Safety of Dupilumab and Risk of Cutaneous T-Cell Lymphoma in Pediatric Patients With Atopic Dermatitis: A Data-Driven Guide to Counseling Patients and Families

M. G. Buethe, T. Sy, and L. F. Eichenfield. Pediatric Dermatology (2026): 1–7, https://doi.org/10.1111/pde.70285.

ABSTRACT

Features distinguishing CTCL from AD.

Recent publications reporting increased cutaneous T-cell lymphoma (CTCL) risk with dupilumab in atopic dermatitis (AD) have sparked debate, amplified by media coverage linking dupilumab to lymphoma. These concerns have reached pediatric populations, where we observe increasing parental hesitancy about initiating dupilumab for their children. This hesitancy is particularly acute given that dupilumab was only approved for infants aged 6 months and older in 2022—the first cohort now approaching 3–4 years of exposure.

Preventive Application of House Dust Mite-Sublingual Immunotherapy Induces Blocking Antibodies in Sensitized Preschool Children

V. Dwivedi, K. Schmidthaler, H. Demir, et al. Allergy (2026): 1–12, https://doi.org/10.1111/all.70387. 

ABSTRACT

Background

Sublingual allergen immunotherapy (SLIT) is an effective treatment for immunoglobulin (Ig)E-mediated allergies. Its success is associated with allergen-specific (s)IgG, which blocks IgE-mediated mechanisms. Preventive effects of SLIT in children before allergy-symptom onset remain largely unexplored.

Methods

Graphical Abstract: HDM-pSLIT induced IgG, IgG1, and IgG4 specific
to major HDM allergens in sensitized non-allergic preschool children
without increasing HDM-sIgE. It blunted the development of new
sensitizations and reduced HDM reactivity in skin and basophils.
HDM-pSLIT treated children displayed a blocking effect on
HDM-induced basophil activation.
HDM, house dust mite; Ig, immunoglobulin; pSLIT,
preventively administered sublingual immunotherapy.

A randomized trial was conducted between October 06, 2017 and December 15, 2022, which included house dust mite (HDM)-sensitized preschool children (aged 3–5 years) showing no allergy symptoms. They were randomized (2:2 blocks) to HDM-SLIT (300 index of reactivity/day, Staloral) or placebo solution for 2 years. Children receiving > 4 months of treatment were included in the analysis. Primary objective of the study was to compare the groups for change in major HDM allergen-Der p 1-sIgG levels from baseline to end of treatment (EOT).

Changes in the Use of Montelukast for Asthma After a US Food and Drug Administration Boxed Warning

Shanmugam H, Kesselheim AS, Liu ITT et al. JAMA Netw Open. 2026;9(5):e2614274. doi:10.1001/jamanetworkopen.2026.14274

Key Points

• Question  Did the use of montelukast to treat asthma change after an US Food and Drug Administration (FDA) boxed warning was announced in March 2020?
• Findings  In this cross-sectional study using national monthly cohorts of up to 614 637 patients with asthma from a national commercial claims dataset, the use of montelukast decreased after implementation of an FDA boxed warning.
• Meaning  These findings suggest that treatment patterns for patients with asthma changed after an FDA boxed warning.

Abstract

Importance  In March 2020, the US Food and Drug Administration (FDA) issued a boxed warning for montelukast amid reports of neuropsychiatric adverse effects.

A Multidisciplinary Approach to Checkpoint Inhibitor Adverse Reactions

Andrews C, Mukherjee E, Gibson A  et al. The Journal of Allergy and Clinical Immunology: In Practice, 14, 1058-1072

Abstract

Overlapping cellular and molecular mechanisms
of ICI efficacy and toxicities.

Immune checkpoint inhibitors are used in a wide range of cancers, offering durable responses for a substantial subset of patients. However, immune-related adverse events, the most clinically consequential checkpoint inhibitor–associated adverse reactions, pose a key challenge in practice, affecting virtually any organ system, resulting in treatment interruption, morbidity, or mortality. Patient education, early recognition, and effective management are essential to limit complications and maintain continuity of immunotherapy.

