30-Second Takeaway
- Use baseline blood eosinophils to individualize systemic steroid duration in hospitalized asthma without early loss of control.
- Consider mepolizumab as a steroid-sparing option for hypereosinophilic syndrome with high remission and eosinophil reduction rates.
- Cold-triggered asthma likely involves epithelial TRPA1–TSLP–ILC2 pathways, suggesting upstream targets beyond bronchodilators.
- Alpha-gal syndrome illustrates expanding, tick-driven food allergy with delayed reactions and complex effector-cell biology.
- Preclinical IgE vaccines and engineered AIT platforms point toward longer-acting, tolerance-focused allergy interventions.
Week ending December 6, 2025
Asthma, Allergy, and Anaphylaxis: From Biomarker-Guided Steroids to Next-Generation Immune Modulation
Eosinophil-guided systemic steroid duration appears safe in hospitalized adult asthma
Adults hospitalized with asthma exacerbations were randomized to usual 5-day prednisolone or eosinophil-guided duration using a 300 cells/µL cut-off. Treatment failure rates were similar and met the non-inferiority margin, despite shorter courses in non-eosinophilic patients. Non-eosinophilic exacerbations in the eosinophil-guided arm received substantially lower cumulative steroid doses than eosinophilic exacerbations. Asthma control, additional steroid bursts, and time to next exacerbation over one year did not differ between strategies.
IgE-kinoid vaccination confers durable protection from anaphylaxis in humanized mice
A kinoid vaccine coupling human IgE Cε3-4 domains to CRM197 induced robust neutralizing anti-IgE antibodies in IgE/FcεRI-humanized mice. Neutralizing anti-IgE persisted for at least 12 months with avidity comparable to omalizumab and no reported adverse signals in this model. Vaccinated mice were protected against both IgE-mediated cutaneous and severe systemic anaphylaxis challenges. These findings suggest that active vaccination against IgE can provide long-term functional IgE suppression in vivo.
Real-world mepolizumab shows high remission and steroid-sparing in hypereosinophilic syndrome
This scoping review summarized 36 real-world reports including 105 glucocorticoid-experienced hypereosinophilic syndrome patients treated with mepolizumab. Across heterogeneous doses and schedules, clinical remission rates ranged from 57.1% to 76.0%. Most studies reported 71.4% to 99.1% reductions in mean blood eosinophil counts on treatment. After 12 months, 85.7% of patients discontinued glucocorticoids, and severe adverse events were rare.
Climate change projected to worsen allergic rhinitis and sinusitis via pollen and pollution
This JAMA Insights article reviews how climate change may increase incidence and severity of allergic rhinitis and chronic rhinosinusitis. Warming and altered seasons are expected to extend pollen seasons and increase airborne allergen loads. Climate-driven changes in air pollution may further aggravate upper airway inflammation and symptom burden. The article underscores roles for anticipatory counseling, mitigation strategies, and clinician advocacy on climate-related health risks.
References
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Additional Reads
Optional additional studies from this edition.