A strategic framework for digital and sustainable transformation in allergy care: An EAACI position paper

Feketea G, Paciência I, Chang YS et al. Pediatr Allergy Immunol. 2026 Jan;37(1):e70270. doi: 10.1111/pai.70270. 

Abstract

Background

Allergic diseases, particularly in children, are increasing worldwide and impose growing clinical, economic, and environmental burdens on healthcare systems. Conventional models of allergy care face limitations in early diagnosis, long-term disease monitoring, patient engagement, and sustainability, highlighting the need for innovative and scalable solutions.

Objectives

This position paper aims to propose a global framework for integrating digital health innovations with sustainable models of allergy and immunology care, with particular attention to pediatric and general allergy services.

Methods

The paper is formulated as an expert opinion–based position document informed by current scientific evidence on digital health applications and sustainable healthcare practices in allergy and immunology. Key domains were identified through literature review and consensus discussions, focusing on digital transformation, environmental sustainability, and international collaboration.

Results

The proposed roadmap highlights three strategic priorities: (1) leveraging digital health solutions—including mobile health, telemedicine, and artificial intelligence—to enhance early diagnosis, personalized treatment, and real-time disease monitoring; (2) embedding environmentally sustainable practices into routine allergy care to reduce healthcare-related carbon emissions; and (3) fostering international collaboration among clinicians, researchers, and policymakers to promote equitable access to digital allergy care across diverse healthcare systems.

Biologic Therapies: A Systematic Review of the Indications, Efficacy, Safety, and Outcomes in Ear, Nose, and Throat Diseases

Al Saloom Z, Alawainati M, Abdeen Z, et al. (January 07, 2026)  Cureus 18(1): e101059. doi:10.7759/cureus.101059

Abstract

Biologic therapies, such as omalizumab, mepolizumab, and dupilumab, are novel therapeutic agents that offer a targeted approach for managing chronic inflammatory and immune-mediated ear, nose, and throat (ENT) conditions. However, the indications, efficacy, and adverse events of these medications in various ENT disorders have not been studied before. Therefore, this systematic review was performed to evaluate their indications, clinical efficacy, and safety in ENT management. A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across five major databases:

The molecular mechanism of the adverse effects of the biological and small molecular drugs in the therapy of inflammatory skin diseases - psoriasis and atopic dermatitis

Lemiesz P, Nowowiejska-Purpurowicz J, Flisiak I. Ann Med. 2026 Dec;58(1):2611461. doi: 10.1080/07853890.2025.2611461.

Abstract

The summary of pathogenesis and comparison between
psoriasis and atopic dermatitis.

Patients with the most common chronic inflammatory dermatoses, namely psoriasis and atopic dermatitis, gained access to state-of-the-art therapeutic options providing spectacular improvement of skin lesions. Although generally safe, biological agents and small molecular drugs have also side effects which may be mild and irrelevant to the therapy course, but sometimes, of a greater extent and influencing further therapeutic decisions. In this review, we summarize the molecular explanation for the most common adverse effects of drugs used in the treatment of psoriasis and atopic dermatitis. Biologics used in psoriasis predominantly target TNFα, IL-17, 23, while in AD inhibit IL-4,13,31. Janus kinase (JAK) inhibitors represent small-molecule therapies effective in both conditions, although more prominently in AD.

Five-Grass-Pollen Sublingual Immunotherapy Drops Are Efficacious and Well Tolerated in Adults: The RHAPSODY Phase III Trial

Didier A, Juhl RG, Dalgaard T et al. Allergy. 2025 Dec 24. doi: 10.1111/all.70191.

ABSTRACT

Background

Tablet formulations of allergen extracts are widely recommended over other formulations for the sublingual immunotherapy (SLIT) of respiratory allergies. However, with adequate clinical trial evidence, SLIT (liquid) drop formulations may be a relevant allergy treatment option.

