Background: Effective communication between physicians and the public has become increasingly important in the modern media environment. Pediatricians and allergist/immunologists play a critical role in shaping public understanding of conditions such as food allergy, asthma, and vaccine safety. Objective: The objective was to provide a practical framework for clinicians to engage effectively with media, improve public health messaging, and enhance patient outcomes through clear, accurate, and impactful communication. Methods: This was a narrative review of literature that integrates health communication, media engagement, pediatric advocacy, allergy and immunology, public health messaging, vaccine communication, and asthma and food allergy education. Results: Successful media engagement requires preparation, audience awareness, message clarity, and strategic delivery. Core principles include simplifying complex medical information; maintaining credibility; and focusing on key public health messages, such as early food introduction, asthma control, and vaccine safety. The RATIO framework (Research, Audience, Targeted Topic, Interview Redirecting, Optimism) provides a structured approach to media advocacy. Conclusion: Physician engagement with media is an essential extension of clinical care. Effective communication can improve public understanding, counter misinformation, promote evidence-based health behaviors, and substantially affect adherence and preventive behaviors, particularly in vaccination and chronic disease management, particularly in pediatric populations.

Background and Objective: This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) levels and peripheral blood eosinophil (EOS) counts in patients with stable asthma who were undergoing general anesthesia as well as to assess their association with postoperative acute asthma exacerbations (AAE) during the perioperative period. Method: A retrospective analysis was conducted by using perioperative clinical data from 118 patients with stable asthma who received general anesthesia in Chongqing University Fuling Hospital. Logistic regression models and receiver operating characteristic curve analysis were used to identify predictive factors for AAEs during the perioperative period. The early predictive value of FeNO levels and EOS counts for AAEs after general anesthesia was quantitatively evaluated. Results: Perioperative intubation response, elevated intraoperative peak airway pressure, postoperative arterial carbon dioxide tension, extubation time, postoperative FeNO levels, and postoperative EOS counts were significantly associated with the occurrence of AAEs (p < 0.05). Multivariate logistic regression analysis demonstrated that the area under the curve for the combined postoperative FeNO and EOS levels was 0.866, with a sensitivity of 88.5% and specificity of 80.4%. These findings indicate that the combined measurement of these biomarkers offers superior early predictive value for postoperative AAEs in patients with stable asthma. Conclusion: Postoperative measurement of FeNO and peripheral EOS counts seem to enhance the early prediction of AAEs in patients with stable asthma who were undergoing general anesthesia. The combined use of these biomarkers may offer a useful tool for early risk stratification, which supports timely implementation of preventive strategies and improved perioperative management, although further validation in larger and prospective studies is needed.

Objective: Penicillin allergy (PA) is associated with an increased risk for cesarean delivery, prolonged postpartum hospital stay, and less-preferred antibiotic prophylaxis and treatment. However, the majority of pregnant women with PA can safely receive penicillin after an allergy evaluation. We aimed to evaluate the safety and efficacy of PA delabeling across all trimesters and to characterize rates of first-line Group B Streptococcus (GBS) prophylaxis after PA delabeling. Methods: We conducted a retrospective analysis of clinical visits for pregnant women with PA referred to Duke Allergy and Immunology Clinic from October 2023 through May 2025. Outcome measures included removal of the PA label and subsequent peripartum antibiotic use. Results: Of the 117 pregnant patients with PA evaluated in the Allergy and Immunology clinic, 112 (96%) underwent PA testing, with gestational age spanning all trimesters. Two patients (2%) had direct oral challenge, which was tolerated without adverse reaction. The other 110 patients (98%) had skin testing, of which 106 (96%) were negative. Of these, 101 women (95%) subsequently passed oral amoxicillin challenge. All patients with negative testing results were delabeled. Among these, 30 women required GBS prophylaxis. Yet, 10 women (33%) received a penicillin alternative or no antibiotics. In total, 18 women were delabeled and reexposed to intrapartum penicillin. None had adverse reactions. Conclusion: PA evaluation is likely safe and effective through all trimesters of pregnancy. Further research, including randomized controlled trials, are needed to expand this knowledge. Most pregnant women referred for PA evaluation can have PA delabeled. Surprisingly, a large portion of women did not receive first-line GBS prophylaxis despite PA removal, reiterating the need for improved interdisciplinary communication.