Impact of IL-4/IL-13 Blockade with Dupilumab on the Microbiome in Type 2 Inflammatory Diseases: A Systematic Review

Mari, PV., Carriera, L., Saviano, A. et al.  Curr Allergy Asthma Rep 26, 37 (2026). https://doi.org/10.1007/s11882-026-01281-6

Abstract

Purpose of Review

To systematically review current evidence on microbiota changes associated with dupilumab treatment across different anatomical sites in type 2 inflammatory diseases.

Recent Findings

Compartment-specific microbiome changes associated with dupilumab.
Dupilumab blocks IL-4Rα signaling, inhibiting IL-4 and IL-13 pathways
and promoting site-specific microbiome modulation.

Fifteen studies were included, comprising two randomized trials and thirteen observational studies, mostly in atopic dermatitis, with fewer data in chronic rhinosinusitis with nasal polyps and NSAID-exacerbated respiratory disease. The skin was the most frequently investigated site, followed by the sinonasal tract and gut.

Evaluating montelukast-second-generation antihistamine combinations versus monotherapy in allergic rhinitis: A network meta-analysis

Wandana A, Tanely JC, Sudrajat RMC et al.  Asia Pac Allergy. 2026 May;16(3):152-166. doi: 10.5415/apallergy.0000000000000236. 

Abstract

Background: 

Allergic rhinitis (AR) is an atopic condition affecting over 400 million people worldwide, impairing quality of life and often leading to complications such as asthma and sinusitis. Montelukast, a leukotriene receptor antagonist, is often used in combination with second-generation antihistamines (sgAHs) to enhance symptom control. However, the relative efficacy of different montelukast-sgAH combinations remains unclear.

Objective: 

To evaluate and compare the efficacy of montelukast combined with various sgAHs versus montelukast monotherapy in patients with AR.

Methods: 

Randomized controlled trials (RCTs) comparing montelukast-sgAH combinations to montelukast alone were identified from 5 electronic databases up to 2025. Outcomes included Total Nasal Symptom Score (TNSS; 0–12), Daytime and Nighttime Nasal Symptom Scores (DNSS, NNSS; 0–3), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; 0–6).

Gold and Nickel Release From Gold-Plated Earrings Under Cysteine-Modified Artificial Sweat Conditions

Jensen MB, Ahlström MG, Jellesen MS et al. Contact Dermatitis. 2026 May 17. doi: 10.1111/cod.70187. 

ABSTRACT

Background

Contact allergy to gold is frequently observed in patch testing, although with low clinical relevance. Nickel allergy, in contrast, is common, clinically relevant, and nickel release from jewellery remains a regulatory concern. Standardised artificial sweat tests show no detectable gold release from gold-containing jewellery.

Objectives

To assess surface composition and the release of nickel and gold from gold-plated earrings under clinically relevant biochemical conditions.

Methods

Ten pairs of low-cost gold-plated earrings were analysed by scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS) and X-ray fluorescence. Metal release was assessed using a cysteine-modified artificial sweat solution at 30°C for 168 h. Gold and nickel concentrations were quantified by inductively coupled plasma mass spectrometry.

Results

Results of nickel and gold release after 168 h in the artificial
sweat solution at 30°C.

Nickel release was detected in 10/10 earrings (median: 2.1 μg/cm2, range: 0.00032–10.0) frequently exceeding the EU regulatory limit.

Systemic IgE promotes allergic rhinitis by licensing Th2-to-Tfh conversion and local IgE production

 Nakai T, Tezuka S, Adachi T et al. Mucosal Immunol. 2026 May 23:100351. doi: 10.1016/j.mucimm.2026.100351.

Highlights

• Systemic IgE and local Th2 cells cooperate to drive AR development.
• Systemic IgE facilitates Th2-to-Tfh differentiation to trigger local IgE response.
• MC/basophil activation potentiates antigen-induced local type-2 responses.

Abstract

Graphical abstract

Although systemic allergen-specific IgE is an essential biomarker for allergic rhinitis (AR), its mechanistic contribution to symptom development remains unclear. Here, using mouse models, we investigated how systemic antigen-specific IgE influences AR symptoms and local type 2 inflammation. Mice were adoptively sensitized with ovalbumin (OVA)-specific IgE (OVA-IgE) and/or in vitro–differentiated OVA-specific Th2 (OVA-Th2) cells, followed by repeated intranasal OVA exposure.

