Allergy & Immunology

rAsp f component sensitization marks a high-risk bronchiectasis phenotype

In 277 bronchiectasis patients from four countries, sensitization to recombinant Aspergillus fumigatus (rAsp f) components correlated with more severe disease. Responses to rAsp f12, f15, and f17 were linked to hospitalized exacerbations, especially in patients with low baseline exacerbation frequency. Low-risk, rAsp f–sensitized patients showed greater bronchiectasis severity and more bronchiectasis–COPD overlap than non-sensitized peers. Polysensitization to these components further increased severe exacerbation risk, with the worst outcomes in sensitized Asian patients. These findings support component-resolved A. fumigatus testing to identify a high-risk, potentially treatable bronchiectasis endotype. 1

Hic-5–mediated mechanotransduction sustains bronchoconstriction via endothelin-1

Mechanical compression of human airway epithelium upregulated Hic-5 in basal cells, modeling bronchoconstriction-induced stress in asthma. Reanalysis of single-cell RNA-seq from allergen-challenged asthmatics confirmed increased Hic-5 expression in airway basal cells in vivo. Hic-5 knockdown attenuated mechanotransduction responses, including stress fiber formation, gene-expression changes, and endothelin-1 secretion. The data support a Hic-5–driven feed-forward loop where epithelial endothelin-1 release perpetuates bronchoconstriction. Targeting Hic-5 or downstream endothelin-1 could complement anti-inflammatory therapy by interrupting mechanically driven airway narrowing. 2

Psychological and system factors shape adherence to asthma biologics

This scoping review included 14 studies (2018–2025) examining biopsychosocial determinants of adherence to asthma biologics. Reported adherence was generally moderate to high, but varied substantially across agents and settings. Financial and system barriers included high out-of-pocket costs, complex insurance procedures, and limited specialist access. Clinically, patients with milder symptoms or low perceived treatment benefit were more likely to discontinue biologics. Psychological factors—fear of injections, illness denial, depression, and stigma—repeatedly hindered adherence, whereas perceived efficacy and supportive care facilitated it. The authors advocate integrating psychological assessment, education, and system-level support into biologic care pathways. 3

Systemic targeted atopic dermatitis therapy: progress and persistent gaps

This narrative review summarizes how JAK inhibitors and IL-4/IL-13 blockers have transformed systemic therapy for moderate-to-severe atopic dermatitis. Despite improved clearance rates, many patients still lack stable disease control, remission, or adequate relief from chronic pruritus. Unmet needs include management of nonresponders, partial responders, and long-term safety and duration strategies for targeted agents. Future directions include dual or multitarget drugs, longer-acting and more convenient formulations, and reduced dosing frequency. The authors emphasize integrating patient-reported outcomes to better capture pruritus, sleep disturbance, and real-world burden. 4