Severe asthma (SA) is a heterogeneous disease composed of various clinical phenotypes, and criteria for selecting the most appropriate biological agent rem

Introduction: Relapse after omalizumab discontinuation in chronic spontaneous urticaria (CSU) is frequent, but predictors of recurrence remain unclear. This study aimed to identify clinical and laboratory factors associated with relapse within 12 months after treatment withdrawal. Methods: We retrospectively analyzed 176 adult CSU patients who received omalizumab for ≥6 months and were followed for ≥12 months after discontinuation. Demographic, clinical, and laboratory variables were compared between relapse and non-relapse groups using logistic regression analyses. Results: Relapse occurred in 118 patients (67.0%) within 12 months after omalizumab discontinuation. In multivariable analysis, three variables were independently associated with relapse: lower baseline Urticaria Control Test (UCT) score (odds ratio [OR] per 1-point increase = 0.60; 95% confidence interval [CI]: 0.47–0.77; p < 0.001), longer time to response after omalizumab initiation (OR per month = 2.64; 95% CI: 1.36–5.12; p = 0.004), and a history of prior relapse after treatment withdrawal (OR = 9.80; 95% CI: 1.52–63.14; p = 0.016). In univariate analysis, urticaria duration was significantly longer in relapsing patients (p < 0.001), but it was not an independent predictor. Additionally, no independent associations were found for age, sex, treatment duration, total immunoglobulin E, anti-thyroid peroxidase antibody, or comorbidities (all p > 0.05). The multivariable model showed excellent discrimination (area under the curve = 0.90; 95% CI: 0.84–0.95). Conclusion: Lower baseline disease control, delayed clinical response, and prior relapse history were independent predictors of recurrence within 12 months after omalizumab discontinuation, whereas treatment duration and routine serologic markers were not. These findings highlight the need for individualized discontinuation strategies in CSU management.

Background: Autoimmune cytopenias (AICs) are among the most frequent non-infectious complications in inborn errors of immunity (IEIs) and may represent early or even initial manifestations. The genetic underpinnings of AICs in IEIs remain heterogeneous and incompletely defined. Objective: This study aimed to determine the prevalence and distribution of AICs and to investigate their associations with underlying monogenic mutations and selected immunophenotypic parameters in adult patients with IEI. Methods: A total of 121 adult IEI patients from a single tertiary immunology center were evaluated retrospectively. Clinical, immunophenotypic, and genetic data were obtained from electronic medical records. Comparisons were made between patients with and without autoimmune manifestations and AICs. Monogenic mutations were identified using targeted next-generation sequencing (NGS). Results: Autoimmune manifestations were present in 48 of 121 patients (39.6%), and autoimmune cytopenias (AICs) were identified in 33 patients (27.5%). Autoimmune hemolytic anemia (AIHA) was the most frequently observed subtype, followed by combined cytopenias and immune thrombocytopenia (ITP). The most common genetic alteration detected was a mutation in TNFRSF13B (TACI), with additional variants identified in DOCK8, RAG1, LRBA, PRF1, PSTPIP1, CECR1, PRKDC, and MRTFA. Logistic regression revealed a strong independent association between TACI mutations and ITP (OR: 46.5, p = 0.002), while no significant relationship was found with autoimmune cytopenias overall. No statistically significant differences were found in class-switched memory B cells (CD27⁺IgD⁻) percentages, CD4⁺/CD8⁺ T-cell ratios, or baseline IgG concentrations between patients with and without autoimmune manifestations or AICs. Conclusion: AICs represent a significant clinical burden in adult IEIs and may occur in association with a wide range of genetic variants. Class-switched memory B cells (CD27⁺IgD⁻) percentages, CD4⁺/CD8⁺ T-cell ratio, and baseline IgG were not significantly associated with autoimmunity in this cohort. These findings underscore the need for broader immunophenotypic and genetic screening to improve the early recognition and management of autoimmune complications in IEIs.

