https://www.explorationpub.com/Journals/eaa Most Recent Articles : Exploration of Asthma & Allergy. en-us Tue, 26 May 2026 23:46:17 GMT https://www.explorationpub.com/Journals/eaa/Article/10091 Not applicable. Editorial Thu, 22 Sep 2022 00:00:00 GMT Giorgio WalterCanonica, EnricoHeffler, Thu, 22 Sep 2022 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10091 https://www.explorationpub.com/Journals/eaa/Article/10092 The incidence of asthma, a heterogeneous inflammatory disease affecting over 300 million people worldwide, continues to increase in developed countries. Human epithelial cells (ECs) express the alarmin-type cytokine thymic stromal lymphopoietin (TSLP) following tissue injury triggered by several environmental insults, which include allergens, smoke, pollutants, or other irritants. Furthermore, TSLP has an emerging but well-documented pathogenic role in asthma. TSLP has been called a “master switch” of allergic inflammation at the epithelial-dendritic cell (DC) interface, where it supports T helper 2 (Th2) inflammatory polarization and promotes the maintenance of Th2 memory responses. Therefore, targeting TSLP/TSLP-mediated signaling may represent an attractive therapeutic strategy for asthma. Several studies of anti-TSLP drugs are ongoing; the first-in-class anti-TSLP monoclonal antibody (mAb) tezepelumab, the immunoglobulin G1 antibody fragment CSJ117, or TSLP-traps [a combination of anti-interleukin-13 (anti-IL-13) and anti-TSLP mAbs] all represent promising new treatment approaches. This article reviews the characteristics of TSLP and discusses the treatment of severe asthma through TSLP-associated mechanisms. Mini Review Fri, 14 Apr 2023 00:00:00 GMT DavidEl-Qutob, AntonioLetran, Fri, 14 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10092 https://www.explorationpub.com/Journals/eaa/Article/10093 Aim: Evaluation of asthma control is the first step in the management of pediatric patient symptoms. The aim of this study was to a) validate the accuracy of the Greek version of the Asthma Control Questionnaire (ACQ) in quantifying asthma status in Greek pediatric patients; b) compare the 6-item with the 7-item ACQ; and c) explore the discriminatory power of the ACQ in relation to medication use. Methods: Cross-sectional analysis of pulmonary data from 64 primary school children with mild asthma (51% boys). At baseline and 6 months, pulmonary function was recorded using spirometry and asthma control using the Greek version of the ACQ. Validity was assessed using Cronbach’s alpha. Results: Cronbach’s alpha showed good internal consistency for both the 7-item and 6-item ACQ (alpha = 0.67, 0.74 respectively). No differences in scores were observed in the presence/or absence of medication therapy. Conclusions: The findings of this study showed good precision and internal consistency of the 6-item ACQ in measuring recent asthma control in Greek children of the mild-asthma phenotype, independent of forced expiratory volume in 1 second (FEV1) and medication use. This suggests that the 6-item questionnaire alone is potentially a robust tool in assessing asthma symptom control in children when pulmonary function tests (PFTs) are not feasible. Original Article Sun, 23 Apr 2023 00:00:00 GMT Maria M.Papamichael, Katrina A.Lambert, CharisKatsardis, DimitrisTsoukalas, CatherineItsiopoulos, BircanErbas, Sun, 23 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10093 https://www.explorationpub.com/Journals/eaa/Article/10094 Lettuce allergy is uncommon and usually attributed to lipid transfer protein (LTP) sensitization. Most LTP-sensitized patients present with heterogeneous symptoms not only to lettuce, but to a large number of other foods and pollen allergens, including peaches, apples, Platanus, and mugwort, with peach LTP being considered as the primary sensitizer. The case of a medical student with a history of lettuce allergy investigated by skin prick tests (SPTs) and oral food challenge (OFC) is presented in this report. SPTs showed sensitization exclusively to lettuce and not to any other known cross-reacting allergens, which contrasts with previous literature and highlights the uniqueness of this case. During OFC, the patient developed generalized symptoms including abdominal discomfort, bilateral tinnitus, facial flushing, generalized itching, and urticaria. No cardiopulmonary compromise was observed at the time, and the reaction was managed with oral antihistamines. More sophisticated molecular analysis is required to identify the patient’s sensitization profile; however, SPTs and OFCs remain the most practical clinical approach. Lettuce allergy deserves further attention and investigation. Case Report Wed, 26 Apr 2023 00:00:00 GMT KyleAlexander, ElpidaMouzoura, AndreasPapademetriou, NicolaosNicolaou, Wed, 26 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10094 https://www.explorationpub.com/Journals/eaa/Article/100958 Aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Patients with EGPA are treated with systemic glucocorticoids and immunosuppressive drugs to induce and maintain remission. However, most patients relapse after tapering glucocorticoids, and there are refractory cases with inadequate response to glucocorticoids. Mepolizumab, a humanized anti-IL-5 antibody, is approved for relapsing or refractory EGPA. Furthermore, recent studies have reported the efficacy of benralizumab, a humanized anti-IL-5 receptor α antibody, in EGPA. Here, we investigate the efficacy of biologics on consecutive cases of EGPA. Methods: We retrospectively collected patients with EGPA treated with mepolizumab in addition to glucocorticoids at the Department of Pulmonary Medicine in Kagoshima University Hospital and Imakiire General Hospital. In this study, we compared the effects of biologics on inflammatory parameters between pre- and post-treatment of biologics in patients with EGPA. Results: Ten patients were included in the study. All patients were treated with mepolizumab, and one was switched to benralizumab later. Treatment with biologics markedly reduced EGPA relapse from 70% (pre-treatment) to 20% (post-treatment), Birmingham Vasculitis Activity Score from 8.4 to 4.0, peripheral blood eosinophil counts from 470.3 /µL to 40.5 /µL, and glucocorticoid doses from 7.3 mg/dL to 1.6 mg/dL. In contrast, lung function and fractional exhaled nitric oxide levels were not affected by treatment with biologics. Furthermore, the duration of biologics was positively correlated with symptom improvement. Conclusions: Treatment with mepolizumab for EGPA was effective in glucocorticoid sparing, symptom reduction, and relapse prevention. Mepolizumab is expected to reduce the risk of glucocorticoid-related adverse events. Therefore, continued administration as well as early intervention with mepolizumab for EGPA might be important to conserve future medical resources and control the disease. Original Article Fri, 20 Sep 2024 00:00:00 GMT TakahiroMatsuyama, HiromiMatsuyama, YoichiDotake, MasashiOniwa, KentaroTsuruzono, HirokoUchida, ShunsukeYasuda, KiyotakaKondo, KoichiTakagi, TakayukiSuetsugu, JunIwakawa, KentaroMachida, KeikoMizuno, KentaroTanaka, HiromasaInoue, Fri, 20 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100958 https://www.explorationpub.com/Journals/eaa/Article/10095 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. Letter to the Editor Thu, 27 Apr 2023 00:00:00 GMT LauraFranceschini, GiancarloLandini, AlessandroFarsi, Thu, 27 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10095 https://www.explorationpub.com/Journals/eaa/Article/100925 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. Case Report Tue, 30 Jan 2024 00:00:00 GMT AngelMazon, Dah-TayJang, BegoñaFerrer, SoniaUixera, MariaPerez-Sabido, LauraIbañez, ElisaBuendia, MariaNieto, AntonioNieto, Tue, 30 Jan 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100925 https://www.explorationpub.com/Journals/eaa/Article/10096 Eosinophilic granulomatosis with polyangiitis (EGPA) is a multiorganic syndrome that affects the cardiovascular, neurologic, renal, and