Ocular surface and systemic responses to repeated carbon black exposure across different durations in a rat model.

B cell development and longevity of IgE plasma cells.

Severe uncontrolled asthma (SUA) represents a complex and heterogeneous form of asthma that persists despite treatment. Allergic immunoglobulin E (IgE)-mediated SUA can be treated with tezepelumab or omalizumab. The aim was to estimate the cost-effectiveness of tezepelumab compared to omalizumab in the treatment of patients with allergic SUA, from the perspective of the Spanish National Health System (NHS). A Markov model was developed with a time horizon of 60 years, 28-day cycles, and five health states: controlled asthma; uncontrolled asthma; controlled asthma with exacerbation; uncontrolled asthma with exacerbation; and death. The efficacy parameters of the model were based on the NAVIGATOR and SOURCE clinical trials for tezepelumab and standard therapy, and on a network meta-analysis for omalizumab. Utilities and disutilities were extracted from NAVIGATOR and SOURCE and from the literature. The model considered direct costs (€, 2025): pharmacological, administration, exacerbations, disease management, and adverse events arising from oral corticosteroid use, obtained from Spanish data sources. Incremental costs per quality-adjusted life-year (QALY) gained were estimated for tezepelumab compared to the 106 omalizumab dosing profiles defined by weight and IgE. The results were contextualized to the Spanish setting using weight and IgE data obtained from the Primary Care Clinical Database and the literature. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed. Tezepelumab was cost-effective compared with omalizumab (450 mg/4 weeks;incremental cost-effectiveness ratio €17,213.44/QALY), considering a willingness-to-pay threshold of €30,000/QALY, and was dominant (more effective and less costly) at higher doses. This represents 69.81% of the dosing profiles and 53.47% of the population with allergic SUA in Spain. The DSA confirmed that tezepelumab was cost-effective compared to omalizumab (450 mg) despite the variations in the parameters used. Tezepelumab was cost-effective or dominant in 80.00% of the PSA simulations. In this analysis, tezepelumab was a cost-effective option compared with omalizumab (≥450mg/4weeks) for the treatment of patients with allergic SUA aged 12years and older from the perspective of the Spanish NHS.

Idiopathic anaphylaxis (IA) is a diagnosis of exclusion, and the etiology remains elusive. Research on immunoglobulin E (IgE)-mediated anaphylaxis has identified histamine as the immune system mediator, but dietary histamine's potential role in IA is often overlooked. For some individuals, excessive histamine may cause IA and mimic signs and symptoms of IgE-mediated anaphylaxis.1 This review provides an overview of IA and the potential role of histamine in symptom manifestation. It aims to enhance awareness and provide nurse practitioners with insights into the complexities of managing IA, emphasizing the importance of considering dietary factors in patient care and treatment strategies.

Background: Reliable biomarkers that predict delayed treatment-free remission with omalizumab in chronic spontaneous urticaria (CSU) remain unclear. Objective: The objective was to identify independent predictors of delayed treatment-free remission with omalizumab by comparing patients who achieved treatment-free remission with ≤ 12 doses with those who required > 12 doses. Methods: This single-center retrospective study included 163 adult patients with antihistamine-refractory CSU who were treated with omalizumab (300 mg every 4 weeks) between January 2018 and October 2025. Treatment discontinuation was considered only after at least six consecutive doses and complete disease control, defined as a urticaria control test (UCT) score of 16 with no wheals or angioedema. Treatment-free remission was defined as a symptom-free period of at least 6 months without pharmacotherapy after discontinuation. Patients were classified as having early remission (≤12 doses) or delayed remission (>12 doses). Demographic, clinical, and laboratory variables were compared, and multivariable logistic regression was performed. Results: Of the 163 patients (median age, 41 years; 60.1% women), 99 (60.7%) had delayed remission and 64 (39.3%) had early remission. Delayed remission was associated with a higher prevalence of autoimmune disease in the delayed remission group than in the early remission group (27.3% versus 12.5%; p = 0.025) longer symptom duration before omalizumab initiation (p < 0.001), and higher baseline total immunoglobulin E (IgE) levels (p < 0.001). In multivariable analysis, longer pretreatment symptom duration (odds ratio [OR] 1.023 [95% confidence interval {CI}, 1.009-1.038]; p = 0.002) and autoimmune disease (OR 2.984 [95% CI, 1.130-7.882]; p = 0.027) independently predicted delayed remission, whereas the total IgE value did not (p = 0.070). Conclusion: Longer pretreatment symptom duration and coexisting autoimmune disease were the strongest independent predictors of delayed treatment-free remission with omalizumab in CSU.

