Prevention and Treatment of Peanut Allergy

George Du Toit, M.B., B.Ch., and Gideon Lack, M.B., B.Ch. Published June 24, 2026 N Engl J Med 2026;394:2449-2458 DOI: 10.1056/NEJMcp2314424

Summary

Modeled Effect of Delayed Peanut Introduction
on the Development of Peanut Allergy

Early introduction of peanut protein reduces allergy prevalence by approximately 80%, with efficacy diminishing as introduction is delayed. Appropriate prevention involves ingestion of approximately 2 g of peanut protein weekly for infants at low risk and 4 to 6 g weekly for infants at high risk. Population-level implementation that targets all infants achieves greater reduction in disease burden than approaches that target only high-risk groups, although disparities exist among some ethnic groups and groups with restricted access to care.

Mepolizumab reduces healthcare resource utilization in patients with chronic rhinosinusitis with nasal polyps: a linked EMR and claims-based pre-post study

Swenson, A., Ahmed, W., Silver, J. et al. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01038-w

Abstract

Background

Real-world evidence on the effectiveness of mepolizumab at reducing healthcare resource utilization (HCRU) and clinical symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is limited.

Methods

This real-world study used linked electronic medical record and claims data from the OM1 Real-World Data Cloud of clinician networks in the US, including an ear, nose and throat physician registry. CRSwNP-related HCRU, procedures, concomitant medications, and sign and symptom outcomes were assessed in adult patients with CRSwNP who initiated mepolizumab on/after July 29, 2021 (index date), with ≥1 mepolizumab record, data available for ≥12 months pre- and ≥6 months post-index (follow-up/post-mepolizumab period).

Results

There was a significant difference in CRSwNP-related HCRU 6-months post- versus pre-mepolizumab initiation (N = 245), mean difference in outpatient visits (95% confidence interval): −0.82(−1.10, −0.53), p < 0.0001; otolaryngologist visits: −0.35(−0.54, −0.16), p = 0.0004; allergist visits: −0.28(−0.43, −0.14), p = 0.0001.

Triggers, clinical spectra and outcomes of pediatric anaphylaxis in a tertiary center: impact of comorbidities and cofactors on severity

Keser-Ozturk, N., Maghdeed, Y., Bozkurt, S. et al. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01033-1

Abstract

Purpose

Anaphylaxis is a potentially life-threatening systemic hypersensitivity reaction. While triggers, clinical manifestations, and severity are influenced by age and sociocultural factors, most evidence regarding the impact of comorbidities and cofactors comes from adult studies. This study aimed to characterize the triggers, clinical features, and outcomes of pediatric anaphylaxis in a tertiary care center, with a particular emphasis on risk factors for severity.

Methods

We retrospectively reviewed records from August 2023–August 2024 at the European Allergy Academy and Clinical Immunology Center of Excellence in Istanbul. Children aged 0–18 years (n = 100) with anaphylaxis as defined by the 2020 World Allergy Organization (WAO) criteria were included.

Estimating work-related indirect costs in allergic rhinitis and asthma using a daily combined symptom-medication score: a MASK-air® study in collaboration with the EAACI Methodology Committee

Vieira RJ, di Bona D, Bognanni A et al. J Allergy Clin Immunol Pract. 2026 Jun 11:S2213-2198(26)00497-6. doi: 10.1016/j.jaip.2026.05.035. 

Highlights

• What is already known about this topic? Allergic rhinitis and asthma have a relevant impact on work productivity, particularly in terms of presenteeism. However, this impact is difficult to quantify in daily clinical practice.
• What does this article add to our knowledge? This study demonstrates that a visual analogue scale can evaluate the impact of allergic symptoms on work productivity. In addition, it estimates the costs resulting from work productivity losses due to poor symptom control.
• How does this study impact current management guidelines? Based on the approach described in this study, practitioners can easily estimate work productivity losses of their patients due to poor rhinitis and asthma control. Results of this study can inform cost-effectiveness studies.

Abstract
Background
Allergic rhinitis and asthma can impair work productivity.

Objective
To validate a daily work productivity visual analog scale (VAS work), comparing it with the Work Productivity and Activity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific (WPAI+CIQ:AS). We also aimed to quantify how allergy control relates to work impairment and indirect costs.

A New Drug Target in Allergic Diseases: Bruton Tyrosine Kinase

Labrador-Horrillo M, Cenni B, Ferrer Puga M.  J Investig Allergol Clin Immunol. 2026 Jun 15;36(3):170-184. doi: 10.18176/jiaci.1183. 

