Allergies

Both allergic rhinitis and chronic rhinosinusitis with or without nasal polyps have important factors in common with asthma. They are often present simultaneously, they have similar pathogenesis processes, and they have synergistic effects on the clinical manifestations. There are also important considerations regarding the common treatment of these pathologies. Taking all these into account, it is possible to place these diseases under the “united airway disease” umbrella. However, matters such as embryologic origins, anatomy and function of the upper and lower airways, as well as cases where the aforementioned pathologies can be observed independently and have different treatment responses, make up reasonable counterarguments for the “united airway disease”. This narrative review attempts to put all these factors into perspective for a slightly better understanding of the complexity of this topic. We will take into consideration factors such as epidemiological data, pathogenesis and pathology, clinical considerations, and the benefits of a common treatment. Full article

This study aimed to evaluate the effects of different dosimetric parameters of photobiomodulation therapy (PBMT) in an experimental model of chronic obstructive pulmonary disease (COPD). C57BL/6 mice were assigned to the following groups: Baseline, COPD, and COPD treated with PBMT at doses of 1 J, 3 J, 5 J, and 7.5 J. Treatment was performed using a diode laser (660 nm, 100 mW) applied for 10 s, 30 s, 50 s, and 120 s, respectively, over 15 consecutive days. COPD was induced by orotracheal instillation of cigarette smoke extract twice weekly for 45 days. Analyses included total cell count, immune cell profiling by flow cytometry, pulmonary infiltration of inflammatory markers, necrosis, apoptosis, and reactive oxygen species (ROS) production. Data were analyzed using one-way ANOVA followed by the Newman–Keuls post hoc test, with statistical significance set at p < 0.05. PBMT significantly reduced inflammatory cell infiltration, with the most pronounced anti-inflammatory effects observed at doses of 1 J and 3 J, highlighting the importance of appropriate dosimetry in optimizing the therapeutic outcomes of PBMT for COPD. Full article

Pruritus (itching) is an underrecognized but often debilitating symptom in patients with central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). It is often considered a paroxysmal symptom. Although less studied than pain or spasticity, pruritus can significantly impair the quality of life. This review aims to provide a comprehensive overview of the pathophysiological mechanisms underlying pruritus in demyelinating CNS disorders, its clinical presentations, and the available treatment options. We explore the central origins of neuropathic itch, focusing on spinal cord, brainstem, and cerebral lesions, with particular emphasis on white matter involvement and spinothalamic tract dysfunction. In addition, we review pruritus triggered or exacerbated by disease-modifying therapies (DMTs) used in MS and NMOSD. Full article

Insect bite hypersensitivity (IBH) is a seasonally recurrent allergic dermatitis representing one of the most prevalent dermatological conditions in horses worldwide. This condition, driven by hypersensitivity to salivary allergens of Culicoides spp., causes substantial discomfort, welfare impairment, and potentially economic loss in equine populations. The pathogenesis of IBH is complex, involving genetic predisposition, epithelial barrier dysfunction, and a skewed T-helper 2 (Th2)-mediated immune response with elevated IgE production and eosinophilic inflammation. Advances in immunogenetics and molecular immunology have improved the understanding of the disease’s multifactorial nature. Research on immunotherapy and cytokine-targeted treatments is contributing to the development of more effective therapeutic options. This review synthesizes current knowledge on the immunopathogenesis and genetic determinants of IBH and discusses both conventional and emerging strategies for its clinical management. Full article

Mast cells (MC) are key effector cells in allergic diseases and are increasingly recognized for their roles in the immunopathogenesis of tuberculosis (TB). In allergic conditions, MCs are hyperactivated, driving T-helper Type 2 (Th2)-skewed immune responses that may antagonize the T-helper Type 1 (Th1)-mediated immunity essential for controlling Mycobacterium tuberculosis (Mtb) infection. This immunological imbalance may contribute to increased TB susceptibility, altered granuloma dynamics, and accelerated fibrotic remodeling. Histopathological and in vivo studies have revealed that MCs are recruited to TB lesions, where they release a spectrum of mediators, including histamine, IL-17A, TNF-α, TGF-β, tryptase, and chymase. These mediators can either support initial immune defense or promote chronic inflammation and tissue damage, depending on context and regulation. Moreover, individuals with chronic allergic diseases such as asthma and allergic rhinitis may experience worse TB outcomes due to their baseline immune dysregulation. Environmental exposures (e.g., air pollution, smoking), genetic polymorphisms (e.g., IL-4 −589C/T, IL-13 R130Q), and gut-lung axis disturbances further modulate MC activity and TB pathogenesis. This review synthesizes current findings on MC involvement in TB, particularly in allergic settings, and highlights the need for epidemiological studies and mechanistic research. It also explores the promise of host-directed therapies (HDTs) that target MCs or their mediators, such as antihistamines, MC stabilizers, leukotriene inhibitors, and cytokine modulators, as novel adjuncts to standard TB treatment. Personalized approaches that consider immune profiles, genetic risk, and comorbid allergies may improve TB outcomes and inform future clinical guidelines. Full article

