Current Opinion in Allergy and Clinical Immunology

Raho, Giorgio S.

doi: 10.1097/aci.0000000000001171pmid: 42286957

Purpose of review Allergic diseases continue to increase globally, and accumulating evidence implicates early-life microbial exposures as central determinants of immune tolerance. This review synthesizes advances from 2024 to 2026 regarding probiotic-mediated immune modulation and their translational implications in allergy prevention and therapy. Recent findings Recent studies confirm strain-specific expansion of Foxp3+ regulatory T cells, suppression of Th2 polarization, reinforcement of epithelial barrier integrity, and durable epigenetic stabilization mediated by short-chain fatty acids such as butyrate. Clinical trials demonstrate benefit in perinatal prevention of atopic dermatitis, modulation of allergic rhinitis symptoms, early-life asthma risk reduction, and probiotic-adjuvanted oral immunotherapy. Summary Probiotics are evolving from adjunctive supplements to biologically active immune modulators with disease-modifying potential. Integration with allergen immunotherapy and precision microbiome profiling may redefine preventive and therapeutic strategies in allergic disease.

Bhattacharya, Sudip; Kundu, Soumi

doi: 10.1097/aci.0000000000001179pmid: 42286950

Purpose of review Antimicrobial resistance (AMR) is increasingly recognised as a global public health emergency that threatens the foundations of modern medicine. While much attention has focused on antimicrobial overuse, under-emphasised drivers such as inaccurate drug allergy labels continue to undermine antibiotic stewardship efforts. Beta-lactam allergy (BLA) labels, particularly penicillin allergy labels, are among the most prevalent and most consequential of these inaccuracies. Mounting evidence demonstrates that the vast majority of individuals labelled as beta-lactam allergic are not truly allergic, yet these labels persist across healthcare systems and generations, driving the use of broader-spectrum, less effective, more toxic and resistance-promoting antibiotics. In this timely review, we argue that beta-lactam de-labelling should no longer be viewed as a niche allergy intervention but as a core antimicrobial stewardship strategy and an ethical obligation in the era of the AMR pandemic. Recent findings Drawing on emerging inpatient and outpatient evidence, including recent paediatric inpatient de-labelling studies, we examine clinical, behavioural, system-level and ethical barriers to de-labelling and propose a reframing of beta-lactam de-labelling as a public health intervention essential for preserving antibiotic effectiveness. Summary We conclude by outlining policy-relevant recommendations for embedding de-labelling into routine care pathways, particularly in low and middle-income countries (LMICs), where the consequences of AMR are likely to be most severe.

Pereira, Tiago; Marques, Maria Luís; Gomes, Eva

doi: 10.1097/aci.0000000000001180pmid: 42286953

Purpose of review Data on pediatric drug-induced anaphylaxis (DIA) are scarce, as drugs are less common triggers of anaphylaxis in children; however, drugs are associated with more severe reactions and unusual presentations. This review summarizes evidence on pediatric DIA, covering epidemiology, clinical manifestations, triggers, and management focusing on pediatric specificities. Recent findings Available data shows that drugs are responsible for up to one-third of childhood anaphylaxis. Approximately half of DIA cases occur in healthcare facilities and triggers vary according to settings. In addition to beta-lactams and NSAIDs, other medications raise concerns in specific populations. Age-dependent and trigger-dependent differences regarding symptoms have been reported. Undertreatment remains a major problem. Summary The importance of DIA in children increases with age. Boys appear more frequently affected. Diagnosis is clinical but challenging especially in younger age groups and in perioperative settings. Elevated tryptase supports diagnosis but lacks sensitivity. Antibiotics and NSAIDs are major culprits, but in hospitalized patients, anesthetics and chemotherapeutic drugs are also relevant. Vaccines, biologicals, and immunotherapy extracts may be important in pediatric allergy practice. Immediate treatment is adrenaline, largely underused in children, even in hospital settings. All patients with DIA should undergo allergy evaluation to prevent recurrences and overlabeling of drug allergy.

Lo Presti, Chiara; Peruzzi, Licia; Licciardi, Francesco

doi: 10.1097/aci.0000000000001175pmid: 42286963

Purpose of review Systemic lupus erythematosus (SLE) is typically considered an acquired disease; nevertheless, a growing body of evidence suggests that, particularly in patients with severe disease and early onset, SLE may be due to single-gene mutations. To identify Inborn Error of Immunity genes that can cause monogenic SLE, we conducted a literature review. For each gene, we evaluated the plausibility of the reported association and defined the prevalent pathological pathway implicated in disease pathogenesis. Recent findings In the latest International Union of Immunological Societies (IUIS) classification, SLE is mentioned as a phenotype in only a subset of the genes identified in this review as SLE-related. At least 25 additional genes included in the most recent IUIS classification have also been recently linked to SLE and should be analyzed in patients with suspected monogenic SLE. Summary Genes related to different immunological pathways (from innate to adaptive immunity) can influence SLE development. A detailed clinical history, including previous infections, and a complete immunological evaluation should be performed in all patients with SLE at diagnosis, especially when monogenic SLE is suspected. Given the large number of genes and pathways associated with SLE, next-generation sequencing should be preferred over Sanger sequencing.

Nahas, Ammar; Zammit Lupi, Daniel; Nunez Colao, Beatriz; Sacco, Keith

doi: 10.1097/aci.0000000000001176pmid: 42286958

Purpose of review Circadian clocks are increasingly recognized as fundamental regulators of innate immune function, yet their relevance to allergy and clinical immunology has only recently been clarified. This review summarizes emerging evidence linking circadian regulation of innate immune cells to allergic inflammation and highlights the translational potential of circadian-informed therapeutic strategies. Recent findings Core clock components are rhythmically expressed in macrophages, mast cells, neutrophils and innate lymphoid cells, where they regulate inflammatory signalling, immunometabolism and activation thresholds. Disruption of these rhythms exaggerates cytokine production, inflammasome activation and mast cell mediator release, contributing to diurnal patterns of allergic disease such as nocturnal asthma. Human and experimental studies demonstrate that circadian misalignment driven by shift work, irregular sleep and mistimed feeding amplifies innate inflammation and worsens allergic outcomes. Summary Circadian regulation represents an underappreciated dimension of innate immunity in allergic disease. Aligning immunomodulatory therapies, vaccination, and lifestyle interventions with endogenous immune rhythms offers a rational approach to improving efficacy and reducing inflammatory burden. Future studies should prioritize time-stratified clinical trials and direct circadian phenotyping in allergic populations.

Bassani, Cintia; Demoly, Pascal; Tanno, Luciana Kase

doi: 10.1097/aci.0000000000001174pmid: 42286949

Purpose of review Drug-induced anaphylaxis during pregnancy, although uncommon, represent potentially serious clinical situation with significant maternal–fetal impact and relevant therapeutic implications. This topic is particularly timely given the need for guidance of health professionals dealing with this challenge and correct labelling patients with drug allergy/hypersensitivity. Recent findings Recent studies report a high prevalence of self-reported β-lactam allergy during pregnancy, with poor correlation with true allergy, underscoring the value of structured, safe, and effective diagnostic evaluation for appropriate delabeling. Summary These findings highlight the need for a systematic approach to drug-induced anaphylaxis in pregnancy, including accurate diagnosis and protocol-based management. Incorporating allergological evaluation into prenatal care can reduce unnecessary risks, optimize maternal and fetal outcomes, and promote rational medication use. Important knowledge gaps remain, emphasizing the need for prospective studies with standardized methodologies and expanded immunological assessment.