New Collaborative Formed to Improve Anaphylaxis Response in Childhood Care: Alice Hoyt, MD

Last week, a multi-disciplinary group of healthcare providers and childcare professionals met to discuss how to best provide early childcare centers with resources to recognize and respond to severe allergic reactions in young children.

The Early Childhood Anaphylaxis Collaborative, spearheaded by Kaléo, strives to educate people on gaps in recognizing

in children < 5 years and provide guidance on stocking epinephrine that is not prescribed to a specific child. Founding partners include Allergic Living, Association for Early Learning Leaders, Asthma and Allergy Foundation of America, Code Ana, Elijah-Alavi Foundation, Food Allergy & Anaphylaxis Connection Team, and Kids with Food Allergies.

Approximately 12 million children ≤ 5 years attend childcare in the US, and up to one-third of food allergic reactions at these centers or schools occur without a food allergy diagnosis.

Many people do not realize that anaphylaxis presents differently in young children than older children or that a child might not experience reactions after the first exposure to a food but could on a later date.

Food allergies are the most common in children < 6 years. Frequent food allergens in this age category include milk, egg, peanuts, tree nuts, sesame, shellfish, soy, wheat, and fish. Research has found that 40% of children with food allergies are allergic to ≥ 2 foods.

, Alice Hoyt, MD, FAAAAI, chief allergist at the Hoyt Institute of Food Allergies and chair of founding partner Code Ana, emphasized the importance of this initiative due to the rising prevalence of pediatric food allergies and childcare center professionals not having anaphylaxis training or access to stock epinephrine.

According to Food Allergy Research & Education (FARE), the food allergy prevalence has been rising for decades, increasing 50% between 1997 and 2011 and again by 50% between 2007 and 2021.

“I know that when I was a little girl, I knew 1 person who had a food allergy, and now it is multiple children that I know of,” Hoyt said. “[It’s] not just because I do food allergy, but being a mom, multiple kiddos have food allergies now in my kid’s classes, and so helping these early childcare centers be prepared is just something we have to do.”

People started reporting food allergies in the 1990s, and it wasn’t until the 1990s that people saw an uptick in peanut allergy. The uptick led experts to recommend avoiding common allergens until a certain age, advice not backed by research. In the year 2000, experts recommended that babies avoid cow milk until 1 year old, eggs until 2 years, and peanuts, tree nuts, and shellfish until 3 years.

“What we saw as a result of that delayed introduction of allergens is an even bigger increase in food allergy,” Hoyt said.

Around 2015, a study showed that early introduction of peanuts could significantly reduce the likelihood of infants developing a peanut allergy.

Hoyt said a large gap in early recognition and response to anaphylaxis in children < 5 years is misunderstanding the symptoms.

“A lot of people think that an anaphylactic or severe allergic reaction is going to have to involve trouble breathing, and it actually doesn't,” Hoyt said.

In children, anaphylaxis occurs within the first 30 minutes of allergen exposure and presents with symptoms from 2 systems, such as the respiratory, skin, gastrointestinal, or nervous systems. For instance, a 13-month-old child who eats peanut butter and gets itchy hives and vomiting is a sign of anaphylaxis, with 2 systems responding.

An anaphylaxis sign could also be a kid who feels sick after lunch and doesn’t want to play during recess. Their mental health may be affected. The gastrointestinal tract and nervous system are both impacted. Hoyt stresses that anaphylaxis is not always the first symptom, even if it could be the first sign.

“It's really important, and that's one reason I'm part of this collaborative,” Hoyt said. “It’s really important that we provide early childcare professionals with evidence-based up to date information on what anaphylaxis looks like, how to prevent it, how to recognize it, and how to respond to it.”

People can learn more and join the Early Childhood Anaphylaxis Collaborative for free at 

A relevant disclosure for Hoyt includes Genentech, Inc.

National Organizations Unite To Prepare Early Childcare Facilities For Rising Incidence Of Food Allergies. Globe Newswire. April 23, 2025. 

https://www.globenewswire.com/news-release/2025/04/23/3066351/0/en/NATIONAL-ORGANIZATIONS-UNITE-TO-PREPARE-EARLY-CHILDCARE-FACILITIES-FOR-RISING-INCIDENCE-OF-FOOD-ALLERGIES.html

National Center for Educational Statistics (NCES). 2019. Fast Facts. Accessed Feb. 21, 2025. 

https://nces.ed.gov/fastfacts/display.asp?id=4

Santos, Mae Jhelene L., et al. Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps. 