Methods

Graphical Abstract

The RHAPSODY multinational, Phase III, parallel-group, double-blind, placebo-controlled, randomised clinical study of adults with moderate-to-severe, grass-pollen-induced allergic rhinoconjunctivitis (ARC) with or without asthma was conducted at 45 investigating centres in six European countries. Participants received 26 months of continuous treatment with active 5-grass-pollen SLIT drops or placebo. The primary efficacy endpoint was the average daily total combined score (TCS, comprising a symptom score and a rescue medication score) during the second peak grass pollen season (PGPS).

Results

Of the 445 randomised patients (mean ± standard deviation (range) age: 32.6 ± 9.9 (18–63); males: 55.1%), 389 completed the trial.

Baseline Monocyte Count Predicts Complete Response to Omalizumab in Chronic Spontaneous Urticaria: A Retrospective Analysis

Turhan İ D, Solak B (January 01, 2026) Cureus 18(1): e100556. doi:10.7759/cureus.100556

Abstract

Introduction: Chronic spontaneous urticaria (CSU) is a distressing skin condition characterized by wheals and angioedema. While omalizumab is an effective biologic therapy for antihistamine-refractory CSU, a subset of patients shows partial or no response. Identifying reliable biomarkers to predict treatment outcomes remains a significant clinical need. This study aimed to investigate the relationship between systemic inflammatory parameters, specifically monocyte counts, and the clinical response to omalizumab.

Methods: This retrospective study included 52 patients with CSU treated with omalizumab (300 mg/four weeks) for at least 12 weeks at a tertiary referral center. Patients were stratified into two groups based on their response at week 12: "Complete Response" (Urticaria Activity Score over seven days (UAS7) = 0) and "Non-Complete Response." Baseline and post-treatment complete blood count (CBC) parameters, C-reactive protein (CRP), and total IgE levels were analyzed. Binary logistic regression was performed to identify independent predictors of response.

Binary logistic regression analysis for independent
predictors of complete response to omalizumab

Results: Eleven patients (21.15%) achieved a complete response. The complete responder group exhibited significantly higher baseline median monocyte counts (0.68 vs. 0.40 K/µL, p = 0.001) and basophil counts (p = 0.032), but significantly lower baseline CRP levels (p = 0.003) compared to non-responders.

Rebound Pruritus and Urticaria Post-discontinuation of Chronic Cetirizine Use: A Case Report.

Seng J, Cai M, Oka P (December 27, 2025) Cureus 17(12): e100214. doi:10.7759/cureus.100214

Abstract

Timeline of events

Cetirizine is a common over-the-counter antihistamine used to treat allergic rhinitis, eczema, and urticaria. There have been increasing reports showing increased risk of rebound pruritus following discontinuation of long-term antihistamine use in the United States and the Netherlands. However, evidence on this condition and its management among Asian populations remains limited. We report the case of a Chinese male in his 50s with a background of hypertension, hyperlipidaemia, and chronic urticaria who had been regularly taking over-the-counter cetirizine for the past two years.

Abstracts of the 14th C1-inhibitor Deficiency and Angioedema Workshop

 Allergy Asthma Clin Immunol 21 (Suppl 2), 55 (2025). https://doi.org/10.1186/s13223-025-00992-1

Preface

We are pleased to welcome all participants to the 14th C1-inhibitor Deficiency & Angioedema Workshop.

The aim of the Workshop is to present new research findings related to rare bradykinin-mediated angioedema disorders. These include conditions caused by hereditary or acquired C1-inhibitor deficiency, as well as those with a hereditary background but normal C1-inhibitor levels. This year, a record number of abstracts will be presented over the four-day program, including 49 oral and 58 poster presentations. In addition to previously unpublished findings, five outstanding keynote lectures will also be delivered.

On the opening afternoon, Nobel Laureate Katalin Karikó will give a special lecture on the development of the mRNA vaccine, sharing all the insights gained from the long and persistent journey that led to the production of life-saving mRNA-based vaccines.

COVID-19 mRNA Vaccination and 4-Year All-Cause Mortality Among Adults Aged 18 to 59 Years in France

Semenzato L, Le Vu S, Botton J, et al.  JAMA Netw Open. 2025;8(12):e2546822. doi:10.1001/jamanetworkopen.2025.4682

Key Points

Question  Are COVID-19 mRNA vaccines associated with the long-term risk of all-cause mortality?