Background: Chronic spontaneous urticaria (CSU) significantly impairs patient quality of life (QoL) through recurrent wheals and pruritus. The urticaria activity score over 7 days (UAS7) and the chronic urticaria quality of life questionnaire (CU-Q2oL) are validated patient-reported outcome measures recommended by international guidelines for monitoring CSU. Whether these two measures track in parallel over a structured treatment course, particularly as disease activity diminishes, remains incompletely characterized, especially in South Asian populations. Methods: A 6-month prospective observational study was conducted at a tertiary-care dermatology center in India. Fifty adult patients with active CSU were enrolled. All received second-generation H1-antihistamines (cetirizine, levocetirizine, or fexofenadine) with dose up-titration up to fourfold as needed per international urticaria guideline recommendations guideline recommendations. No patients required omalizumab during the study period. The UAS7 and CU-Q2oL scores were recorded at baseline and monthly for 6 months. Baseline total serum immunoglobulin E (IgE) values and absolute eosinophil counts (AEC) were correlated with the clinical scores. Statistical analysis included Wilcoxon signed rank tests for longitudinal change and the Spearman rank correlation at each time point. The sample size was based on clinical feasibility; the study is considered exploratory. Results: The mean ± standard deviation baseline UAS7 score was 30.3 ± 9.1 (severe disease), and the mean ± standard deviation CU-Q2oL score was 51.4 ± 13.2. Both scores improved significantly by 6 months (UAS7 score: 5.1; CU-Q2oL score: 12.5; p < 0.0001 for both). The UAS7-CU-Q2oL correlation was moderate when the disease was active (Spearman r = 0.44, p = 0.002 at 1 month) but weakened substantially as disease activity declined (r ≈ 0.25, p = 0.08 at 3 months; r ≈ 0.08, p > 0.5 at 6 months). Baseline total IgE value and AEC did not correlate with disease severity or QoL at any time point. Conclusion: UAS7 and CU-Q2oL scores correlate during active CSU but diverge as disease is controlled. Even after symptom resolution, some patients retain residual QoL impairment. Routine use of both measures is recommended because UAS7 alone may underestimate the patient burden during remission. The total IgE value and AEC are not reliable surrogate markers of CSU severity or QoL in this exploratory cohort.

Background: Pumpkin seed allergy is a rare but potentially severe immunoglobulin E (IgE) mediated food allergy, with limited pediatric data and few documented cases worldwide. Objective: To describe the clinical and diagnostic characteristics of pediatric pumpkin seed allergy and to synthesize all previously reported cases through a systematically searched narrative review. Methods: We retrospectively reviewed the records of children diagnosed with IgE-mediated pumpkin seed allergy at a tertiary pediatric allergy clinic in Turkey (2016-2024). The diagnosis relied on the clinical history, specific IgE (sIgE), and skin-prick tests (SPT); patients in select cases had oral food challenges. Data on clinical presentation, comorbidities, co-allergies, and laboratory findings were extracted. A structured literature search of medical literature data bases identified all published cases of patients with pumpkin seed allergy, which were qualitatively reviewed. Results: Twenty-five children (76% boys) were identified, with a median diagnosis age of 2.98 years. Immediate reactions were universal, and anaphylaxis occurred in 64%. The median SPT wheal was 13 mm, and the median sIgE level was 10.3 kUA/L. Atopic comorbidities were frequent (atopic dermatitis, 92%; asthma, 48%). Co-allergy was common (tree nuts, 76%; other seeds, 72%); watermelon seed sensitization occurred in 83%, with six patients experiencing clinical reactions after watermelon seed ingestion. Pumpkin pulp was tolerated in all the patients. A literature review revealed 14 previously published cases, mostly adults, with 57% experiencing anaphylaxis. Conclusion: Pumpkin seed allergy, although uncommon, frequently causes systemic reactions in children. Our case series underscores the need for clinician awareness, diagnostic inclusion of pumpkin seed in high-consumption regions, and further research into its molecular allergens and cross-reactivity.