Food Allergy Research & Education (FARE). Facts and Statistics. 

https://www.foodallergy.org/resources/facts-and-statistics#:~:text=Food%20allergy%20prevalence%20among%20children,percent%20between%202007%20and%202021.&text=In%20the%20United%20States%2C%20the,tripled%20between%201997%20and%202008

Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13. doi: 10.1056/NEJMoa1414850. Epub 2015 Feb 23. Erratum in: N Engl J Med. 2016 Jul 28;375(4):398. doi: 10.1056/NEJMx150044. PMID: 25705822; PMCID: PMC4416404.

HCPLive spoke with Hoyt about the new Early Childhood Anaphylaxis Collaborative, which strives to educate early childcare centers on how to recognize and respond to anaphylaxis.

New National Push to Improve Anaphylaxis Response in Childcare Centers, with Alice Hoyt, MD

Alice Hoyt, MD

 So in the last few minutes, I'm going to ask each of you as you look into the future caring for our patients with obstructive HCM [hypertrophic cardiomyopathy] and non-obstructive HCM, what other things are you excited about? We talked a little bit about the myosin inhibitors, but clearly there are other things that Milind alluded to that are coming down the pike for us. It's an exciting time to be in HCM position. What are the things that you're most looking forward to and Jim, I'll start with you.

 Yeah, thanks very much. I'll put my clinical trial hat on. We've fully enrolled a clinical trial looking at metabolic manipulation of myocardial function using a partial fatty acid oxidase inhibitor in patients with HCM. So approaching the question from a completely different angle that would be additive together with cardiac myosin inhibition, so thinking about newer pathways to address in patients with HCM to improve their symptoms. That's really exciting to me.

 So speaking as a heart failure, transplant cardiologist is what I spend most of my time doing. I think we still have so many unanswered questions in patients with non-obstructive HCM with advanced symptoms. What's the role of guideline directed medical therapy—was just traditional garden variety heart failure with preserved ejection fraction therapy like mineralocorticoid antagonists, angiotensin receptor neprilysin inhibitors, SGLT2 inhibitors. Do they work? Will they be effective in non-obstructive HCM? I think that is an unmet need in a huge space that I'm hopeful in the future we'll have more answers.

 I agree with you completely. That group of patients are perhaps the most difficult and challenging to treat in the clinic and hopefully will make some headway there. Milind, what are you looking forward to?

 I will start with what Michelle alluded to the next frontier is the non-obstructive HCM. So I am not a heart failure transplant doctor, but can mavacamten or CMIs [cardiac myosin inhibitors] work in this space because it's not all about the LVOT [left ventricular outflow tract] obstruction. There are structural changes that are happening, and we are answering this question in an ongoing randomized clinical trial, RCHCM, and there is another one with aficamten, that is being planned coming down the pike. That will help us clear some of that air. Of course, we need to understand the other drugs like SGLT. Could that work? But the bigger picture I think is the genetic space, the gene therapies, the adenovirus-based therapies that can help modulate the deficient protein in the heart of MYBPC3 so that space is active and brewing the business of gene editing CRISPR, etcetera. All these things obviously, I often joke as long as it does not create mutant Ninja Turtles down the road, meaning the uncertain offshoot effects, I think the future is bright. Honestly, I just told this to one of my patients a couple of days ago is that I can excitedly look forward to having a potential cure for this disease before I hang my boots into retirement. So I'm looking forward to all and plus the PROs [patient reported outcomes] and the shared-decision making. The other thing is the HCMR trial, hypertrophic cardiomyopathy registry from NIH which I am also part of, so I have to plug it in. That is going to start reading out in the next year or so that will help understand the risk stratification space a lot more.

 What's left? They've taken all the low hanging fruit And even the high hanging fruit from the tree. No fruit left on the tree.

 You're climbing all the way up the tree to the top.

