Severe pediatric asthma is a very challenging type of asthma for both physicians and patients. Precision medicine in severe pediatric asthma has undergone important developments in recent years. This therapeutic approach requires an adequate diagnosis and clinical phenotyping of patients and is useful for predicting the prognosis and response to treatment in this type of patient. This article summarizes the scientific information of the last five years in the diagnosis of severe pediatric asthma, focusing on topics such as genetic markers, biomarkers, lung function, radiological techniques, and bronchoscopy.

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disorder affecting millions worldwide, with significant variations in clinical presentation influenced by socioeconomic, racial, and environmental factors. This review explores the current understanding of AD pathophysiology, emphasizing immune dysregulation, epithelial barrier dysfunction, and the role of cytokines, particularly interleukin (IL)-4 and IL-13, in disease progression. Safety and efficacy concerns limit traditional corticosteroids, phototherapy, and systemic immunosuppressants, prompting interest in innovative therapies. New biologic agents, including monoclonal antibodies (mAbs) and Janus kinase (JAK) inhibitors (JAKis), target specific immune pathways, promising outcomes in moderate-to-severe AD cases. Biologics like dupilumab and emerging JAKis have shown substantial efficacy and safety in clinical trials, with notable reductions in inflammation and pruritus. However, these advancements present challenges, including hypersensitivity risks and the high costs of biologics, underscoring the need for further research on long-term safety and accessibility. The shift toward precision medicine in AD management marks a significant evolution, with future approaches likely to integrate targeted therapies alongside multidisciplinary care to enhance patient outcomes and quality of life (QoL).

Glucagon-like peptide-1 (GLP-1) is a hormone that regulates blood glucose levels and is produced by the enteroendocrine glands in the large and small intestines in response to the consumption of foods that contain carbohydrates, fats, and proteins. When GLP-1 is secreted, it acts on the pancreas to increase insulin production and secretion, while decreasing pancreatic glucagon secretion in order to lower serum glucose. However, GLP-1 also regulates metabolism through the gut-brain axis. While GLP-1 is primarily produced in the gut and released into the bloodstream, small quantities of it can also be synthesized in distinct areas of neurons located in the hindbrain. Recent studies have proposed that GLP-1 receptor (GLP-1R) agonists (GLP-1RAs) may protect against neuroinflammatory diseases. GLP-1RAs may also be a therapeutic target for asthma as animal models show that these drugs reduce allergen-induced airway inflammation, as the GLP-1R is expressed on lung epithelial and endothelial cells. There is a notable association between insulin resistance and the onset of asthma, particularly among obese people, with this association suggesting that metabolic dysfunction may play a role in asthma development. There is also evidence that there may be a link between asthma pathobiology and neuroinflammation, suggesting that GLP-1 and its analogs may regulate neuroinflammatory pathways that contribute to asthma pathogenesis. Interest is growing, though research remains limited, in how inflammation in the nervous system and lung might be linked. This review will explore how GLP-1R signaling could inhibit interdependent inflammation in both the lung and nervous system. This review will first focus on the inflammation that is known to exist in asthma, then pivot to the current state of neural regulation of asthma, and finally speculate on how GLP-1RA signaling could inhibit both neural and lung inflammation in asthma treatment.

In a previous study, we conducted an in vitro comparison of two sublingual allergy immunotherapy products, namely, house dust mite (HDM) Staloral 300 IR/mL produced by Stallergenes Greer, and HDM Osiris 300 IR/mL produced by ALK-Abelló. Although both products are labeled with the same unit, that is, the index of reactivity (IR), the definition of this unit is different depending on the product. This resulted in HDM Staloral 300 IR/mL displaying a higher total allergenic activity (TAA) and higher contents in major allergens and proteins. The aim of this study was to extend the comparison to cat sublingual extracts, that is, to cat Staloral 300 IR/mL from Stallergenes Greer and cat Osiris 300 IR/mL from ALK-Abelló. While both cat allergen extracts were qualitatively similar, in that they exhibited similar protein and allergen profiles, cat Staloral 300 IR/mL displayed a 2 times higher TAA than cat Osiris 300 IR/mL (according to an in-house method) and contained 1.6 time more proteins, 1.3 and 1.9 time more major allergens Fel d 1 and Fel d 4, respectively. No conclusions on clinical efficacy or safety can be drawn from these data.

Aim: Short-acting β₂-agonist (SABA) overuse adversely affects asthma-related outcomes and the environment. The latest Global Initiative for Asthma (GINA) report no longer recommends SABA-only therapy. Since 2020, we have implemented an inhaled corticosteroid (ICS)-containing reliever strategy for our moderately severe asthmatics within our practice population. We only administered budesonide/formoterol (BUD/FORM) via a single device maintenance and reliever therapy (MART) across this cohort and eliminated the use of SABA therapy. Methods: Our asthma registry revealed 195 patients in the cohort. All patients were invited for assessment and 101 patients agreed to this new strategy [MART + simultaneous anti-inflammatory reliever (AIR)]. The remaining 94 patients continued with MART and SABA inhalers. Both groups were followed up for 24 months. Results: There were no deaths in either group. Asthma-related hospitalizations fell by 91.5% in the SABA-free group (p=0.003). Exacerbations requiring oral corticosteroids (OCS) fell by 82.1% in the SABA-free group over the 24-month period (p=0.041). At the end of 24 months, 97.5% of patients in the SABA-free group remained SABA-free, with an average of 4.9 cannisters of BUD/FORM prescribed per year, compared with 7.68 cannisters in the MART/SABA groups (p=0.00347). Conclusions: This data provides real world evidence that the use of MART/AIR with BUD/FORM simultaneously with the elimination of SABA is safe and effective for moderate asthmatics within primary care.