Abstract

BTK signaling transduction pathways and inhibitor binding sites 

Though first recognized as a signaling molecule in B cells, Bruton tyrosine kinase (BTK) has been shown to play a crucial role in signal transduction in innate and adaptive immune cells. BTK is an attractive therapeutic target, given its diverse role in immune regulation. Development of the first-generation BTK inhibitor (BTKi), ibrutinib, revolutionized the treatment of B-cell malignancies. Since its approval, newer-generation BTKis with improved pharmacological properties have been developed, with higher selectivity for BTK and fewer off-target effects than ibrutinib. BTK is essential for IgE-driven allergic responses and may influence IgE antibody production by B cells.

Declining venom immunotherapy: patient characteristics and clinical outcomes

Ueberschaar, S., Trautmann, A. & Stoevesandt, J. Allergy Asthma Clin Immunol 22, 38 (2026). https://doi.org/10.1186/s13223-026-01046-w

Abstract

Background

A largely unknown proportion of Hymenoptera venom-allergic patients do not undergo venom immunotherapy (VIT) despite positive allergy testing and counselling. We aimed to identify factors associated with the refusal of VIT, and evaluate the natural course of venom allergy in untreated individuals.

Methods

Out of 1163 candidates for VIT, 271 (23.3%) declined or postponed treatment for at least 12 months. Complete data from 166 of these patients, who were interviewed and counselled during routine follow-up, were available for retrospective evaluation.

Results

Individualised counselling and recommendation of VIT,
taking into account anaphylaxis severity, risk factors/exposure,
and the patient’s needs, fears, and expectations

Patients declining VIT were significantly more likely to be female (P = 0.012) and had a lower grade of index sting-induced anaphylaxis (P < 0.001) compared to those who accepted treatment.

Novelties in the pragmatic management of anaphylaxis in pediatric age

Marseglia, G.L., Tosca, M.A., Miraglia del Giudice, M. et al.  Eur J Pediatr 185, 480 (2026). https://doi.org/10.1007/s00431-026-07147-3

Intranasal adrenaline in pediatric self-management: promise and limits. 

What is Known:

• Intramuscular adrenaline is the first-line treatment for anaphylaxis and should not be delayed.

• Food is the leading trigger in children, while drugs, venom, and cofactors become more relevant with age.

What is New:

• Intranasal adrenaline is a promising needle-free option, but pediatric evidence remains limited.

• Omalizumab and oral immunotherapy may reduce risk but do not replace emergency preparedness.

Abstract

Anaphylaxis is a time-critical, potentially fatal systemic hypersensitivity reaction. This narrative review summarizes recent advances in the diagnosis and management of anaphylaxis in children and adolescents, with emphasis on new diagnostic frameworks, improved self-management strategies, intranasal adrenaline, and disease-modifying therapies.

Predicting sublingual immunotherapy efficacy in allergic rhinitis

Wang, J., Zhu, X. & Ding, Z.  BMC Pulm Med (2026). https://doi.org/10.1186/s12890-026-04394-w

Abstract

Background

Sublingual immunotherapy (SLIT) efficacy for allergic rhinitis (AR) varies considerably, with 30%–40% of patients showing poor response. A reliable tool integrating multidimensional factors for individualized efficacy prediction remains lacking. This study aimed to construct an optimal prediction model incorporating clinical characteristics, environmental exposure factors, and immune-inflammatory indicators to predict SLIT efficacy in AR patients, and further establish a nomogram as an auxiliary interpretable tool for intuitive clinical application.

Materials and methods

A total of 346 AR patients receiving SLIT were included and randomly allocated to training (n = 242) and validation (n = 104) cohorts at a 7:3 ratio. Baseline data included demographics, clinical features, symptom scores, environmental exposures, and immune-inflammatory indicators. Univariate and multivariate logistic regression analyses were performed to screen independent predictive factors. Three models, including random forest, support vector machine, and conventional logistic regression, were developed for performance comparison. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). On the basis of independent predictors, a nomogram was constructed for visual interpretation. Shapley Additive Explanations (SHAP) analysis was further applied to interpret feature importance of the optimal model.

Results

Multivariate logistic regression confirmed these same seven variables as independent predictors of SLIT clinical efficacy in AR: disease duration, baseline symptom score, baseline medication score, air conditioning usage time, specific immunoglobulin E/total immunoglobulin E (sIgE/tIgE) ratio, interleukin (IL)-4, and IL-10 (all P < 0.05).