Background: Aspirin-exacerbated respiratory disease (AERD), also known as nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, is a chronic condition that is both clinically complex and often difficult for patients to understand. As patients increasingly turn to online tools for medical information, it is important to evaluate the quality of the responses they may receive. Objective: This study assessed the medical accuracy and readability of responses generated by ChatGPT 5.1, Gemini 2.5 Flash, and Claude Sonnet 4.5 to 12 common questions that patients often ask their providers about AERD. Methods: The 12 questions were developed by clinicians and patients; the resulting chatbot responses were de-identified and reviewed by an expert panel of 11 AERD specialists who rated each response for medical accuracy on a 10-point scale. Readability was measured by using readability and grade-level analysis programs. Results: Gemini's responses had the highest overall ratings for medical accuracy, followed by Claude and ChatGPT. The models generated responses written at a postgraduate reading level, which is substantially higher than recommended targets for patient-education materials. Questions with more complex responses showed greater variability in expert ratings, potentially reflecting differences in clinical interpretation. Conclusion: Analysis of these findings suggests that, whereas chatbots may improve access to medical information, their current outputs require clinician review and substantial simplification before they can be reliably used for patient education.

Background: Mas-related G protein-coupled receptor X2 (MRGPRX2) and protease-activated receptor 2 (PAR2), are the main markers of nonhistaminergic pruriceptors. Elevated circulating MRGPRX2 levels have been reported in severe chronic spontaneous urticaria (CSU), whereas the role of serum PAR2 remains unclear. Objective: This study aimed to determine the differences in serum MRGPRX2 and PAR2 levels between patients with CSU and normal healthy controls (NC), and to evaluate their associations with disease severity and utility as biomarkers in CSU. Methods: The patients were stratified by the urticaria activity score over 7 days (UAS7) into three groups: severe (UAS7 ≥ 28), moderate (16 ≤ UAS7 < 28), and mild (UAS7 < 16). Serum samples from 60 patients with CSU and 30 NCs were screened for MRGPRX2 and PAR2 by using enzyme-linked immunosorbent assay. Results: The serum MRGPRX2 level was higher in the severe CSU group (0.31 ± 0.12 ng/mL) than in NCs (0.19 ± 0.11 ng/mL) (p < 0.001) and in patients with mild-to-moderate CSU (0.24 ± 0.08 ng/mL) (p = 0.019). Similarly, the serum PAR2 level was also significantly higher in patients with severe CSU (0.38 [0.21-0.53] ng/mL) compared with NCs (0.21 [0.11-0.27] ng/mL) (p < 0.001) and with patients with mild-to-moderate CSU (0.20 [0.15-0.27] ng/mL) (p < 0 .001). Both MRGPRX2 and PAR2 showed positive correlations with UAS7. PAR2 was negatively correlated with the basophil percentage, whereas MRGPRX2 showed no correlation with the basophil percentage. Logistic regression analysis identified serum MRGPRX2 levels ≥ 0.2375 ng/mL (odds ratio 2.498; p = 0.002) and serum PAR2 levels ≥ 0.12 ng/mL (odds ratio 1.901; p = 0.043) as two independent risk factors for CSU. In addition, serum PAR2 levels ≥ 0.271 ng/mL (odds ratio 3.317; p = 0.002) were identified as an independent risk factor for severe CSU. Conclusion: We suggest that serum MRGPRX2 and PAR2 are both biomarkers of disease severity and independent risk factors for CSU.

Background: Cosensitization to multiple allergens may play an important role in the development and clinical expression of allergic diseases. This study aimed to characterize multidimensional patterns of allergen sensitization and their cross-sectional associations with allergic diseases among participants who were sensitized in the U.S. National Health and Nutrition Examination Survey (NHANES) by using allergen-specific immunoglobulin E (IgE) data from NHANES 2005-2006. Methods: In this cross-sectional analysis of participants with at least one positive allergen-specific IgE test, exploratory factor analysis and partitioning around medoids clustering were used to identify latent allergen factors and classify individuals into distinct sensitization patterns. Logistic regression, adjusted for sex, age, race/ethnicity, questionnaire-defined overweight, and household income, evaluated associations between clusters and self-reported allergic diseases. Results: Among 3512 participants who were sensitized, seven allergen factors were identified, and four clusters were defined: limited-sensitization (cluster 1), pollen-enriched (cluster 2), mite-enriched (cluster 3), and fungus-enriched (cluster 4). Notable differences in demographics and in the prevalence of allergic diseases were observed across clusters. Relative to cluster 1, cluster 2 had the highest odds of allergic rhinitis (odds ratio [OR] 2.04 [95% confidence interval {CI}, 1.69-2.48]), whereas cluster 3 had the highest odds of chronic rash (OR 1.58 [95% CI, 1.17-2.09]) and cluster 4 showed the greatest odds of asthma (OR 3.44 [95% CI, 2.68-4.40]). For eczema, clusters 3 and 4 showed comparable elevated odds (OR 1.63 [95% CI, 1.19-2.21] and OR 1.64 [95% CI, 1.14-2.32], respectively). After adjustment for confounders, associations for rhinitis, asthma, and chronic rash were essentially unchanged, whereas the eczema association persisted for cluster 3 (adjusted OR 1.61 [95% CI, 1.16-2.21]) but attenuated for cluster 4 (adjusted OR 1.39 [95% CI, 1.10-2.00]). Conclusion: The participants who were sensitized could be grouped into four distinct sensitization patterns differentially associated with asthma, rhinitis, eczema, and chronic rash. These patterns may help generate hypotheses for future clinical stratification and more tailored management research.

