Recent advances in biological therapies, small molecules and allergen-specific immunotherapy are reshaping the management of immunoallergic diseases, progressively shifting therapeutic goals from short-term disease control toward the possibility of achieving sustained clinical remission. Despite increasing evidence across multiple conditions, a universally accepted and disease-transversal definition of clinical remission (CR) remains lacking. In this review we propose a comprehensive framework for defining clinical remission across a broad spectrum of immune-mediated diseases traditionally managed in Allergy and Clinical Immunology practice, including asthma, allergic rhinitis, chronic rhinosinusitis with nasal polyps, chronic urticaria, atopic dermatitis, mastocytosis, food allergy, and eosinophilic esophagitis. Clinical remission is defined as a sustained state of absence of clinically relevant disease manifestations, independently of underlying biological activity; suppression of inflammatory pathways and normalization of biomarkers define biological remission, which may coexist with, but is not required for, clinical remission. We introduce the 3D-CR model, a pragmatic, disease-adaptable framework integrating 3 complementary domains-clinical, biological, and functional-to characterize remission states as complete, partial, or absent. Building on this model, we propose the Allergic Disease Remission Score (ADReS) as a modular tool designed to support standardized assessment, longitudinal follow-up, and cross-disease comparison in clinical trials and real-world settings. These tools are intended as conceptual and research instruments rather than prescriptive algorithms for individual therapeutic decision-making. Finally, we outline a World Allergy Organization call to action advocating for a harmonized global approach to defining, measuring, and implementing clinical remission as a meaningful treatment target. Establishing standardized remission endpoints has the potential to improve patient outcomes, facilitate precision medicine strategies, enhance comparability across studies, and reduce heterogeneity in clinical research and practice worldwide.

Type 2 memory B cells (Bmem) are the reservoir of pathogenic IgE in allergies. Allergen immunotherapy (AIT) can change the course of disease, but if it involves reprogramming of allergen-reactive Bmem remains unknown. Here, we examine how AIT affects allergen-specific Bmem in house dust mite (HDM) allergic patients.

HDM allergic patients were longitudinally evaluated over 18 months with or without sublingual HDM-AIT. Visual analog scores, lung function tests, medication scores, serum IgE, and flow cytometric analysis of Der p 1 and Der p 2-specific Type 2 Bmem were performed at t = 0, 4, 12, and 18 months.

Patients on HDM-AIT showed clinical improvement over 18 months with reduced intake of other medications and increases in specific serum IgE, IgG2, and IgG4. Allergen-specific Bmem and the proportions of Type 2 Bmem therein became more abundant at 4 and 12 months and showed upregulation of CD29 and IgG4. At 18 months, the Type 2 Bmem proportions were reduced.

A biphasic Bmem response with early phenotypic changes followed by loss of the Type 2 state was observed during 18 months of AIT. As durable unresponsiveness takes 18 months of AIT, deletion of Type 2 Bmem is likely an important step in disease attenuation. Interventions that expedite this outcome may be beneficial in driving remission.

Our previous study demonstrated that laundry detergents induce group 2 innate lymphoid cell-driven eosinophilic airway inflammation by disrupting airway epithelial barriers and promoting IL-33 release, and that detergent residues are present in nearly all household dust. However, their impact on allergen-induced airway inflammation remains unclear.

C57BL/6 background mice were intranasally primed four times with ovalbumin (OVA) or house dust mite (HDM) allergens in the presence or absence of a commercial laundry detergent. Following priming, mice were challenged with the same antigen for 3 consecutive days and sacrificed the day after the final challenge. Bronchoalveolar lavage fluid (BALF) and sera were analyzed by ELISA. Lungs were evaluated histologically and analyzed by qPCR.

Mice intranasally primed with antigen in the presence of detergent exhibited eosinophilic airway inflammation upon antigen challenge, accompanied by increased IL-5 and IL-13 levels in the BALF. Intranasal administration of detergent and antigen also stimulated antigen-specific IgE production. These detergent- and allergen-induced type 2 responses were significantly suppressed in Il33-/- and Il13-/- mice. Administration of an anti-IL-4 receptor α chain antibody during the challenge phase reduced eosinophil counts in the BALF and antigen-specific IgE levels in the serum. By contrast, anti-IL-33 antibody treatment during the challenge phase did not affect eosinophilic airway inflammation or antigen-specific IgE production.

Laundry detergents promote sensitization to co-inhaled allergens and exacerbate eosinophilic airway inflammation and antigen-specific IgE responses via IL-33 and IL-13. These findings suggest that detergents can act as adjuvants that facilitate airway sensitization.

To investigate age-related differences in efficacy and safety of subcutaneous immunotherapy (SCIT) among patients with allergic rhinitis (AR).

Retrospective cohort study.

Tertiary referral center.

