Indoor air pollution (IAP) is an important cause of concern for human health, leading to millions of deaths worldwide each year. Since people spend most of their time indoor the quality of the air inhaled during routine activities is of primary importance. IAP include particulate matter (PM), volatile organic compounds (VOCs), chemical gases, heavy metals, and biological contaminants. Unfortunately, their sources are various and widespread all over the household and other indoor environments, causing relevant health consequences. This narrative review aims to provide a comprehensive framework of the indoor pollutants effects on subjects affected by asthma, allergic rhinitis, and atopic dermatitis. As pivotal barriers against pollutants, in fact, respiratory and cutaneous districts can be particularly affected by IAP, especially in case of atopic diseases. On the other hand, the application of targeted adjustments, such as the avoidance of cigarette smoking, the use of hoods while cooking, the choice of adequate ventilation systems, and the use of low-emitting building materials and furniture may result in the improvement of indoor quality.

A case report of fish allergy is exposed. The responsible allergen was fish collagen, and there was no sensitization to parvalbumin (main fish allergen). The patient acquired collagen sensitization by occupational exposition, not by ingestion.

Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. Despite the availability of therapies and the adoption of security measures, the most effective method to fight COVID-19 remains the induction of immunity through vaccines. Scientific communities have developed several types of COVID-19 vaccines since the beginning of the pandemic, including those with innovative messenger RNA (mRNA) technology. Patients with a history of allergic reactions may have an increased risk of hypersensitivity reactions to COVID-19 vaccines. Therefore, it is important that these patients are evaluated by an allergist to help monitor immediate-type adverse reactions and identify what vaccine component may elicit an allergic reaction. Various strategies have been suggested to prevent hypersensitivity reactions, including performing skin tests or in vitro tests before vaccination in high-risk patients, administering a different vaccine for the second dose in subjects reporting adverse reactions to the first dose, fractional dosing, or pretreating with anti-immunoglobulin E (IgE) monoclonal antibody. The scope of this review is to evaluate, through current evidence available in the literature, the accuracy of skin testing to the excipients of COVID-19 vaccines, especially polyethylene glycol (PEG) and polysorbate, in predicting allergic reactions to vaccination, despite the existing discordance of data and approaches to the question from the various clinical experiences, as to permit the safe administration of COVID-19 vaccines to populations around the globe.

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.

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.

Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by adult-onset asthma, chronic rhinosinusitis with nasal polyps (CRSwNPs), and aspirin/NSAID hypersensitivity, presenting recurrent asthma exacerbation and poor clinical outcomes. Patients with NERD have heterogeneous clinical phenotypes/endotypes, and the management of NERD remains challenging. Dysregulation of arachidonic acid (AA) metabolism and persistent eosinophilic airway inflammation are the major pathogenic mechanisms in the upper and lower airways of NERD. To date, increased levels of urinary leukotriene E4 (uLTE4) [a terminal metabolite of the lipoxygenase (LOX) pathway] have been the most relevant biomarker for NERD. It is demonstrated that mast cells, platelets, and epithelial cells can amplify upper and lower airway inflammation in NERD, and several potential biomarkers based on these complicated and heterogeneous mechanisms have been suggested. This review summarizes potential biomarkers for application in the management of NERD.

As a novel respiratory viral infection, coronavirus disease 2019 (COVID-19) has influenced asthma in unpredictable ways. In the post-COVID era, there is a need to review asthma care and the new challenges and opportunities that are presented. Long COVID is a new and complex syndrome that has arisen. Treatable traits (TTs) have already been developed to address complex asthma and can be adapted to manage long COVID. Consumers are seeking more information on and answers to what to expect with a dual diagnosis of asthma and COVID-19. People with asthma identify a strong need for research into COVID and asthma. Completion of a national survey (n = 593) resulted in a list of research themes. From these, participants prioritized 10 asthma research themes. Among the top 10 asthma research priorities, the theme of COVID and asthma was ranked as the second priority in the overall rank list. Addressing these issues has the potential to improve global asthma health.

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.

Coronavirus disease 2019 (COVID-19) pandemic was a great challenge for healthcare professionals globally and also for allergists/immunologists. The Pegaso low-care COVID center's experience in managing a low-care center for COVID-19 patients was reported, trying to bring out the relevance of this type of structure in reducing the length of stay of patients in high-care settings with the consequent effect of avoiding the collapse of major hospitals. The experience of managing a low-care setting with a day hospital service inside emphasizes, even more, the role of the allergists/immunologists during the COVID-19 pandemic contributing to keeping the medical staff's specialty in a strategic role in the battle against this common enemy. Sharing all the information on public health organizations is crucial to cope in the best possible way with the present and future challenges.

In recent decades, atopic diseases, such as atopic dermatitis (AD), allergic asthma (AA), allergic rhinitis (AR), and food allergy (FA) have been estimated rapidly increasing in prevalence. These diseases are characterized by the presence of specific immunoglobulin E (sIgE) and often relate to each other and develop in sequence (the so-called “atopic march”). AD may be the first early manifestation in infants followed by FA often within the first year of life. Moreover, AD is a risk factor for developing sensitization to airborne allergens later in life that can cause clinical manifestations of AA and AR. According to the dual-allergen exposure hypothesis, allergic sensitization to food allergens is promoted through cutaneous exposure, rather than the oral route. Moreover, there is evidence that exposure to food allergens, in particular peanuts, in the airway would also lead to food sensitization. The most frequent route of sensitization for inhalant allergens is still debated. Of note, a recent case report supports the development of sensitization to cat dander through a cat bite. Our review aims to provide an overview of current knowledge and unmet needs in the pathophysiology of respiratory and FAs.

Desensitization (DSZ) or oral tolerance induction is increasingly used in children who do not outgrow their food allergies. Off-label omalizumab (OMZ) is used as adjuvant therapy for those with severe reactions, but there is little information on outcomes when OMZ is withdrawn. The long-term outcome in a group of children with severe milk or egg allergy who had undergone an OMZ-assisted DSZ procedure is here described. Clinical data from 21 children from the time they started DSZ until database closure were retrospectively collected, to assess the appearance of symptoms and response to clinical decisions under real-life conditions. Patients received OMZ before, during, and after the DSZ procedure itself and OMZ was subsequently discontinued. The scheduled treatment protocol had to be changed in almost all patients due to reactions or individual needs. Three of 21 patients had to prematurely abandon the procedure due to DSZ failure. The other 18 patients were able to tolerate the target dose of food, but nine of them developed symptoms when eating the food 1.5 to 6 months after stopping OMZ. These patients underwent a second course of OMZ-assisted DSZ, which was successful in six, but three had a second relapse 3 to 8 months after stopping OMZ and decided to quit. OMZ-assisted DSZ failed in almost a third of patients with severe allergy even after a second course of OMZ, almost 40% had a successful outcome with one course of OMZ, while almost a third required a second course. Relapses of symptoms occurred up to six months after stopping OMZ.

It is well known that adolescent patients often have less than optimal outcomes. Adolescence is a time of much transition, physically, emotionally, and socially all of which have effects on asthma management and outcomes. Pubertal changes affect asthma, but mostly it is the move towards independence from the parents, peer pressures, stigma of illness, and adherence issues that cause the issue. It is thus important to learn to treat the patient directly, wherein currently often children are treated through the parent, to ensure success.