Gelatin is extracted from beef, pork, and fish tissues. An increasing number of cases of gelatin-induced anaphylaxis are associated with α-Gal syndrome (AGS). Only a few cases of anaphylaxis to bovine gelatin (BG) without AGS (BG-woAG) have been described. We report two new cases of anaphylaxis to BG-woAG, highlight the characteristics of this entity, and propose a procedure in cases of suspected anaphylaxis to BG. We selected articles on gelatin allergy between 1987 and 2024. Results: we report two new cases of severe anaphylaxis BG-woAG. Diagnosis was established using skin tests (ST), IgE, and basophil activation tests (BAT). We confirm the existence of allergies to BG-woAG. The main characteristic of these allergies seems to be the presence of BG IgE which differentiates them from AGS-related allergies. These initial data need to be confirmed by larger case series. We propose a diagnostic algorithm for better patient management. To confirm the diagnosis, ST and IgE to BG and α-Gal should be performed. The role of BAT to Gelofusine^® in the diagnostic strategy remains to be defined.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by a compromised epidermal barrier and heightened immunoglobulin E (IgE) levels, often associated with filaggrin (FLG) gene mutations. Genetic factors like FLG mutations and environmental influences, including microbial exposure and pollutants, contribute to the disease’s progression, leading to itchy, inflamed skin. AD frequently coexists with allergic conditions, severely affecting the quality of life. The disease’s pathogenesis involves complex interactions between genetic predispositions, immune responses, and environmental triggers. Despite advances, the development of effective treatments remains challenging due to an incomplete understanding of how FLG mutations influence immune pathways and the variability in AD presentation. Current biomarkers are insufficient to fully capture disease complexity or predict therapeutic responses, highlighting the need for novel biomarkers and personalized approaches. Emerging therapies such as chimeric antigen receptor (CAR)-T cell therapy, stem cell therapy, and regenerative medicine show promise in addressing AD’s root causes. This review explores key aspects of AD pathogenesis, focusing on epidermal barrier dysfunction, immune mechanisms, and the need for innovative therapeutic strategies to improve patient outcomes.

Telemedicine (TM) is rapidly gaining recognition as a valuable tool for accessing medical treatments globally. The article aimed to review the latest literature on the role of TM in asthma care. It has been shown that TM offers numerous advantages for patients and clinicians, facilitating an easier access to healthcare resulting in higher patient satisfaction. Telemedicine technology, pushed by the COVID-19 pandemic, has improved asthma management, notably treatment adherence. Smart inhalers, wearable gadgets, and smartphone apps allow doctors to make data-driven decisions and empower patients to manage their diseases. Real-world research shows that TM is effective and patient-friendly. Infrastructure constraints, data security issues, and long-term patient engagement must be addressed. In conclusion, a hybrid strategy combining TM and in-person visits, enabled by AI and secure digital solutions, can provide equal, efficient, and comprehensive asthma management.

A high percentage of patients with severe asthma also suffer from nasal polyposis, with dupilumab, an anti-IL-4R antibody both diseases can be treated due to its role in type 2 (T2) inflammation. When these conditions are associated with eosinophilic vasculitis, they may be classified as eosinophilic granulomatosis with polyangiitis (EGPA), which can be treated with mepolizumab. This case report presents an atypical form of EGPA, following an unusual course that began with the final signs and symptoms and then proceeded backward to the prodromal stages. Our patient, indeed, a 46-year-old woman, was asymptomatic throughout her youth, with the exception of nasal polyps. Later, at the age of 34, she developed late onset asthma, which became increasingly difficult to treat, until old and previously unacknowledged evidence of vasculitis was discovered, giving a twist to our patient’s medical history and, subsequently, to the therapeutic strategy adopted to treat her. This case report aims to highlight the importance of conducting a thorough anamnesis in patients suffering from both severe asthma and nasal polyposis, taking into account the high prevalence of EGPA in this category of patients, as well as its wide range of clinical manifestations, not to mention the various available therapeutic strategies, including mepolizumab.

Aim: This study aims to investigate the impact of asthma on quality of life, explore its associations with anxiety and depression, and identify the key determining factors. Methods: A cross-sectional study was conducted in the pulmonology department of Hassan II University Hospital in Fez in 2021. Data were collected using an anonymous questionnaire that included sociodemographic, clinical, and therapeutic information. The Moroccan versions of the Hospital Anxiety and Depression Scale (HADS) and the Short-Form-12 (SF-12) scale were used to assess anxiety, depression, and quality of life. Descriptive analysis was performed, followed by univariate analysis to examine the associations between quality of life, anxiety, depression, and other factors, using statistical tests appropriate for the types of variables studied. A p<0.05 was considered statistically significant. Data entry was performed using Excel 2013, and statistical analysis was conducted using SPSS version 26. Results: Among the 67 patients included (77.6% women, 61.2% aged ≥ 50 years), wheezing (44.8%) and dyspnoea (26.9%) were the most frequent symptoms. Depression was significantly associated with pain (p=0.020), and frequent hospitalizations (p=0.021), while anxiety was more common among women (p=0.034). For quality of life, patients with depression had lower physical component summary (PCS) scores (p=0.008). Patients over 50 years old had significantly lower PCS and mental component summary (MCS) scores (p=0.001 and p=0.002, respectively). Illiterate patients had lower PCS scores (p=0.022), hypertensive patients had lower PCS scores (p=0.032), and a nearly significant difference for the MCS (p=0.053). Diabetic patients had lower MCS scores (p=0.034). Finally, a positive correlation was observed between respiratory function forced expiratory volume in 1 second (FEV₁) and both PCS scores (p=0.025) and MCS scores (p=0.018). Conclusions: This study underscores the importance of an integrated approach to enhancing the quality of life of asthmatic patients, taking into account respiratory, psychological, and social factors.

