Allergy Month in Review: May 2025

As we move through 2025, new research is advancing our understanding of allergy and food hypersensitivity. Recent studies identify GDNF, IL-18R1, and IL-15RA as promising biomarkers in seasonal allergic rhinitis. Meanwhile, evidence points to age 2 as the optimal timing for hen’s egg oral food challenges in FPIES. These insights highlight the need for personalized, population-specific allergy management.

This allergy month in review captures recent discoveries, the US Food and Drug Administration (FDA) warning of severe itching after stopping cetirizine or levocetirizine, and what is driving the rise in food allergies.

FDA/Regulatory Updates

FDA Warns About Rare, Severe Itching After Stopping Cetirizine or Levocetirizine

The FDA announced on May 16, 2025, that a pruritus risk warning will be added to cetirizine and levocetirizine labels after identifying 209 global cases, mostly in the US, of severe itching following discontinuation after long-term use. Though rare, symptoms may require medical care and often resolve if treatment is resumed. Clinicians should inform patients of this risk, particularly when recommending prolonged use of these allergy medications.

FDA Accepts BioCryst’s NDA for Berotralstat Oral Granules in Children With HAE

The FDA accepted BioCryst’s NDA for berotralstat oral granules in children aged 2 – 11 years with hereditary angioedema (HAE) and granted priority review, with a target action date of September 12, 2025. If approved, it would be the first oral prophylactic therapy for this age group, offering a more convenient option to help prevent serious HAE attacks.

New Guidelines Outline When to Consider Sinus Surgery for Chronic Rhinosinusitis

New guidelines from the American Academy of Otolaryngology outline 11 evidence-based steps for deciding when sinus surgery is appropriate in adults with chronic rhinosinusitis. Emphasizing diagnosis confirmation, appropriate imaging, and shared decision-making, the recommendations support surgery when benefits outweigh medical therapy, particularly for patients with polyps, fungal infections, or worsening conditions like asthma. Antibiotic overuse is discouraged.

Expert Perspectives

Microbes, Medicine, Modern Life May Drive Food Allergy Rise, Experts Say

Food allergies have surged 50% since the 1990s, now affecting 33 million Americans. Experts link the rise to delayed allergen introduction, microbiome changes, antibiotic use, C-sections, and environmental factors. Early allergen exposure is now advised. Still, uncertainty remains, prompting calls for more research, revised clinical practices, and anxiety management around food allergies in both patients and providers.

How To Go About Proximity Challenges for Food Allergy Anxiety in the Clinic

Proximity challenges help patients with food allergy anxiety safely confront fears and distinguish anxiety from true allergic reactions. Experts recommend assessing avoidance behavior and using targeted questions and scales. These challenges boost coping skills, correct misconceptions, and improve daily functioning. Homework and tailored strategies support lasting fear reduction across all ages.

Related: How to Address Food Allergy Anxiety with Proximity Challenges

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

The Early Childhood Anaphylaxis Collaborative aims to improve anaphylaxis recognition and response in childcare centers. With food allergies rising in children under 5, the initiative promotes training, awareness of atypical symptoms, and access to stock epinephrine. HCPLive spoke with Alice Hoyt, MD, chair of Code Ana, a founding partner of the collaborative, who emphasized the need for early education to prevent delayed treatment of potentially life-threatening allergic reactions.

Other Discoveries

GDNF, IL-18R1, IL-15RA Identified as Novel Biomarkers in Seasonal Allergic Rhinitis

A new study identified GDNF, IL-18R1, and IL-15RA as novel biomarkers strongly linked to seasonal allergic rhinitis symptoms. These inflammation-related proteins fluctuated with allergy seasons and correlated with nasal symptoms. As urbanization drives rising allergic rhinitis cases, these findings may advance targeted diagnostic tools and therapies by uncovering molecular pathways involved in immune response and symptom development.

Optimal Timing for Hen’s Egg Oral Food Challenge in FPIES May Be Age 2 Years

A new study suggests age 2 is the optimal time for a hen’s egg oral food challenge (OFC) in children with FPIES in Turkey. Earlier OFCs were linked to greater risk of positive reactions. While remission timing varies globally, this research supports population-specific guidelines to reduce unnecessary food restrictions and improve tolerance assessment strategies.