Research Library

Rachid R, Martinez-Blanco M, Kuziel GA, et al.

An NIH-funded early-stage clinical trial found that fecal microbiome transplants via oral capsules safely increased peanut tolerance in 6 of 15 participants with peanut allergies, with benefits linked to expansion of RORγt-expressing regulatory T cells. Gut microbes from responders also protected microbe-free mice, with Bacteroides bacteria and bile acid metabolism playing a key protective role.

Kaushik P, et al.

This review summarizes the pathophysiology of alpha-gal syndrome, emphasizing its association with tick bites and the clinical management of delayed red-meat anaphylaxis.

Brusselle GG, Koppelman GH

Evaluates the selection and efficacy of biologic therapies targeted against IgE, IL-5, IL-4/IL-13, and TSLP in patients with severe uncontrolled asthma.

Leonard SA, et al.

Summarizes emerging phenotypes, international dietary practices, oral food challenge safety updates, and the timeline of tolerance acquisition in pediatric FPIES patients.

Rubio-Tapia A, et al.

Updated clinical guidelines outlining serologic testing, duodenal biopsy confirmation, indications for non-biopsy strategies, and the clinical management of non-responsive and refractory celiac disease.

Kemp HI, et al.

Outlines standardized pathways for diagnosing perioperative anaphylaxis, obtaining serial serum tryptase levels, and conducting post-event skin testing for neuromuscular blocking agents, antibiotics, and chlorhexidine.

Muraro A, et al.

Offers evidence-based consensus recommendations on dietary avoidance, nutritional assessment, allergen immunotherapy, and the prescription of self-injectable epinephrine for accidental exposures.

Cloutier MM, et al.

Provides targeted recommendations on single maintenance and reliever therapy (SMART) using ICS-formoterol, intermittent ICS regimens, bronchial thermoplasty, and the clinical utility of fractional exhaled nitric oxide (FeNO).

Nowak-Wegrzyn A, et al.

Presents international consensus criteria defining acute versus chronic non-IgE-mediated FPIES, protocols for standardized oral food challenge assessment, intravenous fluid resuscitation for severe shock-like reactions, and timelines for tolerance testing.

Cardona V, et al.

Establishes revised diagnostic criteria for anaphylaxis, highlighting early intramuscular epinephrine into the anterolateral thigh as the primary first-line intervention. It provides protocols on serum mast cell tryptase timing and observation for biphasic reactions.

Leder J, et al.

Discusses perioperative anaphylaxis risks associated with alpha-gal syndrome, emphasizing avoidance of mammal-derived surgical products such as bovine or porcine heparin, gelatin-based hemostatic matrices, and biological heart valves.

Zuberbier T, et al.

Establishes an international consensus on the mechanistic ability of omalizumab to significantly decrease reaction risks following accidental food allergen exposure, discussing trial evidence and optimal clinical delivery.

Dellon ES, et al.

Synthesizes multidisciplinary evidence recommending proton pump inhibitors, topical swallowed corticosteroids, and targeted or empiric food elimination diets as primary therapies to achieve histologic remission and alleviate dysphagia.

Commins SP

Provides clinical instruction on diagnosing tick-induced galactose-alpha-1,3-galactose IgE sensitization and navigating the classic 2-6 hour delayed allergic reaction to mammalian meats and dairy products.

Nurmatov UB, et al.

This systematic review and meta-analysis evaluated biologics, primarily omalizumab, as monotherapy and adjuncts to oral immunotherapy. Omalizumab significantly improved desensitization rates and raised challenge tolerance thresholds compared with placebo.

Casale TB, et al.

This guidance outlines practical strategies for initiating and maintaining omalizumab following its FDA approval for IgE-mediated food allergies. It emphasizes that omalizumab provides protection against accidental exposures rather than unconstrained dietary ingestion.

Beasley R, et al.

This meta-analysis synthesized clinical trial data evaluating as-needed ICS-formoterol versus SABA or regular maintenance ICS in mild asthma. Findings demonstrate significant reductions in severe exacerbation rates with as-needed anti-inflammatory reliever therapy.

Agache I, et al.

This network meta-analysis evaluated FDA-approved biologics targeting IgE, IL-5/5R, IL-4R, and TSLP in severe asthma. All targeted therapies significantly reduced exacerbation frequency, with distinct biomarker-guided profiles driving optimal biologic selection.

LaFata SS, et al.

This prospective cohort study analyzed the clinical presentation, endoscopic characteristics, and outcomes of esophageal food bolus impactions in patients with EoE. The findings highlight the diagnostic relevance of bolus clearance severity in monitoring therapeutic response.

Calvani M, et al.

This systematic review examined tolerance acquisition timelines in pediatric FPIES according to trigger food types. While most children achieve tolerance to cow milk and soy by ages 3 to 5 years, resolution of grain and solid food FPIES frequently requires longer periods.

Commins SP, et al.

This clinical review details practical diagnostic algorithms and dietary counseling for patients with tick-induced galactose-alpha-1,3-galactose IgE sensitization. It details avoidance of mammalian meats, mammalian-derived excipients, and safe medication selection.

Garvey LH, et al.

This international consensus provides evidence-based recommendations for recognizing and managing perioperative anaphylaxis provoked by neuromuscular blocking agents, antibiotics, and chlorhexidine. It outlines protocols for acute epinephrine dosing, serial serum tryptase sampling, and post-crisis skin testing.

Shaker MS, et al.

This joint task force guideline update offers clinical recommendations for prompt intramuscular epinephrine administration in community and medical settings. It addresses biphasic anaphylaxis risk factors and stratifies post-resuscitation monitoring intervals based on reaction severity.

Warren CM, et al.

Reviews epidemiology and treatment of food allergies and anaphylaxis, emphasizing that prompt intramuscular epinephrine is first-line and noting that systemic corticosteroids show no clear benefit in preventing biphasic reactions.

Barroso B, et al.

Discusses clinical practicalities and nuances of EAACI anaphylaxis guideline implementations, including acute recognition, intramuscular epinephrine treatment, and observation for biphasic reactions.

Nowak-Węgrzyn A, et al.

This consensus statement standardizes dosing tiers and delayed monitoring intervals (up to 4 to 6 hours) for diagnostic and tolerance-determining food challenges in FPIES. Intravenous fluids and early antiemetics like ondansetron remain first-line, with epinephrine reserved strictly for systemic cardiovascular collapse.

