Aesthetic interventions in patients with allergic skin diseases: Risk assessment and evidence-based preventive risk management

 

Yiğit İK, Türsen Ü, Türsen B et al. Clin Dermatol. 2026 Mar 13:S0738-081X(26)00060-X. doi: 10.1016/j.clindermatol.2026.03.001. 

Abstract

The use of aesthetic dermatologic procedures in patients with underlying allergic and inflammatory skin diseases is on the rise, but specific safety considerations are often overlooked. Individuals with hypersensitivity to injectables, chronic inducible urticaria, allergic contact dermatitis, atopic dermatitis, or hereditary angioedema may face an increased risk of adverse reactions triggered by mechanical trauma, injected substances, or disruption of the skin barrier.

Adverse reactions to local anesthetics are predominantly non-IgE-mediated. Thus, preventive strategies should focus on selecting the appropriate agents and employing proper injection techniques rather than routine pharmacologic prophylaxis. Botulinum toxin, hyaluronic acid fillers, and hyaluronidase can rarely cause immediate or delayed hypersensitivity reactions. This highlights the need for individualized risk assessment and avoidance of reexposure in confirmed cases. For patients with chronic inducible urticaria, aesthetic procedures can act as physical triggers.

Frequency and severity of systemic reactions during beta-lactam skin testing in adults with immediate hypersensitivity allergy

Letón-Cabanillas, P., Noguerado-Mellado, B., Quijada-Morales, P. et al.  Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01032-2

Abstract

Diagnostic workflow for beta-lactam immediate hypersensitivity skin 

testing

Hypersensitivity to beta-lactams (BL) is the most frequent drug allergy, and skin testing (ST) remains the first-line diagnostic tool. Although generally safe, systemic reactions (SR) during ST are a concern. We conducted a 7-year ambispective study (2018–2025) including 216 adults with confirmed immediate hypersensitivity reactions (HSR) to BL, established by positive skin tests (ST) or drug challenge tests (DCT). Among them, 138 (63.9%) had positive ST, predominantly intradermal tests (IDT; 93.5%). Five patients (3.6% of ST-positive; 2.3% of the entire cohort) developed SR during ST, all after IDT following negative skin prick tests (SPT).

Prediction of allergic disease trajectories from birth up to adolescence

Leskien M, Scheerer M, Thiering E e al. Pediatr Allergy Immunol. 2026 Apr;37(4):e70341. doi: 10.1111/pai.70341.

Abstract

Background

Allergic diseases often develop jointly during early childhood. Potential disease trajectories and relevant early-life factors have been described, yet existing prediction approaches mostly focus on single allergic diseases cross-sectionally. Models addressing allergic multimorbidity and disease trajectories are lacking. We aim to predict allergic disease trajectories from birth up to adolescence using early-life factors.

Methods

Preceding research using data from 4646 adolescents of the German birth cohorts GINIplus and LISA identified seven allergic disease trajectories up to the age of 15 years. A set of predictors comprising parental and perinatal factors, early allergic or respiratory symptoms, lifestyle and environmental factors was used with an XGBoost machine learning approach to perform multiclass classification. In a subsample (N = 2109), polygenic risk scores (PRS) for asthma, allergic rhinitis, atopic dermatitis, and any allergy were added to the predictor set.

Results

Sankey Plot illustrating the distributions of observed and predicted
trajectories and their overlaps.

Our approach revealed moderate classification success (multiclass area under the curve (AUC) = 0.69). A macro-averaged sensitivity of 0.26 and specificity of 0.89 were obtained. The most important predictors were early-life skin rash, respiratory symptoms, and air pollution.

Loss of symbiotic gut bacteria in children at diagnosis of food protein–induced enterocolitis syndrome

Winberg A, Simonyté Sjödin K, Öhlund M, West CE. J Allergy Clin Immunol. 2026 Mar 11:S0091-6749(26)00184-3. doi: 10.1016/j.jaci.2026.02.043.

Abstract
Background

Gut microbial composition has been proposed to influence disease onset in children with food protein–induced enterocolitis syndrome (FPIES).

Objective
We sought to investigate differences in gut microbiota profiles in children with newly diagnosed FPIES and healthy control subjects.

Methods
Fecal samples were collected at FPIES diagnosis from 56 children stratified into 3 age groups: mean (SD) age 4.6 (0.5) months, 6.5 (0.6) months, and 11.7 (7.8) months. Gut microbiota profiles were analyzed using 16S ribosomal RNA gene amplicon sequencing and compared between children with FPIES and 43 age-matched control subjects.