 No fruit left on the tree. So I would echo what Jim said. I think that the potential for positive remodeling of the left ventricle not only pathologically with hypertrophy, but maybe reducing the progression of fibrosis would be a major advancement. If we can show that a therapy reduces progressive fibrosis that we can see on late gadolinium enhancement, we know its association with worsening progressive heart failure as well as ventricular arrhythmias, that would be a huge benefit. As Milind said that fibrosis is also shown with severe diastolic dysfunction as well, and many of our patients have some symptoms with outflow tract relief from diastolic dysfunction. So I think that is another unmet need. The last thing I would say is you know how normal can we make patients feel? With obstructive hypertrophic cardiomyopathy, will they be safe to be highly competitive, vigorous athletes, even with this condition? Can we really get close to normalizing what they really can do and feel like they can do and want to do?

 Yeah, that's what's a wonderful goal. It is a lofty goal, but one that we may meet. So with that, I'd like to thank you all for joining our panel today. This has been a very rich, informative and lively discussion and thank you audience for watching our HCPLive Peer Exchange®. You can subscribe to the enewsletter and receive other great content right in your inbox. Thanks again everyone.

Transcript is AI-generated and edited for clarity and readability.

Andrew Wang, MD; James Januzzi, MD; Michelle M. Kittleson, MD, PhD; and Milind Desai, MD, MBA, share a look into the future of oHCM treatment.

The Future of oHCM Treatment

Anjali Owens, MD

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Tennessee, Brad Glick, DO, MPH, spoke in a Q&A interview with the 

 editorial team about his conference talk titled ‘Understanding Topical Steroid Withdrawal (TSW) in Patients with Atopic Dermatitis (AD) - Spotlight Symposium.’

Glick, who is known for his role as a board-certified dermatologist and as the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida, touched on several important comments about topical steroid withdrawal, also known as TSW. The following is a description of his discussion:

Would you share some of the specifics of your topical steroid withdrawal presentation?

 Let's talk about topical steroid withdrawal syndrome. First of all, what is it? Well, it's a profound inflammatory process affecting the skin that appears to happen about 2 to 4 weeks after somewhat chronic use of topical corticosteroids. That's the typical patient, but we've seen it happen in shorter periods of time. The patients can present with widespread, patchy redness, sometimes full redness.

But there are also some characteristic signs of the condition, such as what we call elephant tight skin, which we'll see on the lower parts of the thighs or near the knees, or just below the knees. The skin is very crinkly, much like elephant skin, and it's associated with some pretty significant redness. The hallmark sign is called the red sleeve sign. You know, many of our colleagues may not see this or know this, because there's no specific diagnostic criterion for TSW.

The red sleeve sign is basically redness that occurs most commonly on an upper extremity, but it can be the lower extremity, and there is a distinct sharp cut off right at that wrist area, or the ankle area, which is where it gets its name, the ‘sleeve sign,’ or the so called ‘red sleeve sign.’ So those are some of the characteristics of TSW.

What are some of the most important takeaways from your session regarding TSW that you hope attendees walk away with a greater awareness of?

I think it's really important, topical steroid withdrawal or ‘Red Skin Syndrome.’ There are different names for it, but I think we need to be on the lookout for it. As my colleague Peter Lio always says, it's sometimes very difficult to differentiate it from a really bad flare of atopic dermatitis, but you have to take a step back. You have to get a really good history. You have to talk about whether patients are following the instructions with the use of topical corticosteroids, because that's one of our biggest problems.

You know, we call this steroidophobia, or steroid-phobia, where sometimes we have created the scenario, as those who are providing the medication for the patient, where we urge not to overuse it. Sometimes patients may use it too little, but in this case, the patients are typically pushing through and using steroids rather chronically. Sometimes it's because in the past, that's all we had in our toolbox, of course.

Now, one of the solutions to this problem, once we recognize it, is to take advantage and utilize some of these newer, non-steroidal therapies that we have now. Actually, some of these great systemic agents that we have to treat conditions like atopic dermatitis, biologic agents like dupilumab, nemolizumab, tralokinumab, lebrikizumab, and the 2 JAK inhibitors, abrocitinib and upadacitinib. What we think, because there's no specific criteria for TSW, is that patients should respond quite well to this so-called cytokine storm that we see in these patients.

Outside of atopic dermatitis, what other therapeutic research are you looking forward to in other areas of dermatology?