AR patients who completed a 3-year course of dust mite SCIT with a 2-year post-SCIT follow-up were categorized into pediatric and adult groups. Baseline characteristics, SCIT efficacy, and adverse reactions were compared between groups. Multivariable logistic regression was used to identify independent predictors of SCIT efficacy and adverse reaction.

889 patients were included, comprising 544 children and 345 adults. Adults exhibited higher baseline symptom burden, higher rates of former or current smoking and alcohol consumption, longer AR duration, more frequent dose adjustments during SCIT, and greater prevalence of comorbid asthma and urticaria. In contrast, children had higher frequencies of family history of allergy, monosensitization, food allergy, and secondary immunotherapy. Multivariable logistic regression confirmed that older age, particularly adult status, was an independent risk factor for reduced SCIT efficacy at both 1 and 2 years post-SCIT discontinuation, after adjusting for clinical confounders. Adverse reactions, including both local and systemic events, occurred more frequently in children, though the majority were mild and occurred during the maintenance phase. Notably, older or adult age was independently associated with a lower risk of SCIT-related adverse reactions.

Allergen immunotherapy (AIT), involving subcutaneous (SCIT) or sublingual (SLIT) administration of the culprit allergen, is the only treatment capable of modifying the natural course of allergic diseases, and provides lasting benefits in terms of symptom reduction and medication use. AIT for allergic rhinitis is acknowledged as safe and effective in both adults and children; however, no studies have comprehensively evaluated the safety and efficacy of AIT in these populations, integrating results from randomized controlled trials (RCTs) and real-world evidence (RWE).

We evaluated data in the literature including studies from RCTs and RWE in which the safety and efficacy of AIT in both children and adults have been analyzed. A narrative literature search was conducted in PubMed up to January 2026 using the following keywords for the search string: "allergen immunotherapy," "AIT," "safety," "efficacy," "clinical outcome," and "clinical evaluation."

RCTs and meta-analyses showed that both SCIT and SLIT significantly reduced allergic symptoms and medication use and improved quality of life (QoL). Large SLIT tablet trials have confirmed its efficacy in adults and children, whereas RWE supports its effectiveness in broader populations. Safety data indicated that SCIT carries a small but higher risk of systemic reactions than SLIT, which mainly causes mild local effects.

AIT was effective and safe for treating allergic rhinitis across RCT and RWE studies. Integrating RWE with RCT findings is essential for guideline development, particularly for capturing long-term outcomes and real-world applications.

Allergen immunotherapy (AIT) and biologics such as omalizumab are established treatments for allergic asthma, but long-term data on their combined use are limited.

To compare long-term clinical and immunological outcomes of omalizumab, subcutaneous AIT for house dust mite (SCIT-HDM), and their combination in mild-to-moderate allergic asthma.

In this prospective, randomized, controlled study, 79 patients with HDM-driven allergic asthma were assigned to omalizumab (A), omalizumab plus SCIT-HDM (B), SCIT-HDM (C), or standard therapy (D). Patients were followed for 36 months. Primary outcomes were changes in inhaled corticosteroid (ICS) dose and annual exacerbations. Secondary outcomes included symptom and medication scores, Asthma Control Test (ACT), asthma quality of life (AQLQ), lung function, remission rates, and biomarkers.

All groups showed significant reductions in ICS use, with greater reductions in groups A and B than in C and D (p < 0.05). Combination therapy (B) resulted in lower exacerbation rates and reduced oral corticosteroid use compared to other groups. Improvements in ACT, FEV1, and AQLQ were observed across all groups, with more consistent benefits in A and B. Clinical remission occurred most often in group B (47%), followed by A (31%), C (29%), and D (14%). Biomarker changes indicated reduced type 2 inflammation and immunological responses to therapy. No serious adverse events or systemic hypersensitivity reactions were observed.

House dust mite allergens Der p 1, Der p 2, and Der p 23 are recognized as major clinically relevant allergens worldwide; however, it is difficult to obtain these proteins in purified form from a natural source, which limits their use in molecular targeted immunotherapy and in vivo diagnosis. In this study, we developed and validated robust methodologies for the large-scale purification and individual characterization of native nDer p 1, nDer p 2, and nDer p 23 allergens from the natural sensitization source, Dermatophagoides pteronyssinus. Each allergen was isolated through an independent downstream process based on successive chromatographic steps, achieving high purity and preserving the structural integrity. Molecular standardization was performed in vivo in 27 mite-allergic patients by skin prick testing (SPT), enabling the separate determination of histamine equivalent potency (HEP) values: 7.43 μg/mL for nDer p 1, 8.11 μg/mL for nDer p 2, and 1.55 μg/mL for nDer p 23. These data establish a direct relationship between the protein concentration and biological activity for each major allergen. In conclusion, the successful production and biological standardization of native nDer p 1, nDer p 2, and nDer p 23 proteins provide well-defined reagents for in vivo molecular diagnosis and enable more precise and reproducible standardization compared with complex allergen extracts.