Background: Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by heterogeneous clinical phenotypes, frequently accompanied by autoimmune complications. Beyond recurrent infections, autoimmunity represents a major cause of morbidity and mortality. Early diagnosis and treatment of autoimmune manifestations are of vital importance. Objective: This study aimed to determine the diagnostic value of serum growth differentiation factor 15 (GDF15) levels in patients with CVID and to investigate its potential as a biomarker for predicting autoimmune complications. Methods: This prospective, cross-sectional study included 80 patients with a diagnosis of CVID who were followed up and 40 age- and sex-matched healthy controls. The patients with CVID were divided into two subgroups based on the presence of concomitant autoimmune disease (autoimmunity present, n = 42; absent, n = 38). GDF15 levels were measured by using the enzyme-linked immunosorbent assay (ELISA) method. The diagnostic performance of GDF15 was evaluated by receiver operating characteristic analysis, and its impact on the development of autoimmunity was assessed by using multivariate logistic regression analysis. Results: GDF15 levels were found to be significantly higher in the CVID group with autoimmune disease (median, 2205 pg/mL) compared with both the CVID group without autoimmunity (1526 pg/mL) and the healthy control group (1083 pg/mL) (p < 0.001). A negative correlation was observed between GDF15 levels and serum immunoglobulin G (IgG), IgM, and IgA levels (r = -0.38, p < 0.001; r = -0.299, p = 0.001; r = -0.236, p = 0.01, respectively). In the receiver operating characteristic analysis, the area under the curve value for GDF15 in the diagnosis of CVID was 0.769, and was 0.683 for predicting the presence of autoimmunity. Multivariate logistic regression analysis revealed that elevated GDF15 levels (>1564 pg/mL) independently increased the risk of developing autoimmunity in patients with CVID by 5.1-fold (odds ratio 5.164 [95% confidence interval, 1.386-19.241]; p = 0.014). Conclusion: To our knowledge, this study was the first to demonstrate that GDF15 levels are elevated in patients with CVID and that this elevation is associated with autoimmune complications. GDF15 is a potential biomarker that can be used for determining the risk of autoimmunity and monitoring patients at high risk in the CVID.

Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening disorder characterized by recurrent edema of the extremities, abdomen, face, larynx, trunk, and genital region. It follows an autosomal dominant inheritance pattern and affects both sexes equally; however, attacks may occur more frequently and with greater severity in women due to hormonal factors. Aims: The aim of this study was to evaluate the impact of hormonal changes on HAE attacks in women and to determine how different reproductive stages and hormonal exposures affect attack frequency and course. Methods: In this retrospective descriptive cohort study, 36 postpubertal women with HAE were evaluated to assess the effects of reproductive factors, including menstruation, oral contraceptive use, pregnancy, delivery, lactation, and menopause, on attack frequency and disease activity. Results: Thirty patients had type I and six had type II HAE. The mean age at diagnosis was 23.5 years, with a mean diagnostic delay of 12.6 years. Menstruation triggered attacks in 52.8% of the patients. Among 26 patients with 94 pregnancies, 21.2% ended in spontaneous abortion, and 73.1% had at least one child diagnosed with HAE. During pregnancy, attack frequency increased in 30.6%, decreased in 27.7%, and was unchanged in 41.7%. Attacks occurred within 48 hours postpartum in six deliveries, and three patients reported increased attacks during lactation. After menopause, attacks increased in 25%, decreased in 33.3%, and were unchanged in 41.7%. Conclusion: Hormonal and reproductive life stages influence disease activity in women with HAE, although the direction and magnitude of these effects vary among individuals. The marked delay in diagnosis observed in this cohort suggests that many women experience pregnancies without disease-specific management. Earlier recognition of HAE and individualized treatment approaches may improve care during hormonally dynamic periods.

