With this Synopsis Book, we report on a spectrum of observations and advances that will provide greater understanding of the diagnosis and management of allergic and immunologic disorders impacting children. Reviewers have selected articles that provide clinical “pearls” and insights applicable for daily practice as well as offer data that may lead to new approaches to patient care. In this year’s Synopsis, we also include articles covering the rapid dissemination of knowledge gained regarding coronavirus disease 2019 (COVID-19) as we were globally affected by the challenges of managing a novel pandemic.Allergic disorders affect a large number of children and anaphylaxis remains a focus of ongoing research efforts. In a retrospective study, the authors describe how the rate of hospital admissions for anaphylaxis have significantly increased in the over the 20-year study (1998–2018). Reassuringly, case fatalities rate for food-induced anaphylaxis decreased over that time interval, with peanut and tree nuts noted as the most commonly associated triggers. A sign that anaphylaxis awareness has increased over time is that epinephrine autoinjectors (EAI) prescriptions rose by 11% on a year-by-year basis. However, the impact of increased number of EAIs in the community on anaphylaxis fatality rates is unknown. Furthermore, obstacles remain to caregiver use of EAIs in the setting of severe reactions. Along with previously identified barriers, such as lack of availability and uncertainty of reaction severity, in 1 study, the authors point out that the emotional impacts of witnessing a child’s allergic reactions is a factor to consider.As part of antibiotic stewardship, delabeling of penicillin allergy for many who incorrectly believe they have such a hypersensitivity continues to be a priority. In 1 retrospective study, the authors noted that direct oral challenge without preceding allergy testing can be safe for those with a low-risk history. In 2 studies, the authors performed economic analyses and provide supporting evidence that penicillin allergy evaluation and delabeling is a cost-effective health care practice.Several selected studies were focused on treatments for atopic dermatitis (AD). Caregivers often have concerns about the safety of topical corticosteroids (TCS), leading to undertreatment of their child’s AD. In one study, the authors note that primary care providers also perceive they may be underprescribing TCS for young children, highlighting the need to address TCS hesitancy for both caregivers and health care providers. In a study of crisaborole, a phosphodiesterase 4 inhibitor, the authors add to existing data supporting its efficacy in mild-to-moderate AD. As a nonsteroidal topical agent, crisaborale may be a preferred treatment option for some, especially for those with TCS hesitancy as a potential barrier to care. Although a biological is already Food and Drug Administration approved for AD, development of novel treatments continues. Data from a phase 3 study of nemolizumab (antiinterleukin-31 receptor A monoclonal antibody) in adults and adolescents revealed clinical efficacy in reducing pruritus. Different biologics have been designed to target different drivers of AD; interleukin-31 plays a role in inducing pruritus, so this was the primary outcome of this study.Our reviewers also highlighted multiple studies pertaining to food allergy. Although guidelines for early introduction of peanut allergy to high-risk infants were issued in 2017, implementation is essential for recommendations to impact outcomes. Guideline uptake was examined in a survey study of US allergists. Although guideline awareness was high among participants, concerns about allergic reactions and food challenges as well as reimbursement and liability were identified as barriers. Other potential risk factors for peanut allergy were also investigated. Results from one study support that family history does not predispose a child to peanut allergy, and it is suggested that earlier introduction within the first year of life appears to be more favorable. In other studies, it is suggested that overall increased diversity of the infant diet (introducing more foods in the first year) appears favorable for allergy prevention.Proper management of food allergies requires an understanding of real versus perceived risks for reactions. Results of a retrospective study of airborne challenges to peanut provide reassuring support that this route of exposure is unlikely to trigger significant reactions. A study of food precautionary allergen labeling reinforces that counseling on reading food labels is a key part of patient education and that advocacy to improve labeling requirements may ease the burden on caregivers. As shown in a population-based cohort study of children aged 6 years with food allergy, allergic reactions are common. Thus, education on recognition of signs and symptoms of anaphylaxis remains an integral facet of food allergy management. Identifying that anaphylaxis is occurring can be difficult for caregivers, which can contribute to the underuse of epinephrine autoinjectors for severe reactions. In recent years, oral immunotherapy for food allergy has been the focus of significant research attention. In 2 real-world studies, researchers add further safety and efficacy data and show positive impact on quality of life. Epicutaneous immunotherapy is also in phase 3 trials, and a recently published study reveals that this approach to treatment can be associated with improved quality of life for families living with food allergy.Non-IgE–mediated food allergies are a heterogeneous group of disorders that primarily affect the gastrointestinal tract. These include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome and eosinophilic esophagitis, which are the focus of several reviews in this Synopsis Book. Data from 2 prospective cohort studies suggest that more diagnostic guidance may be beneficial to identify infants with FPIAP. Furthermore, resolution occurs sooner than 1 year of age for many, and reintroduction may be indicated earlier in life, which could mitigate the twofold increased risk for immunoglobulin E–mediated allergy reported for young children with FPIAP. Food protein-induced enterocolitis syndrome is another disorder that requires awareness, and, as one survey-based study reveals, foods less typically seen for immunoglobulin E–mediated allergies (such as oat, rice, sweet potato, and avocado) are often implicated. Similarly, eosinophilic esophagitis can manifest in infants, emphasizing the importance of early recognition and treatment.Our reviewers selected a large number of studies related to asthma, with many focused on risk factors. In several reviews, the authors examined the impact of early-life exposures, including environmental exposures (smoking and pollution) and the microbiome as well as effects of mitigation measures. In a few studies, the authors also highlight the long-term impacts of early-life exposures, with effects on lung function evident well into adulthood.Efforts to improve asthma management are multifaceted. A multicenter national study reveals that implementation of evidence-based clinical pathways for asthma in the emergency department setting can improve quality of care for asthma. Strong partnerships outside the physician office can also support management because studies reveal the benefits of school-based management and community health workers conducting home visits. Novel approaches to support remote monitoring of medication use are also explored. Electronic monitoring of inhaler use may have positive effects on adherence and, thus, asthma control, but further studies will be needed to determine the feasibility of wider use of this type of intervention and its impacts on health care costs and use.Oral corticosteroids are standardly used to treat acute wheezing episodes. In a study, researchers found that, in preschool-aged children presenting with acute wheezing to the emergency department, oral prednisolone may provide short-term benefits, but additional doses do not appear to alter respiratory outcomes at 24 hours or beyond. In contrast, another study reminds us that potential adverse effects (such as gastrointestinal bleed, sepsis, and pneumonia) of oral steroids must be considered when prescribing multiday bursts for children with asthma. Several biologics are now available for pediatric asthma, and 2 studies reveal that omalizumab and mepolizumab, both approved for ≥6 years, are effective in the real-world clinical setting, and home infusions can be done safely in select patients.The immunology section is expanded this year, owing to articles covering COVID-19. Several reviews chronicle the evolving understanding of the immune response against COVID-19 as well as the multisystem inflammatory syndrome that is seen in children. In selected articles on primary immunodeficiency, the authors highlight the success of the newborn screening program in identifying infants with SCID and other severe T-cell immunodeficiencies and that early identification and intervention have resulted in improved clinical outcomes for these vulnerable patients.On behalf our reviewers, we hope that this Supplement provides you practical information to improve the clinical care of children with allergic and immunologic diseases. For additional information about our Section, please visit: http://www.aap.org/sections/allergy/.