Thanks to improvements in asthma care and availability of new biologic treatments, a relatively novel population of adolescents and young adults (AYA) with severe asthma (SA) is growing. Transition from pediatric to adult care represents a critical phase in the management of SA. We herein describe clinical outcomes, therapeutic adjustments and disease management in a group of SA patients transitioning from the pediatric to the adult care center. This is a retrospective study in which demographic and clinical (comorbidities, baseline treatment, number of asthma attacks, spirometry, airway inflammation [fractional exhaled nitric oxide (FeNO) measurements], patient’s compliance) data of four SA patients during visits in the Pediatric center as well as after transition into the Adult Center, were retrospectively recollected. All patients transitioned at 18 years of age. Clinical parameters, spirometry and FeNO showed significant improvement following the addition of biologics to baseline asthma regimen during pediatric follow-up and the early transition phase. Several months after transition to the Adult Center, two males experienced SA exacerbations following voluntary discontinuation of the biologic treatment. Symptom control was gained after a phenotype driven re-introduction of a biologic drug in the regimen. Male patients were less compliant and independent than females in the adult setting. Transition from pediatric to adult care for patients with SA can be effectively managed with coordinated and structured transition processes. While some patients maintain stable clinical and respiratory outcomes, others risk to lose asthma control. A personalized approach supporting both patient’s independence and adherence to treatment is requested for a successful long-term management.

Aim: Emerging epidemiological studies have reported a link between allergic diseases, including asthma, and depression. Evidently, the gut microbiota is involved in the pathogenesis of asthma and depression. Therefore, we investigated whether allergic lung inflammation in mice causes gut microbial dysbiosis, via the gut-brain axis, which is potentially associated with depression. Methods: Wild-type C57BL/6J female mice were sensitized with intranasal house dust mite (HDM) antigen or phosphate-buffered saline (PBS) for 6 weeks to induce chronic allergic lung inflammation. Sucrose preference tests were performed for assessing depression. Fecal samples were collected, and 16S ribosomal RNA gene sequencing was performed to detect differences in gut microbiota composition between the HDM and PBS groups. The distance calculation, clustering of operational taxonomic units, rarefaction analysis, and estimator calculation (α- and β-diversity) were performed. Results: There was a significant difference in β-diversity (Bray-Curtis dissimilarity, F-statistics=6.16, p=0.001) of the gut microbiota between HDM and PBS groups. However, there was no difference in the α-diversity. We observed multiple differentially abundant bacteria in the HDM and PBS groups. The order class Clostridia (p=0.0036) and genus Faecalibaculum (p=0.028) were more abundant in the HDM group, whereas the phylum Firmicutes (p=0.037) and genera Dubosiella (p=0.00024) and Turicibacter (p=0.037) were more abundant in the PBS group. Notably, the relative abundance of some bacteria was correlated with the sucrose preference test results. Conclusions: Six weeks of intranasal HDM administration to mimic the chronic status of lung inflammation in asthma changed the gut microbiome in mice and was associated with depression-like behavioral changes.

Asthma is a prevalent chronic respiratory condition in children, often exacerbated by allergic reactions, with house dust mites (HDMs) being a significant trigger. Traditional asthma management primarily involves inhaled corticosteroids and bronchodilators, which do not address the underlying allergic mechanisms. Allergen immunotherapy, including subcutaneous and sublingual immunotherapy (SLIT), has emerged as a strategy to induce immune tolerance to allergens. This review evaluates the efficacy of HDM immunotherapy in paediatric asthma, focusing on reductions in asthma exacerbations, improvements in lung function, decreases in medication use, and enhancements in quality of life (QoL). The review highlights that both subcutaneous immunotherapy (SCIT) and SLIT significantly reduce asthma exacerbations in children, with SCIT showing superior efficacy in lung function improvement. Combination therapies, particularly SCIT with biologics, demonstrate enhanced outcomes, including exacerbations and medication use reductions. SCIT has also been shown to improve lung function more effectively than SLIT, particularly in children with high baseline levels of HDM-specific IgE. In terms of safety, both SCIT and SLIT are generally well-tolerated, though SCIT is associated with more localized and systemic reactions, which can be mitigated by combination with biologics. Furthermore, HDM immunotherapy significantly enhances the QoL in paediatric patients by reducing asthma symptoms and improving sleep, leading to long-lasting benefits. Despite these positive outcomes, there remain gaps in knowledge, particularly regarding the optimal duration of therapy and long-term effects post-treatment. Future research should standardize treatment protocols, explore personalized approaches, and investigate the long-term sustainability of treatment benefits to fully optimize the use of HDM immunotherapy in paediatric asthma.

In the context of severe asthma, one of the causes of poor disease control has been identified in mucus plugs, which are real obstacles to the physiological flow of air in the bronchi. This clinical case will present the efficacy of dupilumab, as measured by respiratory function and chest computed tomography (CT) imaging, in reducing mucus plugs with consequent improvement in symptoms and function.

Pediatric and adolescent asthma is a significant health challenge with high prevalence and socioeconomic costs. Telemedicine has emerged as a promising solution for enhancing asthma management, especially in resource-limited settings and in response to the increasing demand for specialized care, particularly after the coronavirus disease 2019 (COVID-19) pandemic. However, its integration into routine clinical practice is hindered by limited evidence and the absence of standardized protocols tailored to younger populations. Telemedicine offers the potential to optimize healthcare delivery, improve access to specialized services, and support continuous patient monitoring. This initiative aims to address current gaps in standardized practices, ensuring equitable, efficient, and personalized care, particularly in underserved regions. A systematic review of literature on telemedicine and asthma was conducted using MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases, up to October 2024. Studies were evaluated for effectiveness, safety, patient satisfaction, and ethical considerations. International guidelines were also reviewed, and recommendations were formulated through a modified Delphi process with a panel of seven experts, adhering to Oxford Evidence-Based Medicine grading. Telemedicine significantly enhances asthma management, improving treatment adherence, quality of life, and patient education while reducing unplanned visits. It is particularly beneficial for regions with limited access to specialized care. However, challenges persist, including insufficient data on cost-effectiveness, gaps in professional training, and technological barriers. Telemedicine is a valuable tool for managing pediatric and adolescent asthma, offering numerous benefits in accessibility and care continuity. Nevertheless, further research is needed to address existing challenges, establish best practices, and ensure its adaptability to diverse clinical settings, ultimately paving the way for more effective and equitable asthma care.