Background: Current therapies for food allergy prevention, oral immunotherapy and omalizumab, increase reaction threshold, but their curative potential remains unknown. Dupilumab has emerged as a promising treatment for several atopic conditions. We observed that many children with food allergy who are on dupilumab had profound reductions in food-specific immunoglobulin E (sIgE) levels over time. Objective: We sought to determine whether sIgE levels decrease in children with food allergy who are on dupilumab and whether changes over time were influenced by allergen type, race, sex, indication for therapy, or age of initiation of therapy. Methods: A retrospective analysis of 44 children with food allergy who were on dupilumab was conducted for longitudinal assessment of sIgE. Results: A statistically significant decrease in sIgE levels was observed across multiple allergens in the 44 children treated with dupilumab for a mean of 1.4 years. A stratified analysis identified a statistically significant decrease (p < 0.05) in sIgE levels in children receiving treatment for both atopic dermatitis (AD) and eosinophilic esophagitis (EoE). This reduction remained significant across all subgroups regardless of race, sex, or age of initiation of dupilumab. The rate of change in sIgE levels over time was greater in children with AD than with EoE, but this difference did not reach statistical significance. Notably, age < 6 years at dupilumab initiation was associated with steeper declines and greater absolute reductions in sIgE levels over time (-1.281 versus -0.784 log2 IgE/year), with this difference approaching statistical significance (p = 0.0873), despite the small cohort size. Conclusion: We hypothesize that dupilumab may modify clinical tolerance in younger children during a window of immune plasticity and may increase reaction thresholds in older children. Even if this hypothesis is not confirmed, there is clinical utility in reductions of IgE levels, especially in children who are pansensitized, in whom these reductions likely improve signal-to-noise for clinically relevant sensitization. We advocate for prospective early-intervention trials that evaluate dupilumab as adjunctive therapy in children with comorbid atopy to determine its potential role in preventing food allergy development.

Background: Grass pollen represents one of the most common and clinically important groups of aeroallergens. Objective: This study evaluated the correlation between grass panel (GP) specific immunoglobulin E (sIgE) levels measured using the IMMULITE system and skin-prick test (SPT) reactivity in children with asthma or seasonal allergic rhinitis (SAR) and aimed to determine a clinically meaningful optimal cutoff value. Methods: In this single-center retrospective study, children with SAR and/or asthma who had positive GP sIgE results and underwent grass pollen SPT were included. Demographic, clinical, and laboratory data were extracted from medical records, and diagnoses were established according to the GINA and ARIA guidelines. Serum sIgE levels were measured using the IMMULITE 2000 system. The GP sIgE assay includes orchard grass, meadow fescue, perennial ryegrass, timothy grass, and June grass. SPT was performed using Phleum pratense and/or Graminaceae mix-5 extracts, the latter containing orchard grass, meadow fescue, Italian ryegrass, timothy grass, and Kentucky bluegrass. SPT results were classified as reactive or nonreactive, and the optimal cutoff value for GP sIgE was determined. Results: A total of 888 children with positive GP sIgE results who underwent grass pollen SPT were included; 89.3% (n = 793) were SPT-reactive. Of all patients, 649 (73.1%) had SAR alone, whereas 239 (26.9%) had concomitant SAR and asthma. GP sIgE levels were significantly correlated with eosinophil parameters, total IgE levels, and SPT wheal diameters for both extracts. Receiver operating characteristic analysis identified optimal GP sIgE cutoff values of 15.05 kUA/L for overall grass pollen SPT reactivity, 28.2 kUA/L for Phleum pratense, and 20.5 kUA/L for Graminaceae mix-5, each demonstrating clinically useful discriminatory performance. Conclusion: IMMULITE-measured GP sIgE levels were significantly associated with grass pollen SPT reactivity and provided clinically useful information for the assessment of sensitization. Although Graminaceae mix-5 demonstrated greater discriminatory performance than Phleum pratense, both extracts were informative. Mixed extracts may better reflect cross-reactivity, whereas single extracts may complement species-specific assessment and immunotherapy planning. These cutoff values may aid interpretation when SPT cannot be performed.

A 30-year-old woman presented with glucocorticoid-dependent chronic spontaneous urticaria (CSU) previously treated with high-dose H1-second generation antihistamines, omalizumab, and cyclosporin (This is the current Chronic spontaneous urticaria guidelines: Step 1 - second generation H1 antihistamine up to 4 times than standard dose; Step 2 - Omalizumab; Step 3 - Cyclosporin) that were either intolerable or ineffective at providing symptom relief. She also had two prolonged treatment courses with omalizumab that failed. Her CSU was cyclical worsening during ovulation and improving but not resolving midway through her cycle. Markers for chronic autoimmune urticaria (CAU) were positive. Treatment with progesterone desensitization was partially successful, which allowed her to taper her daily glucocorticoids to prednisone 20 mg a day. She was diagnosed with progesterone hypersensitivity with concomitant CAU. Subsequent treatment with rituximab to remove pathogenic autoantibodies was successful in allowing her to taper off prednisone and tolerate progesterone without hives during or independent of her menstrual cycle. She subsequently was able to conceive a healthy baby girl without recurrence of hives.