Findings  In this cohort study including 22.7 million vaccinated individuals and 5.9 million unvaccinated individuals, vaccinated individuals had a 74% lower risk of death from severe COVID-19 and no increased risk of all-cause mortality over a median follow-up of 45 months.

Meaning  These national-level results found no increased risk of 4-year all-cause mortality in individuals aged 18 to 59 years vaccinated against COVID-19, further supporting the safety of the mRNA vaccines that are being widely used worldwide.

Abstract

Importance  While several studies have assessed the impact of COVID-19 vaccination on short-term mortality, none have compared long-term mortality by vaccination status, particularly in young individuals who are less likely to experience severe disease following SARS-CoV-2 infection.

TZ1391: a computationally designed circular mRNA multi-epitope vaccine candidate against Mycobacterium tuberculosis via TLR3 immunomodulation

Ali, A., Alamri, A., Mishra, V.K. et al.  BMC Immunol (2026). https://doi.org/10.1186/s12865-025-00795-4

Abstract

Graphical Abstract

Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health burden due to latent infection, multidrug resistance, and the limited efficacy of the BCG vaccine. To address this challenge, we computationally designed and evaluated a circular mRNA-based multi-epitope vaccine candidate, TZ1391. Five experimentally validated M. tuberculosis antigens (ESAT-6, CFP-10, Ag85B, PPE18, and HspX) were used to predict immunodominant cytotoxic T lymphocyte (CTL), helper T lymphocyte (HTL), and B-cell epitopes.

Peanut Oral Immunotherapy Using 30 and 300 mg Maintenance Doses

Upton JEM, Toscano-Rivero D, Ke D, Berenjy A et al.  J Allergy Clin Immunol Pract. 2025 Oct 16:S2213-2198(25)00958-4. doi: 10.1016/j.jaip.2025.10.007. 

Abstract

Background

The lowest dose of peanut oral immunotherapy (P-OIT) has not been determined.

Objective

To evaluate whether very low-dose oral immunotherapy (30 mg) may safely and effectively increase tolerated doses and induce immunologic changes.

Methods

Visual Summary

We prospectively enrolled peanut-allergic children reactive to 444 mg peanut protein (PP) or less in double-blind placebo-controlled food challenges (DBPCFC) and randomly assigned them to three groups. Two were double-blinded P-OIT groups escalating to 30 mg (Group 30 mg) or 300 mg (Group 300 mg) PP maintenance doses. A third group followed open-label avoidance (Group Avoid). Cumulative tolerated doses of 443 mg or greater and 1,043 mg or greater PP were compared with Group Avoid by DBPCFC planned at 1 year.

Hypocomplementemic Urticarial Vasculitis: A Case Report

Aparicio E E, Guerrero D V, Alcántara V D, et al. (December 26, 2025) Cureus 17(12): e100143. doi:10.7759/cureus.100143

Abstract

Cutaneous manifestations of hypocomplementemic urticarial vasculitis

Urticarial vasculitis (UV) is an inflammatory condition that affects small vessels, generating urticarial lesions with wheals lasting >24 hours. It can be divided into two main groups: normocomplementemic (NUV) and hypocomplementemic urticarial vasculitis (HUV). The latter is a rare condition, whose association with autoimmune diseases, primarily systemic lupus erythematosus (SLE), makes its diagnosis difficult.

A Systematic Review and Meta-Analysis on the Induction of Confirmed Eosinophilic Esophagitis as a Side Effect of Allergen Immunotherapy: An EAACI Task Force Report

Rossi CM, Terreehorst I, Apostolidou E et al. Allergy. 2025 Dec 16. doi: 10.1111/all.70183.

ABSTRACT

Risk of bias (RoB) domains for the randomized controlled trials (RCT)
on the development of eosinophilic esophagitis (EoE) after allergen
immunotherapy (AIT).

