Asthma-related Pediatric Healthcare Utilization after Hospitalization for RSV and Other Viral Lower Respiratory Tract Infections

Guy Hazan, Mai Ofri, Lital Hertz et al.  Open Forum Infectious Diseases, Volume 13, Issue 7, July 2026, ofag402, https://doi.org/10.1093/ofid/ofag402

Abstract

Background

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) in infants. Although influenza, parainfluenza, and human metapneumovirus also contribute to LRTI-related hospitalizations, their comparative population-level healthcare burden is not well defined. This study compared population-level healthcare utilization (HCU) associated with RSV-LRTI and LRTI caused by other respiratory viruses (ORspV-LRTI).

Methods

This nationwide retrospective cohort study used electronic health records from Clalit Health Services (CHS), covering more than 5 million individuals in Israel. Infants born in 2015–2023 and hospitalized before 12 months of age with PCR-confirmed viral LRTI during the RSV season were included. Acute healthcare utilization (HCU) was assessed within 30 days following hospital discharge, and long-term respiratory HCU was evaluated through 6 years of age.

Regulatory T cells: master orchestrators of immune tolerance and tissue homeostasis.

Bluestone JA, Levings MK, Ramsdell FJ et al. (2026)  Front Sci 4:1792210. doi: 10.3389/fsci.2026.1792210

Abstract

Key features of regulatory T cell (Treg) function in
maintaining immune and tissue homeostasis. 

Harnessing the biology of regulatory T cells (Tregs) for therapeutic development is one of medicine’s most promising opportunities to transform disease treatment. Initially viewed simply as guardians against destructive immune responses, we now understand that Tregs are adaptive and highly specialized coordinators of immune tolerance and tissue repair. This strategic roadmap examines how evolving insights into their central role in maintaining tolerance and health can transform therapeutic development across medical specialties. Early efforts to evaluate Treg therapies have proven safe and shown some clinical benefit. The convergence of biological insights and technological advances has the potential to harness and exploit this specialized tolerogenic population by augmenting function through environmental cues and reinforcing tissue-repair capabilities.

Evidence on the Role of Biologics in Chronic Rhinosinusitis with Nasal Polyposis

Kilgore, K.M., Marino, G.A., Lee, J.T. et al.  Curr Treat Options Allergy 13, 16 (2026). https://doi.org/10.1007/s40521-026-00423-5

Abstract

Purpose of Review

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease that may be refractory to conventional medical and surgical therapies. Advances in the understanding of type 2 inflammatory mechanisms have led to the development of targeted biologic therapies. This review examines clinical trial evidence, and real-world data supporting biologic use in CRSwNP.

Recent Findings

Four biologics (dupilumab, omalizumab, mepolizumab, tezepelumab) are FDA approved in the United States for the management of refractory CRSwNP. Randomized controlled trials and multiple additional studies have demonstrated the efficacy of biologics in reducing nasal polyp burden and nasal congestion in patients who are refractory to traditional medical/surgical therapy or are poor surgical candidates.

Relationship of NSAID-hypersensitivity and Chronic Urticaria. Clinical Implications

Sánchez, J., Caraballo, A. & Diez, S.  Curr Treat Options Allergy 13, 15 (2026). https://doi.org/10.1007/s40521-026-00419-1

Abstract

Purpose of Review

In this review, we conducted a literature search seeking to better understand the relationship between chronic spontaneous urticaria (CSU) and nonsteroidal anti-inflammatory drugs hypersensitivity (NSAID-hypersensitivity) associated with NSAID exacerbated cutaneous diseases (NECD), its clinical course, and gain insight into the answers to clinical questions.

Recent Findings

CSU and NSAID cutaneous reaction interaction

The coexistence of CSU and NSAID-hypersensitivity specially NECD has been well documented. However, many questions remain unanswered: Why does this coexistence occur?

IL-37a facilitates allergen immunotherapy in a house dust mite-induced mouse model of allergic asthma

Jin, Z., Jing, X., Zeng, J. et al.  BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00869-x

Abstract

Serum allergen-specific immunoglobulin levels measured by ELISA. 

In recent years, the incidence of allergic asthma has increased dramatically. Allergen immunotherapy (AIT) is an effective approach to achieve long-term remission of allergic asthma and has gained widespread attention. However, current AIT suffers from low efficacy and long treatment duration. In this study, we found that IL-37a transgenic mice with allergic asthma exhibited reduced pulmonary inflammation, decreased Th2 cytokines, and lower allergen-specific IgE following AIT.