Introduction: The use of medications in older adults is increasing due to the prevalence of chronic diseases. Data on the characteristics of drug allergies (DAs) in older adults are limited. This study investigated the prevalence and clinical characteristics of DAs in patients aged 65 years and older. Methods: Patient records were examined retrospectively between January 2018 and December 2022. The study included 200 patients aged ≥18 years who met the criteria for diagnosis of type B drug reactions. The patients were divided into two groups: the adult group (18–64 years) and the older adult group (≥65 years). Results: Advanced age was an independent risk factor for the development of anaphylaxis and immediate and delayed hypersensitivity reactions (odds ratio [OR] = 4.296; 95% confidence interval [CI] = 1.700–10.855; p = 0.002, OR = 3.800; 95% CI = 1.247–11.579; p = 0.019, OR = 3.028; 95% CI = 1.248–7.343; p = 0.014, respectively). Older adults had higher rates of comorbidities and polypharmacy (p < 0.001, p = 0.016, respectively), beta-lactam antibiotic allergy (p < 0.001), and hospitalization and intensive care unit (ICU) admission for DAs (p = 0.024, p = 0.045, respectively). Conclusion: Older age was an independent risk factor for anaphylaxis and both immediate and delayed reactions. Older adults had higher rates of comorbidities, polypharmacy, beta-lactam antibiotic triggers, and hospitalization and ICU admission.

Objective: This study investigates the prevalence of Common Variable Immunodeficiency (CVID) in patients with cryptogenic cirrhosis. It aims to highlight CVID's role in liver involvement and raise awareness of its potential as an underlying cause of cryptogenic cirrhosis. Methods: This retrospective cohort study, approved by the ethics committee, included patients diagnosed with cryptogenic cirrhosis at a university hospital. Comprehensive evaluations were performed to exclude other causes of cirrhosis, and patients were screened for CVID based on the European Society for Immunodeficiencies (ESID) criteria. Results: This study included 30 patients with cryptogenic cirrhosis, among whom 6.7% (n=2) were diagnosed with CVID. Both CVID patients had low immunoglobulin levels and abnormal immune cell profiles, leading to recurrent infections in one case and suspicion due to low total protein levels in the other. IVIG treatment was initiated for both, and liver biopsy findings in one patient suggested CVID-related liver involvement. Conclusions: Determining the underlying causes of chronic liver diseases is crucial for guiding treatment and follow-up, potentially preventing cirrhosis progression and influencing liver transplantation eligibility. CVID screening in patients with cryptogenic cirrhosis should be considered, with appropriate treatments initiated as needed.

Introduction: Hypersensitivity reactions (HSRs) to taxane- and platinum-based chemotherapeutic agents are common and may interrupt essential cancer therapy. Rapid drug desensitization (RDD) enables patients to continue treatment safely; however, detailed analyses directly comparing desensitization outcomes between taxanes and platinums remain relatively uncommon. The objective of this study was to describe the clinical characteristics of taxane- and platinum-induced HSRs and to compare desensitization outcomes, breakthrough reactions (BTRs), and graded-challenge success between these drug groups. Methods: This retrospective study included 27 patients who underwent 30 desensitization procedures, comprising 94 RDD cycles. Standardized 8-, 12-, or 16-step RDD protocols were applied based on the severity of the index reaction and the clinical risk assessment. Demographic and clinical data, characteristics of index HSRs, BTRs during RDD, and outcomes of graded challenges were recorded and analyzed. Results: Index HSRs most frequently occurred during the first or second infusion (66.6%) and were predominantly moderate in severity (53.3%). Cutaneous symptoms were present in 96.7% of reactions, and anaphylaxis occurred in 30%. Taxane HSRs developed significantly earlier than platinum reactions (69% vs. 24% during the first cycle, p = 0.003). The overall RDD success rate was 97.9%. Seventeen BTRs (18.1%) occurred, most of which were mild (82.4%) and limited to cutaneous involvement (100%). BTRs were significantly more common with platinums than with taxanes (34.8% vs. 2.1%, p < 0.001). Graded challenge was successful more often with taxanes than with platinums (53.8% vs. 17.6%, p = 0.045). No severe or life-threatening BTRs were observed. Conclusion: RDD enabled the safe continuation of chemotherapy with both taxanes and platinums, with high success rates and infrequent, mostly mild BTRs. Platinum desensitizations carried a higher BTR risk, whereas selected taxane-allergic patients successfully transitioned to graded challenge. These findings support RDD as an effective strategy for managing chemotherapy-induced HSRs and highlight the need for individualized, risk-based protocol selection in clinical practice.