The European Academy of Allergy and Clinical Immunology (EAACI) established a Task Force to assess the existing data on the relationship between eosinophilic esophagitis (EoE) and allergen immunotherapy (AIT). This systematic review and meta-analysis aimed to study the incidence of confirmed EoE, developing as a side effect of AIT to food or airborne allergens, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The literature search was performed in three databases (PubMed, Embase and Scopus). Databases were searched from inception to March 31st, 2023. A total of 17 studies met the criteria for inclusion in the review.

Unravelling allergic rhinitis: exploring pathophysiology, advances in treatment, and future directions.

Singh AK, Shaili S, Siddiqui A et al. Front Allergy. 2025 Dec 4;6:1636415. doi: 10.3389/falgy.2025.1636415.

Abstract

The pathophysiology of AR results in typical examination findings 
(A) the allergic salute. (B) Allergic shiners. (C) Dennie-Morgan lines.
 (D) Facial grimacing or twitching. This is related to nasal itching. 
(E) Nasal creasing related to the allergic salute. (F) Allergic facies. 
(G) Typical nasal mucosa.

Allergic rhinitis (AR) is a complex, multifactorial condition that continues to pose significant clinical and public health challenges, despite the availability of established therapeutic strategies. It significantly contributes to a lower quality of life by causing sleep issues, mental fatigue, and a decline in productivity. A thorough grasp of AR is crucial to enhancing diagnosis and treatment results because of its pervasive effects and ongoing management gaps. This review covers a wide range of topics, such as classification schemes, historical perception, and physical consequences of AR.

Comparative efficacy of omalizumab, dupilumab, and remibrutinib in chronic spontaneous urticaria: a network meta-analysis of randomized control trials

Xiong G, Rayner DG, Kim L et al. J Dermatolog Treat. 2025 Dec;36(1):2580374. doi: 10.1080/09546634.2025.2580374.

Abstract
Introduction

Chronic spontaneous urticaria (CSU) is a skin condition that significantly impairs quality of life. While omalizumab remains the standard treatment for patients who have failed antihistamines, emerging therapies show promise in randomized control trials (RCTs). This study aims to compare the relative efficacy of omalizumab, dupilumab, and remibrutinib in CSU.

Methods
Four databases were searched for RCTs evaluating omalizumab (75/150/300 mg Q4W), dupilumab (300 mg Q2W), or remibrutinib (25 mg BID) in CSU. Urticaria Activity Score (UAS7), Itch Severity Score (ISS7), Dermatology Life Quality Index (DLQI; DLQI 0/1), disease control (UAS7 ≤ 6), and symptom remission (UAS7 = 0) were assessed at weeks 12/24. Frequentist random-effects network meta-analysis were conducted in R.

Results

Forest plot depicting reduction in UAS7 compared to placebo
at week 12 of dupilumab 300 mg biweekly, omalizumab 300 mg,
150 mg, or 75 mg every four weeks, and remibrutinib 25 mg
twice daily.

Fifteen studies (4,913 patients) were included. Omalizumab 300 mg demonstrated the greatest efficacy in UAS7, ISS7, symptom remission, and disease control at both timepoints. Remibrutinib showed the greatest DLQI improvement and second-highest UAS7 reduction and odds of symptom remission.

A retrospective cohort study on the association between allergic rhinitis, sublingual immunotherapy, and COVID-19 symptomatology

Zhang, YY., Lu, MP., Chen, YB. et al. Sci Rep (2025). https://doi.org/10.1038/s41598-025-31902-5

Abstract

The impacts of allergic rhinitis (AR) and allergen-specific sublingual immunotherapy (SLIT) on coronavirus disease 2019 (COVID-19) have not been fully understood. Therefore, the aim of this study was to investigate the effects of AR and SLIT on symptoms of COVID-19 within one month after Chinese authorities adjusted their COVID-19 response measures. The study enrolled 1368 participants, including 746 AR patients and 622 controls without allergic diseases. SLIT was administered to 122 infected AR patients (AR with SLIT group), while it was not administered to the other 483 infected AR patients (AR without SLIT group). Patients’ outcomes were compared after propensity score matching (PSM). The data showed that AR played a dual role in COVID-19, acting as both a protective factor against respiratory symptoms and a risk factor increasing the likelihood of olfactory/gustatory dysfunctions and fever, compared to non-allergic individuals.