In vitro IgE diagnostics in inhalant allergy: Plant and mold allergens

Regina Treudler. Allergologie select. 2026; 10: 151-157. doi: 10.5414/ALX02616E.

Abstract

Respiratory allergies represent one of the most prevalent immune-mediated disorders worldwide, such as allergic rhinitis and asthma. The advent of in vitro diagnostic methods, particularly those based on molecular allergology, has revolutionized the diagnostic approach to inhalant allergies by enabling precise identification of sensitizing allergens at the molecular level. This review presents an analysis of the current status of in vitro diagnostics in respiratory allergy to plants and molds, with emphasis on molecular diagnostics for key allergens from trees (e.g., birch/Betula verrucosa), grasses (Poaceae family), weeds (e.g.mugwort/Artemisia vulgaris, ragweed/Ambrosia artemisiifolia), and molds (e.g. Alternaria, Aspergillus). We discuss major allergenic proteins, diagnostic tools, implications for precision medicine, and integration with precision immunotherapy.

Trees, grasses, and weeds share common pan-allergens (i.e., profilins and polcalins), which can lead to false positive reactions in skin prick test or whole allergen extracts.

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Diagnosing NSAID-Hypersensitivity/Allergy and NSAID-Exacerbated or Induced Food Allergy Phenotypes in Children and Adolescents

Valluzzi RL, Urbani S, Sciannamea M et al. J Allergy Clin Immunol Pract. 2026 Jul 8:S2213-2198(26)00582-9. doi: 10.1016/j.jaip.2026.06.044. 

Highlights Box

What is already known about this topic? Hypersensitivity reactions (HRs) to NSAIDs are common in children and adolescents, but in many of them NSAID hypersensitivity/allergy (NH/A) is excluded by testing.

What does this article add to our knowledge? NEFA/NIFA can be diagnosed in about 14% of children/adolescents reporting immediate HRs to NSAIDs, most of whom are sensitized to Pru p 3. Non-hypersensitive/allergic reactions to NSAIDs appear to be primarily related to infections with fever rather than to NSAID exposure itself.

How does this study impact current management guidelines? It supports the performance of targeted food allergy tests in children/adolescents reporting urticarial, angioedematous, and/or anaphylactic reactions to NSAIDs and highlights clinical predictors that help distinguish true NSAID HRs − diagnosed through drug challenges − from non-allergic/hypersensitive reactions in pediatric practice.

Graphical Abstract

Abstract

Ambulatory antibiotic prescribing for acute sinusitis: a multicenter, retrospective cohort study evaluating appropriateness

Arensman Hannan K, Ilges D, Le KT et al. Antimicrobial Stewardship & Healthcare Epidemiology. 2026;6(1):e193. doi:10.1017/ash.2026.10743

Abstract

Objective:

Antibiotics are frequently prescribed for acute sinusitis despite national guidelines recommending antibiotics only if specific symptom criteria are met. We aimed to define the proportion of acute sinusitis encounters meeting criteria for antibiotic prescribing, characterize prescribing practices, and identify factors associated with guideline-discordant prescribing.

Design:

This retrospective cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024 and March 31, 2024. Encounter notes were reviewed for appropriate antibiotic prescribing criteria as per national guidelines. Encounters were evaluated for drug selection and duration concordance based on local guidelines. A multivariable logistic regression analysis was performed to identify predictors of inappropriate antibiotic prescribing.

Setting:

Emergency departments, urgent care centers, and primary care clinics.

Results:

Antibiotic prescription characteristics

Antibiotic prescribing criteria were met for 67.6% of included encounters. Antibiotics were prescribed in 93.5% of encounters that met prescribing criteria, and 80.2% of encounters that did not. Both drug selection and duration were guideline-concordant in 49.2% of total encounters.

Effect of GLP-1RA on blood eosinophil levels in adults: a real-world study

Wu, Y., Lin, Y., Wu, J. et al.  BMC Pulm Med (2026). https://doi.org/10.1186/s12890-026-04469-8

Abstract

Background

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for glycemic control and weight management, especially semaglutide. Potential benefits of GLP-1RAs in asthma, especially in eosinophilic phenotypes, prompt growing scientific interest.

Objective

To investigate the impact of semaglutide on eosinophilic inflammation and to identify clinical and metabolic determinants of eosinophil reduction after treatment.

Methods

We conducted a retrospective, single-center study in Shanghai, China. Eligible subjects were those first prescribed semaglutide in our outpatient clinic. Demographic characteristics, complete blood counts, and lipid profiles before and after semaglutide treatment were collected from electronic medical records. Subgroup analyses were stratified using a blood eosinophil count (BEC) cut-off of 150/µL and a BMI threshold of 28 kg/m². Multiple linear regression analysis was employed to identify factors influencing the reduction in eosinophil counts.