Medium and variable vessel vasculitides are a heterogeneous group of rare, immune-mediated vascular disorders that are associated with significant morbidity and mortality. The standard treatment approach involves glucocorticoids and immunosuppressive agents. However, many patients exhibit poor tolerance or respond inadequately to these medications. Recent advances in biologic therapies and Janus Kinase inhibitors (JAKis) offer promising alternatives. This review consolidates current knowledge on the pathogenesis, immunology, and therapeutic efficacy of biologics and JAKis in the management of medium and variable vessel vasculitis. While further research is needed to establish long-term safety and optimize treatment protocols, biologics and JAKis represent emerging therapeutic strategies with the potential to improve outcomes. Full article

The rising prevalence of pediatric food allergies represents a growing public health concern, with hospitalizations for food-induced anaphylaxis on the rise. Early cutaneous manifestations, particularly in the setting of atopic dermatitis (AD), may indicate sensitization via the skin—a critical route for allergen exposure in early life. Pediatric food allergies can be IgE-mediated, non-IgE-mediated, or mixed, with each type presenting distinct pathophysiological and clinical features. IgE-mediated reactions often involve acute urticaria and angioedema, while non-IgE forms, such as food protein-induced enterocolitis syndrome (FPIES), manifest with delayed gastrointestinal symptoms and limited skin involvement. AD is closely linked with food allergies, both in pathogenesis and symptom exacerbation, with a high prevalence of co-occurrence. Diagnosis primarily relies on clinical evaluation, supported by testing such as skin prick testing, serum IgE, and oral food challenges, though limitations exist in sensitivity and specificity. Management emphasizes allergen avoidance, symptom control, and multidisciplinary care. While many pediatric food allergies resolve with age, others persist or present chronically, necessitating long-term strategies. Coordinated management between allergy and dermatology is key to minimizing complications and supporting better long-term outcomes for affected children. Full article

Mount Etna, located on the eastern coast of Sicily, is Europe’s most active volcano. Over the past five years, it has experienced numerous significant eruptive episodes, with the most recent occurring in August 2024. During this event, substantial amounts of volcanic ash were dispersed over densely populated areas, particularly in the province of Catania. Environmental factors, such as volcanic eruptions, are known to influence inflammatory skin conditions, including atopic dermatitis. We analyzed a cohort of patients with atopic dermatitis who were exposed to volcanic ash during the Mount Etna eruption in August 2024, aiming to evaluate the impact of the eruption on respiratory and cutaneous symptoms, treatment response, use of protective equipment, and changes in EASI scores over an eight-week period. A total of 67 Caucasian atopic dermatitis patients (mean age 41.2) were assessed after a volcanic eruption. Symptom worsening occurred in 58.9% (respiratory) and 26.9% (skin) of patients. EASI scores significantly increased (p < 0.05). No clinical difference was found between treatment types or mask use, which did not prevent symptom exacerbation. Volcanic ash exposure significantly worsened respiratory and skin symptoms in atopic dermatitis patients, underscoring the need for improved protective measures and further research on environmental triggers of chronic inflammatory conditions. Full article

