This editors' choice issue summarizes 6 studies covering: dupilumab in children with asthma and transient eosinophilia (VOYAGE/EXCURSION trials, ages 6–11, ≤1 year + extension); gene-microbiome interactions and childhood wheeze; miR-149 as a skin inflammation regulator; HLA genetic markers for sulfasalazine-induced SCARs; SERPING1 signal peptide variants in HAE; and tezepelumab clinical remission in severe asthma (TERESA, n=107, 52 weeks).
- **Dupilumab/eosinophilia in children**: ~20% of children on dupilumab had early eosinophil increases (≥500 cells/µL at Week 12), but this did not affect long-term efficacy or safety. - **Gene-microbiome/wheeze**: 17q12-21 SNPs (esp. Gasdermin B rs7216389TT) interacted with MSH airway microbiota to increase early-life wheeze risk; CDSB microbiota interactions were protective. - **miR-149/skin**: Loss of miR-149 worsened psoriasis-like and atopic dermatitis-like inflammation in mice; restoring miR-149 in human biopsies suppressed inflammatory markers. - **Sulfasalazine SCARs**: HLA-B\*38:02 (OR 11.69 for SJS/TEN), HLA-B\*39:01 (OR 24.78 for DRESS), and HLA-B\*13:01 (OR 7.00 for DRESS); a 4-allele panel had 84.8% sensitivity in Chinese populations. - **SERPING1 SP variants**: 6 of 33 signal peptide variants caused poor C1-INH synthesis; protein aggregates observed in ER for L10R, G17R, S22L. - **Tezepelumab remission (TERESA)**: 34.6% of patients achieved clinical remission at 52 weeks; 47.4% biologic-naive vs 20.0% biologic-experienced.
This is an editors' summary of multiple studies, not a single primary paper; individual study limitations (post hoc design for dupilumab analysis, single-arm phase 4 for TERESA, Asian-only cohorts for sulfasalazine genetics) apply to each respective article and are not fully detailed here.
In children on dupilumab for asthma, an isolated early rise in eosinophils alone is unlikely to require stopping treatment. For sulfasalazine prescribing in Asian patients, preemptive HLA screening (especially B\*38:02, B\*39:01, B\*13:01) can identify those at high risk for life-threatening skin reactions before starting therapy.
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