Allergies, Volume 6, Issue 1 (March 2026) – 10 articles

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease effectively treated with dupilumab, a monoclonal antibody that inhibits IL-4 and IL-13 signaling. Dupilumab is an effective treatment for type 2 inflammatory diseases such as CRSwNP. Although efficacy of dupilumab in controlling upper airway inflammation is well established, concerns have emerged regarding its potential cardiovascular effects. Emerging evidence suggests that IL-4/IL-13 signaling plays a protective role in post-myocardial infarction remodeling by promoting anti-inflammatory macrophage polarization, angiogenesis, and controlled fibrosis, especially during the early healing phase. Pharmacological blockade of the IL-4/IL-13 signaling pathway, such as that induced by dupilumab, may theoretically impair myocardial repair mechanisms, particularly in male patients who appear more responsive to these cytokines. Although rare, dupilumab-associated hypereosinophilia and myocarditis have been reported. In patients with pre-existing ischemic heart disease or heart failure, a multidisciplinary risk–benefit evaluation should be considered. Concomitant use of cardioprotective agents such as sacubitril/valsartan or SGLT2 inhibitors may help mitigate potential cardiac risks. Future studies are needed to clarify the safety and therapeutic implications of combining dupilumab with cardiovascular therapies in patients with coexisting CRSwNP and heart disease. This review critically evaluates emerging evidence of potential interference with post-infarction myocardial repair and highlights the importance of a multidisciplinary approach in managing patients with coexisting inflammatory and cardiovascular diseases. The aim of this review is to explore the available data on the cardiovascular impact of dupilumab and to provide possible future perspectives. Full article

Background: Current recommendations for infant weaning suggest the early introduction of solid and diverse foods. Although homemade meals are advisable, there is a demand for commercially available complementary foods (CACFs), and the information present on their labeling influences caregivers’ choices. The aim of this study was to evaluate recommended-age-of-introduction labeling of CACFs in the Portuguese market, in light of current guidelines for complementary feeding. Methods: Between November and December 2025, labels of all CACFs found in infant feeding sections of 13 Portuguese grocery retailers were analyzed. Milk formulas, powders, products for children over 15 months, and those for children with food allergies or intolerances were excluded. Results: Of the 539 products analyzed, 458 showed a recommended age for introduction, ranging from 4 to 12 months, with significant variability being observed between food categories. Significant variability was also observed in the recommended age for introduction depending on whether major allergens were present. Conclusions: The results of our study identified an age-segmented approach to complementary feeding recommendations in CACF labeling, not reflecting current infant feeding guidelines that support complementary feeding. Our results reinforce the need for more support from scientific evidence and health guidelines in food availability and marketing. Full article

(1) Allergic rhinitis (AR) is a chronic inflammatory condition of nasal mucosa that impairs quality of life (QOL). Beyond pharmacological treatments, some patients seek non-pharmacological options due to side effects or incomplete symptom control. Allerspray-G (AAG) is a barrier-forming Class IIa medical device (Medical Device Regulation (MDR) 2017/745) designed to reduce allergen contact and alleviate AR symptoms. This study evaluated the safety and efficacy of AAG in adults with AR in a real-life post-marketing setting through an open-label, single-center investigation using a two-stage Fleming design. (2) Tolerance was the primary outcome, assessed through the monitoring of adverse events. Secondary outcomes included efficacy measures, evaluated using the Total Nasal Symptom Score (TNSS) and patient-reported QOL outcomes. (3) In total, 20% reported a possible or probable event related to AAG, with all being mild. The TNSS decreased significantly from baseline (mean change: −1.94, p < 0.001), and 73.3% achieved a ≥30% reduction. Significant improvements were also observed across all QOL domains (p < 0.05). (4) AAG was safe, well tolerated, and improved nasal symptoms and QOL, supporting its use as a non-pharmacological option for symptom relief in allergic rhinitis. These findings are consistent with and further reinforce results from the initial 2017 clinical study. Full article