Results

Among 371 participants included in the final analysis, BEC decreased significantly from 160(150)/µL at baseline to 110(100)/µL after semaglutide treatment (P < 0.001), and eosinophil percentage declined from 2.20(1.80)% to 1.60(1.40)% (P < 0.001).

Synergistic impacts of heat, pollen, and air pollution on allergic rhinitis and asthma under climate change: A 20-year time-series study

Ali EA, Aerts R, Vaes B et al. Environ Int. 2026 Jul;213:110330. doi: 10.1016/j.envint.2026.110330.

Abstract

Background: Climate changes are increasing the frequency of concurrent extremes in temperature, air pollution, and aeroallergens, yet evidence on their joint and synergistic health impacts remains limited. We aimed to quantify the independent, joint, and interactive short-term effects of temperature, air pollutants, and airborne pollen on allergic rhinitis and asthma using long-term general practitioner (GP) data.

 Methods: We conducted a population-based time-series study using 20 years of GP data. Daily maximum temperature, PM2.5, ozone, and pollen concentrations were linked to allergic rhinitis and asthma outcomes. We estimated cumulative relative risks (RR) over lag 0–14 days using distributed lag non-linear models, comparing high (95th percentile) versus median exposure levels. We evaluated effect modification through stratified analyses and quantified additive interaction for joint exposures at extreme levels (90th and 95th percentile) using relative excess risk due to interaction (RERI) and attributable proportion (AP).

Density distributions of environmental exposure values
restricted to days exceeding the 90th percentile of each
exposure-specific study-period distribution.

Findings: Pollen exposure was strongly associated with allergic rhinitis (RR=2.54, 95% CI: 2.40–2.69) and with asthma (RR=1.49, 95% CI: 1.38–1.61). In joint-effects analyses, co-exposure to extreme heat and high pollen concentrations was associated with an increased risk of allergic rhinitis (RR= 2.07, 95% CI: 1.77–2.41), with clear evidence of synergistic interaction on the additive scale (RERI=0.48, 95% CI: 0.32–0.64, AP=0.23, 95% CI: 0.17–0.30).

COVID-19 vaccination induces cross-neutralisation of sarbecoviruses related to SARS-CoV-2

West, G.E., Morse, R.B., Sievers, B.L. et al.  npj Vaccines 11, 125 (2026). https://doi.org/10.1038/s41541-026-01469-x

Abstract

Multi-dose vaccine schedules in a cohort of older individuals
with mixed infection histories induce strong humoral responses
against SARS-CoV-2 Wu-1 and early Omicron lineages.

The combined threats of future sarbecovirus zoonosis and continually emerging SARS-CoV-2 VOCs highlight the need to assess the breadth of existing SARS-CoV-2 vaccine-mediated protection. Here, we investigate a cohort of older individuals who received four COVID-19 vaccine doses, for potential cross-neutralisation against lentiviral particles bearing spikes from either Omicron VOCs or other sarbecoviruses. Despite recent fourth bivalent mRNA vaccine doses (encoding SARS-CoV-2 Wu-1 and Omicron spikes), neutralisation of Omicron lineage VOCs was reduced compared to Wu-1, consistent with an imprinted immune response.

P014 Remibrutinib improves dermatology-related quality of life in patients with chronic spontaneous urticaria regardless of baseline disease severity in the phase III REMIX-1 and REMIX-2 studies

Michael R Ardern-Jones, John Reed, Sinisa Savicet al.  British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.041, https://doi.org/10.1093/bjd/ljag086.041

Abstract

Mean change from baseline in DLQI (observed data, full analysis set).

Many patients with chronic spontaneous urticaria (CSU) experience inadequate disease control and impaired quality of life despite treatment. Remibrutinib, a highly selective Bruton’s tyrosine kinase inhibitor, reduced CSU disease activity and improved quality of life, sleep, and daily activity vs. placebo in the REMIX-1 and REMIX-2 studies. Here, we evaluate the impact of remibrutinib on Dermatology Life Quality Index (DLQI) in the REMIX-1 and REMIX-2 data (pooled), stratified by baseline disease severity per weekly Urticaria Activity Score (UAS7; moderate: 16 ≤ UAS7 < 28, severe: 28 ≤ UAS7 ≤ 42). REMIX-1 and REMIX-2 were randomized, double-blind, placebo-controlled studies of oral remibrutinib 25 mg twice daily in adults with CSU who remained symptomatic with second-generation H₁-antihistamines.

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).