Age-related molecular IgE sensitization to indoor and outdoor respiratory allergens: a two-step cross-sectional study in Algeria and Türkiye

Mahammed LL, Vrtala S, Akinfenwa O et al.  EBioMedicine. 2026 Sep 24:106484. doi: 10.1016/j.ebiom.2026.106484. 

Summary

Background

Immunoglobulin E-mediated allergy is the most important hypersensitivity disease affecting more than 30% of the population worldwide. The analysis of molecular IgE sensitization profiles in defined populations and age groups is important for the development of allergen-specific preventive and therapeutic interventions. The present study was performed to examine if there are differences regarding molecular IgE reactivity profiles in children and adults from two regions with similar climate and exposome.

Methods

This two-step cross-sectional study assessed molecular IgE reactivity profiles using an experimental allergen microarray comprising 105 allergen molecules. In the first step, an exploratory cross-sectional study, serum samples from 539 allergic patients (259 children, 280 adults) who were born and grew up in the Algiers region were analyzed. The second step was a prospective cross-sectional study performed in 272 Turkish allergic patients (133 children, 139 adults) from Istanbul and Samsun regions with a climate and allergen exposome similar to Algiers, with the goal of investigating the reproducibility of possible differences in molecular IgE sensitization profiles between children and adults.

Findings

Age-stratified molecular sensitization to (A, C) indoor and (B, D) outdoor
aeroallergens in children (N = 173; blue bars) and adults (N = 244; orange bars)
with respiratory allergy from Algiers (A, B) and children (N = 133; blue bars)
and adults (N = 139; orange bars) with respiratory allergy from Türkiye (C, D).

In both the exploratory Algiers study and the prospective Turkish study, significantly more children than adults with respiratory allergy were sensitized to major respiratory house dust mite allergens (Algiers: Der p 1, Der p 2: p < 0.001 and Der p 23: p = 0.001; Türkiye: Der p 1: p = 0.018 and Der p 2: p = 0.019) whereas significantly more adults than children were sensitized to regionally common respiratory outdoor allergens (Algiers: Ole e 1: p = 0.037; Phl p 1: p = 0.046; Türkiye: Ole e 1: p = 0.016; Amb a 1: p = 0.002; Amb a 8: p < 0.001). Asthma was significantly more common in children than in adult patients with respiratory allergy (Algiers: p < 0.001; Türkiye: p = 0.034).

Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study

Smart K, Ure A, Johnsen N, Aflatooni S et al. PLoS One. 2026 Sep 23;21(9):e0358883. doi: 10.1371/journal.pone.0358883.

Abstract

Forest plot showing odds ratios (ORs) and 95% confidence
intervals for immune-mediated comorbidities among patients
with chronic spontaneous urticaria (CSU).

Chronic spontaneous urticaria (CSU) is characterized by the idiopathic appearance of wheals and/or angioedema lasting more than six weeks. There is a critical need to evaluate whether the severity of CSU influences the risk of future immune-mediated comorbidities. We aim to evaluate if patients with moderate-to-severe chronic spontaneous urticaria (CSU) have an increased risk of developing immune-mediated comorbidities compared with matched patients with mild CSU.

Comparison of subcutaneous (SCIT) and sublingual (SLIT) immunotherapy in allergic rhinitis and allergic asthma

Perek A, Raszewska J, Jabłoński W, et al. Alergologia Polska - Polish Journal of Allergology. 2026. doi:10.5114/pja.2026.164983.

Abstract

Allergic rhinitis and allergic asthma are among the most prevalent chronic diseases, significantly impairing patients’ quality of life and generating substantial healthcare costs. Allergen immunotherapy (AIT), administered as subcutaneous (SCIT) or sublingual (SLIT) immunotherapy, remains the only treatment capable of modifying the natural course of allergic disease. The aim of this study was to compare the clinical efficacy, safety profile, adherence, and economic aspects of both AIT modalities based on current evidence. A narrative review of randomised clinical trials, meta-analyses, observational studies, and pharmacoeconomic analyses was conducted, with particular emphasis on treatment effectiveness, safety, adherence, and direct and indirect healthcare costs.