Multiple sclerosis (MS) and allergic diseases, traditionally considered immunologically opposing entities, may share pathogenic mechanisms rooted in immune dysregulation. While MS is predominantly mediated by Th1 and Th17 responses and allergies by Th2 responses, emerging evidence suggests overlapping immunological pathways, including the involvement of histamine, regulatory T cells, and innate lymphoid cells. This review synthesizes current knowledge on the epidemiological and immunopathological associations between MS and allergies. Epidemiological studies have yielded inconsistent results, with some suggesting a protective role for respiratory and food allergies against MS onset, while others find no significant correlation. Clinical studies indicate that food allergies in adults may be associated with increased MS inflammatory activity, whereas childhood atopy might exert a protective effect. In addition, we review hypersensitivity reactions to disease-modifying treatments for MS, detailing their immunological mechanisms, clinical presentation, and management, including desensitization protocols where applicable. Finally, we explore how treatments for allergic diseases—such as clemastine, allergen immunotherapy, montelukast, and omalizumab—may modulate MS pathophysiology, offering potential therapeutic synergies. Understanding the interplay between allergic and autoimmune processes is critical for optimizing care and developing innovative treatment approaches in MS. Full article

Background/Objectives: This study assessed teacher self-efficacy in school-based asthma management in two southern states in the United States. Current literature focuses primarily on supporting school-based asthma management, but few studies have focused on teacher self-efficacy in the asthma management process. Methods: With data collected from a two-state survey of a randomly selected group of teachers in grades kindergarten to grade eight (n = 379), teachers’ demographic variables, general opinions about asthma management practices, and their self-perceptions on the Teacher Asthma Management and Information Seeking Scale, which assesses self-efficacy, were examined. Results: Teachers’ self-efficacy in managing asthma and seeking information was significantly higher among teachers who had completed in-service professional learning sessions and those who had access to community resources or links to community agencies. Additionally, teachers with personal experience of chronic illness, asthma, or allergies and those who had students with chronic illnesses in their classrooms reported higher self-efficacy scores. Conclusions: Findings suggest that providing professional learning about asthma for teachers, offering access to asthma action plans and community resources, and increasing awareness of chronic conditions and training for handling medical emergencies can enhance teachers’ self-efficacy and improve outcomes for students with chronic illnesses. Full article

Background/Objectives: Toxocara spp. infection has been associated with severe asthma and allergic manifestations due to the activation of eosinophils by the release of Th2 cell cytokines. The aim of this study was to investigate the association between Toxocara spp. infection and eosinophil levels in severe asthmatic patients. Methods: The socio-demographic, peripheral blood eosinophils counting total IgE, sIgE to aeroallergens and FEV1 results were acquired from the Program of Asthma and Rhinitis Control (ProAR) at the Salvador–Brazil databank; IgG anti-Toxocara spp. levels were measured in 176 severely asthmatic patients by indirect ELISA. Results: The Toxocara spp. seroprevalence was 50.6%. Eosinophilia was present in 54% of the population. The correlation between IgG anti-Toxocara spp. levels and eosinophils levels was positive. Eosinophilic individuals with SPT, sIgE for D. pteronyssinus, D. farinae and B. tropicalis showed positive results; IgE ≥ 160 UI/dL and uncontrolled asthma presented more positive results for IgG anti-Toxocara spp. Conclusions: Our findings suggest that eosinophil levels are influenced by the presence of IgG antibodies against Toxocara spp. Additionally, helminth infection may modulate immunological responses in allergies and uncontrolled asthma, which could help explain the exacerbation of asthma symptoms. Full article

Allergic diseases, particularly respiratory allergies like asthma and allergic rhinitis, are a growing public health concern influenced by environmental factors such as climate change and air pollution. The exposome framework enables a comprehensive assessment of how lifelong environmental exposures shape immune responses and allergic sensitization. Peru’s diverse ecosystems and climates provide a unique setting to investigate regional variations in allergic sensitization. This study characterized these patterns in five Peruvian regions with distinct climatic, urbanization, and socioeconomic characteristics. A total of 268 individuals from Lima, Piura, Tarapoto, Arequipa, and Tacna were analysed for allergen-specific IgE responses using a multiplex IgE detection system. The results revealed significant geographical differences in sensitization frequencies and serodominance profiles, based on descriptive statistics and supported by Chi-square comparative analysis. House dust mites were predominant in humid regions, while Arequipa exhibited higher sensitization to cat allergens. In Tacna, olive pollen showed notable prevalence alongside house dust mites. Tarapoto’s high humidity correlated with increased fungal and cockroach allergen sensitization. Notably, some allergens traditionally considered minor, such as Der p 5 and Der p 21, reached sensitization prevalences close to or exceeding 50% in certain regions. These findings provide the most detailed molecular characterization of allergic sensitization in Peru to date, highlighting the importance of region-specific allergy management strategies. Understanding environmental influences on allergic diseases can support more effective diagnostic, therapeutic, and preventive approaches tailored to diverse geographical contexts. Full article