Graphical Abstract

Results
Age was the strongest determinant of gut microbiota composition, followed by FPIES status. β-diversity differed significantly between children with FPIES and control subjects (P < .01), primarily driven by shifts in Bacteroidota, Proteobacteria, Actinobacteriota, and Verrucomicrobiota.

Hypersensitivity to Excipients in Drugs: An EAACI Position Paper

L. H.Garvey, K.Brockow, A.Barbaud, et al.  Allergy (2026): 1–26, https://doi.org/10.1111/all.70324.

ABSTRACT

Characteristics of immediate drug hypersensitivity

reactions (DHR) caused by excipients.

Drugs contain active pharmaceutical ingredients and excipients, compounds which enhance the pharmacokinetics, stability and palatability of the pharmaceutical formulation. While most drug hypersensitivity reactions (DHR) are caused by active ingredients, excipients may also be involved. Excipient-related DHR are easily overlooked and may lead to repeated anaphylaxis in patients exposed to pharmaceutical formulations containing different active ingredients.

Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis

Islam N, Chu AWL, Sheriff F, et al. JAMA Pediatr. Published online February 09, 2026. doi:10.1001/jamapediatrics.2025.6105

Key Points

Question  What are the risk factors associated with the development of food allergy in children?

Findings  This systematic review and meta-analysis of 2.8 million participants in 190 studies identified the following largest and most certain risk factors associated with the development of food allergies in children: prior allergic conditions (atopic march/diathesis), atopic dermatitis, increased skin transepidermal water loss, filaggrin gene sequence variations, delayed solid food introduction, infant and intrapartum antibiotic exposure, male sex, being first born, family history of allergy, parental migration, self-identification as Black, and cesarean delivery.

Meaning  This systematic review and meta-analysis clarifies the major and minor risk factors associated with developing early-onset food allergy to inform optimal prevention clinical practice, policy, and research.

Abstract

Importance  The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Broad-Spectrum Grass Pollen Immunotherapy: Revisiting the Role of Species Diversity in Allergy Treatment

Feindor, M., Hewings, S., Goodman, J. et al. Curr Treat Options Allergy 13, 4 (2026). https://doi.org/10.1007/s40521-026-00412-8

Abstract

Purpose of Review

This review examines whether allergen immunotherapy (AIT) for grass pollen allergy should expand beyond the recent trend towards a mono-species approach based on Phleum pratense. It explores whether multi-species formulations better reflect natural exposure and could improve clinical outcomes.

Recent Findings

Group 5 homologues identified in individual extracts and
a mixed extract of 13 species of Poaceae family grasses,
using a monoclonal antibody

Research from aerobiology and immunology shows that grass pollen exposure involves diverse species with distinct flowering periods, influenced by climate and geography.

Adverse Events of Biologics in Severe Asthma

Sánchez, J., Caraballo, A. & Álvarez, L.  Curr Treat Options Allergy 13, 3 (2026). https://doi.org/10.1007/s40521-026-00411-9

Abstract

Purpose of Review

To summarize current evidence on the immediate and long-term safety profile of the available monoclonal biological therapy (MBT) approved for the treatment of severe asthma.

Recent Findings

Risk of serious adverse events

Clinical trials and real-world studies have shown that MBT are generally well tolerated, although certain adverse effects such as local reactions, anaphylaxis, parasitic or viral infections, malignancy, and cerebrovascular events are of special concern in these therapies or have already been reported.

Efficacy and Safety of Oral Antihistamines for Allergic Rhinitis: Network Meta-Analysis

Vieira RJ, Gil-Mata S, Ferreira A et al. J Allergy Clin Immunol Pract. 2026 Feb 16:S2213-2198(26)00140-6. doi: 10.1016/j.jaip.2025.12.034.

• What is already known about this topic? Oral antihistamines are one of the mainstays of the pharmacologic management of allergic rhinitis, being widely available and affordable.
• What does this article add to our knowledge? Oral antihistamines are effective in improving rhinitis symptoms and quality of life. Cetirizine, ebastine, bilastine, and rupatadine were among the individual medications associated with the highest efficacy for improving nasal symptoms.
• How does this study impact current management guidelines? This systematic review will inform the Allergic Rhinitis and its Impact on Asthma (2024-2025) guidelines. In particular, it will provide evidence on the efficacy and safety of individual oral antihistamines.

