Changes in the Use of Montelukast for Asthma After a US Food and Drug Administration Boxed Warning

Shanmugam H, Kesselheim AS, Liu ITT et al. JAMA Netw Open. 2026;9(5):e2614274. doi:10.1001/jamanetworkopen.2026.14274

Key Points

• Question  Did the use of montelukast to treat asthma change after an US Food and Drug Administration (FDA) boxed warning was announced in March 2020?
• Findings  In this cross-sectional study using national monthly cohorts of up to 614 637 patients with asthma from a national commercial claims dataset, the use of montelukast decreased after implementation of an FDA boxed warning.
• Meaning  These findings suggest that treatment patterns for patients with asthma changed after an FDA boxed warning.

Abstract

Importance  In March 2020, the US Food and Drug Administration (FDA) issued a boxed warning for montelukast amid reports of neuropsychiatric adverse effects.

A Multidisciplinary Approach to Checkpoint Inhibitor Adverse Reactions

Andrews C, Mukherjee E, Gibson A  et al. The Journal of Allergy and Clinical Immunology: In Practice, 14, 1058-1072

Abstract

Overlapping cellular and molecular mechanisms
of ICI efficacy and toxicities.

Immune checkpoint inhibitors are used in a wide range of cancers, offering durable responses for a substantial subset of patients. However, immune-related adverse events, the most clinically consequential checkpoint inhibitor–associated adverse reactions, pose a key challenge in practice, affecting virtually any organ system, resulting in treatment interruption, morbidity, or mortality. Patient education, early recognition, and effective management are essential to limit complications and maintain continuity of immunotherapy.

Impact of IL-4/IL-13 Blockade with Dupilumab on the Microbiome in Type 2 Inflammatory Diseases: A Systematic Review

Mari, PV., Carriera, L., Saviano, A. et al.  Curr Allergy Asthma Rep 26, 37 (2026). https://doi.org/10.1007/s11882-026-01281-6

Abstract

Purpose of Review

To systematically review current evidence on microbiota changes associated with dupilumab treatment across different anatomical sites in type 2 inflammatory diseases.

Recent Findings

Compartment-specific microbiome changes associated with dupilumab.
Dupilumab blocks IL-4Rα signaling, inhibiting IL-4 and IL-13 pathways
and promoting site-specific microbiome modulation.

Fifteen studies were included, comprising two randomized trials and thirteen observational studies, mostly in atopic dermatitis, with fewer data in chronic rhinosinusitis with nasal polyps and NSAID-exacerbated respiratory disease. The skin was the most frequently investigated site, followed by the sinonasal tract and gut.

Evaluating montelukast-second-generation antihistamine combinations versus monotherapy in allergic rhinitis: A network meta-analysis

Wandana A, Tanely JC, Sudrajat RMC et al.  Asia Pac Allergy. 2026 May;16(3):152-166. doi: 10.5415/apallergy.0000000000000236. 

Abstract

Background: 

Allergic rhinitis (AR) is an atopic condition affecting over 400 million people worldwide, impairing quality of life and often leading to complications such as asthma and sinusitis. Montelukast, a leukotriene receptor antagonist, is often used in combination with second-generation antihistamines (sgAHs) to enhance symptom control. However, the relative efficacy of different montelukast-sgAH combinations remains unclear.

Objective: 

To evaluate and compare the efficacy of montelukast combined with various sgAHs versus montelukast monotherapy in patients with AR.

Methods: 

Randomized controlled trials (RCTs) comparing montelukast-sgAH combinations to montelukast alone were identified from 5 electronic databases up to 2025. Outcomes included Total Nasal Symptom Score (TNSS; 0–12), Daytime and Nighttime Nasal Symptom Scores (DNSS, NNSS; 0–3), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; 0–6).

Gold and Nickel Release From Gold-Plated Earrings Under Cysteine-Modified Artificial Sweat Conditions

Jensen MB, Ahlström MG, Jellesen MS et al. Contact Dermatitis. 2026 May 17. doi: 10.1111/cod.70187. 

