The Evolution of IgE-Based Allergy Testing in Atopic Dermatitis: Where Do We Stand?

Braun C, Graham F, Fleischer DM et al.  J Allergy Clin Immunol Pract. 2025 May 12:S2213-2198(25)00437-4. doi: 10.1016/j.jaip.2025.05.013.

Abstract

Hypothetical mechanisms of IgE sensitization without clinical
allergic mast cell reactivity in patients with atopic dermatitis (AD).

The pathophysiology of atopic dermatitis (AD) involves cutaneous inflammation, predominantly mediated by innate immunity and T cells, in which IgE has a marginal role in most patients. Over previous decades, however, there has been an ongoing debate regarding the relevance of IgE-mediated allergy testing in patients with AD. Patients with AD have a defective skin barrier that facilitates a high inflammatory response to environmental antigens, placing them at greater risk for food allergies. Nevertheless, because these patients often produce high levels of IgE, the positive predictive value of skin prick tests and specific IgE measurements is low; such tests should be performed only when there is a concordant immediate hypersensitivity reaction (ie, urticaria or angioedema) rather than eczema.

The Predictive Value of Serum Total IgE for Antihistamine Treatment Outcomes in Chinese Patients with Chronic Spontaneous Urticaria

Li Y, Peng R, Xue J, Zhao Y. Acta Derm Venereol. 2025 Aug 3;105:adv43568. doi: 10.2340/actadv.v105.43568.

Abstract

 Comparison of clinical and laboratory characteristics
between responders and non-responders to
standard-dosed second-generation H1-antihistamines
(sgAHs) in patients with chronic spontaneous
urticaria (CSU)

Chronic spontaneous urticaria is a common skin disorder with variable treatment responses. Second-generation H1-antihistamines are the first-line treatment for chronic spontaneous urticaria, yet many patients fail to respond to licensed doses. Predictors of treatment response to second-generation H1-antihistamines could help optimize disease management and minimize unnecessary healthcare costs. In this retrospective cohort study of 99 Chinese chronic spontaneous urticaria patients, higher log-transformed serum total IgE levels were significantly associated with poor response to standard-dose antihistamines (aOR = 2.09, 95% CI: 1.29–3.38, p = 0.003).

A mucosal vaccine prevents eosinophilic allergic airway inflammation by modulating immune responses to allergens in a murine model of airway disease

Sevilla-Ortega, C., Angelina, A., Martín-Cruz, L. et al.  Nat Commun 16, 7129 (2025). https://doi.org/10.1038/s41467-025-62632-x

Abstract

MV130 prophylactic treatment prevents allergic sensitization
and HDM-induced eosinophilic airway inflammation, conferring
protection up to 9 weeks after treatment discontinuation.

Allergic sensitization and viral infections are risk factors for asthma development and progression. Sublingual vaccination with MV130, a whole heat-inactivated polybacterial preparation, protects against viral infections, but its impact on allergic sensitization and asthma development remains unknown. Here we show MV130 prevents house dust mite (HDM)-induced local type 2 immune responses and associated eosinophilic airway inflammation, conferring protection up to 9 weeks after vaccination.

Urticaria Voices: Real-World Treatment Patterns and Outcomes in Chronic Spontaneous Urticaria.

Bernstein, J.A., Winders, T.A., McCarthy, J. et al.  Dermatol Ther (Heidelb) 15, 2201–2215 (2025). https://doi.org/10.1007/s13555-025-01461-8

Abstract

Introduction

Chronic spontaneous urticaria (CSU) is characterized by itchy wheals/hives and/or angioedema lasting longer than 6 weeks. Herein, we describe patients’ perspectives from the global Urticaria Voices study reporting treatment patterns, disease burden, treatment satisfaction, and expectations.

Methods

This global, cross-sectional online survey was conducted from February to September 2022 in patients with CSU. Eligible patients had a self-reported clinician-provided diagnosis of CSU. Data were analyzed descriptively and reported as percentages (n/N), means (standard deviation [SD]), or 95% confidence intervals.

