Gaps in Current Chronic Spontaneous Urticaria (CSU) Management

Angèle Soria. British Journal of Dermatology, 2026  https://doi.org/10.1093/bjd/ljag389

Abstract

Graphical Abstract

Despite advances in therapy, chronic spontaneous urticaria (CSU) remains a challenging disease with a significant impact. Although antihistamines, anti-IgE therapy and immunosuppressants form the basis of treatment, there are still substantial gaps in diagnosis, endotyping, prediction of therapeutic response and implementation of international guidelines.

Newly licensed CSU therapeutic agents, such as Bruton tyrosine kinase (BTK) inhibitors and anti-interleukin-4 receptor alpha (anti-IL4Rα) agents, offer hope to patients who do not respond to treatment.

Respiratory Syncytial Virus Vaccine Effectiveness Among US Older Adults, 2023-2024 Season

Lu Y, Smith ER, McEvoy R, et al.  JAMA Netw Open. 2026;9(9):e2634788. doi:10.1001/jamanetworkopen.2026.34788

Key Points

Question  What is the estimated effectiveness of the respiratory syncytial virus (RSV) vaccines against RSV-related hospitalization and death among US adults 65 years or older?

Forest Plot of Vaccine Effectiveness (VE) Estimates and Respiratory
Syncytial Virus (RSV)–Related Death Outcomes

Findings  In this cohort study of 14 819 226 Medicare fee-for-service beneficiaries, both the RSVPreF3+AS01 and RSVpreF RSV vaccines provided substantial protection against RSV-related hospitalization (81.8%) and death (85.0%) during the 2023-2024 season. Effectiveness did not change significantly with age and was also substantial among immunocompromised individuals.

Meaning  This study suggests that both RSV vaccines provided substantial protection among US older adults across all ages 65 years or older and for immunocompromised individuals.

Abstract

Importance  Respiratory syncytial virus (RSV) causes a substantial number of hospitalizations and deaths among older adults. Two RSV vaccines for individuals aged 60 years or older were approved in 2023; it was important to monitor their clinical effectiveness during routine care in the first RSV season after regulatory approval.

Age-related molecular IgE sensitization to indoor and outdoor respiratory allergens: a two-step cross-sectional study in Algeria and Türkiye

Mahammed LL, Vrtala S, Akinfenwa O et al.  EBioMedicine. 2026 Sep 24:106484. doi: 10.1016/j.ebiom.2026.106484. 

Summary

Background

Immunoglobulin E-mediated allergy is the most important hypersensitivity disease affecting more than 30% of the population worldwide. The analysis of molecular IgE sensitization profiles in defined populations and age groups is important for the development of allergen-specific preventive and therapeutic interventions. The present study was performed to examine if there are differences regarding molecular IgE reactivity profiles in children and adults from two regions with similar climate and exposome.

Methods

This two-step cross-sectional study assessed molecular IgE reactivity profiles using an experimental allergen microarray comprising 105 allergen molecules. In the first step, an exploratory cross-sectional study, serum samples from 539 allergic patients (259 children, 280 adults) who were born and grew up in the Algiers region were analyzed. The second step was a prospective cross-sectional study performed in 272 Turkish allergic patients (133 children, 139 adults) from Istanbul and Samsun regions with a climate and allergen exposome similar to Algiers, with the goal of investigating the reproducibility of possible differences in molecular IgE sensitization profiles between children and adults.

Findings

Age-stratified molecular sensitization to (A, C) indoor and (B, D) outdoor
aeroallergens in children (N = 173; blue bars) and adults (N = 244; orange bars)
with respiratory allergy from Algiers (A, B) and children (N = 133; blue bars)
and adults (N = 139; orange bars) with respiratory allergy from Türkiye (C, D).

In both the exploratory Algiers study and the prospective Turkish study, significantly more children than adults with respiratory allergy were sensitized to major respiratory house dust mite allergens (Algiers: Der p 1, Der p 2: p < 0.001 and Der p 23: p = 0.001; Türkiye: Der p 1: p = 0.018 and Der p 2: p = 0.019) whereas significantly more adults than children were sensitized to regionally common respiratory outdoor allergens (Algiers: Ole e 1: p = 0.037; Phl p 1: p = 0.046; Türkiye: Ole e 1: p = 0.016; Amb a 1: p = 0.002; Amb a 8: p < 0.001). Asthma was significantly more common in children than in adult patients with respiratory allergy (Algiers: p < 0.001; Türkiye: p = 0.034).

Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study

Smart K, Ure A, Johnsen N, Aflatooni S et al. PLoS One. 2026 Sep 23;21(9):e0358883. doi: 10.1371/journal.pone.0358883.

