allergens at the molecular level. This review presents an analysis of the current status of in vitro diagnostics in respiratory allergy to plants and molds, with emphasis on molecular diagnostics for key allergens from trees (e.g., birch/Betula verrucosa), grasses (Poaceae family), weeds (e.g.mugwort/Artemisia vulgaris, ragweed/Ambrosia artemisiifolia), and molds (e.g. Alternaria, Aspergillus). We discuss major allergenic proteins, diagnostic tools, implications for precision medicine, and integration with precision immunotherapy.

Trees, grasses, and weeds share common pan-allergens (i.e., profilins and polcalins), which can lead to false positive reactions in skin prick test or whole allergen extracts.

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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