Anagnostou A, et al.

This consensus workgroup report provides practical clinical guidance on patient selection, dosing nomograms, and implementation considerations for omalizumab therapy in IgE-mediated food allergy. It outlines strategies for clinical monitoring, ongoing dietary avoidance, and managing accidental allergen exposures.

Lee S, et al.

This meta-analysis demonstrates that biphasic anaphylaxis occurs in approximately 4-5% of anaphylactic episodes and is strongly associated with initial presentation severity, wide pulse pressure, and delayed epinephrine administration. It reinforces the clinical necessity of observing high-risk patients for a minimum of 4 to 6 hours after initial symptom resolution.

Garvey LH, et al.

This international consensus document details updated protocols for managing and investigating immediate perioperative hypersensitivity, identifying neuromuscular blocking agents and cefazolin as principal culprits. It standardizes timed sequential serum tryptase measurements (at baseline, 1-2 hours, and >24 hours) and establishes timelines for post-crisis skin testing.

Mitselou N, et al.

In a nationwide Swedish population-based cohort study, individuals with celiac disease exhibited a 6.6-fold increased risk of developing subsequent eosinophilic esophagitis compared to matched reference controls. The study emphasizes vigilance for overlapping mucosal inflammation and coexisting allergic-gastrointestinal diseases.

Crossingham I, et al.

This systematic review and meta-analysis confirmed that as-needed ICS-formoterol significantly reduces severe exacerbations and systemic corticosteroid exposure compared to SABA reliever regimens in adolescent and adult asthma. The evidence supports single maintenance and reliever therapy (SMART) as superior for preventing emergency department attendance and hospitalizations.

Singh P, et al.

This comprehensive meta-analysis synthesizes global epidemiological data, establishing an overall biopsy-confirmed celiac disease prevalence of approximately 0.7% to 1.4% with notable geographic heterogeneity. It differentiates serologic positivity rates from true biopsy-confirmed mucosal atrophy and examines the prevalence of non-celiac gluten sensitivity.

Zychowski DL, et al.

Investigating tick bites and regional tick-borne immune responses, this study highlights public health and clinical impacts associated with vector exposure in tick-endemic regions. The findings underscore the systemic immunological manifestations resulting from tick-mediated sensitization.

Nowak-Węgrzyn A, et al.

This updated review clarifies the international consensus diagnostic criteria for acute and chronic FPIES, emphasizing the absence of classical IgE-mediated cutaneous and respiratory signs. It details acute emergency rehydration protocols using intravenous fluids and ondansetron, along with standardized oral food challenge protocols to evaluate resolution.

Reddel HK, et al.

GINA continues to recommend as-needed low-dose inhaled corticosteroid (ICS)-formoterol as the preferred reliever across steps to minimize exacerbation risks compared to SABA monotherapy. Stepped pharmacotherapy algorithms incorporate targeted biologic therapies (anti-IgE, anti-IL-5/5R, anti-IL-4Rα, and anti-TSLP) for confirmed severe type 2 inflammatory phenotypes.

Mehr S, et al.

This clinical overview reviews global trends in infant dietary triggers (such as cow's milk, soy, rice, and oats) and emphasizes intravenous fluid resuscitation as first-line therapy for severe acute FPIES. It provides structured guidance on oral food challenge timing, noting high rates of spontaneous natural tolerance during early childhood.

Chehade M, et al.

In this phase 3 trial, higher-dose dupilumab administered weekly or biweekly led to significant histologic remission and endoscopic and transcriptomic improvements in pediatric patients aged 1 to 11 years with active eosinophilic esophagitis.

Santos AF, et al.

These clinical practice guidelines establish recommendations for diagnostic testing in suspected IgE-mediated food allergy, highlighting the role of component-resolved diagnostics, skin prick testing, basophil activation tests, and controlled oral food challenges.

Nowak-Węgrzyn A, et al.

Synthesizes contemporary diagnostic criteria for acute and chronic FPIES, consensus protocols for supervised oral food challenges to confirm resolution, and updated strategies for emergency hydration and ondansetron administration.

Reddel HK, et al.

This executive summary details the GINA stepped asthma management strategy, reinforcing track 1 anti-inflammatory reliever therapy using low-dose ICS-formoterol across all severity stages to reduce exacerbation risk compared to SABA alone.

Miceli Sopo S, et al.

Evaluates clinical phenotypes and timelines for natural tolerance acquisition in pediatric FPIES cohorts triggered by solid foods and dairy, identifying key determinants governing safe reintroduction intervals.

Peterson CJ, et al.

Reviews the delayed allergic presentation of alpha-gal syndrome following mammalian meat and dairy ingestion, tick bite pathogenesis, diagnostic IgE testing thresholds, and acute anaphylaxis management.

Garvey LH, et al.

Provides multidisciplinary recommendations for immediate recognition and resuscitation of perioperative anaphylaxis, acute and baseline serum tryptase collection, and comprehensive post-event allergy skin testing for neuromuscular blocking agents and antibiotics.

Khan DA, et al.

Details evidence-based approaches for penicillin and cephalosporin cross-reactivity evaluation, perioperative drug allergy de-labeling, direct oral challenge risk stratification, and identification of biphasic reaction risks.

Bagnasco D, et al.

The review synthesizes clinical trial and real-world evidence for severe asthma biologics targeting IgE, IL-5/IL-5R, IL-4Rα, and TSLP, highlighting precision biomarker profiling and clinical remission criteria.

Choi EJ, Lee SH, Lee SH, et al.

Original research identifying placental epigenetic alterations and IL-10 dysregulation as drivers of early persistent food allergy, suggesting prenatal origins of food allergy risk.

Brough HA, et al.

This review discusses the role of omalizumab as a biologic therapy for food allergy, highlighting its use as a monotherapy and as an adjunct to facilitate oral immunotherapy.

Dellon ES, et al.

This protocol describes the EDESIA registry, designed to collect real-world data on the long-term safety and efficacy of dupilumab in patients with eosinophilic esophagitis.

Castro M, et al.

This phase 4 trial demonstrates the efficacy of dupilumab in reducing type 2 inflammatory markers and improving respiratory outcomes in patients with severe asthma.

Wechsler ME, et al.

