Steroid-resistant asthma (SRA) is clinically significant, approximately 10–15% of individuals with asthma do not exhibit a positive response to standard treatments. While this subset represents a relatively small proportion of asthma patients, severe refractory asthma places a substantial burden on healthcare resources and contributes significantly to illness and death. Additionally, the quality of life of patients is greatly affected by the adverse effects of excessive steroid consumption, there is a need to identify individuals who do not react well to steroid medication and the ongoing difficulties of these asthma patients in controlling their diseases, which have a large socio-economic impact. The current short article reviews the common molecular mechanisms responsible for steroid resistance in asthma patients.

Aim: Asthma affects millions of people worldwide and generates a considerable economic impact. This study aims to compare the specific immunoglobulin E (sIgE) profile in sensitized children with severe asthma from two countries with great geographic and climatic differences.
Methods: A cross-sectional study was performed using serum samples analysed with a multiplex tool in 47 children from Sweden and 29 children from Spain.
Results: Patients from Spain were significantly more often sensitized to house dust mites, cockroaches, dogs, Alternaria, Cladosporium, pollen from olive trees, cypress,Platanus, and Parietaria, and to Anisakis and shrimp. Swedish patients were significantly more often sensitized to cats, pollen from birch, hazel, and Alnus, and to apple, soy, and peanut (all P<0.05). With regard to sensitization to allergen molecules, lipid transfer proteins (LTPs), cross-reactive carbohydrate determinant (CCD)-bearing proteins and tropomyosins were more frequent in Spain, while sensitization to pathogenesis-related class 10 proteins (PR-10) molecules and to peanut storage proteins were more common in Sweden.
Conclusions: The immunoglobulin E (IgE) profile in sensitized children with severe asthma differed greatly between Sweden and Spain. The profile results were more similar to that reported in the literature for other sensitized children from the same geographic areas with non-severe disease than to that of severe asthmatics from different areas.

Atopic dermatitis (AD), also referred to eczema, is a common inflammatory skin disease that usually presents during infancy or childhood but affects patients of all ages. It is a pruritic, chronic/relapsing condition that may significantly impact the patients’ quality of life and can be associated with other atopic comorbidities including asthma and rhinoconjunctivitis. Inflammation in AD is mostly sustained by type 2 inflammation. Most patients are satisfactorily managed with a combination of emollients, avoidance of triggering factors, topical glucocorticoids, and/or topical calcineurin inhibitors. However, a proportion of patients with moderate or severe AD might require phototherapy or systemic immunosuppressants, which are limited in time due to possible safety concerns and progressive efficacy loss. In recent years, the availability of T helper 2 (Th2)-blocking agents dupilumab and tralokinumab has revolutionized the long-term treatment of moderate-to-severe AD. Here are discussed recent advances in the clinical development of biologic treatments for AD. The clinical implementation of these novel drugs has the potential not only to greatly improve the quality of life of patients with this chronic and disabling condition but also to clarify the biological processes underlying AD, in turn enabling further development of more effective, safer treatments. This research paper aims to provide an overview of biological therapies currently in use and under investigation in the setting of AD.

Numerous methods for functional diagnostics of nasal obstruction provide various information on nasal airway resistance and may aim to replace physically based methods by so-called simplifications or solely on subjective score systems. This may lead to nonsatisfying results in nasal surgery and prolonged postoperative care. An interdisciplinary analysis of contemporary methods for measurement was the task of the German-Austrian research program “Rhinodiagnost”. This review is intended to discuss basic and wide-spread errors playing a significant role during daily practice and proposes a step program for functional rhinological diagnostics with some modifications to be applied in case of allergic nasal disease. With regard to the content of “position paper on the standardization of nasal allergen challenges (2018)” of the European Academy of Allergology and Clinical Immunology (EAACI) and the results of the consensus conference of Riga in 2016, the differences between of “classic” and 4-phase-rhinomanometry (4PR) and their differences are clarified. The parameters of logarithmic effective resistance (LReff) allow a classification of the obstruction obtained during 36,500 measurements which are correlated to the subjective sensing of obstruction. The classification can be adapted for age and size and is valid for the Caucasian and Chinese populations.

Asthma is the most common chronic disease during childhood. While most of characteristic structural changes in asthma have been identified in the large airways, there is a growing recognition of peripheral airway dysfunction as a crucial factor in the development of asthma. This dysfunction is a defining feature in adults with persistent asthma. However, little is known about the contribution of small airway impairment in children with asthma due to the relatively low sensitivity of conventional lung function tests, such as spirometry. Recently, new diagnostic tools that are sensitive to both large and small airway function and inflammation have been introduced in clinical practice. The most widely studied of these tools in preschool and school-aged children is impulse oscillometry (IOS). This review addresses the latest findings on the usefulness of IOS in identifying small airway dysfunction, predicting the risk of uncontrolled asthma, and ultimately improving the diagnosis and management of asthma in children.

Aim: Most patients with wheat allergy dependent on augmentation factors (WALDA) show specific immunoglobulin E (sIgE) to ω5-gliadin. However, some WALDA patients may show negative results when testing for sIgE to total wheat extract. This is the first study to investigate potential clinical and serological differences in patients with ω5-gliadin-positive, challenge-confirmed WALDA dependent on their sensitization to total wheat extract.
Methods: Clinical and serological characteristics of patients with challenge-confirmed, ω5-gliadin-positive WALDA were analyzed based on the absence or presence of sIgE to wheat (cut-off 0.35 kUA/L).
Results: Thirty-six patients with challenge-confirmed WALDA were included (19 female; median age 50.5 years; median sIgE to ω5-gliadin 6.5 kUA/L). SIgE levels to grass pollen were related to the presence of any atopic comorbidity (P<0.001) and showed a correlation with sIgE to wheat (P=0.003), but not to the gluten-related allergens [all not significant (ns)]. Thirty-nine percent of patients (n=14) showed sIgE levels to wheat lower than 0.35 kUA/L; in 19.4% (n=7) levels were even below the detection limit of 0.01 kUA/L. WALDA patients without sIgE to wheat showed lower levels of total immunoglobulin E (IgE) and sIgE to wheat gluten, gliadins, and ω5-gliadin (all P<0.001) as well as to grass pollen (P=0.03). No significant differences in clinical characteristics like delay until diagnosis, the presence of an atopic condition, reaction severity, or threshold in the oral challenge test were observed.
Conclusions: SIgE to wheat extract was associated not only with sensitization against gluten allergens but also reflected total IgE production and concomitant grass pollen allergy, making it an insensitive and unspecific biomarker for WALDA. There were no clinical divergences between WALDA patients without or with sIgE to wheat. SIgE to total wheat extract does not appear to be clinically relevant and remains negative in a significant proportion of WALDA patients.