This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA ² LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell‐driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert‐guided and evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

The only treatment available for celiac disease (CD), an autoimmune disease, is a gluten-free diet. Restaurant personnel have major roles in understanding the possible risks to consumers with CD, ensuring the availability of and preparing gluten-free foods. We attempted to evaluate the awareness and knowledge of CD among chefs, cooks, restaurant personnel, and owners and assess the availability of gluten-free diet options in the western region of Saudi Arabia. A cross-sectional, questionnaire-based study was conducted in 126 restaurants based in Makkah al-Mukarramah and Jeddah cities. The chefs and owners of the restaurants were interviewed face-to-face to collect data knowledge about CD, gluten sensitivity, food containing gluten, serving gluten-free food, intention to add gluten-free options in the future, and circumstances related to serving gluten-free food. Our study showed that 17.5% and 51.6% of the participants had heard about CD and gluten sensitivity, respectively, and 34.1% checked a right answer of gluten-containing food with a mean of 0.68 (±1.02). About 17.5% of the participating restaurants serve gluten-free meal options (mean: 0.63±1.57), 14.7% had protocols for the preparation of gluten-free food, 7.1% displayed signs or notices that they sell gluten-free products, and 50.8% disclosed an intention to add gluten-free options in the future. Furthermore, 82.5% of gluten-free options were more expensive. Education level, being a trained chef, and experience years were significantly associated with awareness about CD or gluten sensitivity (p<0.05). There is a general lack of awareness of CD, and most restaurants lack gluten-free options. We recommend adding more gluten-free food options for patients with CD.

This meta-analysis assesses pneumococcal vaccine effectiveness in reducing hospitalization and mortality among the elderly. The studies retrieved from PubMed, Scopus, Embase, and Cochrane through March 2025. Of 3,002 identified studies, 35 met inclusion criteria (30 cohort, 3 RCTs, 2 case-control), encompassing 1.65 million vaccinated and 2.62 million unvaccinated individuals. Pneumonia-related hospitalization significantly declined in subgroups receiving mixed pneumococcal polysaccharide vaccine (PPV) and conjugate vaccine (PCV-13), notably among individuals aged >75 and those with chronic conditions. All-cause hospitalization dropped (OR: 0.94; 95% CI: 0.91-0.97), especially in PPV-23 recipients, Asian populations, and those with comorbidities. Pneumonia mortality decreased across age groups >60, and all-cause mortality declined among those aged 60-75. No significant impact was observed on emergency visit rates. Although findings favor vaccine effectiveness, high heterogeneity warrants further comparative trials to confirm outcomes.

Background: The Hajj pilgrimage poses significant public health challenges due to the risk of infectious disease transmission. Despite mandatory vaccination policies, barriers such as hesitancy, logistical issues, and vaccine availability persist. Objective: This study assesses vaccine uptake, reasons for compliance or non-compliance, and barriers among Hajj pilgrims. Methods: A cross-sectional study was conducted during the 2024 Hajj season, with data collected via structured interviews from 5,355 participants. Descriptive statistics and logistic regression analyzed vaccination status and influencing factors. Results: Of the participants, 4298 (80.3%) reported receiving mandatory or recommended vaccines, including influenza, COVID-19, and meningococcal. Primary motivators for vaccination were compliance to mandatory requirements 2240 (52.1%) and healthcare provider recommendations 2018 (46.9%). Among non-vaccinated respondents, the main reasons included belief in vaccine ineffectiveness 250(23.7%), reliance on natural immunity 243(23%), and lack of awareness 174(16.5%). Common barriers included long wait times 721(13.5%) and limited access to vaccination centers 543(10.1%). Women and individuals with higher education demonstrated greater vaccine uptake, while logistical barriers were more prevalent among self-employed and less-educated participants. Conclusion: Despite high vaccine uptake, barriers remain. Addressing hesitancy, improving access, and aligning vaccine availability with Hajj timing are essential to enhance coverage and reduce disease transmission risks. Clinical Trial Number: Not applicable.

Introduction: Patients with primary immunodeficiency (PID) secondary to abnormal recombinase activating genes (RAG) can present with broad clinical phenotypes ranging from early severe infections to autoimmune complications and inflammation. Immunological phenotype may also vary from T⁻B⁻ severe combined immunodeficiency (SCID) to combined immunodeficiency (CID) or antibody deficiencies with near normal T and B cell counts and even preserved specific antibody response to pathogens. It is not uncommon that RAG variants of uncertain significance (VUS) are identified by serendipity during a broad genetic screening process and pathogenic RAG variants are increasingly recognized among all age groups, including adults. Establishing the pathogenicity and clinical relevance of novel RAG variants can be challenging since RAG genes are highly polymorphic. This review paper aims to summarize clinical phenotypes of RAG deficiencies and provide practical guidance for confirming the direct link between specific RAG variants and clinical disease. Lastly, we will review current understanding of treatment option for patients with varying severity of RAG deficiencies. Area covered: This review discusses the different phenotypes and immunological aspects of RAG deficiencies, the diagnosis dilemma facing clinicians and an overview for current and advancement in treatments. Expert opinion: A careful analysis of immunological and clinical data and their correlation with genetic findings help to determine the significance of the genetic polymorphism. Advances in functional assays, as well as anti-cytokines antibodies, make it easier to resolve the diagnostic dilemma.