The Allergist Episode 59 – Highlights from the 2025 Allergy Literature

Keeping up with the allergy literature can feel like a second job layered onto an already full clinic day. Between evolving guidelines, expanding biologic options, and long-held assumptions quietly being challenged, it’s hard to know which papers are worth slowing down for. This episode takes a deliberately selective approach. Dr. David Khan — chair of the American College of Allergy, Asthma, and Immunology literature review — walks through five papers from 2025 that stood out not because they were flashy, but because they asked practical questions allergists actually wrestle with in clinic.

On this episode, Dr. Khan reviews the following literature:

• Timing of repeat epinephrine to inform pediatric anaphylaxis observation periods: a retrospective cohort study
  For most children treated with epinephrine, prolonged emergency department observation may be unnecessary, with two hours appearing sufficient unless cardiovascular features are involved.
• Two-year data of tapered dupilumab shows high effectiveness in chronic rhinosinusitis with nasal polyps with NSAID-exacerbated respiratory disease
  In real-world practice, most patients with CRSwNP maintained excellent control while spacing dupilumab doses far beyond every two weeks, challenging long-term fixed dosing assumptions.
• Remibrutinib and chronic spontaneous urticaria
  This trial marks a major shift for CSU, introducing an oral, targeted option that delivers rapid symptom control and meaningful rates of complete remission.
• A randomized trial comparing direct challenges to penicillin skin testing for outpatient low-risk penicillin allergy evaluations in pregnancy
  For pregnant patients with low-risk penicillin allergy histories, direct oral challenge proved safe, efficient, and more streamlined than traditional skin testing.
• Age differences in inducible laryngeal obstruction in adult populations
  Inducible laryngeal obstruction appears common in older adults, often presents more subtly, and frequently masquerades as asthma or anaphylaxis.

Taken together, these papers reflect a broader shift in allergy care: less reflexive caution, more precision, and a growing willingness to question long-standing habits when better data emerge. Whether it’s shortening observation times, tapering biologics, simplifying drug allergy evaluations, or recognizing long-ignored mimics of allergic disease, the 2025 literature nudges allergists toward care that is more precise, less reflexive, and still clinically vigilant.

Posted on January 6, 2026.