This study evaluates the efficacy of depemokimab, a long-acting anti-IL-5 biologic, in reducing exacerbations for patients with severe eosinophilic asthma.

Binder AM, et al.

This review details the etiology and management of alpha-gal syndrome, emphasizing the role of tick-bite sensitization and the necessity of avoiding mammalian meat products.

De Corso E, et al.

In a head-to-head trial, dupilumab demonstrated superior efficacy compared to omalizumab in improving nasal polyp scores and smell identification in patients with severe chronic rhinosinusitis and coexisting asthma.

Witt BS, Wright BL

A collaborative initiative between the Utah School Nurses Association, Utah Food Allergy Network, and Utah Department of Health developed a web-based curriculum to train school staff to recognize and respond to anaphylaxis. From 2012–2023, the training was completed 5,759 times across 421 Utah schools, with teachers (3,006), office staff (1,480), and principals (276) as top completers. The program achieved a >68% year-over-year retention rate and a 245% increase in schools with unassigned epinephrine, addressing critical gaps in school nurse coverage.

Cho H, Powers JM, Crompton PD, Commins SP, et al.

NIH/NIAID researchers isolated 42 alpha-gal-specific antibodies from malaria-exposed individuals and found 13 could bind to alpha-gal syndrome (AGS) allergens. Two antibodies blocked IgE from AGS patients from attaching to allergens, and one interfered with basophil activation — providing the first evidence that monoclonal antibodies could potentially prevent allergic reactions in people with AGS, the tick-bite-associated red meat allergy with no current treatment.

GINA

The 2026 GINA update provides updated diagnostic and management strategies for difficult-to-treat and severe asthma in adolescent and adult patients.

Du Toit G, et al.

This clinical practice review outlines current strategies for the prevention and treatment of peanut allergy, emphasizing early introduction and modern therapeutic approaches.

Zuberbier T, et al.

This meta-analysis confirms that omalizumab is beneficial as both monotherapy and as an adjunct to oral immunotherapy for patients with IgE-mediated food allergies, improving desensitization rates.

Wood RA, et al.

This randomized clinical trial demonstrated that omalizumab is more effective than multiallergen oral immunotherapy for treating patients with multifood allergies, particularly in reducing allergic reactions to small amounts of allergens.

GINA

The GINA 2025 guide recommends low-dose ICS-formoterol as the preferred reliever for adolescents and adults to reduce the risk of severe asthma exacerbations.

Boston Specialists

A retrospective study evaluating the effectiveness of a step-down dosing regimen for dupilumab in patients with eosinophilic esophagitis.

Santos AF, et al.

Provides standardized recommendations for the diagnosis of IgE-mediated food allergies, emphasizing the role of IgE testing and clinical history.

Casale TB, et al.

This review discusses the FDA approval of omalizumab for reducing allergic reactions to accidental food allergen exposure, highlighting findings from the OUtMATCH trial.

PubMed

Reviews the pathophysiology, diagnosis, and management of pediatric anaphylaxis, emphasizing the necessity of early epinephrine administration.

Global Initiative for Asthma

The 2026 GINA summary guide outlines evidence-based strategies for asthma diagnosis and management, including the use of ICS-formoterol as a reliever.

Blumenthal KG, et al.

Cefazolin is identified as the leading cause of perioperative anaphylaxis. The study advocates for aggressive penicillin de-labeling, as over 99% of patients with a penicillin allergy label can safely receive cefazolin, reducing surgical site infection risks.

Rothenberg ME, et al.

This phase 3 trial demonstrated that weekly 300 mg dupilumab maintains histologic remission (≤6 eos/hpf) and symptomatic relief in 85% of patients through 52 weeks of treatment.

Al-Toma A, et al.

The 2025 guidelines introduce a conditional "no-biopsy" pathway for adults under 45 with anti-TG2 IgA levels ≥10x the upper limit of normal, confirmed by a second positive sample, provided no "red flag" symptoms are present.

Menzies-Gow E, et al.

Long-term follow-up data confirms that tezepelumab, a TSLP-blocking biologic, reduces annual exacerbation rates by over 50% regardless of baseline eosinophil counts or FeNO levels, solidifying its role in non-Type 2 severe asthma.

Tye-Din JA, et al.

This comprehensive review notes that while global seroprevalence is 1.4%, biopsy-confirmed prevalence is only 0.7%, highlighting a massive undiagnosed population. It explores emerging drug therapies like ZED1227 (TG2 inhibitor) currently in phase 2 trials.

Wood RA, et al.

Head-to-head comparison data indicated that omalizumab was superior to multi-allergen oral immunotherapy (OIT) in achieving dose-tolerance for multiple allergens with significantly fewer adverse events and treatment dropouts.

McCarty TR, et al.

This review emphasizes that nearly 70% of AGS patients present with gastrointestinal symptoms (abdominal pain, diarrhea) which are often the sole manifestation, frequently leading to misdiagnosis as IBS or functional dyspepsia.

Chinthrajah RS, et al.

This research investigates the incidence of eosinophilic esophagitis as a potential adverse event during oral immunotherapy for food allergies.

Knudson CM, Metcalf RA, Mindiola Romero AE, Mo A, Schäfer R, Takanashi M, Dunbar NM, et al.

An international, multicenter retrospective cohort study of 558,823 platelet and plasma transfusions found that in U.S. regions with high alpha-gal syndrome prevalence, blood type O patients receiving group B or AB units had significantly higher rates of allergic transfusion reactions (overall RR 3.93; moderate-to-severe RR 9.14). The study provides epidemiologic evidence that transfusion-related alpha-gal syndrome (TRAGS) may be a unique, previously unrecognized transfusion risk, and recommends risk mitigation in AGS high-prevalence regions.

Lieberman J, et al.

A clinical review detailing the diagnostic pathway for IgE-mediated food allergy, emphasizing the role of clinical history, skin prick testing, and serum-specific IgE.

Hahn JW, et al.

A comprehensive meta-analysis tracking the rising global incidence and prevalence of EoE over four decades.

Global Initiative for Asthma

The 2023 update provides a decision tree for the assessment and management of difficult-to-treat and severe asthma in adults and adolescents.

Frontiers Editorial

A case-based review highlighting the importance of epinephrine as first-line therapy for anaphylaxis and the complexities of managing comorbid allergic conditions.

Atanasio A, et al.