Advances in the role of house dust mite allergen components in the pathogenesis of allergic diseases

Guo CF, Wang Y, Wang YN et al. J Microbiol Immunol Infect. 2026 Sep 17:S1684-1182(26)00125-8. doi: 10.1016/j.jmii.2026.09.009.

Abstract

HDM allergen-induced epithelial barrier disruption and inflammatory signaling.

House dust mites (HDMs) represent one of the most prevalent indoor aeroallergens globally and are closely associated with type 2 immune-mediated conditions, including allergic asthma, allergic rhinitis, and atopic dermatitis. To date, over 30 HDM allergenic components have been identified and are classified into proteases, lipid-binding proteins, structural proteins, and proteins with uncharacterized functions based on their structural and biological features. Among these, allergens from group 1, 2, and 23 exhibit robust immunoglobulin E(IgE)-binding activity and play pivotal roles in allergic sensitization and inflammatory cascades.

Comprehensive 17-Allergen Panel for Inhalant Specific IgE: Reliability and Validation of Optimized Quantitative Assays

Ianniello A, Amadsun DO, Bencini E et al. Int Arch Allergy Immunol. 2026 Sep 21:1. doi: 10.1159/iaa/adfag015. 

Abstract

Introduction: Atopic diseases, such as asthma and allergic rhinitis, are chronic inflammatory disorders mediated by immunoglobulin E (IgE) responses to environmental allergens. Detecting allergen-specific IgE is essential for diagnosing sensitization and guiding clinical management. Allergen-specific IgE assays have, thus, become indispensable in clinical diagnostics and allergy research. The CHORUS Specific IgE Capture assays are automated immunoassays designed to quantify up to 17 allergen-specific IgE antibodies in human serum. In this study, optimized versions of the assays have been evaluated to determine their analytical performance in terms of sensitivity, specificity, precision, and overall reliability. 

Vaccines for Cancer: A Translational Science Review

 

ML, Chun BMN, Dhillon KK et al. JAMA. Published online September 21, 2026. doi:10.1001/jama.2026.15540

Abstract

Importance  Advances in tumor immunology and vaccine technology are reshaping cancer vaccine development after decades of limited clinical success. More than 2000 immunogenic tumor proteins or antigens have been identified, the types of immune responses required for tumor eradication have been defined, and safe and effective vaccine delivery technologies have been developed. This progress has renewed clinical investigation of cancer vaccines for multiple types of cancer.

Observations  Vaccines, such as those against human papillomavirus and hepatitis B, are composed of (1) an antigen target, (2) an adjuvant to activate the immune system, and (3) a vaccine delivery vehicle. Antigens can be derived from tumor mutations termed neoantigens, or cancer-associated nonmutated proteins, which are normal human proteins that are abnormally expressed in cancer. The tumor can also act as an antigen source, such as when immunization occurs with whole tumor cells or by directly injecting an immunogenic substance into the tumor to elicit an adaptive immune response. T and B lymphocytes, cells of the adaptive immune system, are stimulated by cancer vaccines and can provide a highly specific and durable immune response directed against cancer.

Nasal Epithelial Immune Signatures Are Associated With Age-Dependent Asthma Trajectories in Early Life

Jakwerth CA, Illi S, Charles H et al.  Allergy. 2026 Sep 6. doi: 10.1111/all.70477. 

ABSTRACT

Background

Preschool wheeze is heterogeneous and only a subset of children progresses to persistent asthma. We hypothesized that early-life wheeze reflects divergent airway epithelial maturation trajectories associated with distinct mucosal immune programs.

Methods

Nasal epithelial transcriptomes from 265 children and young adults (79 healthy, 81 wheezers, 105 asthmatics; median age 10.4 [1.1–20.3] years) from the All Age Asthma Cohort (ALLIANCE) cohort were analyzed using a hypothesis-driven candidate approach based on predefined cytokine axes. Transcriptional signatures were mapped to epithelial cells by scRNA-sequencing. Asthma-outcome associations were assessed in age- and sensitization-adjusted multivariate models.