House dust mites (HDMs) are the most important respiratory allergen sources. In temperate regions, the genus Dermatophagoides predominates, whereas in sub-tropical and tropical regions, the genus Blomia is also of high importance. There is only limited IgE cross-reactivity between Dermatophagoides and Blomia.

To produce a chip containing purified microarrayed Blomia tropicalis (Blo t) and Dermatophagoides pteronyssinus allergens (Der p) capable of identifying patients with a genuine Blo t or Der p IgE sensitisation, co-sensitisation and/or cross-sensitisation.

Chips containing seven purified Blo t and thirteen Der p allergens were generated by microarray technology and tested for IgE and IgG reactivity in HDM-sensitised patients from Blo t-endemic (group 1: n = 115) and Blo t-non-endemic (group 2: n = 33) regions. IgE cross-reactivity was analysed by IgE inhibition studies.

IgE levels to Blo t 2, Blo t 5, Blo t 10, Blo t 12 and Blo t 21 were significantly higher in HDM-sensitised patients from Blo t-endemic as compared to patients from Blo t-non-endemic regions, whereas the opposite was observed for IgE to Der p 2 and Der p 21 in patients from Blo t-non-endemic regions. An algorithm based on IgE reactivity profiles and allergen-specific IgE levels capable of discriminating genuine sensitisation to Blo t and Der p or co-sensitisation was established. In HDM-sensitised patients from Blo t-endemic regions, each of the aforementioned sensitisation profiles was observed, whereas in HDM-sensitised patients from Blo t-non-endemic regions, only genuine sensitisations to Der p and co-sensitisations to Blo t and Der p were observed.

The algorithm based on microarrayed Blo t and Der p allergens for discrimination of Blo t and Der p sensitisation may support prescription of allergen-specific immunotherapy. At minimum, it will be helpful in understanding disease aetiology and for fine resolution mapping of allergic reactivities in HDM sensitisation.

We recently published on the clinical efficacy of a 1-year-long evaluation of 65 asthmatics with severe IgE-mediated food allergy (FA) under Omalizumab: Omalizumab is safe and able to increase reactivity threshold, allows safe food introduction, and improves quality of life (OSAFA-study, ClinicalTrials.gov, NCT06316414). Herein, we assess Omalizumab dose-related efficacy during the first year Omalizumab treatment in achieving food desensitization in patients with severe FA.

Children (6-18 years) with severe asthma and severe allergy to ≥ 1 food allergen were screened. Oral food challenges (OFCs), skin prick test (SPT), complete blood count, chemistry, total and specific IgE were measured at baseline and at 12 months of Omalizumab.

Seventy-six patients (previously published cohort plus 11 newly-enrolled patients) were included (OSAFA [Omalizumab in Severe Asthmatics with Food Allergy] study). 69.7% were male; mean age (SD) 12.2 [4.19] years. 77.6% were allergic to 2+ foods. Total IgE median was 644 kU/L. After adjusting for confounders, such as age, sex, and co-existing allergies, a significant association was observed between the achievement of desensitization and the dosage (mg/month) of Omalizumab (OR: 1.151, 95% CI: 1.066-1.258), while no significant effect was observed for total IgE levels at the baseline (OR: 0.999, 95% CI: 0.998-1.001).

The findings of this study indicate that the efficacy of Omalizumab is independent, all else being equal, from total IgE levels, suggesting that body weight is the most appropriate parameter for calculating its dosage in the treatment of patients with severe FA.

A homologous classification for vespid venoms is missing. This study compared Polistes dominula and Vespula spp. venoms to evaluate their homology level. P. dominula and Vespula spp. extracts, including V. germanica, V. maculifrons, V. pensylvanica, V. alascensis, and V. squamosa in equal proportions, were generated from venom sacs and were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot using Vespula-positive sera. Bands described as allergenic were excised and sequenced through Liquid Chromatography-Mass Spectrometry tandem analysis (LC-MS/MS) to confirm their identity. Phospholipase (group 1) and hyaluronidase (group 2) enzymatic activities were measured. Group 1 and 5 3-D structures and sequence identity were analyzed in silico. The results showed that the P. dominula and Vespula spp. venom extracts exhibit similar protein profiles and comparable allergen composition, with phospholipase and hyaluronidase activities. The structures of Pol d 1 and Ves v 1 and Pol d 5 and Ves v 5 were highly similar, and the identity levels were high across and within the Polistes and Vespula genera (≥50%). These results suggest the inclusion of venoms from Polistes and Vespula genera as candidates to create a new homologous group for wasp venoms and indicate that the currently described homologous groups require revision.