Researchers developed a novel mouse model to study the mechanisms of alpha-gal syndrome, providing a platform for testing future therapeutic interventions.

Mullins RJ, et al.

This study evaluates the impact of updated allergy prevention guidelines on food anaphylaxis admission rates in children, supporting early introduction strategies.

Hasosah M, et al.

A review of the application of dupilumab in pediatric populations, highlighting its role in managing type 2 inflammatory conditions like EoE.

ASCIA, et al.

This updated guideline provides evidence-based recommendations for infant feeding practices specifically aimed at the prevention of food allergy development.

Stanford University, et al.

This clinical trial evaluates the efficacy of using dupilumab as an adjunct to oral immunotherapy (OIT) to enhance treatment outcomes in children with peanut allergy.

Wolfset N, et al.

Clinical trial results showing that dupilumab facilitates the successful reintroduction of trigger foods in patients with EoE without worsening clinical or histologic outcomes.

Global Initiative for Asthma

The 2024 GINA report recommends as-needed low-dose ICS-formoterol as a preferred controller therapy for adults and adolescents with mild asthma.

Anagnostou A, et al.

This review summarizes the clinical evidence for omalizumab in food allergy management, following its 2024 FDA approval for patients aged 1 year and older.

Global Initiative for Asthma (GINA)

The 2024 GINA guide provides updated recommendations for the management of severe asthma, including the use of biologics and stepped management strategies.

Chu DK, et al.

This meta-analysis found that while peanut oral immunotherapy effectively induces desensitization, it significantly increases the risk and frequency of anaphylaxis and other adverse reactions compared to avoidance.

Bender B, et al.

This review examines the barriers and facilitators to adherence for biologic therapies in severe asthma, highlighting the impact of socioeconomic factors and perceived efficacy.

CDC

Official CDC guidance defining alpha-gal syndrome as a tick-bite associated allergy to alpha-gal, emphasizing its potential for life-threatening reactions.

Klinger-O'Donnell L, et al.

A review of recent advancements in food allergy management, including the use of omalizumab, oral immunotherapy, and strategies for prevention.

Global Initiative for Asthma

The 2024 GINA report emphasizes the use of ICS-formoterol as the preferred controller therapy for asthma management across all steps of treatment.

Chehade M, et al.

A subgroup analysis from the EoE KIDS study showing the efficacy of dupilumab in pediatric patients who previously failed or were intolerant to topical corticosteroids.

Lebwohl B, et al.

The updated 2025 guidelines introduce a conditional "no-biopsy" diagnostic pathway for adults with very high IgA anti-TG2 titers (≥10x ULN) and advocate for standardized duodenal biopsy protocols (minimum 6 samples) when endoscopy is required.

Rothenberg ME, et al.

A retrospective multicenter review shows that monthly dupilumab is safe and effective in inducing histologic remission (peak eosinophils <6/hpf) in infants and small children who are currently ineligible for the 2024 FDA-approved pediatric dosing.

Bredenoord AJ, et al.

Analysis of the LIBERTY EoE TREET trial confirms that weekly dupilumab (300 mg) induces histologic remission and improves dysphagia scores even in patients who previously failed swallowed topical corticosteroids or dietary elimination.

Green PHR, et al.

This comprehensive review details the current epidemiological shift toward older age at diagnosis and the complexities of diagnosing non-celiac gluten sensitivity (NCGS) vs. celiac disease in patients already on a self-imposed gluten-free diet.

Wood RA, et al.

This follow-up analysis from the OUtMATCH trial demonstrates that omalizumab monotherapy provided superior safety and tolerability compared to multi-allergen oral immunotherapy (OIT), primarily due to the high rate of adverse events leading to discontinuation in the OIT group.

Haddad J, et al.

A longitudinal cohort study found that cow's milk has surpassed rice as the most common FPIES trigger in the U.S., likely due to earlier introduction of common allergens. The study also noted a significant rise in "atypical FPIES" (positive specific IgE) to peanut and egg.

Commins SP, et al.

This review highlights the "gastrointestinal-only" phenotype of alpha-gal syndrome, which often lacks the classic hives or anaphylaxis, leading to frequent misdiagnosis as IBS. It provides an updated management framework emphasizing total mammalian product avoidance and tick bite prevention to allow IgE titers to decay.

Dubin S, et al.

This clinical review synthesizes the latest GINA recommendations, focusing on the shift away from SABA-only treatment for mild asthma and the implementation of SMART (Single Maintenance and Reliever Therapy) to reduce exacerbation risk.

Nowak-Wegrzyn A, et al.

This updated international consensus provides standardized protocols for clinical and research oral food challenges (OFCs), emphasizing semi-logarithmic dosing and revised safety criteria to minimize severe reactions while ensuring diagnostic accuracy.

Banerji A, et al.

This update emphasizes proactive penicillin delabeling and the use of direct oral challenges for low-risk antibiotic allergies, reducing the reliance on traditional skin testing for beta-lactams and NSAIDs.

Centers for Disease Control and Prevention

A large 2026 seroprevalence study found that in high-risk states like Arkansas and Missouri, over 25% of adults test positive for alpha-gal IgE antibodies, indicating that sensitization far exceeds clinical disease prevalence.

Halken S, et al.

These guidelines shift the focus from passive allergen avoidance to active management, recommending oral immunotherapy (OIT) for peanut allergy in children/adolescents and suggesting biologics like omalizumab for multi-food allergic patients.

Global Initiative for Asthma (GINA)

The 2025 update reinforces "Track 1" management (ICS-formoterol as the preferred reliever) and places increased emphasis on interpreting Type 2 inflammation biomarkers (FeNO, blood eosinophils) to personalize treatment and assess exacerbation risk.

Kliewer KL, et al.

This randomized trial found that eliminating animal milk alone (1FED) is an acceptable initial dietary therapy for adults with EoE, achieving histologic remission in 34% of patients compared to 40% for the more restrictive six-food elimination diet (6FED).

Muraro A, et al.

This guideline recommends omalizumab for IgE-mediated food allergy in children and adults and supports oral allergen-specific immunotherapy for peanut, milk, and egg allergies.

Kopp MV, et al.

This article reviews the epidemiology of non-IgE-mediated conditions like FPIES, noting that triggers vary significantly by geographic region and dietary habits.

Spolidoro GCI, et al.