Th2 cytokine-induced mucociliary remodeling in chronic rhinosinusitis: implications for antiviral defense and epithelial function

Theorell, J., Drnevich, J., Jovanovic Gasovic, S. et al.  Respir Res (2026). https://doi.org/10.1186/s12931-026-03734-y

Abstract

Chronic rhinosinusitis (CRS) is a sinonasal inflammatory disease, often complicated by aberrant Th2-driven immunologic responses and increased susceptibility to viral infections. Th2-induced epithelial remodeling has been proposed to facilitate viral entry and replication, thereby increasing susceptibility to infection and exacerbating inflammation in CRS. This exploratory study investigated if chronic Th2-mediated remodeling alters the transcriptional response to rhinoviral infection between individuals with and without CRS. We hypothesized that Th2 cytokine exposure of human primary nasal epithelial cells during their differentiation disrupts mucociliary function, impairing the antiviral response to rhinovirus. 

Effect of Th2 cytokine exposure on sinonasal epithelial cells

on cytokine secretion

Primary nasal epithelial cells from patients with and without CRS were differentiated at air-liquid interface while being exposed to Th2 cytokines (IL-4, IL-13, or IL-4/13; 10 ng/mL) followed by a rhinovirus (RV-A16) infection. RNA sequencing and inflammatory cytokine profiling revealed significant downregulation of pathways involved in cilia structure, development, and function, as well as lower rhinovirus reads in Th2 cytokine-exposed cultures, with similar trends observed in CRS and non-CRS samples.

Correlation of Patient-Reported Symptoms With Rhinogram Features Beyond Simple Airway Resistance.

Darbari Kaul R, Alvarado R, Choy C, et al. Annals of Otology, Rhinology & Laryngology. 2026;0(0). doi:10.1177/00034894261454654

Abstract

Introduction:

Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance.

Methods:

Image of rhinomanometry testing conducted on a patient
with placement of the sealed pressure sensing
tube and anaesthetic style mask.

A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman’s rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals.

Cytokines and immunologic checkpoint molecules in predicting success of allergen immunotherapy

Berge, M., Hultgren, O., Hugosson, S. et al.  Sci Rep 16, 15356 (2026). https://doi.org/10.1038/s41598-026-53894-6.                                                                                                                                                                                                                                                        

Abstract

Differential expression of immune checkpoint
molecule proteins between consensus clusters.

There are large variations in how individual patients respond to allergen immunotherapy (AIT) against grass and/or birch allergy. There are currently no reliable biomarkers to predict which patients are likely to benefit from the treatment. The purpose of this study was to examine the potential of cytokine and soluble immunologic checkpoint molecule (ICM) levels as biomarkers for AIT success. Blood samples collected before starting AIT were analyzed for concentration of 92 different cytokines and 14 different ICMs. Traditional univariable statistical analysis was performed to evaluate differences between responders and non-responders. Furthermore, both unsupervised and supervised machine learning algorithms were used for multivariable analysis of differences between the responders and non-responders and to try to identify clusters within the subjects which could potentially be linked to endotypes of allergic rhinitis.

Sustained on/off-treatment disease control with abrocitinib for moderate-to-severe atopic dermatitis

Guttman-Yassky E, Bieber T, Kabashima K et al.  J Dermatolog Treat. 2026 Dec;37(1):2672328. doi: 10.1080/09546634.2026.2672328. 

Abstract

Purpose

Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to placebo following 12 weeks of abrocitinib 200 mg.

Materials and methods

In the phase 3 JADE REGIMEN study, patients with moderate-to-severe AD who achieved Investigator’s Global Assessment (IGA) of 0/1 (with ≥2 grades of improvement) and ≥75% improvement in Eczema Area and Severity Index (EASI) after 12 weeks of abrocitinib 200 mg were randomized (1:1:1) to placebo, abrocitinib 100 mg, or abrocitinib 200 mg for 40 weeks.

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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