Affecting around 30–40% of the population worldwide, allergic disorders including asthma, rhinitis, eczema, and food allergies, are relatively common. Environmental factors, such as air pollution and climate change, which aggravate allergic reactions, contribute to the growth of these diseases. Although conventional treatments such as antihistamines and immunotherapy remain the standard for symptom management, growing interest in natural remedies highlights the potential value of medicinal plants as complementary therapies. Commonly present in plants, vitamins and antioxidants have strong anti-inflammatory and antioxidant actions that can control immune responses, lower oxidative stress, and thus reduce inflammation, which is the main element in allergic reactions. By focusing on the fundamental causes of inflammation and immunological dysregulation, phytochemicals have shown encouraging effects in reducing allergic symptoms. This review investigates the role of plant flavonoids, polyphenols, and vitamins in lowering allergic symptoms and inflammation, and suggests their potential in allergy management. It also aims to provide a short review of various plant species that are used in folk medicine for allergy treatment. The inclusion of plant-based compounds in allergy therapy could provide more complete and environmentally friendly remedies to enhance patients’ quality of life. Full article

Purpose: This study aimed to evaluate the immunological response to the 23-valent pneumococcal polysaccharide vaccine (PPV23) in patients investigated for immunodeficiencies due to recurrent infections at EPM-UNIFESP Clinical Immunology outpatient clinic. Methods: This is a longitudinal retrospective study. Data were collected from the medical records of patients between 2012 and 2020. The analyses were developed in two stages: before and after administration of the PPV23 vaccine. Results: A total of 390 patients who received the PPV23 vaccine were selected. Among those who demonstrated an adequate serological response (63.6%), there was a notable decrease in the risk of upper respiratory tract infections (URTI) by 66%, tonsillitis by 74%, otitis by 76%, sinusitis by 49%, and uncomplicated pneumonia (PNM) by 77%. For invasive infections, the risk reduction was 95% for pneumonia with parapneumonic effusion and 93% for meningitis. Conclusions: The study demonstrated a significant decrease in the risk of bacterial infections following the administration of the PPV23 vaccine in this population. Therefore, we recommend including PPV23 in the vaccination schedule following pneumococcal conjugated vaccines for patients with recurrent pneumococcal infections to enhance protection and avoid complications. Full article

Hidradenitis suppurativa (HS) and atopic dermatitis (AD) are both inflammatory dermatoses that can significantly impact patient quality of life, however, limited research exists regarding their association. The purpose of this comprehensive review is to compare the inflammatory pathogenesis of HS and AD, explore the associations between these diseases, and discuss standalone and concomitant disease treatment options. Although HS and AD are understood to be primarily driven by the Th1 and Th2 inflammation pathways, respectively, these conditions both utilize the Janus Kinase/Signal transducer and activator of transcription (JAK/STAT) pathway to promote inflammation. Newer research also suggests that IL-36 and IL-1 receptor-associated kinase 4 (IRAK4) may be two additional inflammatory signals shared between the HS and AD disease pathways. These shared mechanisms are reflected in patient presentations as HS and AD are often concomitantly present and demonstrate a bidirectional association in the current literature. Treatment options for concomitant disease are limited, but leverage the shared immune pathogenesis of both diseases. Dupilumab has been reported to improve both HS and AD symptoms in select patients. JAK inhibitors are currently FDA-approved for the treatment of AD, and early trials have suggested benefits from JAK inhibitors such as upadacitinib, povorcitinib, and topical ruxolitinib for HS. Possible future avenues for research on treating both HS and AD include IRAK-4 inhibitors such as zabedosertib and BAY1830839, and diet and gut microbiome modifications. Full article