A comprehensive meta-analysis providing updated prevalence estimates for major food allergies in Europe, emphasizing the need for standardized diagnostic criteria.

Angela Mulé, Pasquale Mulé, Adnan Al Ali, Catherine Prattico, Xun Zhang, Christine McCusker, Vicky Le Blanc, Moshe Ben-Shoshan

A 2026 cohort study from the Montreal Children's Hospital (McGill University Health Centre) characterizing the clinical presentation, trigger foods, and management of Food Protein-Induced Enterocolitis Syndrome (FPIES) among Canadian children in Montreal, providing real-world epidemiological data on this rare non-IgE-mediated food allergy.

Nowak-Wegrzyn A, et al.

Reviews updates since the 2017 international guidelines, including new data on adult-onset FPIES, atypical phenotypes, and evolving oral food challenge protocols.

Ma M, et al.

Emphasizes that hemodynamic collapse is the primary sign in surgical patients, as cutaneous findings are often absent or masked by drapes, necessitating rapid epinephrine and fluid resuscitation.

Ellis AK, et al.

Reaffirms intramuscular epinephrine as the sole life-saving treatment and notes that home observation may be reasonable if symptoms resolve completely within 15 minutes of one dose.

Wilson JM, et al.

Discusses the mechanism of tick salivary antigens in sensitization and clarifies the clinical presentation of delayed anaphylaxis (2-6 hours post-ingestion) versus immediate reactions.

Varricchi G, et al.

Confirms that TSLP blockade with tezepelumab reduces exacerbations and oral corticosteroid use across both T2-high and T2-low asthma inflammatory phenotypes in clinical practice.

Sindher SB, et al.

Provides expert consensus on patient selection, initiation of therapy, and monitoring for omalizumab following its FDA approval for IgE-mediated food allergies.

Rostami K, et al.

Introduces a conditional no-biopsy approach for adults under 45 with high-titer IgA anti-TG2 (≥10x ULN) and provides refined strategies for seronegative and potential celiac cases.

Pavord ID, et al.

Pooled analysis demonstrates that tezepelumab treatment significantly improves the likelihood of achieving normal lung function at 52 weeks in patients with severe, uncontrolled asthma.

Ruffner MA, et al.

Highlights the lack of high-quality trial data for specific FPIES interventions and recommends a preference-sensitive care approach using shared decision-making for dietary management.

Chehade M, et al.

Demonstrates that dupilumab effectively induces histologic response in both inflammatory and fibrostenotic phenotypes of EoE in adolescents, allowing for successful weaning of steroids.

ESPGHAN et al.

This updated guideline provides a practical framework for the diagnosis and management of pediatric EoE, including the use of simplified elimination diets and the emerging role of biologics for refractory cases.

Global Initiative for Asthma

The 2025 GINA report provides updated evidence-based strategies for asthma diagnosis and management, emphasizing personalized treatment and the use of ICS-formoterol as a preferred controller and reliever therapy.

Unknown et al.

This systematic review evaluates biomarkers and clinical predictors to help clinicians identify which patients with severe asthma are most likely to benefit from specific biologic therapies.

Chinthrajah S, et al.

The COMBINE trial demonstrates that adding dupilumab to omalizumab-facilitated multi-food oral immunotherapy improves desensitization success and reduces gastrointestinal adverse events.

Al-Hameed A, et al.

This systematic review compares biologic therapies for asthma, finding that dupilumab demonstrates superior efficacy in reducing exacerbations compared to other agents in moderate-to-severe populations.

Garg A, et al.

Meta-analysis of real-world data confirms that dupilumab significantly improves histologic and symptomatic outcomes in patients with eosinophilic esophagitis.

Commins SP, et al.

A review of the pathophysiology, diagnosis, and management of alpha-gal syndrome, emphasizing the delayed nature of anaphylactic reactions to red meat.

Reddel HK, et al.

This consensus review highlights the expansion of MART (Maintenance and Reliever Therapy) to younger children and provides updated guidance on the selection of biologics for severe Type 2 asthma.

Dellon ES, et al.

Weekly 300 mg dupilumab significantly improved histologic outcomes and reduced dysphagia symptoms in patients aged 12 and older with PPI-refractory EoE.

Laserna-Mendieta EJ, et al.

Real-world evidence confirms that dupilumab is an effective and safe therapeutic option for the management of eosinophilic esophagitis in adolescents and adults.

Thompson CC, et al.

A rapid review of the current understanding of tick-bite sensitization and the management of delayed red-meat anaphylaxis in alpha-gal syndrome.

Mason AE, et al.

Evaluates the implementation of a standardized clinical pathway in emergency departments to improve adherence to anaphylaxis management guidelines and epinephrine use.

McCann E, et al.

Phase 3 trial results demonstrating that dupilumab significantly improves histologic and symptomatic endpoints in pediatric patients with eosinophilic esophagitis.

Lesmana E, et al.

A large-scale study characterizing the gastrointestinal and systemic manifestations of alpha-gal syndrome, emphasizing the delay between ingestion and symptom onset.

Greenhawt M, et al.

Analyzes caregiver descriptions of severe reactions to identify age-specific diagnostic criteria for non-IgE mediated conditions like FPIES in infants.

Loh W, et al.

This study found a significant reduction in egg allergy prevalence (from 9.2% to 7.6%) following the implementation of guidelines recommending early egg introduction in infants.

Dellon ES, et al.

Pivotal trial data showing the efficacy of weekly dupilumab in achieving histologic remission and improving swallowing symptoms in patients with EoE.

Wu AG, et al.

Evaluates a novel remote-monitoring protocol for oral immunotherapy in patients with alpha-gal syndrome to improve safety and access to treatment.

Larenas-Linnemann D, et al.

Discusses novel management strategies including Anti-inflammatory Reliever (AIR) therapy, SMART protocols, and the potential for tapering biologics in well-controlled severe asthma.

Patton T, et al.

A systematic review exploring the epidemiological link between celiac disease and EoE, finding a significantly higher prevalence of EoE in pediatric celiac cohorts.

Michael Yang, Sarah S. Valaika, Priyanka Dadha, Varun Shankavaram, Christopher Warren, Sai Nimmagadda, Madeleine Kanaley, Lauri Morrison-Frichtl, Donna Emmons, Ruchi Gupta

A collaboration between Northwestern University's CFAAR and the Illinois Head Start Association examined food allergy documentation and preparedness in Illinois Head Start programs. The 2025 Illinois PIR reported 384 cases of life-threatening allergies among 27,023 children across 513 sites, but this likely underestimates true FA burden. The review identified opportunities to strengthen food safety including standardizing emergency protocols, expanding staff training, improving epinephrine access, and supporting allergy-conscious food environments in early childhood programs.

