Honey bee venom (HBV) often triggers severe IgE-mediated allergies. The major allergen icarapin (Api m 10) has attracted attention due to low occurrence in some HBV immunotherapy products. Despite being a major allergen, little is known about the Api m 10 structure and IgE-binding regions. This study aimed to characterize its IgE-binding epitopes and structure in more detail. Overlapping Api m 10-specific peptides covering the sequences of the 11 known Api m 10-isoforms and variants were synthesized and spotted on microarray slides (15 amino acids (AA), off-set: 4 AA). Sera from 28 HBV-allergic patients with detectable Api m 10-specific IgE were used to characterize the distinct IgE-binding profiles to all Api m 10-variants. Sera from ten Api m 10-immunized BALB/c mice were used to investigate possible shared epitopes between humans and mice. All Api m 10-variants were investigated for secondary structural elements via circular dichroism spectroscopy and potential aggregation via dynamic light scattering. We identified 7 different linear IgE-binding motifs. All 28 patients' sera displayed IgE-binding to one specific area (present in Api m 10-isoforms 1 and 2 and putative splice variants 3, 4, 6), indicating a major IgE-epitope. IgE-inhibition provided evidence that the major epitope makes up less than 50% of the total IgE-binding capacity, suggesting that additional (most likely conformational) IgE-epitopes play an important role in Api m 10-sensitization. Api m 10-specific murine IgG and human IgE both predominantly bind to seven different AA-motifs, of which six are identical between both species. Api m 10-isoforms 1 and 2 displayed secondary structural elements and appeared to be aggregated. The structural, clinical and preclinical insights into Api m 10 and its immunodominant epitopes gained in this study provide substantial insights for the future development of active and passive VIT as well as further treatment approaches.

Allergic rhinitis (AR) and asthma caused by cat dander have a highly variable prevalence across countries, which can reach 30% of the population in some regions. Cat allergens are widely distributed in the environment, making exposure nearly unavoidable, even in non-cat-owning households. Eight cat allergens have been identified, with Fel d 1 and Fel d 4 being particularly associated with the development and severity of asthma. Symptoms can range from mild nasal and eye symptoms to severe asthma exacerbations, with many patients experiencing polysensitization to other allergens. Management usually begins with allergen avoidance and pharmacotherapy, but these approaches are often insufficient. Allergen immunotherapy (AIT), both sublingual (SLIT) and subcutaneous (SCIT), offers a disease-modifying strategy, though allergen potency, composition, standardization issues, and low prescription rates limit its use. AIT formulations that include allergens beyond Fel d 1, such as Fel d 4, show promise in improving cat-induced asthma and rhinitis outcomes. Additionally, novel approaches for antigen presentation or combination therapies with monoclonal antibodies may enhance the effectiveness and safety of AIT. To increase treatment success, personalized care using component-resolved diagnostics to identify sensitization profiles and better education for both physicians and patients are essential in the broader adoption of cat AIT.

Adrenaline auto-injectors (AAI) are underused to treat anaphylaxis. New adrenaline devices are currently under investigation or have been recently marketed. This survey aimed to assess the perspectives from allergy-trained physicians regarding the AAI use and their expectations about new adrenaline devices. This electronic survey was created by the European Anaphylaxis Registry and Allergy-Vigilance Network. It was proposed to their participants (March-April 2025) who were asked to rank their responses on a 11-point Likert scale (0: 'not important' to 10: 'very important'). Results are presented as median with interquartile range. One hundred and seventy-five physicians (allergists, 59.4%) participated in this survey. There were only few barriers to AAI prescriptions. Up to 65% of participants estimated the following features as very important for new adrenaline devices: prolonged shelf life (9 [7-10]), improved storage conditions (9 [5-9]), detailed pharmacokinetic-pharmacodynamic data (8 [7-10]), optimised dose ranging (8 [7-10]), availability in public spaces (8 [7-10]), devices easy to carry (8 [7-9]), needle-free device (8 [6-10]). A history of anaphylaxis treated with >1 adrenaline injection (7 [4-9]) or admitted to intensive care unit (7 [3-8]) were reported as the most important barriers to use new adrenaline devices. 75% of participants felt that recommendations from allergy societies and more clinical data are important measures to reduce barriers to new adrenaline devices. Our data provide insights from allergy-trained physicians into AAI limitations and expectations on new adrenaline devices. To advance them, input from allergy societies and more clinical data from anaphylaxis patients are needed.

In the randomised, controlled study Probiotics in the Prevention of Allergy amongst Children in Trondheim (ProPACT), maternal probiotics given from 36weeks pregnancy until 3months post-delivery while breastfeeding reduced atopic dermatitis (AD) in the offspring. Previous analysis of T helper (Th) subsets indicated that the preventive effect may be partially mediated through reduced Th22 percentage at 3months of age. To examine the longitudinal effects of maternal probiotics on Th1, Th2, Th17, Th22, and regulatory T cells (Treg) in offspring at 10days and 2years of age compared to the previously published 3months results. Pregnant women (n=415) were randomised to take probiotic milk (Lacticaseibacillus rhamnosus GG, Bifidobacterium animalis subsp. lactis Bb-12 and Lactobacillus acidophilus La-5) or placebo, and their offspring were assessed for AD at 2years. We analysed the children's blood collected at 10days (n=112) and 2years (n=156) for Treg and Th subsets using flow cytometry and included the results from the previously analysed 3months samples (n=76) in the same study to compare the three timepoints using linear mixed models. There were no statistically significant differences between T cell populations of the children in the probiotics and placebo groups at 10days and 2years. We previously observed reduced Th22 percentage in the probiotics group at 3months. However, since the effect was not seen earlier and did not last, it may not be the main reason for AD prevention.