Background: Although disparities in food allergy (FA) related emergency department (ED) use exist, social context factors are understudied and may play an important role. Objective: We sought to evaluate the role of food security and community resources in explaining disparities in FA-related ED usage. Methods: Electronic medical record data from Hasbro Children's Hospital's FA clinic were extracted from January 1, 2016, to December 31, 2021, for children ages < 18 years. Diagnostic classification codes and chart reviews were used to identify encounters with immunoglobulin E (IgE) mediated FA-related diagnoses. We evaluated the differences in FA-related ED use by age, race and/or ethnicity, community resources (Child Opportunity Index [COI]), and the percentage of households in the census tract that receive Supplemental Nutrition Assistance Program (SNAP) benefits. Logistic regression was performed to identify predictors of FA-related ED use. Results: A total of 1,512 children were seen at the FA clinic for IgE-mediated FA. Those who used the ED for FA were non-Latino White (NLW) (16.1%), Black (22.0%), Latino (23.1%), and Other (23.5%) (standardized mean difference [SMD], 0.10; p < 0.05). The risk of FA-related ED visits differed by age, with fewer visits for older children (odds ratio [OR], 0.7), and by social economic and neighborhood environment variables, with a lower risk of ED visits for more resourced environments (ORs for public insurance, 1.57; OR for SNAP, 1.19; and OR for COI, 0.80). Disparities in ED usage became negligible for patients already connected to routine allergist care, which demonstrated a potential protective factor. Conclusion: Black and Latino children have an increased risk for FA-related ED visits compared with NLW children, although social contextual factors explained most of the disparities. Analysis of the findings demonstrates the need to consider the social economic and neighborhood environment in FA management to inform place-based interventions.

The presence of serum immunoglobulin E (IgE) antibodies to the oligosaccharide galactose-alpha-1,3-galactose (α-gal) was first recognized during the investigation of allergic reactions to the monoclonal antibody cetuximab. The availability of an assay for IgE to α-gal made it possible to show that the patients who reported delayed allergic reactions to meat also had IgE to α-gal. This syndrome of delayed reactions to meat in patients with IgE to an oligosaccharide that was present in nonprimate mammals represented a complete contrast to the other forms of food allergy. However, the realization that the sensitization resulted from bites of the lone star tick, Ambloymma americanum, provided an explanation for the increase in cases in an area of the United States where there had been a major increase in the deer population, which is the primary breeding host of this tick. In contrast to almost all other IgE-mediated reactions, there is no relationship between the delay after eating red meat and the severity of allergic reactions. There is also increasing evidence that serum tryptase in the range of 20-90 ng/mL can occur after severe reactions related to α-gal. In addition, a recently reported fatal anaphylaxis, which started 4 hours after the individual ate a hamburger, included a postmortem tryptase of >2000 ng/mL. A working hypothesis to explain the delay in reactions relates to the time taken to process glycolipids in food derived from mammals, first into chylomicrons and, finally, to low-density lipoproteins. However, the quantitative presence of α-gal that remains on these particles may have major individual differences. In contrast to the patients who have symptoms related to eating meat, there are many individuals who are sensitized and who are not aware of any symptoms. In addition, individuals who are sensitized to alpha-gal can react rapidly to intravenous injections to the monoclonal antibody cetuximab, or polyclonal antibodies to venom, or the newer antivenom digested to Fab or Fab'2.

Specific anti-staphylococcal enterotoxin B IgE levels in intensive care COVID-19 patients.

Long-term changes in lung function in children with symptom control asthma are rare. To assess the trajectory of pulmonary function in children and analyze the influence factors. The effects of gender, age, Body Mass Index (BMI), Immunoglobulin E (IgE), eosinophil count, Fractional exhaled Nitric Oxide (FeNO), and so on on pulmonary function pattern were analyzed. Among the 1931 children, three predicted FEV1 trajectory clusters were identified: downward trend followed by an upward trend (34.96%), downward trend but close to average (32.88%) and continuous downward trend (32.16%). Among the three different trajectories, the first, second, and third clusters had 432 (7.22%), 210 (3.96%), and 327 (3.12%) detections were below the cut point, respectively. And they differed according to the level of FeNO, the count of lymphocyte, interval between diagnosis of asthma and first onset and onset age at enrollment. For FEV1/FVC% pred, 1633 /1931(84.57%) children showed a saddle-shaped form: a gradual rise at first, then a large fluctuation, and finally returned to normal. Other 298 (15.43%) children showed a gradual continuous upward trend. Among the 1858 patients completed of MEF25% pred, 377 (20.29%) had a higher MEF25% pred, 419 (22.55%) children had a trajectory that near the average level, and 1062 (57.16%) children had a trajectory below the average and then catch up at last. Multiple logistic analysis showed that BMI, lymphocyte count, FeNO, time interval of delayed diagnosis and onset age were associated with the change of lung function. Some children with symptom controlled asthma showed a continuous decline in lung function. The decrease of lung function was closely related to BMI, lymphocyte count, FeNO, time interval of delayed diagnosis and onset age.

Allergic disorders, including food allergy, asthma, and atopic dermatitis, affect an estimated 10-30% of the global population, with prevalence continuing to rise in industrialized countries. Allergy is driven by dysregulated type 2 T-helper cells (Th2) and immunoglobulin E (IgE) antibody responses. A range of diagnostic tools is available, but most methods are limited by variable sensitivity and specificity, and the inability to predict clinical reactivity. Although allergen-specific immunotherapy (AIT) remains the only etiological therapeutic method for allergic disorders, conventional AITs are limited by frequent administration, risk of adverse events, suboptimal patient adherence, and inconsistent long-term efficacy. Advances in nanotechnology offer emerging opportunities for improving allergy diagnosis and treatment through enhanced analytical sensitivity, targeted allergen delivery and controlled immune modulation. This review provides a comprehensive overview of the latest research on nanomaterials, including their application in nanomaterials-based diagnostic systems and nano-enabled immunotherapies. We highlight their roles in improving allergen-specific IgE detection, refining functional cellular assays, and enabling next-generation immunotherapies through controlled allergen delivery and immunomodulation. We also critically examine key translational barriers and outline essential future directions required for translating nanotechnologies into clinical practice in allergy medicine.

A novel ferritin-based nanoparticle vaccine targeting lgE confers protection against chronic allergic asthma in a murine model.

Folate receptor-α targeted therapies in ovarian cancer: recent advances and emerging therapeutic strategies.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease frequently associated with allergic sensitization and elevated immunoglobulin E (IgE) levels. Food allergen sensitization is common in children with AD, but its relationship with disease severity and clinical relevance remains uncertain. Objective: To evaluate patterns of food allergen sensitization in children with AD and their association with total IgE levels, disease severity, and polysensitization. Material and methods: This cross-sectional study included 54 pediatric patients (≤18 years) with AD evaluated at the University Clinic of Dermatology. Disease severity was assessed using the SCORing AD (SCORAD) index. Allergy testing included skin prick testing (SPT) and in vitro specific IgE assays for common food allergens. Total serum IgE levels were measured in all participants. Polysensitization was defined as sensitization 3≤ allergens. Results: Food allergen sensitization was detected in 35.2% of patients by SPT and in 37.0% by in vitro IgE testing. Polysensitization occurred in 14.8% and 18.5% of patients, respectively. Egg allergens were the most frequently detected sensitizers. Total IgE levels showed a moderate positive correlation with SCORAD severity (Spearman ρ = 0.396, p = 0.003). Polysensitization patterns involving egg allergens were strongly associated with markedly elevated IgE levels (&gt;1000 kU/L), with the egg white–egg yolk combination showing the strongest association (OR 31.5, p=0.000196). Conclusion: Food allergen sensitization is common in pediatric AD, with egg allergens representing the dominant sensitization pattern. However, sensitization does not necessarily indicate clinically relevant food allergy, and allergy testing should guide targeted management while avoiding unnecessary restrictive diets.

Severe allergic transfusion reactions to group B/AB plasma or platelets in group O recipients are linked to α-Gal sensitization.

IntroductionThe oral microbiome has been shown to be associated with respiratory health, primarily in adult case studies or among children. This relationship has been scarcely investigated in adult population-based cohorts.ObjectivesTo investigate the association between oral microbiome and respiratory health, more specifically asthma, chronic rhinosinusitis (CRS), lung function and fractional exhaled nitric oxide (FeNO) in a population-based cross-continental multicentre study among adults.MethodsSubgingival samples from 355 adult European Community Respiratory Health Survey participants from Norway, Australia and Estonia underwent metagenomic sequencing. Respiratory disease was defined from questionnaires and sensitisation from specific immunoglobulin E (IgE)/skin prick tests. Spirometry and FeNO were measured. The associations between alpha diversity and disease status were evaluated in cross-sectional analyses using logistic regression adjusting for sex, smoking and study centre. Differential abundance analyses were performed using analysis of compositions of microbiomes with bias correction.ResultsAlpha diversity differed by study centre and sensitisation status and was associated with non-allergic CRS (richness: 1.12, 95% CI 1.03 to 1.22). A similar though not statistically significant pattern was seen for forced vital capacity (FVC) below the lower limit of normal (LLN). Lachnospiraceae and Xanthomonas were more abundant in the oral microbiome of non-asthmatics and individuals without CRS, respectively, as compared with asthmatics and CRS patients. Several functional genes (1477–3391) and genera (54-98) were only present in the non-case groups, whereas individuals with affected respiratory health had 0–74 unique functional genes, but no unique genera present only in their respective groups.ConclusionIncreased alpha diversity was associated with non-allergic CRS and a similar trend was seen for FVC below LLN. Bacterial composition and functional profiles of the oral microbiome differed by respiratory health status. This study is novel in exploring functional gene profiling in relation to asthma and FeNO.

Pathophysiology and emerging treatments for dermographic, cholinergic and cold urticaria.

Immunoglobulin E (IgE) is the least abundant antibody class in serum, but plays a central role in type I allergic responses. The Fc region of human IgE (IgE-Fc) contains four potential N-glycosylation sites: Asn265 and Asn371 are modified with complex-type glycans; Asn394 predominantly carries a high-mannose glycan; and Asn383 remains unmodified. Despite the recognized importance of glycosylation in antibody function, the structure-function relationships of the individual IgE-Fc glycans remain poorly understood. This study aimed to elucidate the structural and functional significance of N-glycans on IgE-Fc, particularly the high-mannose glycan attached to Asn394. The expression and secretion of recombinant human IgE-Fc constructs including wild-type IgE-Fc, a high-mannose-deficient mutant (N394Q), and a triple mutant lacking complex-type glycans (N265Q/N371Q/N383Q) was assessed in mammalian Expi293F cells. In addition, the thermal stability of wild-type IgE-Fc treated with Endo H or PNGase F was evaluated by a thermal shift assay. Glycan compositions and pairing patterns in IgE-Fc were characterized by intact mass spectrometry (MS) and liquid chromatography-MS analysis of released glycans. Wild-type IgE-Fc and the triple mutant were stably expressed, whereas secretion of the high-mannose-deficient mutant (N394Q) was markedly impaired, demonstrating that the Asn394 glycan is essential for proper folding and efficient secretion. Endo H treatment significantly decreased the melting temperature of wild-type IgE-Fc, indicating that high-mannose glycans contribute to structural stability. Integration of MS data on the intact protein and LC-MS data on the enzyme-released N-glycans revealed that high-mannose glycans at Asn394 associate in a non-selective manner between heavy chains. These findings establish that the high-mannose glycan at Asn394 is required for both the secretion and structural stability of IgE-Fc. Furthermore, the observation of non-selective glycan pairing between heavy chains provides insight into the temporal coordination of disulfide bond formation and N-glycan processing during IgE biosynthesis, thereby advancing our understanding of the molecular mechanisms underlying IgE structure and function.

Allergic diseases, including pathologies such as allergic rhinitis, asthma, atopic dermatitis, and food allergies, are fundamentally driven by aberrant immunoglobulin E (IgE) production and pronounced T helper 2 (Th2) cell responses. The escalating global prevalence of these conditions represents a substantial public health challenge, stimulating intensive research into novel therapeutic vulnerabilities. Interleukin-18 (IL-18), a pleiotropic cytokine operating at the interface of innate and adaptive immunity, has emerged as a key modulator in this context. While classically associated with augmenting interferon-γ (IFN-γ) production by Th1 cells, IL-18 paradoxically promotes the maturation and functional potentiation of mast cells and basophils, particularly in synergy with IL-2, thereby contributing mechanistically to the immunopathology of allergic inflammation. The bioactivity of IL-18 is contingent upon proteolytic processing, and the precise molecular pathways through which it orchestrates allergic responses remain under active investigation. This review comprehensively synthesizes the current understanding of IL-18 biology, detailing its cellular origins, activation mechanisms, and intracellular signaling cascades. Furthermore, we critically evaluate the multifaceted impact of IL-18 on key immune cell subsets involved in allergic hypersensitivity and discuss the rationale and potential for therapeutic interventions targeting the IL-18 axis in the management of allergic diseases.