Results

Graphical Abstract

The candidate approach identified three antagonistic epithelial immune programs: an interferon-associated (E1; IDO1, CSF3, CCL20), a type-2-associated (E2; POSTN, CCL26, CST1), and a type-17-associated program (E3; IL36G, KLK7, KRTDAP). These programs were detected across basal, ciliated, and secretory epithelial cells. In early childhood (1–3 years), wheezers predominantly exhibited E1/E3-dominant epithelial profiles (n = 36).

Sublingual allergen immunotherapy: evidence from randomized trials, real-world studies and meta-analyses

Paoletti G, Valli N, Di Bona D et al. (2026) Front. Allergy 7:1940709. doi: 10.3389/falgy.2026.1940709

Abstract

Background:

Allergen immunotherapy is the only potentially disease-modifying treatment for IgE-mediated respiratory allergy. Among the available routes, sublingual immunotherapy (SLIT) has gained prominence because of its favorable safety profile and greater patient acceptability. 

Objectives:

This narrative review critically appraises the clinical efficacy, real-world effectiveness, and long-term disease-modifying potential of SLIT for seasonal and perennial respiratory allergies by integrating evidence from randomized controlled trials, large observational cohorts, and meta-analyses, with attention to allergen- and product-specific outcomes and age-related differences. 

Schematic overview of the effects of SLIT on allergic disease.
Evidence from randomized controlled trials and real-world studies
indicates reduced symptoms and medication use in allergic rhinitis,
 improved quality of life, and increased IgG4, secretory IgA (sIgA)/
IgE-blocking activity.
In asthma, SLIT is associated with fewer exacerbations and reduced
use of asthma medications. Sustained clinical benefits after treatment
 discontinuation have been demonstrated in both adults and children,
with evidence reported for pollen and house dust mite allergens.
Created with BioRender.com.

Results:

Robust RCT evidence supports clinically meaningful reductions in symptoms and medication use with grass and HDM SLIT tablets, with sustained benefits observed up to 1–2 years after a 3-year treatment course in key trials.

Planetary Health in Health Guidelines: Expert Workshop Report 2024

Saadat P, Herrmann A, Sousa-Pinto B et al.  Clin Public Health Guidel. 2026 Apr 15;3(2):e70072. doi: 10.1002/gin2.70072.

ABSTRACT

Health systems contribute to environmental degradation while simultaneously being affected by its consequences. Yet, planetary health considerations are largely absent from health guidelines. On November 6–7, 2024, the Planetary Health Expert Workshop convened over 50 experts from the GRADE Planetary Health Project Group at Humanitas University, Italy, to explore methods for embedding planetary health into health guideline development. Through presentations, case studies, and group discussions, participants identified key methodological gaps and proposed processes and tools to advance the integration of planetary health in health guidelines.

Occupational Allergic Contact Dermatitis From Over-Ear Headphones: Chemical Analysis Reveals Octylisothiazolinone and Other Potential Skin Sensitizers

G. Fenech, E. Langlois, E. Pelletier et al.  Contact Dermatitis (2026): 1–9, https://doi.org/10.1111/cod.70246.

ABSTRACT

Background

Over-ear headphones are a growing source of allergic contact dermatitis (ACD). Identifying well-known and new culprit sensitizers in such products is challenging because of a lack of labelling and limited cooperation from manufacturers.

Objectives

To report potential skin sensitizers in occupationally-used headphones from patients attending an occupational allergy clinic.

Patients and Methods

The over-ear headphones from two octylisothiazolinone (OIT)-allergic patients with ear ACD were chemically analysed using ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS).

Results

Different parts of the culprit over-ear headphones of Patient 1,
chemically analysed using UPLC–MS/MS.

