Early and longitudinal response to sublingual immunotherapy across pediatric allergic multimorbidity patterns: A 3-year real-world cohort study

Gonzalez-Uribe V, Prieto-Gomez J, Moreno-Castro S et al.  Pediatr Allergy Immunol. 2026 Aug;37(8):e70462. doi: 10.1111/pai.70462. 

Abstract

Background

The timing of clinically meaningful benefit after pediatric sublingual immunotherapy (SLIT) across allergic multimorbidity patterns remains uncertain. We evaluated early and longitudinal response to SLIT in routine care.

Methods

This retrospective longitudinal cohort included patients aged 3–17 years who received individualized liquid‐drop SLIT and met prespecified adherence and treatment‐persistence criteria. Assessments were performed at baseline and months 6, 12, 18, 24, and 36. The primary outcome was achievement of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) minimal clinically important difference (MCID; increase ≥0.5 points) at month 6.

Results

Among 1208 patients, 1095 had asthma and 954 allergic rhinitis. Overall, 666/1095 (60.8%) achieved month‐6 PAQLQ MCID: 515/671 (76.8%) with asthma plus allergic rhinitis (Asthma+AR), 103/254 (40.6%) with allergic asthma without AR, and 48/170 (28.2%) with asthma, AR, and atopic dermatitis (Asthma+AR + AD).

Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta-analysis

Thomander T, Gil-Mata S, Riera-Serra P  et al. Pediatr Allergy Immunol. 2026 Aug;37(8):e70431. doi: 10.1111/pai.70431. 

Abstract

Background

Allergic rhinitis is the most common chronic disease in children. Information on efficacy and safety of oral allergic rhinitis treatments in children is scarce. We aimed to comprehensively evaluate the efficacy and safety of oral medications for allergic rhinitis in children.

Methods

We performed a systematic review, searching three bibliographic databases and clinicaltrials.gov for randomized controlled trials assessing the use of oral antihistamines (OAH) or leukotriene receptor antagonists (LTRA) in children (<12 years old) with seasonal or perennial allergic rhinitis. Evaluated outcomes included the Total Nasal Symptom Score (TNSS), the Total Ocular Symptom Score (TOSS), the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ), development of adverse or serious adverse events, and withdrawals due to adverse events. We performed network meta-analysis at both class and individual treatment levels. Certainty in the body of evidence was assessed using the GRADE approach for network meta-analysis.

Results

We included eight primary studies with 906 participants. Overall, OAH were more effective against placebo in improving the TNSS (mean difference (MD) = −1.60; 95%CI = −2.25 to −0.95).

Criteria for Control and Remission of Respiratory Allergic Disease With Allergen Immunotherapy: A Delphi Consensus

E. González-Mancebo, J. M. Beitia Mazuecos, A. I. Tabar Purroy, et al. Clinical and Translational Allergy
(2026): e70191, https://doi.org/10.1002/clt2.70191.

ABSTRACT

Background

Allergic rhinitis, conjunctivitis and asthma are prevalent IgE-mediated respiratory diseases that frequently coexist and impair quality of life. Allergen immunotherapy (AIT) has clinical benefits and potential disease-modifying effects. Until recently, standardised definitions of disease control and remission were lacking in routine clinical practice, particularly for allergic rhinitis and conjunctivitis. This study aimed to propose preliminary definitions of control and remission in patients receiving AIT and to assess expert consensus using the Delphi methodology.

Methods

A scientific committee developed a survey based on a literature review and expert input, addressing symptoms, medication use, quality of life, exacerbations and tools for objective and subjective assessment. Forty allergists participated in a two-round Delphi study. Consensus was predefined as ≥ 70% agreement on a 9-point Likert scale.

Results

Criteria for allergic conjunctivitis control and remission achieved with AIT.

Consensus was achieved for all items after two rounds.

Guideline-recommended inflammatory testing in symptomatic dermographism: a real-world study

Bizjak-Suran M and Stojanovič L (2026) Front. Immunol. 17:1901562. doi: 10.3389/fimmu.2026.1901562

Abstract

Introduction: Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria and is increasingly recognized as a burdensome disease. The 2026 international urticaria guideline recommends eliciting dermographism and threshold testing for diagnosis and includes differential blood count and erythrocyte sedimentation rate or C-reactive protein (CRP) as an extended diagnostic work-up in patients with SD. However, the clinical usefulness of these inflammatory tests in SD remains incompletely characterized.

Methods: In this retrospective real-world cohort study, we examined whether routine inflammatory markers provide interpretable signals in SD, using chronic spontaneous urticaria (CSU) as a reference comparator and serum protein electrophoresis-derived markers, including the inflammatory protein ratio (IPR) ([alpha-1 + alpha-2]/albumin × 100), as exploratory measures of inflammation.

Processionary Moth Exposure in Europe: Toxic-Irritant and Immunoglobulin E-Mediated Endotypes, Diagnosis and Management

Dasari P, Haas J, Rohe W et al. Clin Exp Allergy. 2026 Aug 5. doi: 10.1111/cea.70415.