 I mean, the sky's the limit. I think right now, the hot button for me is more and more therapies for hidradenitis suppurativa. I think that we've got psoriasis down pretty well…And that's probably true because we have such effective therapies. I think we've seen a very nice wave for atopic dermatitis as well, in both systemic therapies and topical therapies. But I think for HS, it is very underdiagnosed, and there are patients floating out there who are still not receiving the care that they should be. But the tide is turning. We've got new therapeutics in the toolbox. We've got a lot of research going on, so I'm excited in that particular area

What would you say is the value of RAD as a disease-specific meeting?

 Atopic dermatitis, up to about 7 or 8 years ago, was a disease for which we had not much. Now we do. But now that we have tools in the toolbox, we have to be able to convey those very critical messages about not even so much, how we carefully diagnose a condition like atopic dermatitis, which I think for dermatologists and our advanced practitioner dermatology colleagues, we've got that down. But now, [we have to focus on] how do we use these therapeutics and which therapies for which patients.

I think a meeting like RAD, focusing on atopic dermatitis and related disease states, is critical for all of our understanding, not only of how patients present clinically, but how we hone in on the proper therapeutic interventions for people who are suffering with this condition.

For any additional information on TSW and related topics in the atopic dermatitis space, view the 

latest coverage of the RAD 2025 conference

The quotes used in this summary article were edited for clarity.

Topical steroid withdrawal (TSW) is a significant inflammatory skin condition occurring after chronic use of topical corticosteroids, characterized by symptoms like the "red sleeve sign." Differentiating TSW from severe atopic dermatitis flares requires thorough patient history and understanding of corticosteroid use. The emergence of non-steroidal therapies, including biologics and JAK inhibitors, offers promising treatment alternatives. The RAD conference emphasizes the importance of understanding and utilizing new therapeutic options for atopic dermatitis and related conditions, highlighting ongoing research in areas like hidradenitis suppurativa.

In this Q&A discussion, Glick highlights several important points about topical steroid withdrawal and atopic dermatitis.

Understanding Topical Steroid Withdrawal Versus Atopic Dermatitis, with Brad Glick, DO

Brad Glick, DO, MPH

Panelists discuss how patient history, vaccination status, and risk of infection influence the decision to administer complement inhibitors, with some expressing caution in high-risk cases, particularly in pediatric populations with prior infections or low immunoglobulin levels.

Balancing Complement Inhibition and Infection Risk in C3G Treatment

Video content above is prompted by the following: 

Summary for Physicians on Use of Complement Inhibitors in High-Risk Patients:

Patients with nephrotic syndrome who experience significant protein loss, leading to very low IgG levels, are at an increased risk for infections. These patients may not be ideal candidates for complement inhibitors due to concerns about their ability to fight bacterial infections, particularly encapsulated organisms.

Early trial data, particularly from studies like 

, suggest that while complement inhibitors are used in posttransplant patients on immunosuppressive therapy, they did not significantly increase the risk of infections, especially when vaccinated and managed with prophylactic antibiotics.

Vaccination and prophylactic antibiotics (e.g., penicillin or macrolides) are essential to reduce infection risks when using complement inhibitors. It’s important to assess local infection resistance patterns (e.g., penicillin resistance rates) before initiating therapy.

Clinical trials, such as the APEX trial, excluded patients with a history of recurrent invasive infections caused by encapsulated organisms. However, in clinical practice, the timing of infections, vaccination status, and use of prophylactic antibiotics are important factors to consider.

A patient who has had a meningococcal infection but was not vaccinated may still be a candidate for complement inhibitor therapy if vaccinations are administered and prophylactic antibiotics are used.

In real-world settings, physicians may proceed with complement inhibitors in high-risk patients, provided that adequate precautions are taken, including vaccination, use of prophylactic antibiotics, and consultation with infectious disease specialists when necessary. This approach has been successful in managing patients safely over extended periods.

It’s crucial to address concerns from parents or caregivers, particularly in pediatric populations. Parents need reassurance regarding the safety of long-term use of complement inhibitors, especially in the context of infection risks.

Bradley Dixon, MD

Summary and Closing Remarks

Thanks to you all for this rich and informative discussion. Before we conclude, I’d like to get final thoughts from you.

Biomarkers and clinical indicators play a crucial role in predicting disease outcomes, offering insights into disease progression, treatment response, and patient prognosis. These indicators can be genetic, molecular, or cellular, and are often identified through advanced diagnostic techniques. For instance, specific gene mutations or protein expressions can indicate the likelihood of disease recurrence or metastasis. Additionally, clinical indicators such as tumor size, stage, and patient health status are integral in assessing outcomes. Personalized medicine leverages these biomarkers to tailor treatment plans, enhancing therapeutic efficacy and patient survival rates.

Panelists summarize the key points discussed regarding the evolving landscape of IgA nephropathy treatments, highlighting the importance of addressing unmet needs, the significance of reducing proteinuria, and the role of emerging therapies in modifying disease progression, ultimately emphasizing the necessity for personalized treatment approaches and effective communication with patients to improve clinical outcomes.

Ellie Kelepouris, MD

 Karl, there’s a drug that was mentioned by Nate called daridorexant. It’s a new drug. Can you tell us a little bit about this and what’s new and different about it?

 As Nate mentioned, it’s a dual orexin receptor antagonist [DORA], and it seems to have a shorter half-life than the other DORAs. And it may, for that reason, have different clinical effects. But one of the interesting things about the clinical development of this medication is that it’s also been looked at for daytime functioning disturbances with insomniacs. It has been shown to have some improvement in some areas of daytime functioning, which I think is very interesting, since we’ve been speaking about daytime functioning as being a critical area for insomniacs. I think we need more studies like this. It would be very helpful in the future if we could also develop more objective ways of quantifying daytime dysfunction with insomniacs and see if these medications could be helpful. This medication was also studied in, I believe, a 3-month trial where there was a rapid discontinuation. Of course, that’s a clinical issue with many of our patients who discontinue sleep medications, stop taking them. In this particular case, there was no rebound insomnia, which was very interesting to find out.

 Yes, this is interesting. You mentioned having effects on daytime functioning. When you survey patients, you find that daytime functioning is the biggest complaint, and I think you mentioned that at the beginning of the program. The fact that this medication has shown some benefit, not only at night, but also during the daytime, I think is a good direction. Hopefully, we will have other medications for insomnia that will address this as well and look at various daytime consequences of insomnia, not just look at how it’s improving the nighttime.

 Another medication, Michael, I want to mention in the pipeline is something called IMB-115; it does not have an official name yet. It is a medication being developed for not only insomnia, but also for insomnia associated with alcohol cessation. It actually acts at the receptors that are important for both pain as well as for mood and other issues and those susceptive receptors. And interestingly, it may have some effects on drug addiction as well. Thus, it has been developed as a way of possibly treating alcohol cessation insomnia as well as insomnia, period.

 Yes, I think this is particularly interesting because it’s a whole new different mechanism of action for a hypnotic [medication]. As you said, it’s affecting these pain receptors, it’s a pain receptor agonist. This medication is under investigation at the present time. What’s yet to be seen is whether it will eventually get FDA approved, of course. But it’s nice to think that there are new receptor types that could be affected by medications to help people sleep and not just the traditional ones.

Expert panelists share their excitement for novel agents that may impact the insomnia treatment landscape.

Improving Insomnia Management: Novel Agents in the Pipeline 

Erinn E. Beagin, MD

Jason Bacharach, MD, is the director of research at North Bay Eye Associates.

Perfluorohexyloctane Delivers Rapid Dry Eye Relief, With Jason Bacharach, MD

A recent phase 4, multicenter, open-label study identified rapid and sustained relief with perfluorohexyloctane ophthalmic solution (PFHO; MIEBO) in symptomatic patients with 

2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

, these data observed significant symptom reduction within minutes of administration and high levels of patient satisfaction maintained throughout the 14-day study period.

“At five minutes after the first dose, [we observed] a significant improvement in a variety of symptoms and the total composite dry eye symptom improvement score on the Visual Analogue Scale (VAS) was so large, almost 50% after one dose,” Jason Bacharach, MD, director of research at North Bay Eye Associates, told 

. “That symptom score continued to improve at every time point measured over the first 14 days. This was one of the first studies ever conducted at our research center, looking at improvement five minutes after dosing.”

The trial enrolled 99 adults with a history of DED, all of whom instilled PFHO in both eyes four times daily. Patients completed early outcome surveys on days 1 (baseline), 3, 7, and 14 clinic visits, which assessed DED symptom severity (overall and 8 symptoms) and treatment satisfaction (VAS, 0-100).

At baseline, participants reported a mean tear film breakup time of 3.6 seconds and moderate to severe meibomian gland dysfunction. The primary endpoint—mean change in overall DED symptom severity at Day 7—was statistically significant, with a 61.7% reduction (

 <.0001). Improvements were consistent across all time points and extended across the individual symptom domains, including dryness, burning, irritation, and blurred vision.

The study revealed high treatment satisfaction scores, with a median rating of 83.0 at Day 3, 86.0 at Day 7, and 90.0 at Day 14. Bacharach indicated this could support improved treatment adherence for patients with DED.

“If patients are happy with the therapy, whatever that therapy is, they're more prone to stay on, improving adherence,” Bacharach told 

. “That’s what I have found clinically in my practice. People using PFHO really want to stay on the drop, and that is a huge benefit.”

Dr. Bacharach noted that PFHO’s physical properties contribute to its fast action, noting its small size allows it to stay on the ocular surface and create a barrier at the air-tear film interface.

“We think that because of its ability to create a barrier at the air tear film, particularly lipid level interface, the patients develop a significant improvement early on and then maintain an improvement until their next dosing,” Bacharach told 

. “It reduces evaporation on the front of the eye, with patient satisfaction rising as early as day three.”

Relevant disclosures for Bacharach include Allergan, Bausch + Lomb, EyePoint, Injectsense, Insite, Ocular Therapeutix, and others.

Bacharach J, Kannarr SR, Verachtert AJ, et al. Early Symptom Relief and Satisfaction with Perfluorohexyloctane Ophthalmic Solution in Dry Eye Disease: A Prospective, Multicenter Study. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

A new study highlights rapid relief and high satisfaction with PFHO for dry eye disease, showing significant symptom improvement within minutes.

Jason Bacharach, MD

How Climate Change is Making Your Patients' Allergies Worse

As climate change intensifies, it is not just the environment that suffers—seasonal

are getting worse, too. Global warming has led to increased droughts, wildfires, intense storms, heat waves, and rising sea levels, factors that can contribute to allergies and asthma.

According to the American Public Health Association, the 3 main causes of allergy include ambient air pollution, mold, and pollen.

 The organization also reported that 30% of adults and 40% of children experience nasal allergies.

2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) 

spoke with several experts on climate change’s impact on allergies, exploring strategies clinicians can adopt to mitigate worsening allergic conditions.

, from the University of Texas Health Houston

 from Eastern Virginia Medical School at Old Dominion University

Extended Pollen Seasons and Increased Allergen Potency

Nyenhuis emphasized that pollen seasons are lengthening, especially in the western and southwestern United States, where freeze days have increased by nearly 20.

 This prolonged exposure intensifies symptoms and raises the risk of new allergies. She also noted that air pollution, particularly diesel particles, can amplify pollen’s allergenicity, worsening allergic reactions.

To help patients, Nyenhuis recommended indoor air filtration, wearing masks outdoors, and using hyper-local pollen data instead of historical weather app forecasts, which are becoming less reliable due to climate change.

Air Pollution’s Role in Allergy Development

Mahdavinia explained that air pollutants disrupt the respiratory tract’s epithelial barriers, leading to inflammation and microbiome imbalances in the nose and lungs.

 This can eliminate beneficial bacteria, allowing harmful microbes to thrive and increasing allergy risks. Mahdavinia called for expanded pollen monitoring and broader allergen testing as plant distributions shift.

Climate Change and Emerging Food Allergies

Commins discussed pollen food syndrome, in which pollen absorbed through the skin triggers food allergies.

 He also warned about the rising prevalence of alpha-gal syndrome, a meat allergy caused by tick bites. Warmer winters have expanded tick populations, increasing cases in the US, Europe, Australia, and Asia.

As climate change drives new allergy risks, clinicians must stay alert for evolving conditions such as pollen food syndrome and alpha-gal syndrome. Experts stress the importance of refining allergy diagnostics, improving access to immunotherapy, and implementing preventive strategies to protect patients in an increasingly allergenic environment.

Relevant disclosures include GlaxoSmithKline for Nyenhuis, GENZYME CORPORATION, Optinose US, Inc, and Blueprint Medicines Corporation for Mahdavinia, Regeneron Healthcare Solutions, Genetech USA, and AstraZeneca Pharmaceuticals for Commins, and Optinose US, AERIN MEDICAL, GENZYME CORPORATION, Medtronic, GlaxoSmithKline, Regeneron Pharmaceuticals, and AstraZeneca Pharmaceuticals for Lam.

. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.apha.org/-/media/files/pdf/topics/climate/asthma_allergies.pdf. Accessed March 20, 2025.

Derman, C. Adapting Allergy Care Due to Increased Pollen Seasons, with Sharmilee Nyenhuis, MD. HCPLive. March 1, 2025. 

https://www.hcplive.com/view/adapting-allergy-care-due-increased-pollen-seasons-sharmilee-nyenhuis-md

Derman, C. How Air Pollutants Contribute to Allergies, with Mahboobeh Mahdavinia, MD, PhD. HCPLive. March 1, 2025. 

https://www.hcplive.com/view/how-air-pollutants-contribute-to-allergies-with-mahboobeh-mahdavinia-md-phd

Derman, C. Climate Change’s Impact on Allergies, with Scott Commins, MD, PhD. HCPLive. March 2, 2025. 

https://www.hcplive.com/view/climate-change-s-impact-on-allergies-scott-commins-md-phd

Climate change exacerbates seasonal allergies through increased air pollution, prolonged pollen seasons, and rising allergen potency. Experts highlight the role of air pollutants in disrupting respiratory barriers, leading to inflammation and microbiome imbalances. Emerging conditions like pollen food syndrome and alpha-gal syndrome are becoming more prevalent due to environmental shifts. Clinicians are urged to refine diagnostics, expand allergen testing, and adopt preventive strategies. The importance of using hyper-local pollen data and indoor air filtration is emphasized to mitigate allergy risks in an increasingly allergenic environment.

Climate change worsens allergies by lengthening pollen seasons, increasing air pollution, and driving new food allergies. Experts offer strategies for clinicians.

How Climate Change is Making Allergies Worse—And What Clinicians Can Do

Scott Commins, MD, PhD

Joseph, do you have any final thoughts about, or takeaways from, this discussion?

Education is important for everybody. Many health care providers, including myself, always had this feeling about FMT [fecal microbiota transplant]. Is it dangerous? Will patients wind up getting sick? Where does the stool come from? Is it a mix of donors or a single donor? How much will it cost? And the whole idea of a colonoscopy with bowel prep and propofol, which I mentioned before, seems like a lot. We need to change the way we think about the natural course of 

 infection [CDI]. Hopefully, people will and explore all treatment options that are available at this point.

As far as education with the practitioners, it is about educating the patients as well. If they happen to be frequent fliers for, let’s say, as you mentioned, UTIs [urinary tract infections]. Or they go to their physician, and they say, “I have a cold,” and they’re given an antibiotic. You have to explain to patients as you’re seeing them come into your practice that it’s not important to get an antibiotic every time you go to your physician’s office. And to educate them and not to try to doctor-shop and get an antibiotic if they don’t get the right answer from their primary care physician [PCP] or whomever. It’s important not only for practitioners, but for patients or potential patients for 

 Certainly, we’re going to continue to need patient education, and I appreciate that comment. Andrew?

I am cautiously optimistic now, at this point, as to where we’re headed with CDI treatment, as we have the first FDA-approved FMT product at this point right now with seemingly more on the way. We’ve got the first one through the door, and it’s going to be a matter of seeing where things go from here. As you mentioned earlier, maybe hopefully in the next 10 years we’ll have narrowed it down to which key microorganisms are essential for restoring the microbiota. And if we see these improvements, then hopefully the treatments will continue to become more effective into the future as well.

Appreciate that. I have to say that I’ve considered myself in the past a drug pusher, if you will, in the good sense of the term. But I am excited the fact that there is now an FDA-approved fecal microbiota replacement and that’s a nice, good step forward with assurance that it’s screened and safe, for the most part. And that’s a major step for managing patients with recurrent 

. If you enjoyed the content, please subscribe for e-newsletters to receive upcoming 

 and other great content right in your inbox.

Experts provide practice pearls for educating patients on and using FMTs for the management of CDI.

Key Takeaways on FMTs in the Treatment of CDI

Stuart Johnson, MD

Zaina Al-Mohtaseb, MD, is a board-certified ophthalmologist and surgeon specializing in cataract, LASIK, and cornea surgery for Whitsett Vision Group.

AURN001 Achieves Dose-Dependent Response at 6 Months, With Zaina Al-Mohtaseb, MD

 achieved a dose-dependent response at 6 months in best-corrected visual acuity (BCVA) with a single dose of varied concentrations of human corneal endothelial cell (CEC) therapy in combination with Y-27632 Rho-Kinase Inhibitor (AURN001) in the ongoing Phase 1/2 CLARA trial.

American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

, patient-reported outcomes in the trial indicated benefit for quality of life, consistent with the dose-dependent response, and a favorable safety profile, remaining well-tolerated.

“I think patients are going to love this therapy, and even in the study, it showed a dose-correlated patient-reported outcome in the high-dose arm in comparison,” presenting investigator Zaina Al-Mohtaseb, MD, an ophthalmologist at Whitsett Vision Group and chair of the ASCRS Young Eye Surgeon committee, told 

. “It’s about improving, not just the vision, but what the patient feels in the process, and I think the future is pretty amazing for cornea.”

AURN001 is a combination cell therapy product candidate comprised of allogeneic human CECs (neltependocel) and a rho kinase inhibitor (Y-27632), intended to be administered as a one-time procedure to the anterior chamber of the eye.

The CLARA trial assessed the efficacy and safety of a single dose of varied concentrations of human CECs combined with Y-27632 Rho-Kinase Inhibitor, compared with CECs alone, and Y-27632 alone, for a population with corneal edema. The primary endpoint was the proportion of patients achieving a ≥15-letter improvement from baseline in BCVA at six months.

Secondary endpoints were defined as the change from baseline in BCVA and central corneal thickness (CCT) at six months, with a quality of life endpoint measured by the Visual Function Questionnaire-25 (VFQ-25). Safety was measured by treatment-emergent adverse events, graft rejection, and rescue rates.

With 5 treatment arms, a total of 97 participants with corneal edema secondary to corneal endothelial dysfunction were enrolled across 20 sites in North America. Analysis of CLARA identified a dose-dependent response for the primary and secondary endpoints and the proportion of participants requiring rescue at six months.

A statistically significant improvement in the proportion of responding patients who achieved ≥15 letters of improvement in BCVA, compared with Y-27632 alone, was recorded in the high-dose arm (50% vs 14.3%; 

In the VFQ-25 questionnaire, patients reported dose-dependent quality of life improvement. Safety analysis found no ocular serious adverse events, treatment-emergent adverse events (TEAEs) linked to discontinuation, or graft rejections, across all 5 trial arms.

With these data marking the six-month interim data analysis, the trial is expected to be completed in the first half of 2025 for the full 12-month outcomes.

“You want to make sure that you have, at least, the same statistically significant improvement, if not more, and then the same safety data,” Al-Mohtaseb told 

. “And again, seeing that dose response continues out to 12 months is going to be important, because you obviously want this [response] to last.”

Al-Mohtaseb reports relevant disclosures with Alcon, AbbVie, Bausch & Lomb, Johnson & Johnson, and others.

Al-Mohtaseb Z, Lee WB, Hester CC, Pouly SM, et al. 6-Mo Data Analysis of Clara: A Phase 1/2 Clinical Trial of Human Corneal Endothelial Cell Therapy for Corneal Edema Secondary to CED. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

McGarry J. Aurion biotech announces positive topline data for phase 1/2 clinical trial of AURN001, an allogeneic cell therapy product candidate for the treatment of corneal edema secondary to corneal endothelial dysfunction. Aurion Biotech. December 18, 2024. Accessed April 26, 2025. 

https://aurionbiotech.com/aurion-biotech-announces-positive-data-for-phase_1-2_trial/

A Phase 1/2 trial shows promising results for corneal edema, highlighting significant visual and quality of life improvements with an innovative cell therapy.

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