Nirsevimab vs RSVpreF Vaccine for Respiratory Syncytial Virus–Related Hospitalization in Newborns

Jabagi M, Bertrand M, Gabet A et al.  JAMA. Published online December 22, 2025. doi:10.1001/jama.2025.24082

Key Points

• Question  How does maternal vaccination with the respiratory syncytial virus prefusion F protein (RSVpreF) vaccine compare with passive infant immunization with nirsevimab for the prevention of RSV-related hospitalization?
• Findings  In this French nationwide study, infant immunization with nirsevimab was associated with a lower risk of RSV-related hospitalization compared with maternal vaccination with the RSVpreF vaccine (hazard ratio, 0.74). The risk of severe outcomes, including admission to the pediatric intensive care unit and requiring ventilator support or oxygen therapy, was also lower.
• Meaning  Compared with maternal vaccination with the RSVpreF vaccine during the first RSV season in France, infant immunization with nirsevimab was associated with a lower risk of RSV-related hospitalization.

Abstract

Importance  Respiratory syncytial virus (RSV) is a leading cause of hospitalization in infants. The comparative effectiveness of 2 recently introduced preventive strategies (infant immunization through placental antibody transfer after maternal vaccination with the RSV prefusion F protein [RSVpreF] vaccine and passive infant immunization with nirsevimab) remains unknown.

Objective  To compare the associations of maternal vaccination with the RSVpreF vaccine vs passive infant immunization with nirsevimab for the prevention of RSV-related hospitalization.

Design, Setting, and Participants  This population-based cohort study used data from the French National Health Data System. Maternal vaccination with the RSVpreF vaccine occurred during 32 to 36 weeks’ gestation among infants born in mainland France between September 1 and December 31, 2024. Passive infant immunization with nirsevimab occurred prior to hospital discharge. Infants were matched 1:1 by maternity ward discharge date, sex, gestational age, and region. Follow-up ended at the time of RSV hospitalization or death or on February 28, 2025.

Exposures  Maternal immunization with the RSVpreF vaccine and passive infant immunization with nirsevimab.

Main Outcomes and Measures  The primary outcome was hospitalization for RSV-associated lower respiratory tract infection. The secondary outcomes included admission to the pediatric intensive care unit (PICU), admission to high-dependency unit, ventilator support, and oxygen therapy. The hazard ratios (HRs) were estimated using conditional Cox proportional hazards models with inverse probability of treatment weighting.

Comparative Analysis for Primary Outcome of Hospitalization
for Respiratory Syncytial Virus (RSV)–Associated Lower Respiratory
Tract Infection and Secondary Outcomes Among Matched Infants

Results  A total of 42 560 infants (mean age, 3.7 [SD, 1.4] days; 51.7% male) were included in the study (21 280 per group) with a median follow-up of 84 days (IQR, 70-99 days). Of the 481 hospitalizations for RSV-associated lower respiratory tract infection, 212 (44.1%) occurred in the nirsevimab group vs 269 (55.9%) in the RSVpreF vaccine group (between-group difference, −11.8% [95% CI, −18.1% to −5.5%]).

Association between yellow dust, PM2.5, and hay fever: A large-scale crowdsourced observational study using the AllerSearch smartphone application

Nagino K, Inomata T, Ebihara N et al. Allergol Int. 2025 Dec 16:S1323-8930(25)00127-3. doi: 10.1016/j.alit.2025.11.008.

Abstract

Background

This large-scale crowdsourced observational study investigated the association between yellow dust, particulate matter 2.5 (PM2.5), and hay fever symptoms using the AllerSearch smartphone application.

Methods

Participants with hay fever were divided into four groups based on combinations of high and low pollen and PM2.5/yellow dust dispersion levels. Nine hay fever symptom scores and quality of life (QoL) scores were compared among the groups. Multivariate analysis evaluated independent associations between pollen and PM2.5/yellow dust dispersion levels and hay fever symptom and QoL scores. Risk factors for individuals experiencing worsening hay fever symptoms during PM2.5/yellow dust dispersion were evaluated using multivariate logistic regression analysis.