UPLC–MS/MS confirmed the presence of OIT, but also other biocides (1,2-benzisothiazolin-3-one, cetylpyridinium chloride), rubber accelerators (zinc dibenzyldithiocarbamate, 1,3 diphenyl guanidine, 1,3 di-O-tolyguanidine, tetramethylthiuram disulfide,

As-Needed Versus Regular Medication Use in the Treatment of Allergic Rhinitis in the Pollen Season: A MASK-air Study

B. Sousa-Pinto, R. J. Vieira, A. Bognanni, et al.,  Allergy (2026): 1–18, https://doi.org/10.1111/all.70508.

ABSTRACT

Background

Patients with allergic rhinitis often use as-needed medication instead of regular treatment. Using data from the MASK-air mHealth app, we compared weeks with use of as-needed versus regular medication on treatment satisfaction and symptom control.

Methods

We assessed data from the MASK-air app. We compared weeks in the pollen season in which patients reported the use of one same medication during all the days in the week (“regular treatment”) versus those in which patients reported the use of the same single medication (and no other treatments) in at most 4 days per week (“as-needed treatment”). We built mixed-effects linear regression models, evaluating the differences between regular and as-needed treatments on visual analogue scales for symptom control and treatment satisfaction. We performed sensitivity analyses (i) considering a different definition of as-needed treatment (use of medication ≤ 2 days per week), and (ii) evaluating treatment days preceded by non-treatment days.

Beyond red meat: fish roe-associated reactions in patients with alpha-gal syndrome—a case series from Sri Lanka

Badanasinghe, C.N., Suriapperuma, T., de Silva, S.R. et al. Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01059-5

Abstract

Background

Alpha-gal syndrome (AGS) is an IgE-mediated allergy to galactose-α-1,3-galactose (α-Gal), classically presenting with delayed allergic reactions after ingestion of mammalian-derived foods. Fish roe has recently emerged as a potential but under-recognized trigger in α-Gal-sensitized individuals. We describe the first South Asian case series of three patients with AGS who developed anaphylaxis following fish roe ingestion, highlighting this atypical trigger as a possible emerging cause of anaphylaxis associated with AGS in the region.

Case presentation

We retrospectively reviewed patients evaluated at a tertiary allergy clinic in Sri Lanka between January 2025 and May 2026 who developed allergic reactions following fish roe ingestion and fulfilled the diagnostic criteria for AGS based on a compatible clinical history, positive skin prick testing, elevated serum α-Gal-specific IgE, and symptom resolution following dietary avoidance.

Exhalation Delivery System with Fluticasone in Chronic Rhinosinusitis by Eosinophil, Asthma, and Allergy Status

 Peters AT, Adappa ND, Chandra RK et al. Ann Allergy Asthma Immunol. 2026 Sep 3:S1081-1206(26)00423-0. doi: 10.1016/j.anai.2026.08.024. 

Abstract

Background

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses. Comorbid asthma, environmental allergies, and eosinophilia are associated with CRS. Exhalation delivery system with fluticasone (EDS-FLU) is approved for CRS; however, the influence of these features on treatment response remains unclear.

Objective

To evaluate whether baseline blood eosinophil (EOS) count, asthma, or allergies affect response to EDS-FLU in patients with CRS.

Methods

ReOpen1 and ReOpen2 were randomized, EDS-placebo–controlled studies. Patients with CRS were assigned (1:1:1) to EDS-FLU 186 μg, EDS-FLU 372 μg, or EDS-placebo, administered twice daily for 24 weeks.

Eosinophilia and Hypereosinophilia: A Practical Approach to Navigating a Broad Differential Diagnosis

S. Wigerinck and P. Vandenberghe, European Journal of Haematology (2026): 1–15, https://doi.org/10.1111/ejh.70299.

Abstract

Eosinophilia, defined as an absolute eosinophil count (AEC) of ≥ 0.5 × 109/L, is a frequently encountered finding with a vast spectrum of potential underlying etiologies. Hypereosinophilia (HE) is defined as AEC > 1.5 × 109/L and may become life-threatening when eosinophil-induced organ damage occurs, defining the hypereosinophilic syndrome (HES). Among the many causes of HE, rare hematological malignancies, in particular the “myeloid/lymphoid neoplasms (MLN) with eosinophilia and tyrosine kinase (TK) gene fusions,” represent phenotypically and prognostically heterogeneous and challenging entities.

