Antihistamines for atopic dermatitis (eczema): systematic review and network meta-analysis of randomised trials

Chu A W L, Wen A, Guyatt G H et al. BMJ 2026; 394 :e100163 doi:10.1136/bmj-2026-100163

Abstract

Objective To systematically synthesise the benefits and harms of add-on oral antihistamines for managing atopic dermatitis (eczema).

Design Systematic review and network meta-analysis of randomised trials.

Data sources Medline, Embase, CENTRAL, the United States Food and Drug Administration, and the European Medicines Agency databases from database inception to 5 May 2025.

Study selection Randomised trials assessing add-on oral H1 antihistamines, H2 blockers, mast cell stabilisers (nedocromil sodium and sodium cromoglycate), or their combinations. Paired reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane Risk of Bias tool version 2.

Methods Random effects bayesian meta-analyses synthesised atopic dermatitis severity (oSCORAD—objective scoring atopic dermatitis, 0-83; minimal important difference 8.2; lower better), itch severity (numerical rating scale, 0-10; minimal important difference 3; lower better), sleep disturbance, atopic dermatitis related quality of life, and harms. The network meta-analysis GRADE (Grading of Recommendations Assessment, Development and Evaluation) and Core GRADE approaches informed certainty of evidence ratings.

Network plot of randomised trials examining effects of add-on
antihistamines and mast cell stabilisers on clinician reported
atopic dermatitis severity organised by treatment class
and individual treatments. 

Results 47 trials enrolled 6230 children and adults with primarily moderate to severe atopic dermatitis. With moderate certainty, compared with placebo, adding a first generation or second generation H1 antihistamine likely resulted in a small reduction in atopic dermatitis severity (mean difference -1.87, 95% credible interval -3.47 to -0.27) and itch severity (-0.89, -1.41 to -0.37). Although statistically detectable, these effects are well below established minimal important differences (smallest change in an outcome that a patient would identify as important).

Editorial - Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: Moving Towards Living Guidelines With Regionally Tailored Recommendations

Sousa-Pinto B, Vieira RJ, Klimek L et al.  Allergy Asthma Immunol Res. 2026 Jul;18(4):467-469. doi: 10.4168/aair.2026.18.4.467. 

The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines had their first edition in 1999 (published in 2001),1 with subsequent revisions published in 2008,2 2010,3 2016,4 and 2020.5 Interestingly, ARIA 2016 was used as the case scenario on how to read a health Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based guidelines. Motivated by novel advances in the field, a new revision of the ARIA guidelines focused on the treatment of allergic rhinitis (AR) is currently being developed. This revision is endorsed by the European Academy of Allergy and Clinical Immunology (ARIA-EAACI 2024–2025 guidelines) and follows the GRADE approach.6 The first 2 reports of the ARIA-EAACI 2024–2025 guidelines have been published,7, 8 with one focusing on intranasal treatments and the other on oral and ocular treatments for AR. A third report is being prepared, and it will focus on treatment strategies, such as use of co-medication and the use of rhinitis treatment on an as-needed basis...

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Distinction between allergic rhinitis alone and allergic rhinitis + asthma in MASK-air® real-world studies; a ARIA-WAO task force review

Bernardo Sousa-Pinto MD, PhD, Rafael José Vieira MD, PhD, Ana Margarida Pereira PhD et al. World Allergy Organization Journal Volume 19, Issue 8, August 2026, 101435

Abstract

The recent ARIA-MeDALL hypothesis proposed in 2023 that allergic rhinitis (AR) alone and allergic rhinitis and asthma (A) multimorbidity (AR + A) represent 2 distinct diseases. To improve the knowledge on this topic, we have gathered data from real-world studies using MASK-air®. According to our analyses: (i) An “extreme allergy phenotype” [A + AR + C, Conjunctivitis] was confirmed and found to be more severe (symptoms and work productivity) than single diseases alone. (ii) Patients with AR + A required more rhinitis medications, and had more severe VAS levels for nasal and ocular symptoms than those with AR alone in all countries tested. (iii) In clusters with poorly controlled AR, the frequency of co-medicating with more than 1 rhinitis drug was higher in AR + A than in AR alone. 

