Atlanta Allergy and Asthma Clinic

Invasive fungal infections are a major, yet under-recognized, global health threat, accounting for an estimated 1.6—1.7 million deaths annually-on par with tuberculosis and surpassing many neglected tropical diseases. The disproportionate burden in low- and middle-income countries (LMICs) is compounded by poor diagnostic capacity, outdated treatment options, and lack of access to novel antifungals. This review provides a critical analysis of newly approved and late-stage antifungal agents, evaluates their clinical profiles and regulatory progress, and explores the systemic barriers to affordability and accessibility in LMICs. A narrative review approach was employed, drawing on literature from PubMed, Scopus, Web of Science, and policy databases between 2018 and 2025. The review integrates clinical trial data, pharmacoeconomic assessments, and global access policies, with a focus on seven agents: ibrexafungerp, rezafungin, fosmanogepix, olorofim, oteseconazole, opelconazole, and MAT2203. While these agents represent significant therapeutic advances-targeting drug-resistant Candida auris , azole-resistant Aspergillus , and rare molds-barriers remain formidable. High prices driven by orphan drug status, patent protections, limited registration in LMICs, inadequate fungal diagnostics, and supply chain inequities obstruct access. Strategic interventions are needed, including tiered pricing, pooled procurement, inclusion of antifungals on the WHO Essential Medicines List, and public-private models with access clauses. Furthermore, decentralized trials, local manufacturing, and diagnostic innovation will be essential to align antifungal R&D with global health equity goals. Novel antifungal agents offer transformative potential for managing invasive fungal infections, but without coordinated policy, financing, and access initiatives, LMICs will continue to face unacceptable treatment gaps. Bridging innovation and implementation must become a core global health priority.

Disease duration of urticaria is variable from days to decades. However, the mechanism of persistence for urticaria is largely unknown. To investigate factors which relate to the prognosis of urticaria, we conducted a cross-sectional analysis on disease durations of 1061 patients with urticaria who visited nine primary dermatology clinics from 1st October to 11th November 2020. Among them, 216 (20.4%) had acute urticaria, while 383 (36.1%) and 125 (11.8%) had suffered from urticaria for 3 years or more and for 10 years or more, respectively. There was no significant difference between males and females in disease duration. In patients under 20 years old, 75 (38.9%) had acute urticaria. By contrast, more than 20% of patients older than 50 years had urticaria for 10 years or more. Disease duration for 3 years or more of patients with dermographism and those with cholinergic urticaria was 42% and 45.3%, respectively. Although a majority of urticaria likely remit, more than one-third of patients at primary dermatology clinics suffer from urticaria for 3 years or longer. The disease duration was longer in older patients, those with dermographism and/or cholinergic urticaria.

Human metapneumovirus (hMPV) is a leading cause of acute respiratory tract infections (ARTIs), with severe cases predominantly affecting immunocompromised individuals, such as transplant recipients, cancer patients, and those with chronic illnesses. In these high-risk populations, hMPV pneumonia often leads to prolonged hospitalization and elevated mortality rates. While supportive care remains the cornerstone of hMPV management, targeted therapies are urgently needed. Ribavirin, a broad-spectrum antiviral, combined with intravenous immunoglobulin (IVIG), has shown potential in reducing disease severity and improving outcomes in immunocompromised patients. This manuscript synthesizes the clinical evidence for ribavirin-IVIG therapy, discusses its mechanisms of action, and highlights its relevance in the Indian healthcare context, where respiratory infections impose a significant burden. Despite its promise, challenges such as high costs, limited awareness among clinicians, and logistical barriers restrict the adoption of ribavirin-IVIG in India. This review emphasizes the need for multicenter trials to establish efficacy, optimize dosing, and evaluate cost effectiveness in resource-limited settings. By addressing these gaps, ribavirin-IVIG therapy could play a transformative role in reducing the morbidity and mortality associated with severe hMPV pneumonia.