gastrointestinal systems with an incidence ranging from 0 case to 67 cases per one million person-years, and its pathophysiology remains unknown. It is believed that genetic factors, the environment, and changes in immune system function contribute to the development of EGPA, overlapping the immune mechanisms of vasculitides and the pathologic mechanisms in eosinophilic syndromes. This disease is commonly divided into two phenotypes depending on the presence of antineutrophil cytoplasmic antibodies (ANCA). ANCA-positive patients usually have more vasculitic manifestations like peripheral neuropathy, purpura, renal involvement, and biopsy-proven vasculitis. The keystone of EGPA therapy is systemic corticosteroids (CS) as monotherapy or in combination with other immunosuppressive treatments, and recently the efficacy of eosinophil-targeted biotherapy, anti-interleukin-5 (IL-5), has been shown to be efficacious in EGPA. Although this phenotype/phase distinction has not yet had an impact on the current treatment strategies, emerging targeted biotherapies under evaluation could lead to a phenotype-based approach and personalised treatment regimens for EGPA patients. The present review describes the new therapeutical approaches with biological drugs for EGPA. Review Fri, 09 Jun 2023 00:00:00 GMT AlejandraCarrón-Herrero, CorradoPelaia, GiovanniPaoletti, Fri, 09 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10096 https://www.explorationpub.com/Journals/eaa/Article/10097 Aim: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex disease with different subtypes that affect patients’ quality of life. This study aim to evaluate the severity of CRSwNP and the risk of treatment resistance using the “Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis” (JESREC) algorithm in outpatients at a university hospital. Methods: A retrospective study was conducted reviewing the medical records of CRSwNP outpatients. Clinical data including age, sex, blood eosinophilia, computered tomography (CT) scans, presence of asthma, and nonsteroidal anti-inflammatory drug (NSAID) use were assessed. Results: Medical records of 83 patients diagnosed with CRSwNP were analyzed, with 44 (53%) females and 39 (47%) males. The mean age was 61.8 years ± 14.1 years (range: 19–90 years). According to the JESREC algorithm, 9 (10.8%) patients were categorized as non-eosinophilic chronic rhinosinusitis (neCRS), and 74 (89%) were classified as eosinophilic chronic rhinosinusitis (eCRS). Among the eCRS patients, 13 (17.6%) were mild, 32 (43.2%) were moderate, and 29 (39.2%) were severe. Asthma was identified as a comorbidity in 57 patients (68.6%). Conclusions: A predominance of eCRS with moderate to severe risk of treatment resistance was confirmed. Considering the heterogeneity of chronic rhinosinusitis (CRS), the JESREC algorithm comes up as an instrument that uses objective criteria to assess higher risks of recurrency and refractoriness among patients before surgical treatment, helping to predict type2-driven biologics need. Original Article Fri, 16 Jun 2023 00:00:00 GMT Sérgio DuarteDortas, BiancaVictoria de Oliveira Martins, Fabiana Chagasda Cruz, KelielsonCardoso de Macêdo Cruz, ElaineSilva Oliveira, JoséElabras Filho, Priscila NovaesFerraiolo, Solange Oliveira RodriguesValle, Fri, 16 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10097 https://www.explorationpub.com/Journals/eaa/Article/10098 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. Case Report Fri, 30 Jun 2023 00:00:00 GMT FelipeSantos Vicente, MargaritaLatasa Eceizabarrena, BlancaSantos Latasa, BorjaBartolomé Zavala, Fri, 30 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10098 https://www.explorationpub.com/Journals/eaa/Article/10099 The advent of biological drugs has opened up new therapeutic possibilities in the field of eosinophilic gastro-intestinal diseases (EGIDs). EGIDs are chronic inflammatory diseases of the gastrointestinal tract unrelated to drugs or infections, and eosinophilic esophagitis (EoE) is the most frequent form. EGIDs are complex disorders, which pathogenesis is still partially unknown. The diagnosis of EGIDs relies on the combination of different data, such as clinical manifestations, laboratory tests, endoscopic, and histological data. The gold standard at present is the histological examination obtained from biopsies under endoscopic guidance, but the diagnostic criteria for each disorder are still not fully defined, and few clinical scores are validated, for all these reasons, conducting clinical trials on EGIDs is challenging. The dietary approach remains currently a first-line treatment, despite its efficacy being influenced by patients’ compliance. Exclusion diets, nevertheless, involve potential nutritional deficiencies. Two of the pivotal pharmacological therapies for the treatment of EGIDs are proton pump inhibitors (PPIs), especially for EoE, and systemic or topical steroids. Long-term corticosteroid therapies are, however, associated with even severe side effects, so steroid-sparing therapies are needed to achieve the same results, in the last years monoclonal antibodies have been studied. To date, dupilumab is the only approved biological drug for EoE therapy, but many others are currently being tested in clinical trials also for the other forms of EGIDs. This work presents a complete review of the role of biological drugs in EGIDs to date, systematically structured by pathology. Review Fri, 30 Jun 2023 00:00:00 GMT FrancescaLosa, AriannaCingolani, Fri, 30 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/10099 https://www.explorationpub.com/Journals/eaa/Article/100912 In Europe, allergen products from different manufacturers can be labeled using the same unit with yet different definitions of that unit, which may cause confusion, as is the case for the index of reactivity (IR). In this context, house dust mite (HDM) Staloral 300 IR/mL, from Stallergenes Greer, and HDM Osiris 300 IR/mL, from ALK-Abelló, were characterized in vitro. Qualitatively, namely in terms of protein and allergen profiles, the two products were similar. Quantitatively, and despite the same 300 IR/mL labeling, the two products were shown to have different biological potencies, with HDM Staloral 300 IR/mL displaying a 2.4 times higher total allergenic activity (TAA) than HDM Osiris 300 IR/mL. This higher biological potency of HDM Staloral 300 IR/mL was paralleled by higher allergen and protein contents, namely 1.5 times more Der p 1 and Der f 1, 3.0 times more group 2 allergens, 2.7 times more Der p 23, and 1.8 times more protein. In contrast, HDM Staloral 300 IR/mL was shown to contain far fewer culture medium-derived proteins than HDM Osiris 300 IR/mL. Letter to the Editor Mon, 28 Aug 2023 00:00:00 GMT ThierryBatard, StéphaneDreux, MatthieuRouet, KarineJain, ChristellePéguillat, MathildeDelecroix, SylvieVillardsaussine, HenriChabre, ChristelDayang, LaurentMascarell, Mon, 28 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100912 https://www.explorationpub.com/Journals/eaa/Article/100910 Asthma is a chronic condition characterized by inflammation throughout the entire bronchial airways. Recent findings suggest that ventilation inhomogeneity and small airway dysfunction (SAD) play a particularly significant role in asthma development and clinical manifestations. Obesity is a considerable risk factor for asthma development and morbidity in children and adults. A growing body of evidence suggests that SAD is linked to more severe asthma and poor asthma control in obese patients. However, the knowledge about the relationship between peripheral airway compromise and obesity in asthma is limited, mainly because of the historical lack of access to non-invasive assessment methods for studying SAD. Conventional lung function measurements, like spirometry, cannot accurately assess small airway function. However, in recent years, new specialized tests available in outpatient settings have been found to distinguish SAD from large airway obstruction more accurately compared