ABSTRACT

Background

Contact allergy to gold is frequently observed in patch testing, although with low clinical relevance. Nickel allergy, in contrast, is common, clinically relevant, and nickel release from jewellery remains a regulatory concern. Standardised artificial sweat tests show no detectable gold release from gold-containing jewellery.

Objectives

To assess surface composition and the release of nickel and gold from gold-plated earrings under clinically relevant biochemical conditions.

Methods

Ten pairs of low-cost gold-plated earrings were analysed by scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS) and X-ray fluorescence. Metal release was assessed using a cysteine-modified artificial sweat solution at 30°C for 168 h. Gold and nickel concentrations were quantified by inductively coupled plasma mass spectrometry.

Results

Results of nickel and gold release after 168 h in the artificial
sweat solution at 30°C.

Nickel release was detected in 10/10 earrings (median: 2.1 μg/cm2, range: 0.00032–10.0) frequently exceeding the EU regulatory limit.

Systemic IgE promotes allergic rhinitis by licensing Th2-to-Tfh conversion and local IgE production

 Nakai T, Tezuka S, Adachi T et al. Mucosal Immunol. 2026 May 23:100351. doi: 10.1016/j.mucimm.2026.100351.

Highlights

• Systemic IgE and local Th2 cells cooperate to drive AR development.
• Systemic IgE facilitates Th2-to-Tfh differentiation to trigger local IgE response.
• MC/basophil activation potentiates antigen-induced local type-2 responses.

Abstract

Graphical abstract

Although systemic allergen-specific IgE is an essential biomarker for allergic rhinitis (AR), its mechanistic contribution to symptom development remains unclear. Here, using mouse models, we investigated how systemic antigen-specific IgE influences AR symptoms and local type 2 inflammation. Mice were adoptively sensitized with ovalbumin (OVA)-specific IgE (OVA-IgE) and/or in vitro–differentiated OVA-specific Th2 (OVA-Th2) cells, followed by repeated intranasal OVA exposure.

Th2 cytokine-induced mucociliary remodeling in chronic rhinosinusitis: implications for antiviral defense and epithelial function

Theorell, J., Drnevich, J., Jovanovic Gasovic, S. et al.  Respir Res (2026). https://doi.org/10.1186/s12931-026-03734-y

Abstract

Chronic rhinosinusitis (CRS) is a sinonasal inflammatory disease, often complicated by aberrant Th2-driven immunologic responses and increased susceptibility to viral infections. Th2-induced epithelial remodeling has been proposed to facilitate viral entry and replication, thereby increasing susceptibility to infection and exacerbating inflammation in CRS. This exploratory study investigated if chronic Th2-mediated remodeling alters the transcriptional response to rhinoviral infection between individuals with and without CRS. We hypothesized that Th2 cytokine exposure of human primary nasal epithelial cells during their differentiation disrupts mucociliary function, impairing the antiviral response to rhinovirus. 

Effect of Th2 cytokine exposure on sinonasal epithelial cells

on cytokine secretion

Primary nasal epithelial cells from patients with and without CRS were differentiated at air-liquid interface while being exposed to Th2 cytokines (IL-4, IL-13, or IL-4/13; 10 ng/mL) followed by a rhinovirus (RV-A16) infection. RNA sequencing and inflammatory cytokine profiling revealed significant downregulation of pathways involved in cilia structure, development, and function, as well as lower rhinovirus reads in Th2 cytokine-exposed cultures, with similar trends observed in CRS and non-CRS samples.

Correlation of Patient-Reported Symptoms With Rhinogram Features Beyond Simple Airway Resistance.

Darbari Kaul R, Alvarado R, Choy C, et al. Annals of Otology, Rhinology & Laryngology. 2026;0(0). doi:10.1177/00034894261454654

Abstract

Introduction:

Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance.

Methods:

Image of rhinomanometry testing conducted on a patient
with placement of the sealed pressure sensing
tube and anaesthetic style mask.

A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman’s rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals.