Sofia Holmqvist-Jämsén, PhD, from the University of Helsinki

Respiratory Allergies Linked to Vocal Symptoms

may extend beyond nasal and pulmonary symptoms, contributing to a clinically meaningful burden of vocal dysfunction. In an interview with 

, Sofia Holmqvist-Jämsén, PhD, from the University of Helsinki, discussed findings from a cross-sectional study examining the relationship between diagnosed respiratory allergies and focal vocal symptoms, as well as potential gender differences in this association.

The cross-sectional analysis included 1220 Finnish adults aged 18 – 46 years, drawn from a twin cohort and adjusted to mitigate relatedness bias. Overall, 25.6% of participants reported a diagnosed respiratory allergy, and 19.8% experienced ≥ 2 vocal symptoms on a weekly or daily basis over the prior year. These findings highlight the substantial overlap between allergic disease and voice-related complaints in the general population.

Holmqvist-Jämsén noted that the study was motivated by two 2 gaps: a lack of large-scale epidemiologic data linking allergy flares to vocal symptoms, and limited evidence supporting the “unified airway” model in relation to laryngeal outcomes.

“Clinicians often observe that allergy flares coincide with hoarseness or throat clearing or voice fatigue, but large population-based data have been scarce,” she said.

The results demonstrated a significant association between respiratory allergies and increased vocal symptom burden. Individuals with diagnosed respiratory allergies were more likely to report ≥ 2 frequent vocal symptoms compared with nonallergic peers (24.6% vs 18.2%; 

 <.05). This association was particularly pronounced in women, among whom 30.2% of those with allergies reported greater symptom burden, compared with 20.4% without allergies (P <.01). The association was not observed among men.

From a symptom-level perspective, allergic individuals were significantly more likely to report hoarseness or low voice (16.1% vs 11.4%; 

 <.001), strained or tired voice (15.2% vs. 10.1%;

 <.001) and the sensation of a lump or tension in the throat (18.3% vs. 13.0%; 

 <.05). Although coughing and throat clearing were the most commonly reported symptoms overall (29.9%; n = 92), their association with allergy was less distinct statistically, though still clinically relevant.

These findings support the unified airway concept, which posits that inflammatory processes in 1 region of the respiratory tract can affect contiguous structures. According to Holmqvist-Jämsén, allergic inflammation may contribute to laryngeal symptoms through several mechanisms, including mucosal edema and altered vibratory function of the vocal folds.

“Allergic remedies can contribute to swelling and altered vibratory characteristics of the vocal folds, increasing phonatory effort and hoarseness, and then also postnasal drip and cough, where throat clearing can irritate the larynx and reinforce a cycle of tension and fauna trauma,” Holmqvist-Jämsén said.

The observed gender differences may warrant particular clinical attention. Women not only reported more frequent vocal symptoms overall but also demonstrated a stronger association between allergies and symptom burden (≥ 2 frequent symptoms: 22.8% vs 13.7%; 

 <.001). Potential explanations include anatomical and physiological differences, such as smaller vocal folds that may be more susceptible to edema, as well as heightened cough sensitivity and greater representation in voice-intensive professions.

“[The] bottom line that women with allergies may be at particular risk for clinically significant voice issues and deserve proactive screening and counseling more than men,” Holmqvist-Jämsén said.

Despite its strengths, including a large, population-based sample, the study has limitations. All data were self-reported without objective laryngoscopic or acoustic validation. Additionally, potential confounders such as corticosteroid use were not fully captured.

Nonetheless, the findings underscore the importance of integrating voice assessment into allergy management. For clinicians, this may include targeted history-taking around vocal symptoms, consideration of laryngeal irritation in patients with persistent throat complaints, and multidisciplinary approaches involving otolaryngology or speech-language pathology when appropriate.

Holmqvist-Jämsén S, Wakene H, Jern P, Simberg S. Association Between Respiratory Allergies and Vocal Symptoms: A Cross-sectional Population-Based Study. 

Videos

Population study links respiratory allergies to hoarseness, throat clearing, and vocal fatigue, with greater symptom burden in women and unified airway implications.