to spirometry. Therefore, understanding the degree of peripheral airway implication in the underlying pathology is critical for effective asthma control and therapeutic decisions. This review highlights recent findings on the impact of SAD on asthma patients who are obese. Additionally, it explores how new diagnostic methods, such as impulse oscillometry (IOS), may be used in outpatient settings to detect small airway impairment in obese asthma at an early stage, potentially leading to improved asthma treatment. Review Tue, 15 Aug 2023 00:00:00 GMT JackPepys, CarloLombardi, PasqualeComberiati, MassimoLandi, AlviseBerti, EnricoHeffler, GiovanniPaoletti, MarcelloCottini, Tue, 15 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100910 https://www.explorationpub.com/Journals/eaa/Article/100911 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. Review Thu, 24 Aug 2023 00:00:00 GMT Hyo-InRhyou, Young-HeeNam, Hae-SimPark, Thu, 24 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100911 https://www.explorationpub.com/Journals/eaa/Article/100913 The Global Initiative for Asthma (GINA) provides the most comprehensive and frequently updated guidelines for the management of asthma. The primary aim of guidelines is to bridge the gap between research and current medical practice by presenting the best available evidence to aid clinical decision-making, thereby improving patient outcomes, quality of care, and cost-effectiveness. Guidelines are particularly useful in situations where scientific evidence is limited, multiple treatment options exist, or there is uncertainty about the best course of action. However, due to variations in healthcare system structures, many countries have developed their own local guidelines for the management of asthma. Adoption of GINA recommendations into local guidelines has been uneven across different countries, with some embracing the changes while others continue to follow older approaches. This review article will explore the impact of the noteworthy changes in GINA guidelines, particularly in the 2019 version, on local guidelines and some of the challenges associated with implementing them. Review Tue, 10 Oct 2023 00:00:00 GMT RiyadAllehebi, HamdanAL-Jahdali, Tue, 10 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100913 https://www.explorationpub.com/Journals/eaa/Article/100914 Allergen-specific immunotherapy (AIT) is a proven efficacy treatment for allergic rhinitis (AR), asthma, and Hymenoptera venom allergy, but its use in food allergy (FA) is still under investigation. Because some efficacy and safety concerns still remain, biologic drugs, including omalizumab and dupilumab, have been studied as an adjunctive therapy to AIT for these conditions. In this article, the evidence supporting the use of monoclonal antibodies (mAbs) as an add-on therapy to AIT for FA, AR, asthma, and Hymenoptera venom allergy has been reviewed. The review will delve into the mechanisms of action of different mAbs, their efficacy, and how they can be integrated into personalized medicine approaches to treat allergic diseases. Furthermore, future research areas will be considered. Evidence suggests that omalizumab in combination with AIT may be a beneficial option for respiratory allergies or food desensitisation, especially during the escalation or build-up phase, when adverse events are more frequent. Currently, there is a small number of well-structured clinical trials in Hymenoptera venom allergy, and the available data consist mainly of single-case reports that provide information of limited value. Dupilumab has been studied as adjunctive therapy in patients with respiratory and FAs. Clinical trials are ongoing to evaluate the efficacy of dupilumab as monotherapy or as an adjunct to oral immunotherapy (OIT) in peanut allergy. Other studies are investigating the use of dupilumab in patients with multiple FAs and as an adjunct to milk OIT. Overall, mAbs have the potential to improve outcomes in various allergic conditions when used as an add-on to AIT, especially during the build-up phase. Further research is needed to fully understand their optimal dosing and duration of treatment, as well as to identify which patients may benefit the most from these therapies. Review Fri, 20 Oct 2023 00:00:00 GMT PalmaCarlucci, FedericoSpataro, Michelina FrancescaDaddato, GiovanniPaoletti, DaniloDi Bona, Fri, 20 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100914 https://www.explorationpub.com/Journals/eaa/Article/100915 Aim: Allergy to lipid transfer proteins (LTPs) clinically manifests from oral allergy syndrome (OAS) to anaphylaxis. The risk of systemic symptoms and cross-reactivity make it an important target for allergen immunotherapy. Sublingual immunotherapy (SLIT) with Pru p 3 is effective and safe, but the induction phase (IP) of standard protocol (SP) is time consuming. Rush protocols (RPs) are described without serious adverse effects. The aim was to compare the safety of RP with SP and assess the existence of predictive factors for adverse reactions (ARs). Methods: Retrospective study of patients with LTP syndrome followed at the Food Allergy Unit undergoing SLIT with Pru p 3 between 2012 and 2021. SP has an IP of 4 days and an RP of 2 days. The safety of the IP was assessed by recording the AR. Results: Fifty-one patients: 41 (73.2% women) in SP group (SPG) and 10 (80% women) in RP group (RPG). Anaphylaxis as a presentation of LTP syndrome was overlapping in both groups (SPG 34.1%, RPG 33.3%). There were 5 (12.2%) ARs in SPG: 3 (60%) OAS, 1 (20%) oropharyngeal tightness, and 1 (20%) uvula edema; and 5 (50%) ARs in RPG: 4 (80%) OAS and 1 (20%) palmar pruritus and cough. All patients completed IP. Mean Pru p 3 specific immunoglobulin E (sIgE) value (kUA/L) of patients with ARs in IP: 6.7 kUA/L in SPG and 5.7 kUA/L in RPG. No group showed significant differences (P > 0.05) between Pru p 3 sIgE value, presence of atopy or greater severity in LTP syndrome presentation, and greater probability of AR/more severe ARs in IP. Conclusions: ARs in IP were similar in both groups. No association was found between Pru p 3 value, atopy and higher probability of ARs in IP. RP appears to be a safe and less expensive option. Original Article Tue, 31 Oct 2023 00:00:00 GMT Maria Inês T.Silva, MarisaPaulino, Fátima CabralDuarte, ElisaPedro, CéliaCosta, Tue, 31 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100915 https://www.explorationpub.com/Journals/eaa/Article/100916 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. Review Wed, 01 Nov 2023 00:00:00 GMT AlanKaplan, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100916 https://www.explorationpub.com/Journals/eaa/Article/100917 Asthma is a respiratory disease affecting more than 300 million people around the world. Airflow obstruction and inflammation due to asthma usually involve large airways, but recently small airway involvement (internal diameter < 2 mm) has been shown to represent one of the main determinants of asthma and asthma control. In fact, compared to large airway involvement, small airway dysfunction (SAD) has been demonstrated across all the asthma severity in the majority of patients, as assessed with Global Initiative for Asthma (GINA) steps. Clinically, SAD is associated with, among other features, exercise-induced bronchoconstriction, asthma-related night awakenings, obesity/overweight, more severe airway hyperresponsiveness, worse asthma control, and more severe exacerbations. Impulse oscillometry (IOS), a forced oscillation technique (FOT) requiring less effort than spirometry from the patients, demonstrated to accurately measure SAD in children and adults. The fall in resistance from 5 Hz to 20 Hz (R5–R20), which is the most used index for the resistance of peripheral airways, is how SAD is usually identified by IOS. Other crucial parameters measured by IOS are the reactance at 5 Hz (X5), reflecting elastic recoil of the peripheral airways, the resonant frequency (Fres), which is the frequency at which the inertial properties of the airway and the capacitance of the lung periphery are equal, and the reactance area (AX), reflecting the elastic properties of the lung periphery. In this mini review, the latest findings on the utility of IOS to identify SAD and the associations between SAD and clinical features in adult asthmatic patients were addressed. Mini Review Wed, 01 Nov 2023 00:00:00 GMT MarcelloCottini, CarloLombardi, PasqualeComberiati, MassimoLandi, AlviseBerti, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100917 https://www.explorationpub.com/Journals/eaa/Article/100918 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. Review Mon, 20 Nov 2023 00:00:00 GMT Mandya V.Greeshma, MohammedKaleem Ullah, UlaganathanMabalirajan, SubbaRao V.Madhunapantula, Padukudru AnandMahesh, Mon, 20 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100918 https://www.explorationpub.com/Journals/eaa/Article/100919 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. Original Article Tue, 28 Nov 2023 00:00:00 GMT JaumeMartí-Garrido, Jon R.Konradsen, GunillaHedlin, Mariannevan Hage, AntonioNieto García, MaríaNieto Cid, SoniaUixera, AngelMazon, Tue, 28 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100919 https://www.explorationpub.com/Journals/eaa/Article/100963 This review delves into the complex role of 12/15-lipoxygenase (12/15-LOX) in asthma pathogenesis, focusing on its contributions to mitochondrial dysfunction, oxidative stress, epithelial injury, and airway remodeling. We provide new insights into potential therapeutic strategies aimed at improving asthma management. Additionally, we examine the pro-inflammatory functions of interleukin-4 (IL-4) and its regulatory mechanisms that upregulate 12/15-LOX, leading to increased oxidative stress and airway remodeling. Key interventions such as vitamin E, esculetin, and baicalein are highlighted for their potential to inhibit 12/15-LOX activity, reduce oxidative stress, and restore mitochondrial function. Vitamin E suppresses IL-4 transcription, reducing 12/15-LOX expression and its inflammatory metabolites, while esculetin and baicalein directly inhibit 12/15-LOX, mitigating inflammation and oxidative damage. These antioxidants also promote mitochondrial biogenesis, protect mitochondrial DNA, and enhance respiratory efficiency, contributing to improved cellular metabolism and reduced apoptosis. This comprehensive approach emphasizes the therapeutic potential of targeting 12/15-LOX pathways to alleviate asthma symptoms and improve patient outcomes, paving the way for novel treatment strategies that significantly enhance asthma therapy. Review Tue, 22 Oct 2024 00:00:00 GMT Mandya V.Greeshma, AntaraBaidya, UlaganathanMabalirajan, SubbaRao V.Madhunapantula, Rajesh KumarThimmulappa, Padukudru AnandMahesh, Tue, 22 Oct 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100963 https://www.explorationpub.com/Journals/eaa/Article/100920 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. Mini Review Fri, 08 Dec 2023 00:00:00 GMT Carlo AlbertoVignoli, Riccardo G.Borroni, Fri, 08 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100920 https://www.explorationpub.com/Journals/eaa/Article/100921 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. Review Thu, 14 Dec 2023 00:00:00 GMT KlausVogt, SebastianRoesch, Thu, 14 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100921 https://www.explorationpub.com/Journals/eaa/Article/100922 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. Review Tue, 19 Dec 2023 00:00:00 GMT PasqualeComberiati, MarcelloCottini, MassimoLandi, AlviseBerti, CarloLombardi, DiegoPeroni, Tue, 19 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100922 https://www.explorationpub.com/Journals/eaa/Article/100923 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. Original Article Thu, 28 Dec 2023 00:00:00 GMT ValentinaFaihs, ClaudiaKugler, Rebekka K.Bent, TiloBiedermann, KnutBrockow, Thu, 28 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100923 https://www.explorationpub.com/Journals/eaa/Article/100924 Not applicable. Correction Wed, 17 Jan 2024 00:00:00 GMT , Wed, 17 Jan 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100924 https://www.explorationpub.com/Journals/eaa/Article/100926 Asthma is one of the most common respiratory diseases in humans throughout the world. The illness continues to be the most prevalent cause of respiratory morbidity and affects both adults and children. Asthma is mainly caused by microbes, especially the species of Aspergillus. It causes continuous irritation and distracts the mental attention of the patient, leading to physical weakness and depression resulting in immune-compromised conditions. Asthmatic patients need careful attention and continuous treatment. Taking into account its major effects on patients’ quality of life, the challenging nature of the therapy, and side effects of the novel therapeutic strategies that influence the clinical course of asthma are required to be considered before finally deciding the course of treatment. Children with asthma and wheezing are frequently sustained by a type-2 immune response. In addition, people with wheezing and asthma can be identified by the presence of digestive and respiratory tract dysbiosis. Therefore, oral probiotics could be used as an additional asthmatic medication to manage asthma, but the decision should be constantly monitored by specialized persons. During the last two decades, the importance of probiotics in the treatment of various ailments has been realized and several researches are being conducted to find out the impact of healthy gut microbiome on the management of various diseases including asthma. Review Tue, 20 Feb 2024 00:00:00 GMT Amar P.Garg, AfeefaAteeq, NehaBisht, BajeeraoPatil, Tue, 20 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100926 https://www.explorationpub.com/Journals/eaa/Article/100927 Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and paranasal sinuses. Eosinophilic inflammation is described as a common endotype. The anti-interleukin-5 (IL-5) antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe CRSwNP when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, therapy monitoring and follow-up documentation are required, and therapy discontinuation has not been adequately established yet. In this paper, recommendations for monitoring the course and efficacy of therapy as well as for reviewing the duration and possible termination of therapy are provided. For this purpose, a literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching MEDLINE, PubMed, and the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including October 2022 were considered. Based on the international literature and previous experience, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given by an expert panel on the basis of a documentation sheet. Review Thu, 22 Feb 2024 00:00:00 GMT LudgerKlimek, UlrikeFörster-Ruhrmann, HeidiOlze, Achim G.Beule, Adam M.Chaker, JanHagemann, TilmannHuppertz, Thomas K.Hoffmann, StefanDazert, ThomasDeitmer, SebastianStrieth, HolgerWrede, WolfgangSchlenter, Hans-JürgenWelkoborsky, BarbaraWollenberg, SvenBecker, FrederikeBärhold, FelixKlimek, IngridCasper, JaronZuberbier, ClaudiaRudack, MandyCuevas, Constantin A.Hintschich, OrlandoGuntinas-Lichius, TimoStöver, ChristophBergmann, PascalWerminghaus, OliverPfaar, JanGosepath, MoritzGröger, CarolineBeutner, MartinLaudien, Rainer K.Weber, TanjaHildenbrand, Anna-SophieHoffmann, ClausBachert, Thu, 22 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100927 https://www.explorationpub.com/Journals/eaa/Article/100928 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. Review Wed, 28 Feb 2024 00:00:00 GMT FabioViggiani, GianfrancoCalogiuri, DonatoPaolino, DanielGriscti Soler, FrancescoPugliese, IppolitaZaza, GabriellaLastella, Maria AlessandraLassandro, GiovannaPastore, Chiara MariaCalabrese, VirginiaNacci, Danilo DiBona, EustachioNettis, Wed, 28 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100928 https://www.explorationpub.com/Journals/eaa/Article/100929 Food allergy is