Hereditary angioedema (HAE) is a rare inherited disorder characterized by unpredictable and potentially life-threatening attacks of swelling. This international Delphi panel aimed to address questions related to on-demand treatment of HAE attacks. A modified Delphi method was conducted with three rounds of surveys. Two non-voting co-chairs designed and managed the surveys, data collection, and analysis with a third-party administrator. The international panel consisted of 19 expert HAE clinicians. Consensus was defined as ≥75% agreement with ≥75% of panelists voting. The panel confirmed 24 statements across five key areas related to on-demand treatment: defining "early" treatment, barriers to early administration, burden of treatment, tolerability and convenience, and patient-clinician interactions. Panelists defined early treatment as ≤60min after onset of an HAE attack. Obstacles to early treatment include recognition of an HAE attack, and embarrassment/anxiety about administering parenteral treatment. Access to on-demand treatment (i.e., carrying medication, cost, insurance coverage, regulatory approval) can be a burden for patients with HAE, and increasing access may improve adherence to guidelines. Logistical obstacles of parenteral administration that impact convenience, tolerability concerns (e.g.,side effects), and cost of medication can all limit early use of on-demand treatment. Additional options for on-demand therapies beyond parenteral treatments could reduce some of the burdens. Panelists agreed that patient-physician shared decision-making should be utilized. The Delphi consensus statements demonstrate the need for accessible and convenient on-demand treatments for HAE attacks that will enable patients with HAE to improve adherence to guidelines.

Food allergy (FA) in early childhood can be challenging for families, even before a diagnosis is made, as parents often experience anxiety and have to change their routines. Research integrating parental and pediatrician perspectives during the pre-diagnostic phase is scarce. This study aimed to develop a journey map illustrating the FA pre-diagnostic process in early childhood from both perspectives. We triangulated 30 transcripts (16 parent interviews; 11 interviews and three focus groups with pediatricians) from two qualitative studies within the Food Allergy Biomarker Application Consortium (NAMIBIO App) using qualitative content analysis and data visualization. Four phases emerged: (non-)awareness, suspicion, healthcare seeking, and diagnostics. Parents were often unaware of FA risks, even with risk factors present. Pediatricians hesitated to address FA risk proactively, due to lacking specific guideline recommendations and concerns about triggering parental health-related anxiety. Both parents and pediatricians mentioned gaps in communication between pediatricians and midwives. During the suspicion phase, families searched for information or adjusted feeding practices while symptoms were often vague. Healthcare seeking often involved lengthy referrals. Pediatricians reported knowledge gaps among colleagues regarding FA. In the diagnostic phase, parents perceived delays in diagnosis; pediatricians mentioned limited resources, particularly for oral food challenges. Integrating both perspectives revealed shared concerns and different views on how to improve the process. Key intervention points to improve the pre-diagnostic process include clear, up-to-date guidelines, risk communication and improved interdisciplinary collaboration to reduce uncertainty and promote parental confidence.

ABSTRACTBackgroundJapanese cedar (JC) pollen sublingual immunotherapy (SLIT)‐tablets (5000 Japanese allergy units [JAU]) are licensed for the treatment of JC‐pollinosis with no age restriction on the basis of the results of a 5‐year clinical trial. However, there have been no large‐scale surveys of 5000 JAU in an actual clinical setting.MethodsThis was a multicenter observational prospective study. We assessed the safety and effectiveness of the long‐term use of 5000 JAU in patients with JC‐pollinosis, with an observation period of two seasons of JC pollen dispersal, at clinical sites in Japan.ResultsOur safety analysis included 516 patients and the effectiveness analysis included 469 patients. Adverse drug reactions (ADRs) occurred in 68 patients (13.18%) and mainly comprised administration site‐related events that occurred during the early phase of administration. Treatment discontinuation due to ADRs occurred in 18 patients (3.49%). No deaths, anaphylactic shock, or serious ADRs occurred. Regarding effectiveness, the severity of JC‐pollinosis was rated as “almost asymptomatic + mild” in 82.19% of patients in Season 1 and 92.58% in Season 2. Quality of life was rated as “score 0 (Fine) + 1” in 75.83% of patients in Season 1 and 86.09% in Season 2. Overall improvement was rated as “improved + slightly improved” in 95.68% of patients in Season 1 and 96.38% in Season 2 following the initiation of JC pollen SLIT‐tablets. Nasal and ocular symptom scores also decreased with increasing treatment duration. Treatment continuation rates were 89.53% in Season 1 and 78.29% in Season 2.ConclusionThe JC pollen SLIT‐tablets appear to be safe and effective in an actual clinical setting during two seasons. No new safety or effectiveness issues were identified, and no additional safety or effectiveness precautions were required.