Since January 2024, in Albania, we have noted an increased number of visits because of Bordetella pertussis affecting all age groups. The increased numbers reflect increased circulation of Bordetella pertussis in Albania. Increasing cases of Bordetella pertussis are noticed in different European countries (European Centre for Disease Prevention and Control. Increase of pertussis cases in the EU/EEA. 2024.), and its appearance represents a public health problem to be addressed correctly such as introducing the booster dosage of Bordetella pertussis vaccine in the preschool, teenagers and pregnancy, identifying the contacts and early beginning of post-exposure prophylaxis are very important for preventing the burden of Bordetella pertussis and its fatalities.

Activation of eosinophils and mast cells in dysregulated type 2 immunity may play key roles in allergic diseases. Eosinophils are linked to the pathobiology of multiple human diseases, including eosinophilic gastrointestinal disorders (EGIDs), functional gastrointestinal disorders (FGIDs), Kimura’s disease, hypereosinophilic syndrome (HES), rheumatoid lesions, allergy, asthma, and some forms of heart disease etc. Eosinophils are part of the innate immune response involved in combating multicellular parasites and some infections. Mast cells play a key role in allergies, allergic conjunctivitis, allergic dermatitis (eczema), allergic rhinitis (hay fever), anaphylaxis, asthma, and mast cell activation syndrome (MCAS). Mast cells can also play a key role in eosinophilic diseases. Eosinophils respond to interleukin 5 (IL-5) and chemotactic chemokine eosinophil chemotactic factor (eotaxin) released from activated mast cells. Mast cells can be activated by fragment crystallizable (Fc) receptor bound immunoglobulin E (IgE) and G (IgG) antibodies bound to allergens and viruses. Cross talk between eosinophils and mast cells can result in chronic inflammations or eosinophilias. Vasoconstriction of capillaries by histamine contracted pericytes is also predicted to contribute to a subset of these diseases. This article proposes that for these diseases, activation of mast cells is a key step in disease pathogenesis. Targeting activated mast cells in these diseases are potential adjunctive therapies to evaluate in clinical studies. A review of relevant eosinophilia literature is presented that supports the role of mast cells in the pathogenesis of multiple allergic and eosinophilia diseases.

Over 330 million people globally have asthma, a chronic disease with multiple endotypes and observable phenotypes. This disease has a substantial socioeconomic impact. A thorough assessment of multiple clinical aspects (such as the presence of atopy, comorbidities, and clinical presentations), characteristics of lung function (such as the degree of bronchial reversibility, the involvement of the airway obstruction, and airway hyperreactivity), and the interaction of sputum and systemic inflammatory factors (such as neutrophilic, eosinophilic, and mixed) are required to determine the specific endotypes of asthma. The precision medicine approach to asthma represents a new paradigm, with improved opportunities for more effective and appropriate personalized therapies and new insights into the immunological aspects of asthma that demand further research. In the world of precision medicine, biomarker-based therapies for individual patients are just the beginning of an exciting and emerging journey in allergy treatment. A collection of biomarkers might be utilized to define and classify the endotypes based on the phenotyping of asthma, which will be more likely with omics information and unbiased clustering. This review will contribute to the development of personalized therapy for asthma, enabling more accurate treatment. It will also serve as a source of novel targets and new treatments for every identified endotype.

Air pollution is an increasing global concern with serious health and economic impacts. Among its many effects, respiratory health is particularly vulnerable. As the first point of contact with inhaled pollutants, the nasal passages play a crucial role in airway defense, making rhinitis one of the key inflammatory conditions linked to environmental pollution. This review explores the relationship between air pollution and rhinitis, highlighting key pollutants such as particulate matter (PM, PM_2.5, PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), which contribute to airway inflammation, epithelial barrier dysfunction, immune system dysregulation, and epigenetic changes. Epidemiological studies demonstrate a strong association between pollutant exposure and increased prevalence, severity, and healthcare utilization for allergic rhinitis. However, there is limited research focusing on non-allergic rhinitis. Beyond health concerns, air pollution also imposes a significant economic burden due to rising healthcare costs and lost productivity. Effective mitigation strategies include air quality monitoring, indoor air filtration, policy interventions, and lifestyle modifications. Addressing pollution-related rhinitis requires a multidisciplinary approach involving public health initiatives, clinical management, and environmental policies to reduce exposure and improve patient outcomes. Additionally, limitations in current research are discussed, and further studies are recommended to fill existing knowledge gaps.

Climate change in the form of rising temperatures and pollution can intensify pollen allergies, increasing health burdens and demanding proactive public health policies. Here, we discuss the current perceptions of physicians and patients on the impact of climate change and some of the initiatives to address its impact on global health. Recent surveys suggest growing concern among healthcare professionals and patients over the expanding evidence that climate change is contributing to the onset and exacerbation of respiratory allergies. Limited evidence exists on effective strategies, but some of the proposed public policy solutions include enhanced pollen monitoring networks, promoting climate-health education in medical curricula, development of early warning systems for thunderstorm asthma, and allergen-reducing urban planning. Collaboration among clinicians, researchers, and policymakers is critical for developing targeted measures that build resilience against climate-driven pollen allergy.