Abstract

Background

Real-world patient's practices in the management of allergic rhinitis in the Philippine setting

Enecilla MLB, Recto MST, Navarro-Locsin CG et al.  Asia Pac Allergy. 2026 Feb;16(1):20-29. doi: 10.5415/apallergy.0000000000000214. 

Background:

Abstract: 

Allergic rhinitis is a prevalent disease and there is a need for local real-world data to create relevant guidelines and care pathways in its management.

Objective:

The aim was to investigate the health-seeking behavior and practices of Filipinos in managing allergic rhinitis symptoms.

Methods:A cross-sectional stratified online survey was conducted among Filipinos with allergic rhinitis symptoms. Stratified sampling, based on age group and region of residence in the Philippines, with proportional allocation, was used to select the respondents of this study.

Results:

Compliance to prescribed medications for allergic rhinitis.

A total of 317 respondents (213 adults and 104 pediatric) were included in the analysis. The majority (61.83%) had moderate-severe intermittent allergic rhinitis.

Guidelines of care for the management of atopic dermatitis in pediatric patients

Davis DMR, Alikhan A, Bercovitch L et al. J Am Acad Dermatol. 2028 Apr 28:S0190-9622(26)00343-9. doi: 10.1016/j.jaad.2026.02.113.

Abstract

Background

Pediatric atopic dermatitis (AD) is a common, chronic inflammatory skin disorder that significantly impacts the quality of life of affected children and their families. Multiple therapies were approved to treat AD in children and adolescents since publication of the AAD's 2014 AD guidelines.

Objective

To provide evidence-based recommendations on the use of topical therapies, phototherapy, and systemic therapies for AD in children and adolescents.

Age-Related Differences in Efficacy and Safety of Subcutaneous Immunotherapy in Allergic Rhinitis: A Real-World Study

Jia, J., Yuan, X., Liu, L. et al.  (2026)  OTO Open, 10: e70229. https://doi.org/10.1002/oto2.70229

Abstract

Objective

To investigate age-related differences in efficacy and safety of subcutaneous immunotherapy (SCIT) among patients with allergic rhinitis (AR).

Study design

Retrospective cohort study.

Setting

Tertiary referral center.

Methods

AR patients who completed a 3-year course of dust mite SCIT with a 2-year post-SCIT follow-up were categorized into pediatric and adult groups. Baseline characteristics, SCIT efficacy, and adverse reactions were compared between groups. Multivariable logistic regression was used to identify independent predictors of SCIT efficacy and adverse reaction.

Results

Comparison of SCIT efficacy between children and adults.

889 patients were included, comprising 544 children and 345 adults. Adults exhibited higher baseline symptom burden, higher rates of former or current smoking and alcohol consumption, longer AR duration, more frequent dose adjustments during SCIT, and greater prevalence of comorbid asthma and urticaria. In contrast, children had higher frequencies of family history of allergy, monosensitization, food allergy, and secondary immunotherapy.

Antibody therapeutics with high affinity for FcγRs exacerbate anaphylaxis via FcγR-mediated capture by tumor-associated myeloid cells

Tang R, Aibai A, Tamemoto Y et al. Journal for ImmunoTherapy of Cancer. 2026;14:e013316. https://doi.org/10.1136/jitc-2025-013316

Abstract

Background Antibody therapeutics have revolutionized cancer treatment, but their use is increasingly associated with adverse events. Among these, anaphylaxis is particularly concerning due to its severity and unpredictability. Our previous studies demonstrated that repeated administration of anti-programmed death-ligand 1 antibodies to tumor-bearing mice induces antidrug antibodies (ADAs) and anaphylaxis. However, the specific characteristics of antibody therapeutics responsible for this effect and the underlying mechanism of ADA production remain poorly understood. This study aimed to identify the immunological and molecular determinants of ADA-associated anaphylaxis following antibody therapeutics in tumor-bearing hosts.

Methods CT26 and 4T1 tumor-bearing mice were repeatedly administered various therapeutic antibodies with differing affinities for Fcγ receptors (FcγRs). Anaphylaxis symptoms, body temperature, and mortality were evaluated. Serum ADA levels were quantified using ELISA. Antibody affinity for mouse FcγR was determined using surface plasmon resonance. Antibody distribution in the spleen was assessed via immunofluorescence staining, and antibody glycosylation was analyzed by liquid chromatography-mass spectrometry. Immune cell populations were examined using flow cytometry.