For this reason, the evaluation of HE constitutes a diagnostic and therapeutic challenge. In this review, we provide a concise overview of eosinophil biology, highlight their physiological role as regulators of immunity, tissue homeostasis, and inflammation, their involvement in diseases affecting nearly all organ systems, and in hematological malignancies in particular. Furthermore, we present a practical, stepwise diagnostic approach to HE, emphasizing early recognition of eosinophil-mediated organ dysfunction to initiate timely treatment, as well as red flags that should raise further hematologic evaluation, including molecular and cytogenetic investigations to identify an underlying clonal disorder. Treatment strategies depend on the underlying etiology and range from supportive care, over corticosteroids to targeted biological therapies and tyrosine kinase inhibitors (TKIs).

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Efficacy of Biological and Steroid Therapies in Adolescent and Adult Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis With Meta-Regression

Al Hayek M, Lucendo AJ, Savarino E et al. Clin Gastroenterol Hepatol. 2026 Sep;24(9):2374-2386. doi: 10.1016/j.cgh.2026.04.003.

Abstract

Background & Aims

The therapeutic hierarchy of current pharmacologic options for eosinophilic esophagitis (EoE) has not been established. We performed a network meta-analysis to evaluate the comparative efficacy of pharmacological therapies for EoE.

Methods

PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to May 25, 2025, for randomized controlled trials (RCTs) ≥12 weeks in duration comparing corticosteroids, biologics, or proton pump inhibitors with placebo or active comparators in participants aged ≥12 years. Key outcomes included changes in dysphagia from baseline and histologic remission (≤6 eosinophils/high-power field) at 12, 24, and 48 weeks. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results

Graphical Abstract

Thirteen RCTs were included. For dysphagia improvement compared with placebo and active comparators, dupilumab 300 mg and cendakimab 360 mg demonstrated moderate-to-high-certainty benefit at 12 and 24 weeks, whereas budesonide oral suspension (BOS) 2 mg demonstrated moderate-to-high-certainty benefit at 12 weeks; no 24-week data were available for BOS. At 48 weeks, budesonide orodispersible tablets (BOT) 0.5 and 1 mg demonstrated high certainty benefits for dysphagia improvement compared with placebo and active comparators.

Chronic Symptomatic Dermographism in a Young Atopic Adult With Fluctuating Serum IgE Levels and no Correlation to Disease Activity: A Case Report

A. A. Shaju, S. Sadaf, M. Hasanuzzaman, and N. Nawal.  Clinical Case Reports 14, no. 8 (2026): e73352, https://doi.org/10.1002/ccr3.73352.

ABSTRACT

Chronic symptomatic dermographism is a challenging dermatologic condition characterized by recurrent wheals triggered by nonspecific physical stimuli, and management typically begins with H1-antihistamines, escalating as needed, with anti-IgE therapy such as omalizumab reserved for refractory cases based on clinical response rather than serum IgE levels. We report a 20-year-old male with a long-standing history of symptomatic dermographism and childhood atopy, provoked by minimal mechanical stimuli such as friction from clothing or light stroking of the skin, which significantly impaired his daily activities and academic performance. 

Multiple erythematous, raised, and edematous wheals of varying
sizes involving the extensor aspect of the forearm, with
ill-defined borders and blanching on pressure.

Diagnosis was made clinically and by exclusion of systemic disease, with laboratory investigations revealing fluctuating serum IgE levels over multiple measurements, ranging from markedly elevated to near-normal, without correlation to disease severity, highlighting the limitations of using IgE to guide therapy. Standard management included up-dosed second-generation H1-antihistamines (up to fourfold the standard dose) and intermittent short courses of oral corticosteroids resulting in partial disease control.

Common Food Emulsifiers Impair Epithelial Barrier Integrity and Trigger Pro-Inflammatory Responses and IgE Production

Yazici D, Hayashi Y, Pat Y et al. Allergy. 2026 Aug 8. doi: 10.1111/all.70473. 