This mini-review examines the link between climate change, air pollution, and aeroallergen-induced respiratory diseases in Europe. The articles selected in this mini-review highlighted the links between climate change, air pollutants and the impact on aeroallergen-induced respiratory disease. Searching data base PubMed returned results, but not all were relevant. The search conducted for a geographical scope of Europe after 2015 returned a large number of results, clinical studies, manuals, guidelines and recommendations from international recognized institutions or organizations, such as Global Initiative for Asthma (GINA), World Health Organisation (WHO) from which only published texts containing both general information and specific quantifiable information on climate change and air pollutants and their effects on health were selected. The findings highlight how environmental stressors interact to exacerbate allergic respiratory diseases, and emphasize the need for environmental policies.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) burden among infants. Maternal vaccination is a promising preventive strategy, conferring passive immunity through transplacental antibody transfer. The current narrative review was conducted to summarize the current evidence of efficacy and safety of maternal RSV vaccination and assess the practical barriers to its implementation. This review was based on a structured literature search of PubMed/MEDLINE and Google Scholar to identify peer-reviewed studies published between January 2022 and March 2025 using terms such as “maternal RSV vaccine”, “efficacy”, “safety”, “pregnancy”, “Abrysvo”, and “hesitancy”. The review included 5 clinical trials evaluating maternal RSV vaccines and 17 observational and survey studies assessing vaccine acceptance across diverse settings. The bivalent RSVpreF vaccine (Abrysvo) is the only licensed maternal RSV vaccine as of May 2025. In the MATISSE phase 3 trial (n=7,358), the vaccine demonstrated 81.8% efficacy against medically attended RSV-LRTI at 90 days and 69.4% at 180 days, with 57.1% efficacy against severe RSV-LRTI. No major safety concerns were identified; adverse events and preterm birth rates were comparable between groups. In contrast, trials of GSK’s RSVPreF3-Mat vaccine revealed higher rates of preterm birth (6.8% vs. 4.9%) and a numerical imbalance in infant deaths (0.4% vs. 0.2%), prompting early termination. Across 17 studies (n=14,959), RSV vaccine acceptance ranged from 39% (France) to 87% (Netherlands), with safety concerns and cultural context influencing attitudes. This review highlights that maternal RSV vaccination with RSVpreF offers effective infant protection with an acceptable safety profile. Future research should focus on long-term infant outcomes, comparative effectiveness in diverse settings, and next-generation vaccines. Implementation will require public trust, cultural sensitivity, and equitable global access.

Hypersensitivity reactions (HSRs) to paclitaxel, particularly those mediated by the solubilizer Cremophor^® EL, are common, occurring in approximately 10% of patients despite premedication. Nab-paclitaxel, a newer formulation using human serum albumin as the vehicle, is generally considered a safer alternative due to a lower rate of HSRs. We present the case of a 44-year-old woman with breast cancer who developed severe HSRs following multiple doses of paclitaxel and carboplatin. Despite standard premedication, she experienced fever, erythematous skin eruptions, arthralgias, and systemic symptoms following her fourth and fifth cycles of treatment. Subsequent administration of nab-paclitaxel also elicited a similar severe reaction. Skin testing revealed a positive reaction to paclitaxel, but not to carboplatin, suggesting sensitization to paclitaxel. In the context of the similar reaction to nab-paclitaxel, this suggests sensitization to the taxane moiety itself rather than to the solubilizer. The combination of features consistent with both type IV hypersensitivity and cytokine release syndrome further complicates the presentation as well. To our knowledge, this is the first reported case of cross-reactivity between paclitaxel and nab-paclitaxel, challenging the assumption that nab-paclitaxel is always a safe alternative. This emphasizes the need for vigilance and thorough evaluation in patients experiencing atypical chemotherapy reactions, as cytokine release reactions may play a role even in the absence of immunotherapy. It also raises the concern that alternative formulations like nab-paclitaxel may not always be safe in patients with atypical or severe reactions, as they could possibly be sensitized to the taxane moiety itself.

Aim: Despite the revolutionary impact of biologics (Bx) on severe asthma management, predicting individual treatment responses remains challenging. We aimed to characterize the heterogeneous nature of clinical status and disease activity in patients with severe asthma after biologic therapies through a comprehensive evaluation of real-world clinical outcomes. Methods: In this retrospective, multicenter study of 53 patients with severe asthma who received biologic therapies, hierarchical clustering analysis was performed based on three key parameters during treatment: exacerbation, maintenance oral corticosteroid (mOCS) dose, and lung function. Canonical correlation analysis and multinomial logistic regression were used to identify predictors of response patterns. Results: Clustering analysis revealed three distinct control groups: well-controlled (n=23), moderately controlled (n=22), and poorly controlled (n=8). Well-controlled patients exhibited minimal exacerbations, no oral corticosteroid (OCS) use, and optimal or stabilized lung function. Moderately controlled patients showed minimal exacerbations and no mOCS use but variable lung function improvements. Poorly controlled patients exhibited persistent exacerbations, mOCS dependence, or both with limited lung function improvement. Baseline forced expiratory volume in 1 second (FEV₁) %predicted (percent predicted FEV₁) values and blood eosinophil counts independently differentiated well-controlled from moderately controlled patients, whereas baseline mOCS use distinguished moderately controlled from poorly controlled patients. Conclusions: Our findings reveal distinct patterns of disease control following biologic therapy in severe asthma, with baseline lung function, eosinophilic inflammation, and OCS use as key predictive factors. These results support the need for personalized treatment approaches in severe asthma management.

Asthma is a chronic inflammatory airway disorder characterized by recurrent symptoms, airflow obstruction, and bronchial hyperresponsiveness. Approximately 5–10% of asthma cases are classified as severe, requiring high-dose inhaled corticosteroids (ICS) plus additional controllers, often including systemic corticosteroids. Severe asthma imposes a substantial burden on patients due to frequent exacerbations and reduced quality of life. The pathophysiology of severe asthma involves distinct phenotypic and endotypic variations, primarily classified into high-type 2 (T2) and low-T2 inflammatory profiles. While high-T2 asthma, encompassing eosinophilic and allergic subtypes, benefits from targeted biologic therapies such as monoclonal antibodies against interleukin-5 (IL-5), IL-4/IL-13, thymic stromal lymphopoietin (TSLP), and IgE, treatment options for low-T2 asthma remain limited. The advent of precision medicine has facilitated the identification of novel biomarkers for severe asthma, guiding therapeutic decisions and enabling disease stratification. However, key clinical challenges remain, including selecting the most effective biologic therapy, optimal treatment duration, and safe de-escalation strategies upon achieving remission. This review explores the latest evidence on biological therapies, their immunomodulatory effects, and their potential role in reversing bronchial remodelling. Additionally, it discusses emerging biomarkers that may predict treatment response and remission, ultimately contributing to a more personalized approach to asthma management.

Artificial intelligence (AI) is poised to transform clinical allergy practice by enhancing diagnostic accuracy, personalising treatment, and streamlining healthcare delivery. This narrative review critically examines the current landscape of AI in allergy care, spanning clinical workflows, diagnostics, immunotherapy, and research applications. AI-powered tools such as clinical decision support systems (CDSS), natural language processing (NLP), and conversational agents are being integrated into allergy services, offering improvements in documentation, risk stratification, and remote patient engagement-particularly in paediatric and multilingual settings. Diagnostic innovations include machine learning models that predict oral food challenge outcomes and interpret multi-omics data for personalised allergy phenotyping. AI also supports adaptive immunotherapy dosing, remote monitoring via wearable biosensors, and digital coaching to promote adherence. Federated learning and explainable AI (XAI) emerge as pivotal developments-enabling privacy-preserving collaboration and fostering trust among clinicians and patients. Despite these advancements, significant challenges remain. These include data inequities, algorithmic bias, lack of real-world validation, and regulatory ambiguity. The “black box” nature of many models risks undermining clinician confidence, while over-reliance on alerts could contribute to alarm fatigue. Ethical concerns-particularly around transparency, consent, and liability-require urgent attention. Equitable implementation demands robust governance, diverse training data, and inclusive design that prioritises patient safety. Looking ahead, AI has the potential to power digital twins, support augmented reality training, and enhance allergy surveillance through the integration of environmental and population-level data. With multidisciplinary collaboration, transparent oversight, and patient-centred innovation, AI can help build a more predictive, efficient, and equitable future for allergy care.

Despite its proven effectiveness in treating allergic conditions, allergen immunotherapy (AIT) remains significantly underevaluated in clinical practice. On the contrary, there is a scientific interest in AIT research with more than doubled number of manuscripts published in the last decade respect to the previous years. This gap limits its potential to improve patient outcomes and advance our understanding of allergy management. To address this issue, healthcare professionals, researchers, and policymakers must prioritize comprehensive evaluation of AIT. Increased investment in clinical trials, real-world studies, and education will help clarify its long-term benefits, safety profile, and optimal application across diverse patient populations. Collaborative efforts will ensure that AIT achieves its full potential, ultimately enhancing the quality of life for those affected by allergies.

Allergic fungal rhinosinusitis is typically described as a condition involving nasal polyposis and eosinophilic mucin in which fungal hyphae are entrapped within enlarged sinus cavities, accompanied by an immune hypersensitivity response to fungi. There are rare reports in the pediatric literature. Early diagnosis and management with surgery represent the primary therapeutic approach, complemented by corticosteroid therapy and long-term follow-up to prevent relapse. In addition, novel biologic therapies have been investigated in recent years for the treatment of allergic fungal rhinosinusitis. Here, we report the case of a child with allergic fungal rhinosinusitis and summarize the literature review of data published.

Aim: Allergic conjunctivitis (AC) is an inflammatory response of the conjunctiva triggered by exposure to common allergens, including pollen, dust mites, and animal dander. This study aimed to identify probable allergens in Iranian patients with AC. Methods: This cross-sectional study included individuals with AC from Southwestern Iran in 2024. Skin prick tests (SPTs) were performed using commercial extracts of various allergens, including tree mix, weed mix, grass mix, dust mite mix, fungi mix, as well as cat and cockroach allergens. Results: Among 92 patients with conjunctivitis, with a mean age of 23.66 ± 14.70 years, 80 patients (86.96%) had a positive SPT to at least one of the applied extracts. Sensitization rates detected by SPTs were as follows: weed mix 68.48%, tree mix 58.70%, grass mix 53.26%, dust mite mix 45.65%, cockroach 29.35%, fungi mix 22.83% and cat allergen 17.39%. A significant difference in dust mite sensitization was observed between patients with seasonal and perennial AC (p=0.023). Conclusions: This study highlights the allergic sensitization of patients with conjunctivitis and its connections to other allergic conditions. Allergists can play a crucial role in managing conjunctivitis through comprehensive testing and holistic treatment approaches.

Aim: Olea europaea, an endemic plant of the Mediterranean basin, exhibits a flowering period from April to June, requiring high temperatures and sensitivity to low humidity, rainfall, and windiness. Allergy to O. europaea affects 13.85% of the Southern Italian population. This study investigated O. europaea pollen concentration, morphological and biochemical variations, and clinical symptoms over a 6-year period (2017–2022). Methods: Pollen concentration in Southern Italy (Apulia, Bari) was analyzed alongside weather variables (temperature, precipitation, humidity, and windiness) using existing databases (Arpa Puglia; time and date). Optical and fluorescence microscopy techniques were employed to assess pollen morphology and biochemical characteristics. Additionally, the absolute number of prescriptions for various antihistamine drugs (cetirizine, ebastine, bilastine, desloratadine, rupatadine, levocetirizine, fexofenadine, loratadine) was calculated. Results: The lowest pollen count occurred in the 2018 (91.1 pollen per m³/week), while the highest was recorded in the 2021 (2,545.3 pollen per m³/week). In 2019, the pollen peak was delayed by 2 weeks. Notably, 2018 exhibited more rainy days in May and June and higher humidity percentages (April 73%, May 70%, June 72%). In contrast, 2021 had lower humidity values (April 68%, May 61%, June 59%) and fewer rainy days (1 day in May and none in June). No changes in pollen size were observed, but modifications in O. europaea pollen fuchsin fluorescence were noted in 2018 and 2021. The number of drug prescriptions was highest in 2021. Conclusions: This study highlights that the flowering period, morphology, and pollen production of O. europaea may influence patient symptomatology and the need for antihistamine medications.

Aim: Eosinophilic gastrointestinal disorders (EGIDs) are chronic inflammatory conditions defined by eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes. This study aimed to synthesize current evidence on the clinical spectrum, pathogenesis, diagnostic criteria, and prognostic implications of EGIDs, including eosinophilic esophagitis, gastritis, duodenitis, ileitis, and colitis. Methods: A retrospective, multi-source observational analysis of published clinical datasets on EGIDs was conducted. Systematic searches of PubMed, Scopus, Web of Science, and EMBASE identified eligible studies that included ≥ 10 patients with EGIDs and provided quantitative data on eosinophil counts, clinical features, endoscopic and histopathological findings. Articles reporting secondary causes of eosinophilia were excluded. Data extraction was done and independently verified by two reviewers. Special emphasis was placed on unresolved diagnostic hurdles, pediatric versus adult presentations, and long-term disease implications. Results: A total of eligible datasets highlighted common molecular drivers, including epithelial barrier dysfunction, Th2-skewed immune responses, and genetic susceptibilities (e.g., TSLP, CAPN14). Core symptoms varied by site, with dysphagia predominating in eosinophilic esophagitis, and abdominal pain and diarrhea more frequent in distal EGIDs. Endoscopic findings included rings, furrows, and nodularity, while histology demonstrated patchy eosinophilic infiltration and epithelial damage with site-specific thresholds. Laboratory abnormalities included elevated eosinophil counts, IgE, and biochemical markers of malabsorption. Prognosis was variable, with frequent recurrence and heterogeneity in treatment response. Conclusions: Significant knowledge gaps persist in EGID research and practice. Priority areas include establishing consensus-driven histological thresholds and developing non-invasive biomarkers for disease monitoring. Urgent unresolved questions involve the utility of biomarkers in guiding therapy, monitoring response and systematic evaluation of pediatric versus adult differences. Addressing these gaps will require multidisciplinary collaboration, standardized diagnostic protocols, and longitudinal multicenter studies to improve both clinical care and research consistency.

Eosinophilic esophagitis (EoE) is an adaptive immune T-cell-mediated type 2 inflammatory disease involving the esophagus. Major advances were made in diagnosis and therapy for EoE in the last decade. A correct diagnosis is important to guide therapy to achieve optimal treatment goals. The diagnostic algorithm eliminated the need for a proton pump inhibitor (PPI) trial, allowing for direct proceeding to disease-specific anti-inflammatory drugs if indicated. PPIs are the first line of therapy in EoE. Two topical steroids and one biologic drug, dupilumab, have been used for the treatment of EoE, with a number of novel therapeutic agents in the pipeline. Because of the chronicity of the disease and nonresponders to PPIs and topical steroids, a subgroup of patients may require long-term therapy with dupilumab. More data also became available on dietary interventions, elimination diets in adults with EoE. A least restrictive diet should be trialed first with milk or milk and wheat elimination. Importantly, EoE patients with fibrostenotic disease often do not respond well to drug therapy and require esophageal dilations. Medical therapy may need to be tailored for each patient depending on the patient’s specific comorbidities, patient preferences, and health status. This review will summarize a current approach to the treatment of adult patients with EoE.

Schnitzler syndrome is a rare acquired autoinflammatory disorder defined by a chronic urticarial rash, monoclonal IgM (or IgG) gammopathy, and systemic features including fever, arthralgia, and elevated inflammatory markers. Interleukin-1 blockade with anakinra is the current treatment of choice. We report the case of a 75-year-old woman who, after seven years of misdiagnosis as chronic spontaneous urticaria, fulfilled the Strasbourg Criteria for Schnitzler syndrome. Treatment with anakinra induced rapid clinical improvement but was complicated by the onset of recall urticaria (RU), characterized by delayed giant wheals at both current and previous injection sites. Laboratory findings suggested an inflammatory response, and the reaction was managed with corticosteroids and antihistamines, followed by colchicine, which achieved stable disease control. RU is a rare hypersensitivity phenomenon previously described with immunotherapy, heparin, NSAIDs, and other biologics, but to our knowledge, this is the first report associated with anakinra. This case broadens the spectrum of anakinra-related adverse effects and highlights the need for further investigation into the immunopathogenesis of RU.

In recent years, biological therapy based on endotyping has become a therapeutic option for patients with type 2 inflammatory process with chronic rhinosinusitis with nasal polyps with or without bronchial asthma. It is also used in the course of a particularly aggressive chronic rhinosinusitis with nasal polyps in patients with bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drug (NSAID-exacerbated respiratory disease, N-ERD). Identification of the patient’s inflammatory endotype enables targeted biological treatment and optimal results from biological therapy. The search for biomarkers that identify patients who will benefit from biological treatment remains a current topic of investigation. A particularly difficult therapeutic decision concerns patients with a mixed endotype (eosinophilic/allergic), which affects patients with N-ERD. The authors present a case of multidimensional beneficial results in a 39-year-old female patient with N-ERD syndrome during biological treatment with omalizumab. The parameters of inflammation, the results of computed tomography, and the results of questionnaires assessing the patient’s quality of life before, after 4 months and 9 years of biological treatment are presented. Excellent results were found in all criteria of efficacy of biological treatment: reduced nasal polyp size (complete remission of polyps in the paranasal sinuses), reduced need for systemic corticosteroids (no systemic steroids have been used since the start of therapy), improved sense of smell, reduced impact of comorbidities (complete control of bronchial asthma) and in the patient’s opinion, an extremely significant improvement in quality of life. Thus, the patient can be considered as a super-responder. Analysis of the parameters of patients who achieved optimal therapeutic results may also be helpful in selecting type of biological treatment for future patients.