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Respiratory Allergies Linked to Vocal Symptoms, With Holmqvist-Jämsén, PhD

Christopher Kramer, MD, FACC, is the current president of the American College of Cardiology.

Artificial Intelligence in Cardiology: The ACC’s Implementation Pipeline, With Christopher Kramer, MD, FACC

Artificial intelligence (AI) has grown by leaps and bounds in the last few years; due to its rapid advances, the technology is beginning to be incorporated into both the clinical and managerial sides of the healthcare industry at large, and of 

The American College of Cardiology (ACC) has, over the last few years, committed to adapting AI models to cardiology care, on both a clinical and practical level. Current president Christopher Kramer, MD, FACC, has taken this movement to new heights with the integration of an AI implementation task force, consisting of several subcommittees within the College.

“During my year as president, we have begun to create an ACC AI implementation task force, which began last Fall. The task force is overseeing all of the integration of AI into the workings of the ACC,” Kramer told 

 in an exclusive interview. “There are so many ways that AI interfaces with the College that we thought an implementation task force was needed as an umbrella group to oversee implementation.”

Kramer also broke down several of the AI programs currently in use at the ACC, including scribing programs and cardiovascular imaging. These programs have streamlined the intake and diagnostic processes, allowing clinicians to quickly collect patient information and perform basic scans.

“AI is used every day, for example, in cardiac MR and cardiac CT,” Kramer said. “It’s integrated into MR in every aspect, from speeding up image acquisition to automatic analysis of images. Cardiac CT AI is used every day in post processing software to do plaque analysis, to quantify ejection fraction with high accuracy, and so on. It has not necessarily been integrated at most institutions yet, but it’s coming.”

Ultimately, this push for further AI implementation mirrors the common belief that similar technology is positioned to revolutionize the field. Even beyond the clinical setting, devices such as ChatGPT are actively reshaping the way information is collected and disseminated among clinicians and patients. Recent publications from the Journal of the ACC have highlighted the potential for AI adaptation into living clinical guidelines, effectively minimizing the lag time between the discovery of new information and its implementation.

Kramer also discussed upcoming presentations at the 

, taking place in New Orleans, Louisiana, from March 28-30. Along with hands-on training for the prompting of generative AI like ChatGPT, the program includes 2 keynote lectures regarding the real-world implementation of AI. The first, the 57th Annual Louis K. Bishop keynote, will address scaling AI and cardiology, while the second, the Douglas Sipes Distinguished Young Scientist Award, focuses on bottlenecks in translating AI research into clinical care.

“The ACC 26 intensive will address the practical implementation of AI in daily practice, daily patient care,” Kramer said. “We will also address financing and governance, as those are ongoing questions that our health systems at hospitals and clinicians have. There will be efforts on-site to answer these questions.”

Editors’ Note: Kramer reports disclosures with Cytokinetics, Eli Lilly, Bristol Myers Squibb, and the American College of Cardiology.

Krumholz H. Guiding the AI Revolution in Cardiovascular Medicine. 

https://doi.org/10.1016/j.jacc.2025.08.021

Reddy, R, Danford, D, Schuster, A. et al. Closing the Guideline Gap: AI and the Rise of Living Cardiovascular Recommendations. 

https://doi.org/10.1016/j.jacadv.2026.102639

Kramer, the president of the American College of Cardiology, discusses the organization’s recent movement to adapt rapidly growing AI technology to clinical care.

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Akl Fahed, MD, MPH, Interventional Cardiologist at Massachusetts General Hospital and Instructor in Medicine at Harvard Medical School.

Multi-Ancestry Genetic Risk Score Shows Value of Global Collaboration in Metabolic Disease, With Akl Fahed, MD, MPH

A multi-ancestry metabolic polygenic risk score (PRS) of 20 metabolic traits from over 8.5 million individuals points to the utility of global collaboration in genetic research.

The metabolic PRS outperformed existing ones in predicting obesity and T2D across 6 ancestries, effectively identifying individuals at high risk for metabolic multimorbidity and predicting clinical outcomes, including GLP-1 receptor agonist initiation.

“We haven’t yet seen this level of integration for diabetes and obesity. However, these scores are becoming more widely available,” Akl Fahed, MD, MPH, Interventional Cardiologist at Massachusetts General Hospital and Instructor in Medicine at Harvard Medical School, said in an interview. “Many health systems are beginning to implement them, and individuals can also access them through direct-to-consumer approaches.”

The metabolic diseases, obesity, and T2D have a shared pathophysiology. Traditionally, previous polygenic risk scores focused on them separately, with study investigators noting that the single-disease approach has fallen short in capturing the full dimension of metabolic dysfunction.

To address this gap in research, investigators derived a biologically enriched metabolic PRS, composite score that uses multi-ancestry genome-wide association studies of 20 metabolic traits from over 8.5 million individuals, optimized to predict obesity and T2D.

The model was trained and tested in the UK Biobank before being externally validated in 3 multi-ethnic cohorts comprising up to 300,000 participants. According to investigators, the risk scores identified individuals at high risk for clinical outcomes such as cardiovascular disease and stroke. In a median 5.5 years follow-up, even individuals with a high PRS who were healthy at baseline were approximately 2 times as likely, specifically, those in the top decile compared to the middle quintile, to eventually receive GLP-1 agonist medications or bariatric surgery.

Investigators see the biologically enriched metabolic PRS as an opportunity to work together with traditional metrics, such as body mass index, to add more information to disease prediction and management approaches for metabolic diseases.

As uptake of these tools grows, additional clinical trials will be needed to guide how clinicians should respond to elevated genetic risk. Fahed noted that while identifying individuals at high risk for obesity may support earlier lifestyle intervention, it remains unclear whether this should also prompt earlier use of pharmacologic options, including GLP-1–based therapies or other incretin agents, an area that will require further study. He also emphasized that the findings reflect a large-scale international effort, with contributions from researchers across the United States, the Middle East, China, and other regions.

"We relied on harmonizing data from multiple large biobanks and working closely with methodological experts. The field of genomics depends on this kind of global collaboration and access to shared data. Without publicly available datasets, work like this simply wouldn’t be possible.”

, where he discusses efforts to address longstanding Eurocentric bias in genomics. He explains how expanding genomic datasets to include more non-European populations, alongside advances in analytic methods, is helping improve the accuracy and generalizability of polygenic risk scores across diverse ancestries.

Editor’s Note: Fahed reports relevant disclosures with Goodpath, MyOme, HeartFlow, and Foresite Labs.

New genetic risk score better predicts diabetes, obesity and downstream complications. EurekAlert! Published March 16, 2026. 

https://www.eurekalert.org/news-releases/1119751

Ghatan S, Jeroen van Rooij, Mandy van Hoek, et al. Defining type 2 diabetes polygenic risk scores through colocalization and network-based clustering of metabolic trait genetic associations. 

https://doi.org/10.1186/s13073-023-01255-7

Fahed explains how a multi-ancestry metabolic poly genetic risk score from over 8.5 million individuals points to the utility of global collaboration in genetic research. 


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Dietary Epitopes Drive Oral Tolerance, With Jamie Blum, PhD

New translational research is beginning to clarify a long-standing gap in immunology: which specific food-derived antigens drive oral tolerance. A study identified discrete dietary epitopes from common seed storage proteins that are recognized by intestinal regulatory T (Treg) cells, offering mechanistic insight into how the immune system classifies foods as “safe.”

, Jamie Blum, PhD, of the Salk Institute, emphasized that advancing understanding of tolerance is critical to addressing

“While we understand more and more about food allergies, we actually know comparably little about oral tolerance,” Blum said. “What is it? How does it develop? So, I think my study is starting to identify what are the protein antigens that are recognized, and if we understand how those antigens are normally seen through the tolerance response, we might be able to apply those same principles to allergy cases to help better prevent food allergies.”

Using murine models fed standard chow, investigators isolated intestinal Treg cells and identified their cognate antigens through T cell receptor (TCR) mapping. The analysis revealed 3 key epitopes derived from seed storage proteins in corn, wheat, and soybean.

 One of the most robust responses was directed against a maize protein, α-zein, a digestion-resistant storage protein.

“When we started the study, I had expected we might find dozens of different epitopes, and it was unexpected and striking that we saw the strong convergence on just 1 protein, which may suggest that a few key proteins in diet are… are garnering most of the immune response,” Blum said. “If you can tune how the immune response sees those proteins, you can set the overall tone for interpretation of the food.”

These proteins are highly abundant and resistant to digestion, allowing prolonged exposure in the gut for immune sampling. As Blum noted, they “resist proteases,” enabling their role in tolerance induction. Clinically, this convergence suggests a small number of dietary antigens may disproportionately shape immune tolerance.

The study also provides insight into the ontogeny of tolerance. Blum and colleagues observed that antigen-specific Treg populations emerge around the time of weaning, coinciding with initial exposure to solid foods.¹ Blum noted that this developmental window aligns with clinical data supporting early allergen introduction for immune tolerance. This paradigm is supported by the Learning Early About Peanut Allergy (LEAP) trial, which demonstrated that early peanut exposure significantly reduces the risk of peanut allergy and informed current guideline recommendations to introduce allergens between 4 and 6 months of age.

Mechanistically, the identified Treg cells exhibited canonical immunosuppressive functions, including secretion of anti-inflammatory cytokines and inhibition of effector T cell proliferation.

 These cells help maintain immune homeostasis.

An additional finding is the potential for cross-tolerance. The study demonstrated that TCRs recognizing a soybean-derived epitope also responded to structurally similar proteins in other foods, including sesame and quinoa.

 This suggests that exposure to 1 food antigen could confer tolerance to related proteins, even in the absence of direct exposure.

“What this could suggest, and my lab is working on this a bit now, is perhaps if we could map cross reactivity for things like a peanut, you could become tolerant to peanut by eating something that has those shared proteins without actually having the peanut exposure,” Blum said.

Blum JE, Kong R, Schulman EA, et al. Identification and characterization of dietary antigens in oral tolerance. 

. 2026;11(117):eab4684. doi:10.1126/sciimmunol.aeb4684. 

https://www.science.org/doi/10.1126/sciimmunol.aeb4684

Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. 

. 2015;372(9):803-813. doi:10.1056/NEJMoa1414850. 

https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

New research identifies dietary epitopes driving oral tolerance, offering insight into Treg responses, early exposure, and future food allergy therapies.

Food Allergy

Experts discuss therapeutic switching in patients already on biologic therapy and adherence challenges specific to oral agents.

Managing Established Patients: Switching, Adherence, Spontaneous Remission, and Treatment Duration 

For patients currently well-controlled on omalizumab or dupilumab, routine therapeutic switching is not indicated and may introduce unnecessary disruption to a successful regimen. The clinical rationale for switching or adding remibrutinib is strongest in patients experiencing breakthrough disease where BTK inhibition offers a mechanistically distinct intervention. The availability of 3 step-up agents also creates a practical bridging opportunity: remibrutinib's rapid onset makes it well-suited for patients experiencing a flare while pursuing prior authorization for a long-term biologic. For new patients, presenting all 3 options with a clear explanation of their respective profiles supports genuine shared decision-making without defaulting to a prescribing hierarchy that the evidence does not support.

Adherence to a twice-daily oral regimen presents a real-world challenge distinct from the adherence profile of injectable biologics. Patients managed with injections typically have adherence supported by clinic-based or pharmacy-based administration schedules; oral agents depend entirely on patient behavior. This is compounded by a disease-specific dynamic: patients who achieve rapid symptom control on remibrutinib may question the need for continued therapy precisely because the treatment has worked. Clinicians should proactively address this at initiation, counseling patients that symptom improvement does not signal that therapy is no longer necessary and that premature discontinuation will likely result in recurrence. A structured re-evaluation at 6 to 12 months of complete control is a reasonable framework for discussing a monitored discontinuation attempt in appropriate patients.