characterized by an abnormal immune reaction that occurs reproducibly upon exposure to a specific food. This immune response can lead to a variety of symptoms, the prevalence of food allergies has increased in recent decades, most likely due to environmental factors that likely play a role in the expression of genetic susceptibility. Recent understanding of the immunopathogenesis of allergic diseases has suggested that these atopic diseases may be due to monogenic mutations associated with inborn errors of immunity (IEI). Aspects to be assessed in suspected IEI involve the onset of atopic disease within the initial months of life, the progression of the condition, and the response to conventional therapy. A prospective study was conducted on 385 patients admitted to the clinic with suspected immunodeficiency. Most children were referred for recurrent respiratory infections, but almost half had concurrent atopy (44%), atopy and autoimmunity (3%), autoimmunity (6%) and malignancy (1%). The results of the study underline the importance of the allergic phenotype and suggest that children with more severe allergic diseases should be screened for possible underlying inborn defects of immunity. If a congenital disorder of immunity is suspected, comprehensive immunologic testing is required, and genetic testing is essential to identify the specific genetic abnormalities. Molecular diagnosis provides a comprehensive understanding of congenital immune disorders, allowing tailored interventions and personalized surveillance strategies. Mini Review Thu, 29 Feb 2024 00:00:00 GMT PolinaKostova, VeraPapochieva, MartinShahid, GuerganaPetrova, Thu, 29 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100929 https://www.explorationpub.com/Journals/eaa/Article/100930 Allergen-specific immunotherapy for inhalant allergies, using allergen extracts of proven value, is highly effective in selected patients with allergic rhinoconjunctivitis and allergic asthma. Both subcutaneous and sublingual immunotherapy (SLIT) have been shown to modify the underlying cause of the disease, with long-term clinical benefits that persist for years after their discontinuation. Real-world studies have confirmed the long-term efficacy of allergen immunotherapy in allergic rhinitis (AR) and asthma and shown a reduction in the incidence of lower respiratory tract infections. Sublingual house dust mite (HDM) immunotherapy has been suggested to improve innate antiviral immunity—a likely explanation for this finding. Based on robust randomized controlled trials, the Global Initiative for Asthma (GINA) guideline has incorporated the use of SILT for the treatment of adults with HDM-driven asthma and concomitant AR, with sub-optimal control, regardless of the use of low-to-high doses of inhaled corticosteroids, as long as the patient’s forced expiratory volume in 1 second (FEV1) is > 70%. Mini Review Thu, 29 Feb 2024 00:00:00 GMT ChiaraAsperti, MartinPenagos, Stephen R.Durham, Thu, 29 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100930 https://www.explorationpub.com/Journals/eaa/Article/100931 Aim: There is an increasing interest in defining the role of small airway disease (SAD) in asthma, chronic obstructive pulmonary disease (COPD), and asthma with coexisting COPD. Based on the specific pathophysiologic components of small airway dysfunction (SAdf) of these diseases, single lung function parameters characterize only fractional aspects of SAdf and that the phenotypic diagnosis of SAD, and therefore, the functional assessment must be based on more than one parameter, reflecting airway dysfunction, pulmonary hyperinflation (PHI), energy costs, trapped gases, and/or gas transfer disturbances. Methods: The present study was undertaken to define the interactive contribution of several spirometric and plethysmographic parameters such as forced expiratory flow between 25% and 75% of vital capacity (FEF25–75), effective specific airway resistance (sReff), plethysmographic functional residual capacity (FRC; FRCpleth), the parameter defining PHI, the aerodynamic resistive work of breathing at rest (sWOB), the volume of trapped gas at FRC (VTGFRC), and the carbon monoxide diffusion capacity (DLCO) as the parameter of the gas transfer. Results: The study clearly demonstrates that the diagnosis of SAD cannot be based on one single lung function parameter, especially not on the spirometric FEF25–75 only. Interestingly, sWOB has a high discriminatory power to define SAD in these diseases. Conclusions: Within a future framework including functional and treatable traits, it is mandatory to define SAdf parameters diagnosing unambiguously SAD, for a successful concept of precision medicine. Original Article Tue, 02 Apr 2024 00:00:00 GMT RichardKraemer, HeinrichMatthys, Tue, 02 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100931 https://www.explorationpub.com/Journals/eaa/Article/100932 Respiratory changes are often associated with anxiety disorders, particularly panic disorder (PD). Individuals experiencing PD are subjected to unexpected panic attacks, marked by overwhelming anxiety and fear, leading to a variety of autonomic and respiratory symptoms. PD patients have increased sensitivity to carbon dioxide (CO2). In response to respiratory stimulants like CO2, patients with PD tend to hyperventilate and panic, triggering the activation of an excessively reactive fear network. While their respiratory physiology may appear normal, the presence of subtle breathing abnormalities and other functions related to bodily homeostasis. This fear network, comprising the hippocampus, medial prefrontal cortex, amygdala, and its connections to the brainstem, seems to be hypersensitive in PD’s patients. This review aims to present a comprehensive overview of the current landscape on the link between PD and respiratory disorders. In July 2023 a literature search was undertaken for articles examining the relationship between PD, respiratory disorders, and psychological implications. Multiple databases were searched: PubMed, PubMed Central, PsycINFO, Web of Science, Elsevier Journal, Health & Medical Collection, and Springer. The analysis of six studies focused on the correlation between PD and asthma revealed important links between these two disorders. Anxiety and panic can have significant impacts on the manifestation and aggravation of asthma. Furthermore, the review indicates that psychological therapeutic approaches, in particular cognitive-behavioral therapy, may represent a valid intervention to improve clinical outcomes in patients suffering from both disorders. Future investigations in this field may help highlight new intervention strategies in the psychological area to help individuals with PD decrease concomitant asthma, significantly improving their quality of life. Review Mon, 08 Apr 2024 00:00:00 GMT Graziella ChiaraPrezzavento, Mon, 08 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100932 https://www.explorationpub.com/Journals/eaa/Article/100992 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. Review Thu, 25 Sep 2025 00:00:00 GMT MelvinLee Qiyu, WanlertHorsaengchai, PanchanitHorsaengchai, QasimMalik, Thu, 25 Sep 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100992 https://www.explorationpub.com/Journals/eaa/Article/100933 Nutritional therapy through exclusive enteral nutrition (EEN) is successful with Crohn’s disease (CD), but most patients relapse when returning to a normal diet. Personalized and sustainable diets over time have not been tried. This pioneering case report shows the successful response to the use of a skin prick test (SPT) with a 0.5 mm cutoff and a combination of parameters to guide the diet of a child with CD, ensuring continued remission and a regular diet over a follow-up period of 3 years. The 5-year-old patient had a history of chronic diarrhea. Laboratory showed anemia, hypoalbuminemia, high erythrocyte sedimentation rate (ESR), and fecal calprotectin (FCP) > 2,100 µg/g. Endoscopies revealed duodenal ulcer scar and ulcerative pancolitis. Simple