Allergy & Immunology

Farm lifestyle in infancy associates with enhanced IgG4/IgA and less egg allergy

Infants from an Old Order Mennonite farming community had higher systemic IgG and IgA and mucosal IgA than urban and suburban controls. Farm-exposed infants and their mothers showed higher egg ovalbumin-specific infant IgG4 and milk IgA, which correlated with lower egg allergy incidence. Egg-specific IgG4 and IgA associated with earlier or more frequent ingestion of lightly cooked egg but also with farm-related, egg-independent factors. Detection of food antigens and antigen-specific IgA in cord blood suggested in utero exposure and accelerated B-cell maturation in farming communities. 1

Mepolizumab improves outcomes and attenuates airway remodeling in severe eosinophilic asthma

In 37 adults with severe eosinophilic asthma treated with mepolizumab for 12 months, asthma control and pre-bronchodilator FVC improved while exacerbations, oral steroid courses, and hospitalizations declined. Bronchial biopsies showed significant reductions in reticular basement membrane thickness, airway smooth muscle mass, and proliferating airway smooth muscle cells by 6 and 12 months. BAL fluid levels of tenascin-C and fibulin-1 decreased, indicating dampened extracellular matrix remodeling signals. Blood eosinophils fell markedly and BAL eosinophils were almost completely depleted, whereas submucosal eosinophilia decreased less. Findings support that anti–IL-5 therapy can modify structural airway changes alongside inflammation in severe eosinophilic asthma. 2

Dupilumab shows strong efficacy and reassuring safety in pediatric IEI with severe atopy

A single-center cohort followed ten children with genetically confirmed inborn errors of immunity and severe atopic manifestations treated with dupilumab. Mean EASI scores decreased from 34.33 to 2.67, and Dermatology Life Quality Index improved similarly, with benefit maintained beyond 18 months. Peripheral eosinophil counts declined substantially, and a child with severe asthma improved Childhood Asthma Control Test scores without further exacerbations. Only mild conjunctivitis and transient hypereosinophilia occurred, and no systemic or opportunistic infections were observed during follow-up. Data support dupilumab as a high-yield, apparently safe option for refractory Th2-driven atopic disease in selected pediatric IEI patients. 3

Early-onset atopic dermatitis usually remits, but multimorbidity and early sensitization predict persistence

The MAS German birth cohort followed participants with repeated questionnaires and clinical assessments from birth to 30 years. Cumulative atopic dermatitis incidence in the first 5 years was higher in children with allergic parents than in those with nonallergic parents. Among 529 children with onset in the first 5 years, 87% reported no symptoms at ages 20 and 30 years, indicating frequent long-term remission. Persistent disease was linked to onset before age 2, female sex, early allergic sensitization, asthma at 6 years, and rhinitis at ages 3 to 5 years. These trajectories allow more individualized counseling about prognosis and highlight children needing closer longitudinal allergy follow-up. 4