Sindher SB, et al.

This report provides consensus-based guidance on integrating omalizumab into clinical practice for the treatment of food allergies, focusing on patient selection and safety.

Sindher SB, et al.

A randomized clinical trial investigating the efficacy and safety of omalizumab compared to or in combination with oral immunotherapy for patients with multiple food allergies.

Dubin S, et al.

This review summarizes recent shifts in asthma management, emphasizing the use of ICS-formoterol as a rescue therapy for mild asthma as recommended by GINA.

El-Shazly A, et al.

A comprehensive overview of current asthma phenotypes and the evolving landscape of biologic therapies for severe disease management.

Lim WK, et al.

This study demonstrates that dupilumab treatment leads to significant normalization of the EoE disease transcriptome and reduction in eosinophil-associated gene signatures.

Wood RA, et al.

Comparing omalizumab monotherapy to multi-allergen oral immunotherapy (OIT) in the OUtMATCH Stage 2 trial, omalizumab was superior in terms of patient retention and safety. Omalizumab achieved higher success rates for tolerance of multiple allergens primarily due to high discontinuation rates in the OIT group.

Vaz-Rodrigues R, et al.

The paper reviews diagnostic tools for alpha-gal syndrome, including basophil activation tests and anti-alpha-gal IgE measurements. It discusses the potential for tick-salivary-molecule-based vaccines to prevent sensitization in the future.

Rothenberg ME, et al.

In children aged 1 to 11 years, weight-tiered dupilumab regimens significantly increased the rate of histologic remission compared to placebo. Treatment also led to marked improvements in endoscopic and transcriptomic measures of esophageal inflammation.

Nowak-Wegrzyn A, et al.

This update incorporates emerging evidence on adult-onset FPIES and revised management for acute episodes, including the use of ondansetron. It highlights the need for standardized oral food challenge (OFC) protocols to assess tolerance development.

Myleus A, et al.

Celiac disease prevalence is estimated at 1% to 2% in wheat-consuming populations and is increasing globally. The review outlines the stages of celiac epidemiology and identifies children and females as having the highest diagnostic prevalence.

Mayerhofer C, et al.

This meta-analysis of 34 studies found that while the six-food elimination diet (SFED) had the highest clinical response rate (92.8%), simpler diets like the one-food elimination diet (OFED) also achieved significant histologic remission (51.4%).

Cook TM, et al.

The NAP7 study evaluated perioperative cardiac arrest and anaphylaxis in the UK. It found that anaphylaxis remains a leading cause of perioperative morbidity, with antibiotics and neuromuscular blocking agents identified as the most frequent triggers.

Clarke K, et al.

This comprehensive review summarizes current evidence on celiac disease management, emphasizing the importance of a multidisciplinary approach for gluten-free diet adherence and the emergence of non-dietary therapies currently in clinical trials.

Menzies-Gow A, et al.

The WAYFINDER trial demonstrated that monthly tezepelumab injections allow for a significant reduction in maintenance oral corticosteroid (OCS) doses. A substantial proportion of severe asthma patients were able to discontinue OCS entirely without losing symptom control.

Turner PJ, et al.

This systematic review identifies severity of the initial reaction and delayed administration of epinephrine as key risk factors for biphasic anaphylaxis. It supports the 2024 practice parameter recommendation for selective rather than universal prolonged observation.

Copaescu AM, et al.

The PALACE trial demonstrated that a direct oral challenge is safe and effective for delabeling low-risk penicillin allergies identified by the PEN-FAST tool, potentially reducing unnecessary use of broad-spectrum antibiotics.

Nowak-Wegrzyn A, et al.

This consensus update details the phenotypic variations of FPIES, including acute and chronic forms. It provides updated protocols for oral food challenges and stresses the importance of rapid fluid resuscitation for acute reactions.

Du Toit G, et al.

The LEAP-Trio study demonstrated that early peanut introduction in infancy leads to long-lasting tolerance into adolescence, regardless of subsequent peanut consumption patterns. This confirms the durability of early-life interventions for allergy prevention.

King JA, et al.

This meta-analysis reports a global celiac disease prevalence of approximately 1%, with rising rates in previously low-prevalence regions. It highlights the significant diagnostic gap remaining in many populations.

GINA Science Committee.

The 2026 update consolidates the shift away from SABA monotherapy, emphasizing ICS-containing relievers as the preferred track for all steps. It introduces new primary care flowcharts and expands recommendations for biologic use in severe eosinophilic phenotypes.

Agache I, et al.

A comprehensive evaluation of biologics targeting IL-4, IL-5, and TSLP shows significant reduction in asthma exacerbations and improvement in quality of life for patients with T2-high severe asthma. The review supports the integration of these therapies into late-stage asthma care.

Anvari S, et al.

Reviews emerging evidence on adult-onset FPIES and various clinical phenotypes identified since 2017. It details the clinical presentation of delayed vomiting and the shift toward center-specific food challenge protocols.

Trogen B, et al.

Analyzes clinical trial data supporting dupilumab's efficacy in improving histologic outcomes and reducing symptoms in patients aged 12 and older. It highlights the medication's role as the first approved biologic for this indication.

Halken S, et al.

Evidence-based assessment of early dietary introduction for allergy prevention, confirming that early exposure to common allergens like peanut and egg reduces the risk of sensitization. It supports current guidelines promoting diverse infant diets.

Shaker MS, et al.

This updated practice parameter provides evidence-based recommendations on epinephrine administration, biphasic reaction monitoring, and the management of perioperative and drug-induced anaphylaxis.

Rothenberg ME, et al.

Treatment with dupilumab 300 mg weekly showed sustained histologic remission and symptomatic improvement through 52 weeks in patients with eosinophilic esophagitis.

Nowak-Wegrzyn A, et al.

This update provides refined diagnostic criteria for FPIES, standardized oral food challenge protocols, and management strategies for acute episodes and long-term nutrition.

King JA, et al.

This large-scale meta-analysis provides updated global prevalence rates of celiac disease, noting higher incidence in female and pediatric populations and increasing rates over time.