ABSTRACT

Graphical Abstract

The global rise in allergic and autoimmune diseases since the 1960s has been associated with environmental disruptions of epithelial barriers, particularly in the gastrointestinal tract. Among the implicated factors are food emulsifiers, which have become increasingly prevalent in processed foods such as peanut butter. This study investigates the biological effects of two commonly used food emulsifiers in peanut butter, soy lecithin and diacetyl tartaric acid esters of mono- and diglycerides (DATEM), on gastrointestinal tissue responses and immune responses using advanced in vitro gut-on-a-chip models, human adult stem cell-derived colon organoids-on-a-chip, and murine models.

Microneedles for allergy skin testing: Comprehensive analysis of agreement, accuracy, and pain

Sirichuwong M, Kanchanapoomi K, Piboonpocanun S et al. J Allergy Clin Immunol Glob. 2026 Jul 23;5(5):100765. doi: 10.1016/j.jacig.2026.100765. 

Abstract

Background

The skin prick test (SPT) is a standard method for identifying allergic sensitization. However, pain and needle phobia often compromise pediatric compliance. Microneedle devices offer a minimally invasive alternative to conventional lancets.

Objective

We evaluated the agreement, diagnostic accuracy, and patient tolerability of a novel microneedle compared to a lancet for SPT.

Schematic illustration of novel microneedle device and SPT procedure.

Methods

Subjects with allergic rhinitis underwent SPT using both devices with Dermatophagoides pteronyssinus (Dp) extract, histamine, and saline controls. Net mean wheal diameters (MWD) were calculated by subtracting the saline MWD from the Dp and histamine MWDs. Agreement was assessed by Bland-Altman analysis and Cohen kappa (k), diagnostic performance by receiver operating characteristic analysis, and pain by a visual analog scale.

Results

Bland-Altman plots showing difference versus average
of MWDs between microneedle device and lancet. 

Of 150 subjects (aged 8-60 years), 53.3% were sensitized to Dp. Both devices produced significantly larger Dp and histamine MWDs than saline MWD (P < .001). Median [interquartile range] Dp MWD was smaller with microneedle (2 [0-8.13] mm) than lancet (4 [0-12.5 mm], P < .001).

EAACI Guidelines on Environmental Science for Allergy and Asthma—Evidence-Based Recommendations for Prevention and Public Health Action to Mitigate the Impact of Pollen Exposure on Respiratory Allergy

L. Cecchi, I. Annesi-Maesano, B. Biagioni, et al.  Allergy (2026): 1–25, https://doi.org/10.1111/all.70423.

ABSTRACT

Developed using the GRADE methodology, these EAACI guidelines provide evidence-based recommendations on the effectiveness of pollen reduction/avoidance strategies for allergic rhinitis (AR) and asthma, the utility of biomarkers for monitoring pollen-induced asthma and the efficiency of mitigation measures and of public health strategies. Systematic and narrative reviews and health economic analysis support the recommendations. According to GRADE, the certainty of evidence was moderate to very low, therefore conditional recommendations are provided to guide healthcare professionals, patients, and policymakers in developing personalized, preventive, and scalable interventions.

Optimising allergic rhinitis management in primary care using the respiratory allergy optimiser: results from the AERO study

van Geer-Postmus, I., Ryan, D., Arling, C. et al.  npj Prim. Care Respir. Med. (2026). https://doi.org/10.1038/s41533-026-00551-0

Abstract

Digital tools may support healthcare professionals in providing guideline-directed management for patients with allergic rhinitis (AR). This study aimed to develop and implement the Respiratory Allergy Optimiser, a digital decision-support tool aligned with AR guideline recommendations, and evaluate its effect on symptom severity in primary care. The AERO study was an interventional study conducted in 11 general practices in the Netherlands (August-November 2025). Adult patients with a diagnosis of AR and/or allergic conjunctivitis and/or prescribed AR medication (past three years) were eligible. The Respiratory Allergy Optimiser assessed symptom severity using a visual analogue scale (VAS, 0–100 mm) and collected information on patient and disease characteristics, symptoms, medication use, adherence, and nasal spray technique.