Symptom probability increases at low pollen exposure in adolescents with allergic rhinitis findings from the GINIplus and LISA birth cohorts

Schmid J, Grill P, Flexeder C et al.  Pediatr Allergy Immunol. 2026 Jul;37(7):e70429. doi: 10.1111/pai.70429.

Abstract

Background

Pollen-induced allergic rhinitis increases significantly with age among children and adolescents and is associated with reduced quality of life due to symptom severity, social impacts, and decreased school performance. This study examines associations between pollen exposure and allergic rhinitis symptoms in German adolescents.

Methods

In the 15-year follow-up of the GINIplus and LISA birth cohorts at the Munich study area, monthly occurrence of nasal symptoms was assessed in 1594 participants. Pollen concentrations of birch, grass, ragweed, and mugwort between January 2010 and March 2014 were considered. Monthly individual pollen exposures (grains/m3) were assigned as the sum of all pollen types to which participants were sensitized. Associations between pollen exposure and monthly nasal symptoms were analyzed using adjusted generalized additive mixed-effect models.

Results

GAMM curves of the partial association of mean individual
pollen exposure on probability of nasal symptom occurrence
in the total study period.

A non-linear association between individual pollen exposure and nasal symptoms was observed, with symptom probability increasing significantly at low pollen concentrations and plateauing around 24 grains/m3 (birch) and 14 grains/m3 (grass).

Efficacy of probiotics on immunological and clinical outcomes in allergic rhinitis: an umbrella review and updated meta-analysis of RCTs in children and adults

Wang, Z., Lu, Y.  BMC Immunol (2026). https://doi.org/10.1186/s12865-026-00873-1

Abstract

Background

Allergic rhinitis (AR) is a prevalent inflammatory condition with limited long-term treatment options. Probiotics have been investigated as immunomodulatory agents, yet evidence remains inconsistent. This umbrella review with updated meta-analysis evaluated probiotic efficacy on immunological and clinical outcomes in children and adults with AR.

Methods

We systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase through May 2026. Randomized controlled trials assessing probiotics effects on IgE, antigen-specific IgE, eosinophil count, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Total Rhinitis Symptom Score (RTSS) were included. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using random-effects models with REML estimation; Hartung-Knapp-Sidik-Jonkman (HKSJ) was used for outcomes with ≤ 5 studies.

Results
Twenty-nine RCTs comprising 2,078 participants were included. Probiotic supplementation was associated with significant reductions in total IgE (WMD: -198.35, 95%CI: -291.10 to -105.61), global RQLQ (WMD: -9.43, 95%CI: -11.71 to -7.15), nasal-RQLQ (WMD: -1.52, 95%CI: -2.89 to -0.15), and nasal-RTSS (WMD: -1.97, 95%CI: -3.61 to -0.32). No significant effects were observed for antigen-specific IgE, eosinophil count, eye-RQLQ, global-RTSS, or eye-RTSS. The umbrella review of seven meta-analyses (2008–2025) confirmed consistent benefits for quality of life and nasal symptoms.


Conclusions

Probiotic supplementation may improve quality of life and nasal symptoms while reducing IgE in AR patients, but evidence is limited by high heterogeneity, fragility of the IgE finding, and pooling of diverse strains. Routine clinical recommendation is not supported by high‑certainty evidence; further strain‑specific RCTs are needed.

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Insights into Pathogenesis of Chronic Spontaneous Urticaria

Torsten Zuberbier, Hanna Bonnekoh, Emek Kocatürk, et al.  British Journal of Dermatology, 2026, ljag277, https://doi.org/10.1093/bjd/ljag277

Abstract

Molecular mechanisms of CSU

Chronic spontaneous urticaria (CSU) is a mast cell–mediated inflammatory disease marked by recurrent wheals and/or angioedema in the absence of identifiable external triggers. Once considered idiopathic, CSU is now recognized as a heterogeneous immunological disorder that results in mast cell activation. Two major endotypes have been described: autoallergic (type I) CSU, mediated by IgE autoantibodies directed against self-antigens, and autoimmune (type IIb) CSU, mediated by IgG autoantibodies targeting IgE or FcεRI on mast cells and basophils. Type IIb CSU is associated with higher disease severity, autoimmune comorbidities, low total IgE levels, and reduced responsiveness to antihistamines and omalizumab.

Efficacy and Safety of Dupilumab in Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Roy Khalaf, Alexandre Ton That, Natacha Tardioet al.  Int Arch Allergy Immunol 2026

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus driven by type-2 inflammation. Dupilumab, a monoclonal antibody targeting the IL-4Ra subunit shared by the IL-4 and IL-13 receptor complexes , has recently emerged as a targeted biologic therapy for EoE. This systematic review evaluates the evidence for dupilumab in EoE across pediatric and adult populations, focusing on efficacy, safety, and symptom improvement. 

Methods: MEDLINE and Embase were searched from inception to June 30, 2025. Eligible studies included randomized controlled trials, cohort studies, case-control studies, and case reports reporting dupilumab use in confirmed EoE. Study screening and quality assessment were performed in duplicate. . Data on demographics, atopic comorbidities, dosing regimens, histologic outcomes, symptom improvement, and adverse events were extracted and summarized descriptively. 

Forest plot of histological remission rates with dupilumab
across included randomized controlled trials

Results: Nineteen studies (three randomized trials, nine cohorts, seven case reports) comprising 760 patients were included.

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?