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.

Cost-Effectiveness of Allergen Immunotherapy for Allergic Rhinitis: A Systematic Review

J. Jacob, A. Fong, C. Joyce, M. Lloyd, A. Lowe, and C. Katelaris.  Allergy (2026): 1–22, https://doi.org/10.1111/all.70382.

ABSTRACT

Allergic rhinitis imposes a substantial clinical and socioeconomic burden globally. While symptomatic pharmacotherapy such as oral antihistamines and intranasal corticosteroids offers temporary relief, allergen immunotherapy provides disease-modifying benefits but requires higher upfront costs. This systematic review synthesises cost-effectiveness evaluations of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) compared to symptomatic pharmacotherapy (SP). 

Selection of studies into the review (PRISMA flow diagram).

A systematic search of electronic databases was undertaken, identifying 35 eligible economic evaluations. Due to methodological heterogeneity, a narrative synthesis was performed. Thirty-two evaluations (91%) concluded that allergen immunotherapy represents a cost-effective intervention, with incremental cost-effectiveness ratios predominantly falling below jurisdictional willingness-to-pay thresholds.

Clinical Efficacy and Safety of Intramuscular Injections of Autologous Total IgG in Patients With Chronic Spontaneous Urticaria: An Open-Label Prospective Pilot Trial

 Y.-M.Ye, M.-E.Kim, B.Kwon, and D.-H.Nahm. Experimental Dermatology 35, no. 4 (2026): e70249, https://doi.org/10.1111/exd.70249.

ABSTRACT

Chronic spontaneous urticaria (CSU) remains challenging to manage in patients who do not respond adequately to antihistamines or currently available immunomodulatory therapies. Intramuscular injection of autologous total IgG (autologous immunoglobulin therapy: AIGT) has demonstrated clinical efficacy, safety and immunomodulatory effects in patients with moderate-to-severe atopic dermatitis in a randomized placebo-controlled clinical trial. However, the clinical usefulness of AIGT in patients with CSU has not been evaluated. We conducted a prospective open-label pilot study to assess the efficacy and safety of AIGT in antihistamine-refractory CSU. Fifteen adults with CSU received nine weekly intramuscular injections of 100 mg autologous IgG from Week 0 through Week 8 (inclusive). 

Longitudinal changes in UAS7 (A), UCT (B), CU-QoL (C) and VAS (D)
from baseline to Weeks 4, 8, 12, 16, 20 and 24.

The primary outcome was the change in Urticaria Activity Score over 7 days (UAS7) at Week 12 from baseline. Secondary outcomes included the Urticaria Control Test (UCT), chronic urticaria-specific quality of life (CU-QoL) scores and patient-reported disease burden using a visual analogue scale (VAS).

Novel Approaches to Ambulatory Antibiotic Allergy Clinics.

Cox F, Dowden A, Sousa-Pinto B, Li PH. J Allergy Clin Immunol Pract. 2026 May;14(5):1014-1022.e1. doi: 10.1016/j.jaip.2025.12.013.

Abstract

Hypothetical patient journey illustrating many missed opportunities throughout
a lifetime for evaluation of a penicillin allergy label and the negative impact
of such a label. GYN, Gynecology; OB, osbtretrics; PCP, primary care provider;
STD, sexually transmitted disease; URI, upper respiratory infection.

Antibiotic allergy labels, especially to penicillins, are common but often inaccurate, with more than 90% disproven on formal evaluation. These unverified labels lead to suboptimal antibiotic use, increased health care costs, and worse clinical outcomes. Traditional allergist-led assessment models are not scalable due to global shortages of allergy specialists. Recent evidence supports a shift toward proactive, ambulatory, multidisciplinary delabeling strategies that integrate risk-stratified direct oral drug provocation testing into routine care. Validated point-of-care tools now enable nonallergists, including pharmacists, nurses, and physicians, to safely identify low-risk patients suitable for delabeling without skin testing.

Clinical applications and methodology updates in HLA typing

Feng, K., Chang, L., Yan, Y. et al. BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00845-5

Abstract

The Human Leukocyte Antigen (HLA) system is a key component of the immune system, involving aspects such as autoimmune reactions, transplant rejection reactions, and related diseases. HLA typing technology enables precise decision-making in clinical tissue matching, disease susceptibility assessment, and drug response prediction. Therefore, this article summarizes the genetic characteristics of HLA, several commonly used methods for typing, including serological methods and molecular biology methods. It also explores the clinical applications of HLA typing, such as in organ and stem cell transplantation, blood transfusion, and disease association studies. In addition, in recent years, the combination of Single Nucleotide Polymorphism (SNP) and PCR technology has shown its potential application in various gene typing.

Long-term benefits of upadacitinib for Atopic Dermatitis: deep responses in patient-reported outcomes over 140 weeks from the Measure Up 1 and Measure Up 2 clinical trials

Simpson, E. L., Prajapati, V. H., Bunick, C. G. et al. Journal of Dermatological Treatment, 37(1). https://doi.org/10.1080/09546634.2026.2665961

Abstract

Objectives

Atopic dermatitis (AD), a chronic, immune-mediated inflammatory disease, is characterized by intense itch, eczematous rash, and skin pain, which can have negative impacts to quality-of-life (QoL), sleep, and mental health (especially anxiety and depression). Evaluation of the impacts of AD on the patient’s lived experience are most accurately assessed by the patient, making measures of patient-reported outcomes (PROs) indispensable. The objective of the current study was to assess the long-term impact of upadacitinib, a once-daily oral selective Janus kinase inhibitor approved for the treatment of moderate-to-severe AD, on patient-reported outcomes, providing a comprehensive in-depth evaluation of results of patient experience across multiple domains.

Methods

Using integrated data from the Measure Up 1 & 2 trials, the current study characterizes the efficacy of upadacitinib on several measures that assess the impact of AD on patients’ lives, including patient-reported disease and symptom severity, sleep, emotional well-being, daily activities, QoL, and treatment satisfaction.

Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)

Piggott T, Saadat P, Herrmann A et al.  Ann Intern Med. 2026 May 12. doi: 10.7326/ANNALS-25-04761. Epub ahead of print.

Abstract

GRADE framework for integrating planetary health in health guidelines.

Human health and natural systems are intrinsically linked—stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap.

Actual use of PROMs in asthma and rhinitis recommended by guidelines in clinical settings: PROMUSE respiratory study

Cherrez-Ojeda I, Bousquet J, Zuberbier T et al.   Front Allergy. 2026 Apr 24;7:1666241. doi: 10.3389/falgy.2026.1666241. 

Abstract

Rationale: Guidelines advise for the implementation of patient-reported outcomes (PROMs) to provide crucial insights into patients' perceptions of their disease burden, treatment needs, and quality of life. Despite their proven benefits in managing chronic respiratory diseases like asthma, allergic rhinitis (AR), and rhinosinusitis (RS), there is limited data on their adoption among physicians treating these conditions.

Objectives: Our objective is to identify the utilization patterns of PROMs, together with the reasons for their usage and the barriers to their adoption among practitioners managing patients with asthma, AR, and RS.

Methods: This was a cross-sectional observational study using a questionnaire encompassing all pertinent PROMs and disseminated to practitioners associated with the ARIA, UCARE, ADCARE, and ACARE networks. Individuals unfamiliar with PROMS or lacking prior experience with it were eliminated. Descriptive and analytical data were utilized, categorized by the frequency and type of PROMs applied. Stata 18.0 was utilized, with p < 0.05 indicating statistical significance.

Frequency of use of specific PROMs across asthma,
allergic rhinitis, and chronic rhinosinusitis

Results: A total of 439 practitioners participated, with PROMs predominantly utilized by physicians certified for over 30 years and by respiratory specialists (16.67% and 12.46%, respectively; p < 0.05). Pulmonologists exhibited the greatest utilization of asthma PROMs at 86%, while allergists predominantly employed AR and RS PROMs at 38.42% and 33.33%, respectively (p < 0.001). ACT (66.74%), RCAT (27.79%), and SNOTT22 (15.26%) were the predominant PROMs utilized primarily for asthma (79.19%), AR (51.23%), and RS (57.26%), respectively (p < 0.001). The foremost purposes for their application were disease control monitoring (93.39%) and evaluation of performance of therapy approaches (90.2%). The most significant barrier identified was time constraint, rated at 75.40% (p > 0.05 across all groups).

Conclusions: The use of PROMs is suboptimal, primarily due to time limitations. It is imperative that methods be swiftly implemented to include these techniques into the therapeutic environment to attain enhanced outcomes.

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