Results

Patient-reported disease control with H1-antihistamines

Overall, 582 patients with CSU were included in this analysis (62% women; mean [SD] age: 42.0 [11.9] years). At the time of the survey, patients reported taking 2.9 (2.6) concomitant therapies; most patients (79%) were prescribed H1-antihistamines (H1-AH), of which 42% took first-generation H1-AH and 52% took second-generation H1-AH.

Perspectives in the Molecular Mechanisms Underlying Anaphylaxis

Esteban V, Skrabski F, Perales-Chorda C, Puente-Crespo Y, Muñoz-Cano R, Cardona V; Anaphylaxis Committee of the Spanish Society of Allergy and Immunology (SEAIC).                   J Investig Allergol Clin Immunol. 2025 Jul 29;35(4):251-266. doi: 10.18176/jiaci.1080.

Abstract

The complexity of anaphylaxis in terms of clinical features and etiology-pathogenesis makes it difficult to establish precise endotypes that correspond to specific phenotypes. Therefore, interest in unravelling the cellular and molecular mechanisms underlying anaphylactic reactions has grown.
A large group of anaphylactic reactions are characterized by the classical immunological mechanism of type I hypersensitivity, which leads to IgE-mediated activation of mast cells and basophils.

Hypersensitivity Reactions to Gadolinium-Based Contrast Agents: Update From an Allergist's Point of View

Losa F, Paoletti G, Costanzo G, et al.  Clin Transl Allergy. 2025;e70086. https://doi.org/10.1002/clt2.70086

ABSTRACT

Background

The increasing use of Magnetic Resonance Imaging (MRI) has led to a rise in the administration of gadolinium-based contrast agents (GBCAs), accompanied by a growing number of reported adverse events (AEs).

Objective

This review aims to provide an updated overview of hypersensitivity reactions (HSRs) to GBCAs, focusing on diagnostic and management strategies from an allergological perspective.

Cross-reactivity patterns in IgE- and T-cell-mediated hypersensitivity
reactions to gadolinium-based contrast agents (GBCAs).

Methods

We reviewed recent literature concerning the classification, clinical presentation, and pathophysiological mechanisms of HSRs to GBCAs. Particular attention was given to current recommendations for diagnosis, risk stratification, and prevention.

Exploring the impact of chronic urticaria profile as a key predictor of alexithymia: A cross-sectional study

Ojeda IC, Thomsen SF, Gimenez-Arnau AM et al. Clin Transl Allergy. 2025 Jul;15(7):e70075. doi: 10.1002/clt2.70075.

Abstract

Introduction

The relationship between chronic urticaria (CU) and alexithymia, a cognitive-affective impairment characterized by difficulty in identifying and expressing emotions, is complex and underexplored. This study aimed to identify predictors of alexithymia in CU patients by focusing on the impact of coexisting mental illnesses and antihistamine use.

Methods

An online survey was distributed to specialized allergy and dermatology centers from 2021 to 2022. The survey included the TAS-20, UAS-7, UCT, CU-Q2oL, and demographic information. Participants were 18–80 years old, diagnosed with CU, and had no prior diagnosis of alexithymia.

Tropomyosin-based cross-reactivity and asymptomatic shellfish sensitization in patients with perennial allergy

Hollstein MM, Schuppe MC, Hahn KK et al.  Front Allergy. 2025 Jun 27;6:1598583. doi: 10.3389/falgy.2025.1598583.

Abstract

Background: Mite, cockroach, and shellfish (crab, clam, and shrimp) proteins share allergenic epitopes. The determination of specific IgE (sIgE) against cockroach (Blattella germanica, relevant in asthma) and shellfish allergens (relevant in food allergy) using whole-body extracts necessitates detailed knowledge of IgE cross-reactivity.

Objective: This study aimed to evaluate whether cross-reactivity between aeroallergens and food allergens is clinically relevant and whether subjects with mite and/or cockroach sensitization are at risk of false-positive results in shellfish food allergy diagnostics.

Methods: In this cross-sectional, single-center study, we recruited 200 patients with elevated sIgE against ≥1 allergen at random from our outpatient clinic and assessed allergic comorbidity.