Psoriasis is a chronic inflammatory autoimmune disease primarily affecting the skin and, in some cases, the joints, and is characterized by erythematous, scaling lesions. Building up the doses has been conventional, but many patients will not obtain good results and a new, more targeted therapeutic strategy is desired. In the past few years, immune checkpoint inhibitors have revolutionized moderate to severe psoriasis management by blocking crucial pro-inflammatory cytokines, introducing new avenues for biological therapies. This review summarizes recent developments in biological therapies, including their mechanisms of action and clinical efficacy. While bimekizumab, an IL-17A and IL-17F inhibitor, strongly suppresses inflammation, selective inhibition of the IL-12/23 pathways is targeted with the small molecule TYK2 inhibitor deucravacitinib. For example, spesolimab, an inhibitor of IL-36 signaling, is being investigated for generalized pustular psoriasis. In this respect, new therapies provide better efficacy and quality of life, target specific psoriasis subtypes, and are safer and more effective than anti-inflammatory treatments. Such therapies could radically inform the standards of care, and the long-term safety and patient-centered outcomes of these innovative strategies will be the subject of continued research. Full article

The interplay between allergic diseases and neurological disorders has gained increasing attention over the past decades, highlighting potential shared pathophysiological pathways. Allergic diseases, including asthma, eczema, and allergic rhinitis, are characterized by chronic inflammation and immune dysregulation, which may impact the pathogenesis of certain neurological conditions. Emerging evidence suggests that conditions such as multiple sclerosis (MS), migraine, epilepsy, neurodegenerative diseases, and neurodevelopmental disorders may be influenced by systemic inflammation and altered immune responses associated with allergies. The purpose of this paper is to provide an overview of current epidemiological evidence suggesting a relationship between allergic and neurological diseases. Understanding the complex interactions between allergic and neurological diseases could provide new insights into their aetiology and reveal novel therapeutic targets, paving the way for integrated approaches in managing comorbid allergic and neurological conditions, ultimately improving patient outcomes and quality of life. Full article

Esophageal fibrotic remodeling is a major complication of chronic inflammation in eosinophilic esophagitis (EoE) and represents one of the main determinants of symptoms in adult patients with EoE, with a remarkable impact on patients’ quality of life and the healthcare system. Esophageal fibrotic remodeling is diagnosed through upper gastrointestinal endoscopy, radiological studies, and a functional luminal imaging probe. However, diagnostic underestimation of esophageal strictures and suboptimal adherence to EoE guidelines still represent limitations of current clinical practice. Combined with medical therapy and/or elimination diets, endoscopic dilation remains the cornerstone treatment for esophageal strictures and rings, offering a safe and effective option for managing obstructive symptoms. Different modalities are available for esophageal endoscopic dilation of EoE, including mechanical and balloon dilators. Mechanical dilators provide tactile feedback during the procedure and exert longitudinal and radial forces. In contrast, balloon dilators apply a purely radial force and enable direct visualization of the esophageal mucosa during the procedure. Both mechanical and balloon dilators are safe and effective, with no single modality demonstrating clear superiority. Consequently, the choice of dilation technique is guided by stricture characteristics, the expertise of the endoscopist, and considerations related to the financial and environmental sustainability of the devices. This review aims to summarize the most relevant evidence on the endoscopic evaluation and dilation of fibrostenotic complications in EoE, also providing practical guidance for clinicians to optimize the endoscopic management of these patients. Full article

Allergic rhinitis and asthma are significant public health concerns worldwide. While previous studies have explored how nasal and buccal bacteriotas influence these conditions, few have directly compared their bacteriomes within the same cohort. To bridge this gap, I analyzed 16S rRNA next-generation sequencing data from 347 individuals, including participants with allergic rhinitis, asthma and healthy controls. The nasal and buccal bacteriomes shared all dominant bacterial taxa but differed significantly in their phylum- and genus-level relative abundances. Alpha-diversity was significantly higher in the buccal cavity, while beta-diversity varied significantly across all indices and clinical groups. Over 80% of the predicted metabolic pathways were differentially regulated between the two cavities, yet these functional differences remained fairly consistent across clinical groups. Naso-buccal bacterial networks exhibited striking differences in structure, complexity and hub nodes. Notably, the network of healthy controls showed a clear segregation between nasal and buccal bacteria, with 93.5% of the interactions occurring within each respective cavity, and contained few pathogenic keystone taxa. In contrast, bacterial networks from diseased individuals exhibited reduced ecological specialization and more pathogenic keystone taxa linked to airway disease. These findings, thus, demonstrate that the naso-buccal bacteriome plays distinct yet interconnected roles in allergic rhinitis and asthma. Full article