Results

Heatmaps showing the distribution of the number of participants,
pollen dispersion levels, and PM2.5/yellow dust dispersion levels
 by prefecture in Japan from February to May.

This analysis included 6468 participants. All hay fever symptom scores except “ear and/or mouth itching,” and all QoL scores were significantly higher in the “low pollen and moderate-to-high PM2.5/yellow dust” group versus the “low pollen and low PM2.5/yellow dust” group.

Aspergillus fumigatus sensitization is associated with high-risk bronchiectasis

Tiew PY, Narayana JK, Jaggi TK et al.  Chest. 2025 Dec 10:S0012-3692(25)05826-X. doi: 10.1016/j.chest.2025.12.001. 

Abstract

Background: Fungal sensitization is an increasingly recognized endophenotype in chronic respiratory disease, however, its role in bronchiectasis remains poorly defined. This study aims to provide the most comprehensive evaluation to date of fungal sensitization and its clinical relevance in bronchiectasis using an expanded panel of crude and recombinant fungal allergens.

Research question: What is the prevalence and clinical implications of fungal sensitization in bronchiectasis?

Study design and methods: We conducted an international, multi-centre evaluation of fungal sensitization across six tertiary centres in four countries (Singapore, Malaysia, United Kingdom and Italy) prospectively recruiting N=277 individuals with bronchiectasis. Using a comprehensive, expanded allergen panel including 11 crude and 24 recombinant fungal allergens (total: 35 allergens and 9,695 individual assays), we assessed sensitization responses in relation to clinical characteristics, exacerbation frequency and geographic origin. Low baseline exacerbations is defined as < 3, and high as ≥ 3 in the preceding 12 months of study recruitment.

Polysensitization to recombinant Aspergillus fumigatus (rAsp f)
12, 15 and 17 associates with 587 increased severe
(hospitalized) exacerbations in bronchiectasis. 

Results: Sensitization to recombinant Aspergillus fumigatus (rAsp f) links to bronchiectasis severity. Measurable responses to rAsp f allergens 12, 15, and 17 associates with severe (hospitalized) exacerbations. particularly in those with low baseline exacerbations (low-risk) .

Cardiovascular Events 1 Year After Respiratory Syncytial Virus Infection in Adults

Hviid A, Fischer TK, Biering-Sørensen T, Bech Svalgaard I.  JAMA Netw Open. 2025;8(12):e2547618. doi:10.1001/jamanetworkopen.2025.47618

Key Points

Question  Is respiratory syncytial virus (RSV) infection in adults aged 45 years or older associated with an increased risk of cardiovascular events beyond the immediate acute phase?

Findings  In this cohort study in 17 494 matched patients with and without RSV infection, RSV infection was associated with 4.69 additional cardiovascular events for every 100 older individuals with infection in the year following RSV infection.

Meaning  These findings suggest that public health measures, such as vaccination, may prevent not only acute respiratory disease but also cardiovascular disease.

Abstract

Importance  Respiratory syncytial virus (RSV) infection has recently been recognized as common among adults, but data on the burden of cardiovascular disease (CVD) beyond the immediate acute phase are lacking.

ARIA WEBINAR N°3: 8th, 9th & 12th December 2025. ARIA 2024-2025 guidelines: Recommendations on oral and ocular treatments

AGENDA

ARIA 2024-2025 guidelines: Recommendations on oral and ocular treatments

Jean Bousquet:

- Presentation of the recommendations of oral antihistamines versus intranasal treatments for the ARIA 2024-2025 guidelines
- Why is it important to evaluate as-needed vs chronic treatment in allergic rhinitis?

- Why is it important to evaluate rhinitis alone and rhinitis+asthma in the treatment of allergic rhinitis?

Bernardo Sousa Pinto:

- Co-medication vs dose increase medication: Methods and preliminary results of the systematic review and Roadmap for developing recommendations
- As-needed vs chronic treatment in allergic rhinitis: Roadmap for developing recommendations