Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and -13 signaling, is approved for the treatment of eosinophilic esophagitis (EoE) based on phase III clinical trials. However, real-world data on dupilumab use for EoE are lacking.

Recall urticaria is a rare hypersensitivity phenomenon characterized by the reappearance of urticarial wheals strictly confined to previously exposed skin sites following systemic re-exposure to a trigger. Although reported with several drugs, its clinical features and underlying mechanisms remain poorly defined. A 25-year-old man with ulcerative colitis developed acute pruritic wheals localized exclusively to prior subcutaneous injection sites approximately 15 min after intravenous administration of vedolizumab. He had experienced repeated localized injection-site reactions during prior subcutaneous therapy. Histopathology revealed mild perivascular inflammation with eosinophils. The eruption resolved spontaneously within 24 h without systemic symptoms, and vedolizumab therapy was continued. This case represents the first report of vedolizumab-associated recall urticaria. A review of previously reported cases highlights strict site specificity as the defining feature, irrespective of the route or timing of re-exposure. Recall urticaria should be recognized as a site-specific hypersensitivity reaction distinct from systemic drug allergy.

Dapsone is widely used for inflammatory dermatoses and vasculitides but may cause severe systemic hypersensitivity reactions. Diagnosis can be challenging when clinical features overlap with underlying inflammatory disease and when eosinophilia is absent. We report a case of a young man with biopsy-confirmed immunoglobulin A vasculitis (Henoch-Schönlein purpura) who developed facial and neck edema, a diffuse morbilliform eruption, and hepatocellular liver injury approximately four weeks after initiation and dose escalation of dapsone. Laboratory evaluation demonstrated elevated aminotransferases with normal creatinine and absent eosinophilia, along with anemia and reticulocytosis suggestive of concurrent dapsone-related hematologic toxicity. The patient was receiving ongoing cyclosporine and had recent high-dose corticosteroid exposure at the time of presentation. Dapsone was discontinued and systemic corticosteroids were administered with rapid clinical improvement. This case highlights diagnostic pitfalls in recognizing severe drug reactions in immunosuppressed patients and emphasizes the importance of integrating medication timelines, organ involvement, and immunosuppression status when evaluating suspected drug reactions.

Therapeutic monoclonal antibodies can elicit anti-drug antibodies (ADAs) in patients, which impact drug pharmacokinetics, reduce efficacy, and occasionally cause hypersensitivity reactions. Growing evidence indicates that early detection of ADA responses improves therapy outcomes, yet their monitoring has remained underappreciated. Conventional assays are complex, time-consuming, and confined to centralized laboratories, thereby delaying clinical decisions. In contrast, emerging biosensor technologies represent a promising alternative for timely, on-site ADA detection. This review examines advancements in ADA detection and provides a critical overview of its clinical relevance based on contemporary findings. Furthermore, the challenges and complexities of accurately biosensing ADAs are discussed. Finally, we explore the prospects of biosensors for on-site analysis and their integration into proactive therapeutic drug monitoring.

Remimazolam, an ultra-short-acting benzodiazepine metabolized by carboxylesterase-1 (CES1), permits specific antagonism by flumazenil, enabling active reversal unavailable with propofol-based sedation. However, the safety profile of this reversal strategy-including re-sedation risk, seizure concerns, and special population considerations-remains incompletely characterized.

Pulmonary hypertension (PH) and diabetes frequently coexist, and metabolic dysregulation plays a role in PH pathogenesis. While preclinical studies indicate that certain antidiabetic therapies may beneficially impact the pulmonary vasculature and right heart function in PH, clinical data remain limited. We conducted a retrospective cohort study of veterans with PH and diabetes using Veterans Health Affairs data (2003-2015). The associations between exposure to antidiabetic medications at the time of PH diagnosis and survival were analyzed using Cox proportional hazards regression. We identified 41,670 veterans with PH and diabetes, largely older men (median age 69, 97% male). Average survival from PH diagnosis was 3.5 years. After adjustment for demographics, comorbid conditions, renal function, and hemoglobin A1c, metformin and thiazolidinedione (TZD) exposure were associated with lower mortality (HR 0.828, 95% CI 0.799-0.857 and HR 0.838, 95% CI 0.793-0.885, respectively). Conversely, insulin use was associated with higher mortality. These associations remained consistent across multiple analytical approaches and were independent of baseline hemoglobin A1c levels. Interactions were observed between drug effects and both renal function and PH comorbidities, with metformin's protective effect enhanced in patients with lower eGFR but attenuated in those with lung disease. In conclusion, metformin and TZD use were associated with improved survival in veterans with PH and diabetes, while insulin use was associated with reduced survival. These findings suggest that metabolic modulation may represent a viable therapeutic strategy in PH, though could be context dependent. Prospective trials are needed to evaluate therapeutic approaches targeting the metabolic pathobiology of PH.

Trichomonas vaginalis is the causative agent of trichomoniasis, the most common and prevalent sexually transmitted infection (STI) globally, with about 156 million cases annually. Trichomoniasis is a critical public health problem, and it is aggravated due to its association with a higher risk of HIV-1 acquisition and transmission and complications such as preterm delivery and pelvic inflammatory disease. This STI is treated mainly through the 5-nitroimidazole class, specifically metronidazole and tinidazole. However, drug resistance, which can represent between 5 and 20% of clinical cases, and hypersensitivity reactions are a general concern. In this context, drug development for trichomoniasis is an ever-growing research field. Therefore, considering how important drug targets and the mechanism of action of compounds can be to drug discovery, there is a growing interest in better understanding how some molecules can be used as targets. This article offers an overview of T. vaginalis drug targets, their significance in metabolism, pathogenesis, or survival, and their contribution to drug development for trichomoniasis.