Urticaria is a mast cell-mediated disorder commonly encountered in women of reproductive age, making its interaction with pregnancy clinically relevant. Gestation induces profound hormonal and immunologic adaptations—including shifts between Th1/Th17 and Th2/Treg responses and sustained exposure to sex steroids and placental hormones—that can modulate mast cell reactivity. As a result, chronic urticaria (CU) shows heterogeneous behavior during pregnancy: approximately half of patients improve, one third worsen, and the remainder remain stable. Pregnancy also presents several urticaria-like dermatoses, notably polymorphic eruption of pregnancy (PEP/PUPPP), atopic eruption of pregnancy (AEP) and pemphigoid gestationis (PG), as well as rare hormone-induced hypersensitivity reactions. Additionally, systemic disorders such as intrahepatic cholestasis of pregnancy (ICP), chronic kidney disease–associated pruritus and urticarial vasculitis may mimic urticaria but differ markedly in prognosis, maternal–fetal risk and management. Given this complexity, accurate diagnosis requires integration of temporal pattern, lesion morphology and duration, distribution, systemic features and targeted investigations, as outlined in the diagnostic algorithm proposed. Most pregnancy-specific eruptions are benign, whereas PG, ICP and urticarial vasculitis warrant prompt recognition due to potential fetal implications. Management of CU in pregnancy generally follows standard guidelines, with second-generation H1-antihistamines as first-line therapy and omalizumab reserved for severe refractory cases. Full article

Introduction: The potential role of food hypersensitivity in the insurgence of inflammatory activity in arthritis such as Rheumatoid Arthritis (RA) has received intermittent attention, also supported by theoretical links involving mucosal immunity, mast-cell activation, and microbiome–immune interactions. Despite biological plausibility, the clinical significance of dietary antigens in RA remains uncertain. Methods: A systematic review was conducted following the PRISMA guidelines. Searches using PubMed, Scopus, and Web of Science identified studies exploring dietary interventions or food hypersensitivity in RA. Eligible articles included clinical trials, case reports, and observational studies, in English or Italian, up to the 10 December 2025. Data extraction and quality assessment were performed using the Newcastle–Ottawa Scale. Results: Eight studies met the inclusion criteria. Findings indicate that elimination or elemental diets occasionally yielded subjective improvements—such as a reduction in pain, morning stiffness, and functional improvements—yet objective inflammatory markers rarely changed. Small, highly selected, cohorts demonstrated immuno-histological alterations, including reduced mast-cell density, while long-term diets (e.g., gluten-free or vegan) have reduced specific IgG levels without altering radiographic progression. Conclusions: Evidence suggests that dietary interventions may offer symptomatic relief only in a minority of RA patients. Due to methodological constraints, inconsistent outcomes, and limited applicability to contemporary treatments, dietary approaches need further exploration and investigation. Rigorous trials in modern cohorts are warranted to clarify whether food hypersensitivity meaningfully influences RA pathophysiology. Full article

Penicillin allergy delabelling improves patient outcomes, reduces healthcare costs, and supports antimicrobial stewardship. While PADL protocols (PADL-P) are increasingly used in clinical practice, the consistency of Australian PADL-Ps and their alignment with established guidance remain unclear. A cross-sectional study (from June to August 2025) identified Australian PADL-Ps through organisational and professional outreach, the literature, and structured internet searches. Protocol features were extracted iteratively and deductively. Citation counts and overlap were determined using the Graphical Representation of Overlap for OVErviews (GROOVE) methodology. Protocols were applied to 20 validated penicillin allergy scenarios, and the Australasian Society for Clinical Immunology and Allergy (ASCIA) Consensus Statement for the Management of Suspected Penicillin Allergy and risk alignment were compared. Fifteen Australian PADL-Ps were identified. They shared similar features; however, differences were observed in the no/low-risk criteria and subsequent delabelling actions. Protocols cited a mean of nine references (mean of 4.7 (43.9%) unique), with one protocol citing no references. When applied to clinical scenarios, protocol-assigned risk did not consistently align with the ASCIA risk classification (54.6% of adult and 77.8% of paediatric protocols assigned scenarios to the same risk level). Adult protocol alignment was lowest for no-risk (31.9%) and low-risk (50.0%) scenarios and highest for moderate-risk scenarios (78.8%), whereas paediatric protocol alignment was 33.3% for moderate risk and 100% for low and high-risk scenarios. Although Australian PADL-Ps shared core structural features, incongruencies in risk criteria and alignment with established guidelines may result in different clinical outcomes for patients with similar penicillin allergy histories. These findings emphasise the complexity of clinical decision-making around penicillin allergy and suggest a need for standardisation of PADL-Ps to maximise delabelling benefits and safety across Australian healthcare settings. Full article

