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).

Predictors of psychosocial burden in parents of children with food allergy

Kubala S, Young F, Callier V et al. Annals of Allergy, Asthma & Immunology, 2026; 0

Abstract

Background

The psychosocial burden of food allergy (FA) impacts the entire family, particularly the affected child and their parents.

Objective

To evaluate psychosocial parental burden (PB) in families of children with FA, identify factors associated with PB, and assess its relationship with child-reported and parent-proxy food allergy quality of life (FAQOL).

Methods

A total of 114 children aged 2 to 17 years with IgE–mediated FA and their parents (mothers = 86.5%) completed validated age-specific FAQOL and PB questionnaires. Associations between demographic and clinical variables and scores were analyzed.

Results

Strict allergen avoidance and trace reactions relate to PB.

Greater PB was associated with more frequent and/or severe reactions, reactions to trace allergen exposures, multiple FAs, wheat or unbaked milk or egg allergy, and/or a history of oral food challenge (regardless of outcome).

Advances in the management of allergic rhinitis: clinical relevance of the mometasone furoate-olopatadine association and the challenge of patient self-diagnosis and self-treatment

D'Amato M, D'Amato G. Drugs Context. 2026 May 25;15:2026-2-5. doi: 10.7573/dic.2026-2-5.

Abstract

Mechanism of Action

Allergic rhinitis is a highly prevalent inflammatory disease that significantly impairs sleep, daily functioning and quality of life, with symptoms increasingly amplified by environmental changes such as prolonged pollen seasons and urban pollution. Despite effective therapies, many patients remain poorly controlled due to delayed diagnosis, inappropriate self-selection of over-the-counter medications, limited adherence and incorrect intranasal technique. The fixed-dose intranasal combination of mometasone furoate and olopatadine addresses these gaps by uniting rapid antihistaminic, mast-cell stabilizing effects with potent, sustained anti-inflammatory activity.

Partisan and Geographic Variation in Emotional Responses to COVID-19 Vaccination on Social Media

Jaidka K, Wu Y, Rani A, et al.  JAMA Netw Open. 2026;9(6):e2615409. doi:10.1001/jamanetworkopen.2026.15409

Key Points

Question  How did collective emotional expressions on social media vary across US counties in response to the first COVID-19 vaccine administration?

Findings  In this cross-sectional study of over 18 million geotagged social media posts from 3065 counties, joy and anger expressions increased, while fear decreased after the first vaccine dose on December 14, 2020. Democratic-leaning counties and those with higher COVID-19 death tolls showed larger increases in joy.

Meaning  These findings suggest real-time social media monitoring can reveal heterogeneous emotional responses to public health milestones, informing targeted communication strategies.

Abstract

Importance  Public acceptance of the first COVID-19 vaccine administration was not uniform, yet the nature and county-level characteristics of heterogeneous emotional responses remain poorly characterized.

Oral immunotherapy for the treatment of pumpkin seed allergy: a real-world case series

Paradis, V., Kanou, M., Paradis, L. et al.  Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01043-z

Abstract

Background

Pumpkin seed, a member of the Cucurbitaceae family, is increasingly consumed because of its high protein content and perceived health benefits. Along with its growing use, cases of pumpkin seed allergy are being reported. However, data on pumpkin seed allergy and oral immunotherapy (OIT) remain scarce.

Methods

We conducted a retrospective chart review at a tertiary pediatric center (Sainte-Justine University Hospital Center, Montreal, Canada) including all patients who initiated or completed pumpkin seed OIT since 2019. OIT protocols were individualized, with dose increases typically performed every four weeks. Target maintenance doses were at least 300 mg of pumpkin seed protein.

Results

Caracteristics of the population

Eleven patients (median age at OIT initiation: 6.5 years; range 1–12) underwent pumpkin seed OIT. Ten patients (91%) reached maintenance dosing within a median of 9.5 months (range 6–22) while one patient discontinued OIT due to persistent abdominal pain.

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.