In this video segment, Nicole Chase, MD, and Jason Hawkes, MD, examine spontaneous remission as the key variable underlying discontinuation decisions. Without a validated biomarker to predict its onset, the only practical way to determine whether a patient has remitted is to attempt discontinuation after a defined period of disease control. Chase suggests a minimum of 6 months of sustained control, and ideally 1 year, before considering this step in patients with severe disease, framing the continued treatment period as suppression of the underlying pro-inflammatory state rather than simply symptom management. Both experts agree that patients who discontinue and experience recurrence typically return to therapy quickly, because the memory of symptomatic disease reasserts itself rapidly once hives return — a self-correcting dynamic that reduces the clinical stakes of a monitored discontinuation attempt while reinforcing the importance of patient education about the likely outcome.

Managing Established Patients: Switching, Adherence, Spontaneous Remission, and Treatment Duration

Experts address how quickly clinicians should escalate from antihistamines to step-up therapy and examine remibrutinib's clinical trial data on speed of response.

Antihistamine Escalation, Time to Step-Up, and Remibrutinib's Rapid Onset of Action 

Bhatt shares his thoughts on the recently released dyslipidemia guidelines, highlighting the return of goal-based LDL-C therapy and Lp(a) receiving a COR 1 suggestion.

Dyslipidemia

Atherosclerotic Cardiovascular Disease

Updated ACC/AHA Dyslipidemia Guidelines Incorporate LDL-C Goals, Lp(a) Focus, With Deepak Bhatt, MD, MPH

Allergist-immunologist at Yale New Haven Hospital

Su emphasized how care should be shifted to reflect known impacts of NNAALs on obstetric care.

The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Andres Gelrud, MD, is a gastroenterologist at Baptist Health Miami Cancer Institute, part of Baptist Health South Florida

Gerlud explains why exocrine pancreatic insufficiency is often missed, even in high-risk patients. 


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, IBS and IBD, Crohn's disease, and more.

Why Exocrine Pancreatic Insufficiency Is Frequently Underdiagnosed, With Andres Gelrud, MD

Piotr Witkowski, MD, PhD, is a professor of surgery in the Transplantation Institute at the University of Chicago.

Witkowski discusses the data presented at ATTD 2026, highlighting the investigative anti-CD40L monoclonal antibody in facilitating insulin independence.

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Tegoprubart Improves Glycemic Control Following Islet Transplantation for T1D, With Piotr Witkowski, MD, PhD

Julia W. Angkeow, a PhD candidate and former research technologist at Johns Hopkins Medicine

Angkeow discusses a recent study finding that PhIP-Seq analysis links diverse IgG responses to food allergy phenotypes.

IgG Reactivity Patterns in Pediatric Food Allergy, With Julia Angkeow

Learn how clinicians confirm iron deficiency anemia, interpret ferritin, and trace dietary, menstrual, or GI causes for targeted treatment.

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Diagnosing Iron Deficiency Anemia — Ferritin Thresholds, Confirmatory Testing, and Workup 

Abdallah Geara, MD, is an Associate Professor of Clinical Medicine at the University of Pennsylvania.

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Geara breaks down the clinical framework for the modern era of IgA nephropathy. 


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Stratifying Risk, Optimizing Therapy in IgA Nephropathy, With Abdallah Geara, MD

Mark Taylor, MD, a consultant psychiatrist from The Edinburgh Practice and a professor in the school of medicine and dentistry at Griffith University.

National cohort study finds semaglutide tied to reduced depression, anxiety, and self-harm risk in patients with diabetes and comorbid mental illness.
 

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Semaglutide Linked to Lower Suicidality Risk in Diabetes, With Mark Taylor, MD

Discover how new IBD therapies, combo drugs, and microbiome research aim to predict response, prevent Crohn’s complications, and expand trial options.

Latest News

Respiratory Allergies Linked to Vocal Symptoms, With Holmqvist-Jämsén, PhD

Artificial Intelligence in Cardiology: The ACC’s Implementation Pipeline, With Christopher Kramer, MD, FACC

Multi-Ancestry Genetic Risk Score Shows Value of Global Collaboration in Metabolic Disease, With Akl Fahed, MD, MPH

Dietary Epitopes Drive Oral Tolerance, With Jamie Blum, PhD

Managing Established Patients: Switching, Adherence, Spontaneous Remission, and Treatment Duration