Background: Dermatitis affecting the earlobe is a highly frequent clinical presentation, predominantly attributed to Allergic Contact Dermatitis (ACD) caused by metallic ions like nickel from earrings. However, a significant subset of patients presents with recurrent eczematous lesions highly suggestive of ACD but with inconclusive or negative patch test results, posing a profound diagnostic and therapeutic dilemma. Objective: This comprehensive review critically evaluates the differential diagnosis of earlobe eczema in the context of negative patch tests. Drawing from a representative case of a 30-year-old female with recurrent earlobe eczema and a strong family history of psoriasis, we explore alternative non-immunological and endogenous mechanisms, specifically Irritant Contact Dermatitis (ICD) and the Koebner Phenomenon on a background of Psoriatic Diathesis. Methods: We performed an extensive review of the current literature focusing on the epidemiology and pathogenesis of metal ACD, non-allergic mechanisms of jewelry-induced dermatitis (ICD), the molecular basis of the Koebner phenomenon, and the clinical overlap between eczema and psoriasis (Eczematous Psoriasis). Results: The localized nature of the inflammation, coupled with the absence of generalized nickel sensitivity, strongly suggests that the mechanical and occlusive trauma from earrings can induce a purely irritant reaction. Crucially, the presence of a familial psoriatic diathesis supports the hypothesis that this local irritation acts as a Koebner phenomenon trigger, leading to an eczematous manifestation of an underlying psoriatic tendency. Conclusions: Not all recurrent eczematous lesions at common contact sites are caused by ACD. Clinicians must adopt an integrated diagnostic approach, factoring in personal and family history alongside patch test results, to differentiate true allergy from ICD and the Koebner phenomenon. This nuanced perspective is vital for providing appropriate counseling (strict jewelry avoidance) and targeted, often steroid-sparing, management (e.g., topical calcineurin inhibitors) for a durable therapeutic outcome. Full article

Food allergy diagnosis remains challenging due to the difficulty of distinguishing true clinical allergy from asymptomatic sensitization. Inaccurate diagnosis may result in unnecessary dietary restrictions, reduced quality of life, or, conversely, failure to identify individuals at risk of severe allergic reactions. This review critically analyzes the efficacy, limitations, and clinical utility of currently available diagnostic tests for food allergy, with particular emphasis on their ability to predict true clinical reactivity. A comprehensive literature review was conducted to evaluate the sensitivity, specificity, and predictive values of both traditional and emerging diagnostic modalities. English-language guidelines, systematic reviews, and key clinical studies published primarily within the past 15 years (up to 2025) were identified through PubMed and Google Scholar. Classic diagnostic tools, including skin prick testing (SPT) and serum-specific IgE (sIgE), were assessed alongside novel approaches such as component-resolved diagnostics (CRD), basophil activation test (BAT), mast cell activation test (MAT), atopy patch testing (APT), cytokine profiling, and omics-based diagnostics. Particular attention was given to how these tests compare with the oral food challenge (OFC), which remains the diagnostic gold standard. The findings demonstrate that while conventional tests offer high sensitivity and are valuable for initial risk assessment, their limited specificity often leads to overdiagnosis. Emerging molecular and cellular assays show improved specificity and functional relevance, especially in complex cases involving polysensitization or unclear clinical histories and may reduce reliance on OFCs in the future. However, accessibility, cost, and lack of standardization currently limit their widespread clinical application. Advances in artificial intelligence and data integration hold promise for improving diagnostic accuracy through enhanced interpretation of complex immunological data. Based on the synthesized evidence, this review proposes an evidence-based, stepwise, and individualized diagnostic algorithm for food allergy. Integrating clinical history, targeted testing, and selective use of OFCs can improve diagnostic certainty, enhance food safety, minimize unnecessary dietary avoidance, and optimize patient outcomes. The review underscores the need for continued research, standardization, and validation of novel diagnostic tools to support personalized and precise food allergy management. Full article