ABSTRACT

Graphical Abstract

Processionary moths (Thaumetopoea spp.), particularly the oak processionary moth (Thaumetopoea processionea), are an increasingly relevant cause of allergic and toxic disease in Europe, occurring in the context of reported range expansion, changing environmental conditions and persistent contamination with airborne urticating hairs (setae). Clinical manifestations range from toxic–irritant dermatitis and ocular injury to respiratory symptoms, while a subset of exposed individuals develops genuine IgE-mediated disease, including rhinoconjunctivitis, asthma, and rare cases of anaphylaxis.

Antihistamines for atopic dermatitis (eczema): systematic review and network meta-analysis of randomised trials

Chu A W L, Wen A, Guyatt G H et al. BMJ 2026; 394 :e100163 doi:10.1136/bmj-2026-100163

Abstract

Objective To systematically synthesise the benefits and harms of add-on oral antihistamines for managing atopic dermatitis (eczema).

Design Systematic review and network meta-analysis of randomised trials.

Data sources Medline, Embase, CENTRAL, the United States Food and Drug Administration, and the European Medicines Agency databases from database inception to 5 May 2025.

Study selection Randomised trials assessing add-on oral H1 antihistamines, H2 blockers, mast cell stabilisers (nedocromil sodium and sodium cromoglycate), or their combinations. Paired reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane Risk of Bias tool version 2.

Methods Random effects bayesian meta-analyses synthesised atopic dermatitis severity (oSCORAD—objective scoring atopic dermatitis, 0-83; minimal important difference 8.2; lower better), itch severity (numerical rating scale, 0-10; minimal important difference 3; lower better), sleep disturbance, atopic dermatitis related quality of life, and harms. The network meta-analysis GRADE (Grading of Recommendations Assessment, Development and Evaluation) and Core GRADE approaches informed certainty of evidence ratings.

Network plot of randomised trials examining effects of add-on
antihistamines and mast cell stabilisers on clinician reported
atopic dermatitis severity organised by treatment class
and individual treatments. 

Results 47 trials enrolled 6230 children and adults with primarily moderate to severe atopic dermatitis. With moderate certainty, compared with placebo, adding a first generation or second generation H1 antihistamine likely resulted in a small reduction in atopic dermatitis severity (mean difference -1.87, 95% credible interval -3.47 to -0.27) and itch severity (-0.89, -1.41 to -0.37). Although statistically detectable, these effects are well below established minimal important differences (smallest change in an outcome that a patient would identify as important).

Editorial - Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: Moving Towards Living Guidelines With Regionally Tailored Recommendations

Sousa-Pinto B, Vieira RJ, Klimek L et al.  Allergy Asthma Immunol Res. 2026 Jul;18(4):467-469. doi: 10.4168/aair.2026.18.4.467. 

The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines had their first edition in 1999 (published in 2001),1 with subsequent revisions published in 2008,2 2010,3 2016,4 and 2020.5 Interestingly, ARIA 2016 was used as the case scenario on how to read a health Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based guidelines. Motivated by novel advances in the field, a new revision of the ARIA guidelines focused on the treatment of allergic rhinitis (AR) is currently being developed. This revision is endorsed by the European Academy of Allergy and Clinical Immunology (ARIA-EAACI 2024–2025 guidelines) and follows the GRADE approach.6 The first 2 reports of the ARIA-EAACI 2024–2025 guidelines have been published,7, 8 with one focusing on intranasal treatments and the other on oral and ocular treatments for AR. A third report is being prepared, and it will focus on treatment strategies, such as use of co-medication and the use of rhinitis treatment on an as-needed basis...

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Distinction between allergic rhinitis alone and allergic rhinitis + asthma in MASK-air® real-world studies; a ARIA-WAO task force review

Bernardo Sousa-Pinto MD, PhD, Rafael José Vieira MD, PhD, Ana Margarida Pereira PhD et al. World Allergy Organization Journal Volume 19, Issue 8, August 2026, 101435

Abstract

The recent ARIA-MeDALL hypothesis proposed in 2023 that allergic rhinitis (AR) alone and allergic rhinitis and asthma (A) multimorbidity (AR + A) represent 2 distinct diseases. To improve the knowledge on this topic, we have gathered data from real-world studies using MASK-air®. According to our analyses: (i) An “extreme allergy phenotype” [A + AR + C, Conjunctivitis] was confirmed and found to be more severe (symptoms and work productivity) than single diseases alone. (ii) Patients with AR + A required more rhinitis medications, and had more severe VAS levels for nasal and ocular symptoms than those with AR alone in all countries tested. (iii) In clusters with poorly controlled AR, the frequency of co-medicating with more than 1 rhinitis drug was higher in AR + A than in AR alone. 

Impact on work and VAS global depending
on the RCA multimorbidity

(iv) In the CONSTANCES general population cohort, a co-medication pattern (intranasal corticosteroid and oral H1-antihistamines) was associated with the presence of AR + A (vs AR alone).