Menzies-Gow E, et al.

In patients with severe, uncontrolled asthma, tezepelumab significantly reduced the annualized rate of asthma exacerbations compared to placebo regardless of baseline eosinophil counts.

Commins SP.

This review summarizes the current understanding of tick-bite sensitization, the delayed nature of red meat anaphylaxis, and practical avoidance strategies for alpha-gal patients.

Lebwohl B, et al.

A clinical review detailing the current standards for serologic testing, the role of biopsy-free diagnosis in specific populations, and the management of gluten-free diet adherence.

Casanale J, et al.

Clinical data supporting the pharmacological bioequivalence and safety of neffy, the first FDA-approved needle-free intranasal epinephrine spray for emergency treatment of anaphylaxis.

Dhar A, et al.

Comprehensive guidelines for EoE management, including the use of topical steroids, proton pump inhibitors, and the integration of biologics like dupilumab into the treatment algorithm.

Halken S, et al.

A review of the evidence supporting the early introduction of peanut and egg in the first year of life to prevent the development of food allergies in high-risk infants.

Barni S, et al.

This systematic review analyzes various oral food challenge (OFC) protocols for FPIES, concluding that standardized lower-dose challenges may reduce the severity of reactions.

Rubio-Tapia A, et al.

Comprehensive guidelines updating the diagnostic pathway for celiac disease, including the conditional use of a no-biopsy strategy in specific pediatric cases and the role of gluten-free oats in the diet.

Austin K, et al.

A high-level synopsis summarizing the 2023 ACG guidelines, focusing on the strong recommendation for multiple duodenal biopsies to confirm diagnosis in symptomatic adults and children.

Commins SP.

This update reviews the expanding geographic range of the lone star tick and current best practices for diagnosing AGS using delayed reaction history and alpha-gal-specific IgE testing.

Murphy ZR, et al.

A large-scale study of 112,817 encounters confirms that the prevalence of cefazolin-induced perioperative anaphylaxis is extremely low (0.02%) and does not differ significantly for patients with a penicillin allergy label.

Nowak-Wegrzyn A, et al.

This review provides an update on FPIES clinical phenotypes, emerging evidence on adult-onset disease, and revised oral food challenge protocols to improve diagnostic accuracy.

Haddad K, et al.

A retrospective study identifying a shift in FPIES triggers, with cow's milk now surpassing rice as the most common trigger, and egg and peanut emerging as significant new allergens.

Rothenberg ME, et al.

Weekly dupilumab 300 mg demonstrated sustained histological remission and significant improvement in dysphagia symptoms over 52 weeks in patients with EoE.

Rubio-Tapia A, et al.

Updated guidelines recommend multiple duodenal biopsies for confirmation and suggest a non-biopsy diagnostic strategy in selected children with high tTG-IgA and positive EMA.

Commins SP.

This clinical overview details the typical delayed allergic presentation of alpha-gal syndrome and emphasizes the importance of alpha-gal specific IgE testing and dietary avoidance.

Kliewer KL, et al.

Eliminating animal milk alone (1FED) was found to be an acceptable initial dietary therapy for EoE, showing similar histologic remission rates to the more restrictive 6-food elimination diet.

Baker MG, et al.

Analysis of recent FPIES trends shows that cow's milk remains the most common global trigger, but resolution rates and median age of tolerance vary significantly by specific food trigger.

Casale TB, et al.

Reviews the pharmacokinetic data and clinical potential of needle-free intranasal epinephrine for the emergency treatment of Type I allergic reactions, including anaphylaxis.

Reddel HK, et al.

The 2024 GINA update emphasizes ICS-formoterol as the preferred reliever across all steps (Track 1) and provides new guidance on asthma diagnosis and remission criteria.

Ambrose CS, et al.

Tezepelumab reduced annualized asthma exacerbation rates across various subgroups, including those with low blood eosinophils and those with comorbid nasal polyps.

Nowak-Wegrzyn A, et al.

This review summarizes current knowledge on FPIES, highlighting evolving epidemiology, updated oral food challenge protocols, and management strategies for acute reactions.

Argiz L, et al.

Systematic review identifying standardized oral food challenge protocols to improve safety and diagnostic accuracy for pediatric FPIES.

Lebwohl B, et al.

Expert consensus establishing standardized endpoints and trial designs to accelerate the development of non-dietary pharmaceutical treatments for celiac disease.

Husby S, et al.

Updated pediatric guidelines reinforcing the safety and reliability of the no-biopsy diagnostic pathway in symptomatic children with high tTG-IgA levels.

Brusselle GG, et al.

This large-scale study evaluates the real-world effectiveness of increasing ICS doses versus maintaining lower doses with add-on therapies to control asthma symptoms.

Lee CJ, et al.

Retrospective data show that dupilumab provides significant histologic and endoscopic improvement in refractory EoE patients, including those with fibrostenotic features.

Syverson EP, et al.

Review summarizing the clinical development and real-world utility of dupilumab as the first approved biologic therapy for pediatric and adult EoE.

Ghouri HI, et al.

This review highlights the efficacy and safety of omalizumab as a useful intervention to reduce the risk of anaphylaxis and enhance allergen tolerance in food-allergic patients.

Bourdin A, et al.

This review discusses the importance of precision phenotyping using biomarkers such as eosinophil counts and FeNO to guide the selection of biologic therapies in severe asthma.

Maddukuri C, et al.

Clinical pearls highlighting that emergency medical activation may not be required for all patients responding promptly and completely to home epinephrine.

Wong GWK

Global review describing food allergy as the "second wave" of the allergy epidemic — 1 in 3 children in developed countries are affected by at least one allergic disorder, food is the most common cause of childhood anaphylaxis, allergen patterns vary markedly across regions, and prevalence is lower in rural areas.

Du Toit G, et al.

Landmark trial showing that early, sustained peanut consumption in high-risk infants reduced peanut allergy by 81% — reshaping prevention guidelines worldwide.

Du Toit G, et al.

Demonstrates that the tolerance achieved through early peanut introduction persists into adolescence regardless of later consumption patterns.

Gupta RS, et al.

Nationally representative estimate that ~8% of U.S. children have a food allergy, with nearly 40% reporting a history of severe reaction.

Gupta RS, et al.