Background: Presence of milk, fruits, eggs, fish, nuts and wheat antigens in the amniotic fluid is described in the literature. Studies show a contradictory relationship between maternal exposure to allergens and early sensitization of the fetus to allergens. Hemochorionic type of the human placenta allows for easier transfer of nutrients and antibodies from the mother’s blood to the fetal circulation through the direct contact of maternal blood with the fetal chorion. During the third trimester of pregnancy, immunoglobulin G (IgG) is actively transferred through the placenta into the fetal via neonatal FcRN receptor (FcRN). In addition, monomeric immunoglobulin E (IgE) cannot cross the placenta Aim: The objective of our study is to track intrauterine sensitization to essential food proteins at birth in umbilical cord blood in mothers with established peripheral blood eosinophilia and in their infants using allergen-specific IgE and IgG. Methods: An observational study was carried out in a cohort of 22 mothers with eosinophilia and their babies. Differences in expression between groups were assessed. Blood samples were collected to determine serum IgE and IgG specific to a set of inhalant and food allergens. Results: We did not find a significant correlation between specific IgE to cow’s milk (p = 0.857), egg white (p = 0.926) and egg yolk (p = 0.096) in umbilical cord blood and maternal blood samples taken immediately before birth. Spearman’s correlation of the specific IgE and IgG in umbilical cord blood showed no dependence between the two variables. In contrast, statistical analysis showed that maternal eosinophilia in peripheral blood could be a risk factor for the development of allergy in the offspring (χ², p = 0.0347). However, given the small number of patients, this claim needs to be confirmed with further studies. Conclusions: Due to the functional immaturity of the developing immune system of the fetus, the generation and maintenance of an independent immune response to allergens are incomplete. Maternal IgG (specific) passes to the baby and high maternal IG to a specific allergen reduces babies IgE production. In addition, low maternal specific IgG may promote IgE production in the baby under the influence of microenvironmental factors (cytokine background). The main limitation of our study is the small number of patients. Further research is needed in this direction to clarify the mechanisms and risk factors for early sensitization in newborns. Full article

Lupin (Lupinus spp.) is increasingly incorporated into processed foods as a gluten-free ingredient and alternative protein source, but it is also a regulated allergen in the European Union due to cross-reactivity with other legumes, especially peanut. Reliable methods for detecting undeclared lupin traces in complex food matrices are therefore essential for consumer protection. In this study, a loop-mediated isothermal amplification (LAMP) assay was developed for rapid and sensitive detection of lupin DNA. Several nuclear and chloroplast regions were evaluated for primer design, and gene encoding the Lup a 1 allergen was selected as the optimal target. Amplification was monitored by real-time fluorescence, agarose gel electrophoresis, and visual colorimetry. The selected primer set achieved a detection limit of 25 pg of lupin DNA and consistently detected lupin in binary mixtures down to 10 mg/kg, with no cross-reactivity against closely related legumes or tree nuts. Application to processed foods confirmed detection in products declaring lupin and revealed potential undeclared presence in some commercial samples. Colorimetric detection provided reliable results comparable to real-time monitoring, enabling simple readouts without specialized equipment. Overall, the developed LAMP assay represents a rapid, specific, and sensitive alternative to PCR-based methods for allergen monitoring and food safety management. Full article