Abstract

Forest plot showing odds ratios (ORs) and 95% confidence
intervals for immune-mediated comorbidities among patients
with chronic spontaneous urticaria (CSU).

Chronic spontaneous urticaria (CSU) is characterized by the idiopathic appearance of wheals and/or angioedema lasting more than six weeks. There is a critical need to evaluate whether the severity of CSU influences the risk of future immune-mediated comorbidities. We aim to evaluate if patients with moderate-to-severe chronic spontaneous urticaria (CSU) have an increased risk of developing immune-mediated comorbidities compared with matched patients with mild CSU.

Comparison of subcutaneous (SCIT) and sublingual (SLIT) immunotherapy in allergic rhinitis and allergic asthma

Perek A, Raszewska J, Jabłoński W, et al. Alergologia Polska - Polish Journal of Allergology. 2026. doi:10.5114/pja.2026.164983.

Abstract

Allergic rhinitis and allergic asthma are among the most prevalent chronic diseases, significantly impairing patients’ quality of life and generating substantial healthcare costs. Allergen immunotherapy (AIT), administered as subcutaneous (SCIT) or sublingual (SLIT) immunotherapy, remains the only treatment capable of modifying the natural course of allergic disease. The aim of this study was to compare the clinical efficacy, safety profile, adherence, and economic aspects of both AIT modalities based on current evidence. A narrative review of randomised clinical trials, meta-analyses, observational studies, and pharmacoeconomic analyses was conducted, with particular emphasis on treatment effectiveness, safety, adherence, and direct and indirect healthcare costs.

Advances in the role of house dust mite allergen components in the pathogenesis of allergic diseases

Guo CF, Wang Y, Wang YN et al. J Microbiol Immunol Infect. 2026 Sep 17:S1684-1182(26)00125-8. doi: 10.1016/j.jmii.2026.09.009.

Abstract

HDM allergen-induced epithelial barrier disruption and inflammatory signaling.

House dust mites (HDMs) represent one of the most prevalent indoor aeroallergens globally and are closely associated with type 2 immune-mediated conditions, including allergic asthma, allergic rhinitis, and atopic dermatitis. To date, over 30 HDM allergenic components have been identified and are classified into proteases, lipid-binding proteins, structural proteins, and proteins with uncharacterized functions based on their structural and biological features. Among these, allergens from group 1, 2, and 23 exhibit robust immunoglobulin E(IgE)-binding activity and play pivotal roles in allergic sensitization and inflammatory cascades.

Comprehensive 17-Allergen Panel for Inhalant Specific IgE: Reliability and Validation of Optimized Quantitative Assays

Ianniello A, Amadsun DO, Bencini E et al. Int Arch Allergy Immunol. 2026 Sep 21:1. doi: 10.1159/iaa/adfag015. 

Abstract

Introduction: Atopic diseases, such as asthma and allergic rhinitis, are chronic inflammatory disorders mediated by immunoglobulin E (IgE) responses to environmental allergens. Detecting allergen-specific IgE is essential for diagnosing sensitization and guiding clinical management. Allergen-specific IgE assays have, thus, become indispensable in clinical diagnostics and allergy research. The CHORUS Specific IgE Capture assays are automated immunoassays designed to quantify up to 17 allergen-specific IgE antibodies in human serum. In this study, optimized versions of the assays have been evaluated to determine their analytical performance in terms of sensitivity, specificity, precision, and overall reliability. 

Vaccines for Cancer: A Translational Science Review

 

ML, Chun BMN, Dhillon KK et al. JAMA. Published online September 21, 2026. doi:10.1001/jama.2026.15540

Abstract

Importance  Advances in tumor immunology and vaccine technology are reshaping cancer vaccine development after decades of limited clinical success. More than 2000 immunogenic tumor proteins or antigens have been identified, the types of immune responses required for tumor eradication have been defined, and safe and effective vaccine delivery technologies have been developed. This progress has renewed clinical investigation of cancer vaccines for multiple types of cancer.

Observations  Vaccines, such as those against human papillomavirus and hepatitis B, are composed of (1) an antigen target, (2) an adjuvant to activate the immune system, and (3) a vaccine delivery vehicle. Antigens can be derived from tumor mutations termed neoantigens, or cancer-associated nonmutated proteins, which are normal human proteins that are abnormally expressed in cancer. The tumor can also act as an antigen source, such as when immunization occurs with whole tumor cells or by directly injecting an immunogenic substance into the tumor to elicit an adaptive immune response. T and B lymphocytes, cells of the adaptive immune system, are stimulated by cancer vaccines and can provide a highly specific and durable immune response directed against cancer.