High-affinity FcγR-binding anti-PD-L1 antibody clone, 10F.9G2,
but not low-affinity clones nor deglycosylated 10F.9G2 induced anaphylaxis. 

Results Repeated administration of antibodies with high affinities for FcγRs to tumor-bearing mice induced robust ADA production and anaphylaxis, whereas antibodies with low affinities for FcγRs against the same target elicited only minimal ADA responses and did not trigger anaphylaxis.

Clinical Evaluation of Allergen Immunotherapy for Allergic Rhinitis

Catamerò F, Bragato MC, Lozano MA et al.  Vaccines. 2026; 14(4):326. https://doi.org/10.3390/vaccines14040326

Abstract

Background/Objectives: Allergen immunotherapy (AIT), involving subcutaneous (SCIT) or sublingual (SLIT) administration of the culprit allergen, is the only treatment capable of modifying the natural course of allergic diseases, and provides lasting benefits in terms of symptom reduction and medication use. AIT for allergic rhinitis is acknowledged as safe and effective in both adults and children; however, no studies have comprehensively evaluated the safety and efficacy of AIT in these populations, integrating results from randomized controlled trials (RCTs) and real-world evidence (RWE). 

Methods: We evaluated data in the literature including studies from RCTs and RWE in which the safety and efficacy of AIT in both children and adults have been analyzed. A narrative literature search was conducted in PubMed up to January 2026 using the following keywords for the search string: “allergen immunotherapy,” “AIT,” “safety,” “efficacy,” “clinical outcome,” and “clinical evaluation.” 

Efficacy and safety of allergen immunotherapy in allergic rhinitis.
AIT, allergen immunotherapy; SCIT, subcutaneous immunotherapy;
SLIT, sublingual immunotherapy.

Results: RCTs and meta-analyses showed that both SCIT and SLIT significantly reduced allergic symptoms and medication use and improved quality of life (QoL). Large SLIT tablet trials have confirmed its efficacy in adults and children, whereas RWE supports its effectiveness in broader populations.

Etiologic diagnosis of seasonal allergic rhinitis supported by artificial intelligence: the @IT-2020 project

Matricardi PM, Monnati F, Palmieri L et al.  J Allergy Clin Immunol. 2026 Mar 26:S0091-6749(26)00215-0. doi: 10.1016/j.jaci.2026.03.011. 

ABSTRACT

Background

A precise etiological diagnosis of seasonal allergic rhinitis (SAR) is essential for a tailored prescription of its only curative treatment, allergen-specific immunotherapy (AIT). This is a challenging task in temperate climates, where most patients are polysensitized to multiple pollen with overlapping seasons.

Objective

The study aims to develop a modular, flexible and validated Clinical Decision Support System (CDSS) generated with Artificial Intelligence for the etiologic diagnosis of SAR.

Methods

Study Workflow

In the context of the @IT-2020 Project, we developed a CDSS for SAR etiological diagnosis. We aimed to automate the CDSS by integrating Machine Learning (ML) algorithms. The CDSS adopts three progressive diagnostic modules: (a) clinical history and Skin Prick Tests (SPT), (b) plus molecular specific Immunoglobulin E (sIgEmol) tests, (c) plus an electronic clinical and environmental Diary. To this end, three raters identified, following international guidelines and a Delphi-like procedure, the culprit pollen on 100 SAR patients in Rome (Italy).

Results

Three models best performing (AUROC >95%) have been then generated by ML training and tested on 2/3 and 1/3 patients, respectively.

Analysis of the results of specific IgE detection for cat and dog dander allergens in 141, 165 tests with allergic diseases

Li, Y., Xu, M., Li, J. et al.  BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00825-9

Abstract

Objective

The incidence of pet allergies continues to rise. This study investigates the clinical distribution characteristics and changes of cat and dog dander allergens among all outpatients and inpatients treated at Hangzhou First People’s Hospital from 2016 to 2024. It aims to provide data support for clinical allergen screening, individualized avoidance strategies, and precision diagnosis and treatment.

