30-Second Takeaway
- Earlier asthma biologic initiation in high‑risk children yields greater exacerbation reduction, independent of specific agent.
- Mepolizumab improves eosinophilia and CT burden in diffuse CRS, with variable symptom response across phenotypes.
- Adult‑onset asthma carries higher multimorbidity and treatment burden than childhood‑onset disease.
- Short‑term air pollution exposures meaningfully increase pediatric asthma risk, with PM2.5–NO2 synergy and emerging genetic mediators.
- Mast cells and epithelial antigen transport remain central, targetable hubs in CSU and food allergy pathogenesis.
Week ending February 21, 2026
Asthma, airway disease, and allergy in 2026: timing biologics, parsing phenotypes, and confronting environment
Earlier pediatric asthma biologic initiation linked to greater exacerbation reduction in high‑risk children
In this retrospective cohort of 122 children with moderate to severe asthma, biologics reduced severe exacerbations by about half (aOR 0.47). Most received dupilumab, followed by omalizumab and mepolizumab, with no significant differences in exacerbation benefit among agents. Benefit was greater with initiation at age ≤11 years and in children with early polysensitization or multiple early‑childhood risk factors. These data support earlier biologic consideration in high‑risk school‑age children rather than delaying therapy until adolescence.
Mepolizumab lowers eosinophils and CT burden in primary diffuse CRS, including CRSsNP
Among 277 adults with primary diffuse CRS treated ≥6 months, mepolizumab significantly reduced serum eosinophils and Lund‑Mackay CT scores. Radiographic improvement was similar in CRSwNP and CRSsNP and independent of prior ESS, supporting an endotype‑driven approach. Symptom and endoscopic gains were modest and inconsistent, and nearly one quarter switched biologics for recalcitrant disease. Clinicians can expect biomarker and CT improvement but should counsel patients about variable symptom response and potential need for ESS.
Mast cell–directed agents broaden options for antihistamine‑refractory chronic spontaneous urticaria
This review underscores CSU as a mast cell–mediated disease involving both IgE‑dependent and non‑IgE pathways. Guidelines still recommend second‑generation H1‑antihistamines first, but many patients have persistent symptoms. Emerging treatments include dupilumab, BTK inhibitors, anti‑KIT antibodies, JAK inhibitors, MRGPRX2 inhibitors, IL‑17 and IL‑5 blockers, and anti‑TSLP antibodies. Mast cell silencers, other pathway‑targeted drugs, and low‑histamine diets are also being investigated for refractory CSU.
Mucus characterized as a treatable trait across chronic airway diseases
This narrative review frames mucus abnormalities as a distinct, modifiable trait in asthma, COPD, bronchiectasis, and cystic fibrosis. It links mucus overproduction, altered composition, and impaired clearance to symptoms, airflow obstruction, exacerbations, and progression. The authors integrate mechanisms, clinical assessment, and biomarkers to support mucus‑focused phenotyping. Targeting mucus burden offers a precision approach that complements traditional disease labels and could improve individual outcomes.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.