Estimates that at least 10.8% (>26 million) of U.S. adults are food-allergic, while nearly 19% believe they are — highlighting diagnostic and awareness gaps.

Gupta RS, et al.

Foundational prevalence study establishing an 8% childhood food allergy rate in the U.S. and quantifying severe reaction burden.

MacGinnitie AJ, et al.

NIH-funded trial showing omalizumab (Xolair) enabled rapid desensitization to multiple allergens and outperformed oral immunotherapy alone for multi-food allergy.

Pooled evidence that omalizumab combined with oral immunotherapy significantly increases reaction threshold and desensitization rates versus OIT alone across multiple food allergens.

Russell AF, Bingemann AT, Cooke TA, et al.

AAAAI work group report making the clinical and public-health case for requiring stock (undesignated) epinephrine in all schools, citing gaps in access, delayed first-line treatment, and evidence that stock epinephrine saves lives in the school setting.

Islam N, Foroutan F, Guyatt GH, Chu DK, et al.

Systematic review and meta-analysis synthesizing evidence on prenatal, perinatal, and early-life risk factors associated with the development of food allergy in infants and children, to inform prevention and early-intervention strategies.

Turner P, Dowdall N

PROSPERO-registered review finding allergic reactions are 10–100x less common during flights than on the ground, with no evidence supporting airborne nut-allergen transmission. Recommends passengers wipe down seat/tray/entertainment surfaces (proteins are “sticky”), carry two adrenaline autoinjectors, and airlines stock general-use epinephrine and publish consistent food-allergy policies.

U.S. Food and Drug Administration (FDA)

FDA Q&A companion to the 5th edition of its Food Allergen Labeling guidance, covering the nine major food allergens (milk, egg, fish, Crustacean shellfish, tree nuts, wheat, peanuts, soybeans, sesame) and key 2025 updates — expanded interpretation of milk/eggs to include non-cow ruminants and non-chicken birds, removal of coconut and certain tree nuts from the major-allergen list, and manufacturing controls for allergen cross-contact under 21 CFR Part 117.

Quinn J (CDC)

Official CDC guidance for clinicians counseling severely allergic international travelers — covering pre-travel planning 4–6 weeks out, medication supplies, asthma action plans, airline nut policies, translated chef cards, buffer zones from animals, and carrying two epinephrine autoinjectors. Includes a curated table of worldwide air-quality, pollen, and food-allergy airline-policy resources (AAFA, EAACI, FARE, DOT, FARRP).

Global Initiative for Asthma

The annually updated international evidence-based strategy covering diagnosis, assessment, and stepped pharmacologic management of asthma across all ages.

Reddel HK, et al.

Peer-reviewed summary of the GINA 2024 changes, including updated criteria for stepping up therapy and ICS-containing controller recommendations.

Brahmbhatt M, et al.

Reviews contemporary asthma management, emphasizing ICS-formoterol as preferred reliever across all steps and biologics for severe asthma phenotypes.

Global Initiative for Asthma

The 2025 update of the international evidence-based strategy, incorporating new science on diagnosis, ICS-containing controllers, and biologic eligibility for severe asthma.

Reviews current severe-asthma biologics (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, tezepelumab) and emerging targets, with guidance on phenotype-based selection.

Practical algorithm aligning with GINA 2025 and ERS/ATS criteria for severe asthma and biologic referral, covering stepwise assessment and treatment escalation.

Dellon ES, et al.

Defines EoE as a clinicopathologic condition requiring esophageal dysfunction symptoms plus ≥15 eosinophils/hpf, with elimination of other causes.

Dellon ES, et al.

Concise summary of the revised diagnostic framework, including histologic thresholds and the requirement to exclude PPI-responsive esophageal eosinophilia.

Dellon ES, et al.

Full consensus manuscript detailing the multi-stakeholder diagnostic criteria, endoscopic findings, and approach to repeat biopsy confirmation.

Chu SH, et al.

Pooled randomized-trial evidence confirming dupilumab produces significant histologic and symptomatic improvement in EoE, supporting its first-in-class FDA-approved role.

Musburger BG, et al.

Reviews dupilumab, the first FDA-approved EoE therapy (2022, expanded 2024), plus emerging agents and the histologic/symptomatic endpoints guiding treatment.

Hasosah M, et al.

Reports symptomatic relief in 82%, endoscopic improvement in 73%, and histologic improvement in 90% of pediatric EoE patients treated with dupilumab.

Nowak-Węgrzyn A, et al.

The first international evidence-based guidelines for Food Protein-Induced Enterocolitis Syndrome, standardizing diagnostic criteria, oral food challenges, and acute management.

Anvari S, et al.

Reflects on the impact of the 2017 guidelines and emerging directions in FPIES diagnosis, phenotyping, and management.

Mathew M, et al.

Reviews the major/minor diagnostic criteria, trigger foods, acute reaction management, and natural history of tolerance development.

The 2024 international algorithm update refining FPIES diagnostic criteria, acute reaction management, oral food challenge protocols, and tolerance assessment.

Reviews FPIES presentation from infancy through adulthood, emerging phenotypes, and the 2024 updated diagnostic and treatment algorithm across age groups.

Lebwohl B, et al.

Comprehensive review of rising celiac incidence, varied presentations, serologic and biopsy-based diagnosis, and non-celiac gluten sensitivity.

Lebwohl B, Ludvigsson JF, Green PHR

Seminar review covering ~1% global prevalence, pathogenesis, gluten-free diet management, complications, and refractory disease.

Rubio-Tapia A, et al.

Foundational population study finding 0.71% U.S. prevalence (~1 in 141), with the majority of cases previously undiagnosed.

Al-Toma A, et al.

2025 European consensus updating celiac disease diagnosis, gluten challenge protocols, serologic/biopsy criteria, and management of refractory and non-responsive disease.

Manza F, et al.

2025 review of NCGS/NWS epidemiology, symptom profiles, the gluten-free diet as current therapy, and the boundary between NCGS, celiac disease, and wheat allergy.

Commins SP, Platts-Mills TAE, et al.

Identifies tick bites as the cause of IgE alpha-gal sensitization and characterizes delayed red-meat anaphylaxis across the southern U.S.

Commins SP, Platts-Mills TAE, et al.

Prospective evidence that tick bites produce ≥20-fold rises in alpha-gal IgE, establishing the tick-mediated sensitization mechanism.