Methods

A retrospective cohort study was conducted. All outpatients and inpatients who underwent serum allergen-specific IgE (sIgE) antibody testing at Hangzhou First People’s Hospital from January 2016 to December 2024 were retrospectively included. The study analyzed each test individually, repeated tests performed at different time points for the same patient were included in the analysis. The characteristics and trends of cat and dog dander allergens were analyzed over a nearly 9-year period, encompassing a total of 141,165 test instances.

Rebound Pruritus and Urticaria After Discontinuation of Chronic Antihistamine Use—A Scoping Review

J. J. B.Seng, P.Oka, and N. C.Tan,  Clinical & Experimental Allergy (2026): 1–10, https://doi.org/10.1111/cea.70291.

ABSTRACT

Background

Rebound pruritus and urticaria have been increasingly reported following discontinuation of chronic antihistamines, particularly with cetirizine and levocetirizine, prompting the United States Food and Drug Administration to issue a recent safety warning for these two medications. Currently, there are significant gaps regarding the risk factors, course and optimal management of rebound pruritus and urticaria after discontinuation of chronic antihistamine use, and if this represents a class-specific adverse effect. This review aimed to map the literature related to rebound pruritus and urticaria after discontinuation of chronic antihistamine use.

Methods

A scoping review was conducted across four major literature databases (PubMed, Embase, Web of Science and Cochrane database) and grey literature (GreySource, OpenGrey, Google Scholar) from inception to December 2025. Articles describing rebound pruritus following discontinuation of chronic antihistamine use in paediatric or adult populations were included. Antihistamines evaluated included all first- and second-generation histamine-1 antagonists.

Patient-Perceived Benefits of Named-Patient Product Sublingual Immunotherapy in Allergic Rhinitis and Asthma: Primary Results From the ERAPP Real-World Cohort Study

Caimmi D, Abouelfath A, Lassalle R et al. Allergy. 2026 Mar 8. doi: 10.1111/all.70270.

ABSTRACT
Background
Named-patient product sublingual immunotherapy (NPP-SLIT) is widely used in France, yet real-world evidence on patient-perceived benefit remains limited.
Objective
To assess treatment expectations and patient-perceived benefit over 12–15 months among recent NPP-SLIT initiators using the Patient Benefit Index (PBI) and validated patient-reported outcome measures (PROMs).
Methods
ERAPP is a prospective, multicenter, observational study in children and adults with IgE-mediated respiratory allergy. Initiators (≤ 6 months on NPP-SLIT at baseline) completed digital PROMs at baseline, Month 6, and Month 12–15. The primary endpoint was the proportion with PBI ≥ 1 at Months 12–15. Secondary endpoints were changes in PROMs; exploratory analyses examined higher PBI thresholds and item-level fulfillment.
Results
Of 9439 enrolled, 4794 were initiators (950 children; 3844 adolescents/adults). At Month 12–15, PBI ≥ 1 was achieved by 83.8% of children and 84.0% of adolescents/adults.

Comparison of Respiratory Syncytial Virus (RSV)-Specific Antibody Durability in Pregnant/Postpartum Individuals and Older Adults After RSV Vaccination

Kachikis A, Frivold C, Pike M et al.  J Infect Dis. 2026 Mar 26:jiag111. doi: 10.1093/infdis/jiag111. 

Abstract

Box plots of respiratory syncytial virus (RSV) prefusion F protein
binding antibody titers (A) and neutralizing Ab titers (B), stratified by
study group and collection time point.
Abbreviation: AU, arbitrary units.

Respiratory syncytial virus (RSV) vaccination is recommended in pregnancy. Limited data exist regarding antibody (Ab) durability to inform revaccination timing. We conducted prospective cohort studies among pregnant and older adults after first RSV vaccination in 2023–2024. Longitudinal samples from 50 pregnant (36 vaccinated) and 16 vaccinated older adults were collected until 12–15 months after vaccination and tested for RSV binding and neutralizing Ab.

The importance of long-lived IgE plasma cells for protracted allergies

Robinson MJ. Trends Immunol. 2026 Mar 17:S1471-4906(26)00009-8. doi: 10.1016/j.it.2026.01.006.

Abstract

Advances in long-lived IgE plasma cell biology
revealed through fate mapping

IgE contributes to allergy, but its cellular sources are rare and hard to identify. Genetic fate mapping and single-cell sequencing approaches have now revealed that two cell populations maintain IgE: long-lived IgE plasma cells (PCs) and ‘type 2’ memory B cells. This forum piece discusses recent discoveries on long-lived IgE PCs.

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