Aim: Angioedema is a common but often underestimated manifestation of chronic spontaneous urticaria (CSU). Its presence may indicate higher disease severity, longer duration, and autoimmune involvement. This study aims to assess the clinical relevance and associations of angioedema in CSU patients with disease severity and duration, treatment response to H1-antihistamines, correlation with autoimmune status, and autologous serum skin test (ASST) positivity. Methods: A prospective study was conducted at the Dermatology Department, General Hospital 8th September, Skopje, North Macedonia, from December 2021 to November 2022, including 230 CSU patients. Disease activity was assessed using the Urticaria Activity Score over 7 days (UAS7), and severity was categorized accordingly. Response to H1-antihistamines was defined as achieving UAS7<7 for several months. Angioedema was recorded as a symptom regardless of localization. Autoimmune status was based on autoimmune disease history and/or autoantibody (AAb) detection. The ASST was performed, classifying patients as ASST-positive (ASST⁺) or ASST-negative (ASST⁻). Results: Angioedema was observed in 70% of CSU patients, all with accompanying wheals. It was significantly more common in severe CSU than in moderate (82.02% vs. 65.38%, p=0.026), mild (82.02% vs. 65.96%, p=0.036), and well-controlled disease (82.02% vs. 45.45%, p=0.0004). Patients with a positive autoimmune status more often had angioedema than those with a negative status (75.17% vs. 61.18%, p=0.025). CSU showed longer duration in patients with angioedema (p=0.000012), with no association to good antihistamine response (p=0.55). Conclusions: Angioedema in CSU is associated with higher disease activity, autoimmune status, and prolonged disease duration but not with differences in antihistamine response. Its presence marks a more severe phenotype, emphasizing the need for careful monitoring and individualized management.

Intranasal treatments combining corticosteroids with antihistamines are a safe and effective alternative for treating moderate to severe seasonal allergic rhinitis in children over 12 years of age and adults. Evidence for their use in children under 12 years of age is limited and based on four studies: three examining azelastine hydrochloride and fluticasone propionate combination (AzeFlu) (including one placebo-controlled efficacy study, one comparative efficacy study, and one safety study) and one examining olopatadine hydrochloride and mometasone furoate combination (OloMom) (a placebo-controlled study). The recommendations from these studies could be conditional for school children aged 6 to 11 years with seasonal (non-perennial) allergic rhinitis, but only when symptoms cannot be controlled with a single drug.

Asthma is one of the most common chronic respiratory diseases worldwide, traditionally defined as airway inflammation, reversible obstruction, and hyperresponsiveness. While this framework has guided decades of research and treatment, it fails to capture asthma as a heterogeneous and systemic condition. This pathology is shaped by complex interactions among genetic, epigenetic, immunological, neuroendocrine, metabolic, and environmental factors. Its coexistence with chronic obstructive pulmonary disease (COPD) in overlapping syndromes further complicates diagnosis and therapeutic decision-making. Asthma etiology involves oxidative stress, genetic susceptibility, and epigenetic regulation, along with age- and sex-dependent hormonal influences that modulate immune responses. Emerging evidence shows that structural and functional changes in the respiratory epithelium, airway smooth muscle (ASM), and alveoli extend the pathology beyond acute inflammation, involving processes such as epithelial barrier dysfunction, airway remodeling, and impaired mucociliary clearance (MCC). Neuro-immune-endocrine interactions have emerged as central contributors to asthma pathogenesis. Endocrine regulation shapes inflammatory activity and treatment responsiveness. Metabolic factors such as obesity introduce additional complexity by generating low-grade systemic inflammation, oxidative stress, adipokine imbalance, and steroid resistance, resulting in a distinct and often more severe asthma phenotype. Parasympathetic and sensory neural pathways amplify bronchoconstriction and inflammation through reciprocal communication with eosinophils, mast cells, innate lymphoid cells, and pulmonary neuroendocrine cells (PNECs). Neurotrophins and neuropeptides further promote airway hyperreactivity and remodeling. Current management integrates inhaled corticosteroids, bronchodilators, and targeted biologics-such as thymic stromal lymphopoietin (TSLP) inhibitors-alongside emerging non-pharmacological strategies. Psychological interventions, particularly mindfulness-based approaches, have demonstrated improvements in quality of life, stress reduction, and patient-reported asthma control, supporting the relevance of addressing the psychosocial dimensions of chronic disease. Understanding asthma as a systemic disorder underscores the need for personalized, multidimensional treatment strategies that integrate pharmacological, behavioral, and lifestyle components. This paradigm provides a more comprehensive framework for improving long-term outcomes and reducing the global burden of asthma.

Background: The diversity of physiological actions and pharmacological effects of glucocorticoids (GCs) allows their use in a large group of diseases and pathological conditions. However, this treatment can be accompanied by a multitude of more or less severe side effects. As the mainstay of treatment for asthma and chronic obstructive pulmonary disease (COPD), inhaled corticosteroids (ICS) dramatically reduce morbidity and mortality. This research aims to examine the safety considerations associated with glucocorticoid therapy in patients with COPD and asthma. Methods: The search was performed in PubMed, EBSCO, UpToDate, Medline, and Google Scholar for pertinent English-language articles published between 1990 and 2025, using the following keywords: glucocorticoids, asthma, COPD, management, and side effects. Results: GCs stand out as one of the most widely prescribed classes of drugs globally, with well-established effectiveness in addressing acute or chronic inflammation, allergic conditions, and acute pathological situations. The undeniable efficacy of GCs, however, comes with a range of reported side effects. These include but are not limited to immunosuppression, cardiovascular issues, manifestation of Cushingoid features, development of diabetes, osteoporosis, suppression of the hypothalamic-pituitary-adrenal (HPA) axis, and adverse effects on the gastrointestinal and dermatologic systems. However, the majority of these events are associated with systemic drug administration, which is less commonly indicated in the treatment of COPD and asthma. There are several factors and specific considerations when deciding on GC treatment in COPD. In the context of corticosteroid treatment for asthma, the overarching impact involves the suppression of inflammatory genes, leading to reduced transcription of genes responsible for cytokines, chemokines, adhesion molecules, inflammatory enzymes, and receptors. Discussion: GCs are associated with fewer side effects in both COPD and asthma treatment. It’s crucial to take into account factors such as the patient’s overall health, the severity of symptoms, the presence of comorbidities, and the responsiveness of specific features to GCs therapy.