Impact on work and VAS global depending
on the RCA multimorbidity

(iv) In the CONSTANCES general population cohort, a co-medication pattern (intranasal corticosteroid and oral H1-antihistamines) was associated with the presence of AR + A (vs AR alone).

Treatment of Multifood Allergy With Omalizumab or Multiallergen Oral Immunotherapy: A Randomized Clinical Trial

Wood RA, Togias A, Burk CM, et al.  JAMA Pediatr. Published online July 27, 2026. doi:10.1001/jamapediatrics.2026.2910

Key Points

Question How do omalizumab and oral immunotherapy (OIT) compare in the treatment of patients with multifood allergy?

Findings In this randomized clinical trial comparing omalizumab with multiallergen OIT (MOIT) in 117 participants with multifood allergy, omalizumab was superior in terms of both efficacy and safety.

Meaning Although the intention-to-treat analysis found a higher rate of treatment success in those receiving omalizumab, there was no difference in efficacy after accounting for the high rate of study withdrawals in the group of participants treated with omalizumab-facilitated MOIT.

Abstract

Importance Food allergy is common, affecting up to 8% to 10% of children and adults. Treatment options include oral immunotherapy (OIT) and omalizumab, an anti–immunoglobulin E (IgE) monoclonal antibody.

Objective To compare omalizumab with OIT for the treatment of patients with multifood allergy.

Treatment of Multifood Allergy With Omalizumab 

or Multiallergen 

Oral Immunotherapy

Visual Abstract

Design, Setting, and Participants This was a double-blind, placebo-controlled, randomized clinical trial comparing omalizumab with omalizumab-facilitated multiallergen OIT (MOIT) in participants who completed stage 1 of the Omalizumab as Monotherapy and as Adjunct Therapy to Multiallergen OIT in Children and Adults With Food Allergy (OUTMATCH) trial, which led to the approval of omalizumab.

Respiratory mucosal vaccines for emerging viruses: promise and challenges

Beeton K, Case JB.  J Virol. 2026 Jul 23:e0174825. doi: 10.1128/jvi.01748-25.

ABSTRACT

Mediators of respiratory mucosal immunity. 

Systemically administered vaccines were instrumental in reducing severe disease, hospitalizations, and deaths during the SARS-CoV-2 pandemic. However, they often failed to consistently elicit robust immunity at mucosal sites. This minireview examines a central role for respiratory mucosal immunity in protection against emerging viral pathogens and highlights key takeaways from the SARS-CoV-2 pandemic. Evidence from SARS-CoV-2 and influenza studies demonstrates that mucosal vaccination uniquely induces secretory IgA, as well as resident memory B and T cells within the upper and lower airways, thereby promoting broader and more potent protection.

Proportion of Antiepileptic Drug–Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis

Lee EY, Knox C, Sugumar C, Phillips EJ. JAMA Dermatol. Published online July 22, 2026. doi:10.1001/jamadermatol.2026.2473

Key Points

Question  What is the global proportion of antiepileptic drug–associated Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Findings  In this systematic review and meta-analysis of 50 studies including 4403 patients, 23% of SJS/TEN cases were attributed to antiepileptic drugs. Nearly all antiepileptic drug–associated cases involved aromatic agents (96%), most commonly carbamazepine (39%), phenytoin (19%), and lamotrigine (15%).

Meaning  These findings support the view that antiepileptic drugs are a major cause of SJS/TEN worldwide and reinforce the preferential use of nonaromatic alternatives when clinically appropriate.

Abstract

Importance  Antiepileptic drugs (AEDs) are frequently implicated in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are the most severe type of drug hypersensitivity reaction, with a mortality rate up to 50%. However, the overall proportion of these cases attributed to AEDs has not been systematically reviewed.

REACH Study: Broncho-Vaxom (OM-85) Cuts Recurrent Respiratory Tract Infections

 

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).