Allergy & Immunology

Systematic review quantifies childhood food allergy incidence and key risk factors

Across 190 studies including 2.8 million children, challenge-confirmed food allergy incidence to age 6 was about 4.7% (moderate-certainty). Early-life atopic conditions were strong predictors: eczema in the first year (OR 3.88; RD 12.0%), allergic rhinitis (OR 3.39; RD 10.1%), and wheeze (OR 2.11; RD 5.0%). Markers of impaired skin barrier, including increased transepidermal water loss (OR 3.36; RD 10.0%) and filaggrin variants (OR 1.93; RD 4.2%), substantially increased risk. Delayed solid food introduction, such as peanut after 12 months (OR 2.55; RD 6.8%), and infant antibiotic exposure were associated with higher food allergy risk. Family history, male sex, firstborn status, parental migration, and Black self-identification were additional risk factors with modest to moderate risk differences. 1

Network meta-analysis suggests dupilumab has lowest asthma and rhinitis risk in AD RCTs

This network meta-analysis of 26 RCTs (13,069 atopic dermatitis patients) compared asthma and allergic rhinitis events with biologics and JAK inhibitors. Compared with nemolizumab 90 mg, dupilumab 300 mg reduced asthma risk (RR 0.1; 95% CI 0.01–0.93), as did tralokinumab 150 mg (RR 0.03; 95% CI 0–0.77). SUCRA rankings suggested tralokinumab 150 mg had the lowest asthma-related adverse event probability, whereas ISB 830 600 mg ranked worst. For allergic rhinitis, dupilumab 200 mg ranked safest (SUCRA 93.8%), while abrocitinib 100 mg had the highest incidence (SUCRA 10.3%). Cluster analysis indicated dupilumab 200 mg offered the lowest combined asthma and rhinitis risk, though dose–age–severity confounding precludes dose-specific guidance. 2

Prenatal PFAS exposure, potentiated by PM2.5, increases childhood respiratory allergic disease

In 4,166 Shanghai mother–child pairs, 23.9% of children developed respiratory allergic disease by age 8, including asthma and allergic rhinitis. A doubling of maternal PFOA concentration in early pregnancy was associated with higher respiratory allergic disease risk (aOR 1.21; 95% CI 1.03–1.41). The molar sum of five carboxylate PFAS showed a similar association (aOR 1.21; 95% CI 1.03–1.42), implicating PFAS mixtures. Higher prenatal PM2.5 strengthened PFAS effects, with a significant interaction for PFOA and allergic rhinitis (aOR 1.35; 95% CI 1.07–1.72). These findings support efforts to reduce pregnant patients’ PFAS and particulate exposures to mitigate pediatric allergic airway disease burden. 3