endoscopic score for CD score (SES-CD) = 16 (severe). Pathology showed CD. EEN started with a polymeric formula, later moving to an elemental formula due to a suboptimal response. Medication included prednisolone, mesalazine, azathioprine, and methotrexate. Foods were introduced guided by the SPT and included 54 protein extracts from food tested every 3–4 months. The patient has clinical and histological remission despite having lamb, turkey, eggs, cereals (including wheat), and fish in his diet. FCP has been measured with every change in diet and maintained at < 100 µg/g with the reintroduction of food, with the exception of fish and eggs which, despite a negative SPT, gave mild symptoms and raised FCP to 223 µg/g. Both eggs and fish were successfully reintroduced (FCP < 100 µg/g) after 7 and 11 months respectively from failed reintroduction. This innovative approach based on SPT and strict clinical and follow-up inflammatory markers can potentially ensure remission, reintroducing foods with objective parameters, and improving the patient’s quality of life. Case Report Tue, 16 Apr 2024 00:00:00 GMT AnaMuñoz-Urribarri, Tue, 16 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100933 https://www.explorationpub.com/Journals/eaa/Article/100935 Seaweed, a rich source of bioactive compounds, has gained increasing attention for its potential therapeutic applications in allergy and inflammation. This review examines the current scientific literature investigating the effects of seaweed derived food and diet factors on allergic and inflammatory conditions. Seaweed is abundant in polysaccharides, peptides, polyphenols, and fatty acids, which possess anti-inflammatory, antioxidant, and immunomodulatory properties. These bioactive compounds have the capacity to modulate immune responses and mitigate allergic reactions, rendering seaweed a promising candidate for the development of functional foods and dietary interventions targeting allergy and inflammation. Explorations into the effects of seaweed consumption on allergic conditions such as allergic rhinitis, asthma, and atopic dermatitis have shown encouraging results. Factors found in seaweed have the potential to alleviate symptoms, reduce inflammation, and boost immune function in allergy sufferers. Furthermore, inquiries into the effectiveness of diets incorporating seaweed in preventing and managing chronic inflammatory conditions like inflammatory bowel disease and rheumatoid arthritis have been undertaken. The mechanisms underlying the therapeutic effects of seaweed derived compounds are being unraveled, revealing their ability to modulate immune cell activity, regulate cytokine production, inhibit inflammatory mediators, and promote gut microbiota balance. Understanding these molecular mechanisms is crucial for targeted interventions and the identification of specific bioactive compounds responsible for the observed therapeutic effects. Seaweed derived food and diet factors hold significant promise as natural interventions for the prevention and management of allergic and inflammatory conditions. However, further research is required to establish the optimal dosage, formulation, and long-term effects of seaweed-based interventions. Additionally, clinical trials are necessary to validate their efficacy and safety in diverse patient populations. This review emphasizes the therapeutic potential of seaweed derived compounds and underscores the importance of incorporating seaweed into dietary strategies to combat allergy and inflammation. Review Tue, 23 Apr 2024 00:00:00 GMT LeonelPereira, AnaValado, Tue, 23 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100935 https://www.explorationpub.com/Journals/eaa/Article/100934 Aim: Asthma represents a significant health burden in Kuwait, with high prevalence rates among adults and children. Most asthma patients rely on government healthcare facilities for management, so there is a pressing need to optimize asthma care and treatment strategies. A cross-sectional paper-based survey was conducted to gather insights from allergists and pulmonologists across various healthcare facilities in Kuwait. Methods: Twenty-six medical professionals participated, sharing their perspectives on asthma management practices and adherence to the Global Initiative for Asthma (GINA) 2022 guidelines through answering a modified single round Delphi survey. Results: A high level of consensus on the practicality of guideline changes and the importance of spirometry in diagnosis were reported. However, agreement varied regarding optimal management strategies and medication preferences, indicating areas of divergence among experts. Notably, while there was strong support for inhaled corticosteroid (ICS)-long-acting β2 agonist (LABA) therapy during exacerbations, opinions differed on the use of short-acting β2 agonist (SABA) inhalers as rescue medication. Additionally, the study highlighted challenges in achieving higher levels of agreement, particularly regarding the frequency of inhaler technique checks and specialist referrals for severe asthma cases. Conclusions: This study provided valuable insights into current asthma management practices in Kuwait and identified opportunities for consensus-driven strategies aligned with GINA guidelines. By incorporating diverse perspectives from expert allergists and pulmonologists, it contributed to the enhancement of asthma care and patient outcomes in Kuwaiti healthcare settings. Original Article Fri, 19 Apr 2024 00:00:00 GMT YasmeenOthman, MonaAl-Ahmad, AsmaaAli, Fri, 19 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100934 https://www.explorationpub.com/Journals/eaa/Article/100936 Food protein-induced enterocolitis syndrome (FPIES) is an allergic disorder that manifests as reproducible gastrointestinal symptoms within hours of ingestion of the causative food, which can progress to dehydration and hypotension. Historically, FPIES has been recognized as a disease affecting the pediatric population but it can also develop de novo in adults. The pathophysiology is not well understood; however, the local adaptive immune system and gene expression linked to innate immune activation are implicated. Adult-onset FPIES has some differences with pediatric FPIES. Vomiting may be absent, while abdominal pain is the most common manifestation. A clear predominance in women occurs, being seafood the most common trigger, although many other foods have also been implicated. Diagnosis of adult-onset FPIES is based on a thorough clinical history but in many cases, it should be followed by an oral food challenge (OFC), due to the absence of vomiting in some patients and the lack of confirmatory diagnostic test. The first-line treatment for acute FPIES reactions is fluid replacement, by the oral route in mild to moderate reactions or via the intravenous route in severe reactions. Ondansetron may be effective in shortening the duration of emesis. Management of patients after diagnosis includes dietary advice and follow-up with supervised OFC at regular intervals to monitor for resolution. Tolerance to the trigger food in children is commonly achieved, a finding not so common in adult-onset FPIES. The aim of this article is to review the most important current concepts in epidemiology, pathophysiology, diagnosis, and management of FPIES. Review Wed, 24 Apr 2024 00:00:00 GMT PurificaciónGonzález-Delgado, AnaEntrala, RamonNuñez-Orjales, EvaMarchan, JavierFernández, AnnaNowak-Wegrzyn, Wed, 24 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100936 https://www.explorationpub.com/Journals/eaa/Article/100937 The Finnish Asthma Program, which ran between 1994 and 2004, has long been heralded as a benchmark of success in how to improve management and reduce asthma-related health service utilization. In Australia, there were 38,792 asthma hospitalizations in 2017–18, and 80% of these were considered avoidable (J Asthma Allergy. 2021;14:797–808. doi: 10.2147/JAA.S311721). To address this issue, Asthma Australia has set a strategic objective of halving avoidable asthma presentations to hospital by 2030. This article provides an overview of the Finnish Asthma Program, including an evaluation of critical success factors, outputs, and outcomes, followed by a synthesis of these findings for relevance and applicability to the contemporary Australian context that will inform policy and practice recommendations. Early diagnosis, effective anti-inflammatory medication, guided self-management, and monitoring disease control are still the keys to mitigating asthma burden. In the spirit of the Finnish Program, the digital transformation of healthcare and social media is enabling a new kind of systematic approach, both for patients and professionals. Review Tue, 21 May 2024 00:00:00 GMT KristinCarson-Chahhoud, KelseySharrad, MalcolmBrinn, RoseBell, TariHaahtela, Tue, 21 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100937 https://www.explorationpub.com/Journals/eaa/Article/100938 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. Review Fri, 31 May 2024 00:00:00 GMT ErminiaRidolo, AndreaPederzani, AlessandroBarone, MartinaOttoni, MariangiolaCrivellaro, FrancescaNicoletta, Fri, 31 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100938 https://www.explorationpub.com/Journals/eaa/Article/100939 Aim: This study aims at assessing dupilumab’s response in severe chronic rhinosinusitis with nasal polyps (CRSwNP) and its impact on concurrent mild to moderate asthma. Methods: The study involved severe, uncontrolled CRSwNP patients starting dupilumab treatment (300 mg/2 weeks) at the Allergy unit in University General Hospital “Attikon” in Athens, Greece, from May 2020 to July 2022. Assessments were conducted at baseline (week 0) and weeks 2, 4, 16, 24, and 52, covering 22-item Sino-Nasal Outcome Test (SNOT22), blood eosinophil counts, fractional exhaled nitric oxide (FeNO) concentration, Lund-Mackay CT scores (weeks 0, 16, and 52), Asthma Control Test (ACT) scores (weeks 0, 16, and 52), and forced expiratory volume in one second (FEV1) measurements (weeks 0, 16, and 52). Systemic corticosteroid usage, nasal surgeries, and anosmia improvements were also monitored throughout the study. Results: Six patients (50% male, mean age 53.1 years) with severe CRSwNP had severe uncontrolled baseline symptoms: complete anosmia, impaired quality of life (mean SNOT22: 71.6 ± 16.2), and Lund-Mackay CT score of 19.3 ± 2. Within the past year, 83.3% received over three courses of systemic corticosteroids for CRSwNP, and 50% had more than three polypectomies. After two weeks of dupilumab treatment, notable improvements were seen: reduced SNOT22 scores (week 2: 32.5, week 4: 18.1, week 16: 14, week 24: 13.8, week 52: 9.3), improved olfaction (weeks 4–16), reduced polyp size based on Lund-Mackay CT score (week 16: 13.3, week 52: 12.8), and enhanced lung function (FEV1 baseline: 3.15 L, week 16: 3.22 L, week 52: 3.22 L). Control was achieved by week 16 (ACT: 25/25). FeNO levels decreased [week 2: (18.2 ± 8.7) ppb, week 4: (16.5 ± 7.4) ppb, week 16: (16.9 ± 7.8) ppb, week 24: (13.7 ± 8.3) ppb, week 52: (13.4 ± 5.6) ppb]. No patients required nasal surgery. Conclusions: Dupilumab effectively targets interleukin 4 (IL4) and IL13, controlling type 2 inflammation spectrum, thus providing significant disease control for CRSwNP patients. Moreover, it improves asthma, even in mild to moderate cases, showcasing its broader therapeutic benefits. Original Article Thu, 06 Jun 2024 00:00:00 GMT NikiPapapostolou, MichaelMakris, Thu, 06 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100939 https://www.explorationpub.com/Journals/eaa/Article/100940 Aim: Chronic migraine (CM) is a condition characterized by attacks of severe headaches leading to an increase in time off work, decrease in work productivity and in physical functioning. The aim of this study was to investigate the role of sinus anatomic variants (SAV) on the evolution of migraine from episodic to chronic form. Methods: Two hundred and seven migraineurs [110 with episodic migraine (EM) and 97 with CM] with no evidence of nasal septal deviation with a contact point on the lateral nasal wall were evaluated for endoscopic, radiologic and anatomic variant (AV) abnormalities using Lund-Kennedy endoscopy (LKES) and Lund-Mackay radiology scores (LMRS). Headache day frequency, duration, severity and lost time at work were compared with regard to the presence of any AV and concha bullosa (CB) as well. Results: There was a very significant difference between EM and CM patients with regard to overall SAV and endoscopy scores. However, no significant difference was seen between the groups with regard to radiology scores and headache pain severity. The presence of one AV increased headache day frequency, severity and days off work in all patients. CB was found to worsen headache severity and lost time at work in all patients. Conclusions: Patients with CM have more SAV and worse endoscopy scores than patients with EM. The presence of any of the AVs increases headache day frequency, pain severity and days off work in migraineurs. Original Article Fri, 07 Jun 2024 00:00:00 GMT AyşegülVerim, SemraKülekçi, TuğbaÇelik, Fri, 07 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100940 https://www.explorationpub.com/Journals/eaa/Article/100941 Eosinophilic gastrointestinal diseases (EGIDs) are a group of chronic conditions, characterized by an excessive accumulation of eosinophils in various areas of the mucosal of the gastrointestinal (GI) tract. EGIDs encompass a spectrum of diseases, including eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC), each affecting different segments of the GI tract. The pathogenesis of EGIDs is multifaceted and involves an intricate interplay between genetic predisposition, environmental triggers, and dysregulated immune responses. Although the exact etiology behind EGIDs is not fully understood, it is clear that they are immune-mediated, with eosinophils having a central role in inflammation and tissue damage of GI mucosal. Clinical manifestations depend on the organ that is affected by the disease and on the depth of the eosinophil infiltration of the bowel wall. They range from mild discomfort to severe dysphagia, abdominal pain, malnutrition, and growth failure, particularly in pediatric cases. Regarding EGID management, it is a challenging issue to achieve clinical and histologic remission using pharmacotherapy and dietary elimination. Corticosteroids and proton pump inhibitors can be selected as an effective first-line treatment for certain patients and six-food elimination diet (6-FED) has been proven effective in inducing remission. Furthermore, biologic therapies have emerged as essential tools in controlling eosinophilic-driven inflammation. This review focuses on the complex pathogenesis and treatment of these inflammatory diseases, especially EoE. Review Fri, 07 Jun 2024 00:00:00 GMT GeorgiaPapaiakovou, ApostolosPapageorgiou, AgamemnonBakakos, Athanasios C.Sinaniotis, NikolettaRovina, Fri, 07 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100941 https://www.explorationpub.com/Journals/eaa/Article/100942 There are no plausible arguments to consider that the best evidence-based asthma treatment should be different in low- and middle-income countries (LMICs). A few decades ago, the recognition of asthma as an inflammatory disease of the airways positioned the inhaled corticosteroids (ICS) as the cornerstone of the treatment of this disease, maintaining bronchodilators, especially the short-acting beta-agonists (SABA), as symptom-reliever medications for use as needed. However, adherence to regular use of ICS is very low, especially in LMICs, favoring the overuse of SABA, which has been related to an excess of exacerbations and mortality. Recently, the Global Initiative for Asthma (GINA) strategy has recommended the mandatory use of ICS every time a bronchodilator is used as needed (for symptoms relief), whether only as needed or with a background of regular dose of ICS, and has named it: anti-inflammatory reliever (AIR) therapy. This form of therapy, which has been related to a significant reduction of asthma exacerbations, is very attractive for LMICs where patients do not have guaranteed a proper medical follow-up and the access to on-the-counter medications is high. However, the implementation of AIR therapy in LMICs will face many of the already recognized barriers for the diagnosis and treatment of asthma in these countries, especially related to limited access to care in very different health systems, low education level of patients and communities, insufficient health personnel training in asthma in primary care, the unfordable cost of medications, and the lack of political commitment. This review analyzes some of these challenges and strategies for facing them in LMICs. Review Wed, 12 Jun 2024 00:00:00 GMT Carlos A.Torres-Duque, IsabellaPerna-Reyes, AbrahamAlí-Munive, Wed, 12 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100942 https://www.explorationpub.com/Journals/eaa/Article/100943 Recent data has resulted in an interest in the metabolic shift in cellular metabolism to aerobic glycolysis, increased reactive oxygen species (ROS), and mitochondrial dysfunction associated with asthma. There has been a push to better understand the immune and metabolic changes in allergy to improve understanding of disease pathology and treatment. Aerobic glycolysis seen in epithelial cells in asthma promotes chronic inflammation and the production of inflammatory cytokines. Asthma epithelial cells share a number of features proposed in the stages of cancer initiation including aerobic glycolysis and increased apoptosis with proliferation, all within a chronic inflammatory microenvironment. Metabolic reprogramming in malignant cells has been widely investigated since the glycolytic characteristics were first described last century. It is still debated whether these metabolic changes are the cause or consequence of carcinogenesis and oncogenic cell-selective pressures. Although historic results have been conflicting, recent data has found an increased lung cancer risk in asthma patients, independent of risk factors. A review of emerging research on the metabolic changes seen in asthma helps us to propose a pathway between the initiation of aerobic glycolysis and the selective pressures of the epithelial microenvironment and resulting malignant transformation risk. Review Thu, 13 Jun 2024 00:00:00 GMT ThomasDymond, Thu, 13 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100943 https://www.explorationpub.com/Journals/eaa/Article/100944 Over the last two decades, the emergence of lethal virulent strains of coronavirus (CoV), including the severe acute respiratory syndrome CoV 2 (SARS-CoV-2), which is responsible for the coronavirus disease 2019 (COVID-19) pandemic, has become a matter of great attention to the scientific community. Despite the implementation of preventive measures throughout the world, the spread of this disease and associated co-morbidities and mortality continue in all countries, continents, and populations of all ages. COVID-19 is highly contagious. Clinical manifestations are diverse and range from asymptomatic, mild to severe, life-threatening complications in the elderly and patients with underlying conditions such as cardiovascular disease, diabetes, obesity, and asthma. In addition, viral infections can trigger asthma attacks. To date, there is no specific treatment schema to combat COVID-19 disease. Current patient care revolves around disease severity and supportive treatment of symptoms from home-rest in mild disease to anti-viral therapy, oxygen support, anti-inflammatories, and anti-coagulants in severe COVID-19. Regarding prevention, the World Health Organization recommends vaccination, social distancing, quarantine, the wearing of surgical masks, and handwashing. In many countries, vaccination is optional, and given that parents are often reluctant to vaccinate themselves and their children for fear of side effects, identifying ways to enhance or support the immune system to prevent infection or improve recovery in vulnerable populations is worth investigating. Furthermore, research has focused on the pharmacological management of COVID-19 symptoms and much less has been published on nutrition therapy. Therefore, the scope of this review is to summarize the latest evidence on the use of vitamin D to support the metabolism and the immune system of asthma patients during the COVID-19 pandemic. A brief overview of asthma and COVID-19 pathophysiology, COVID-19 treatment guidelines for asthma patients, and the role of vitamin D in lung health, including the optimal blood level required to enhance immunity, will be suggested. Review Thu, 27 Jun 2024 00:00:00 GMT Maria MichellePapamichael, CharisKatsardis, Thu, 27 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100944 https://www.explorationpub.com/Journals/eaa/Article/100945 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. Review Fri, 28 Jun 2024 00:00:00 GMT YutoHamada, Eleanor C.Majellano, Peter GerardGibson, Fri, 28 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100945 https://www.explorationpub.com/Journals/eaa/Article/100946 Chronic rhinosinusitis (CRS) is a prevalent and burdensome condition worldwide, characterized by inflammation of the paranasal sinuses. Ideally, instead of treating CRS, we would identify ways to prevent the development of this chronic condition. Occupational exposures may be an excellent target for prevention. Occupational exposures have been shown to play a critical role in the pathogenesis of multiple lower airway diseases, such as asthma, silicosis, asbestosis, and hypersensitivity pneumonitis. However, evidence for the association between occupational exposures and the development of upper airway disease, like CRS, is less well-defined. This manuscript examines the association between occupational exposures and CRS. A scoping review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 19 relevant studies. The populations examined and the methods and criteria used for defining CRS diagnosis and occupational variables significantly varied between the studies. Diagnosis of CRS was most often determined by self-reported symptoms or medical record review. Occupational variables ranged from employment status to occupation type to specific exogenous compounds encountered. Overall, substantial evidence demonstrates a general association between occupational exposures and CRS diagnosis; however, limitations in study methodologies, including variations in CRS diagnostic criteria, occupational exposures, assessment methods, and populations, hinder drawing more specific conclusions. Moving forward, rigorous research methodologies and standardized criteria are essential to draw conclusions supported by multiple studies. Critical components of future studies should include large, diverse populations, use of consensus CRS diagnostic criteria, and inclusion of many specific and quantitatively defined exposures. Ultimately, such efforts can help inform preventative measures and interventions for CRS, thus mitigating the burden of CRS on individuals and populations worldwide. Review Fri, 19 Jul 2024 00:00:00 GMT Aurelia S.Monk, Cameron P.Worden, Ezer H.Benaim, CristineKlatt-Cromwell, Brian D.Thorp, Charles S.Ebert, Brent A.Senior, Adam J.Kimple, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100946 https://www.explorationpub.com/Journals/eaa/Article/100947 Aim: Evaluation of real-world data regarding the use of omalizumab on lung function, asthma control, exacerbations, and oral corticosteroid (OCS). Methods: The single-centre, retrospective study included data from adult patients with severe allergic asthma treated with omalizumab for at least five years to ten years to evaluate its long-term efficacy. The primary outcome parameters were lung function (FEV1), the asthma control test (ACT) score, the number of exacerbations, and OCS use. Results: Data from 74 adults (mean age 51 years, 61% females, median IgE 276 kU/L), with severe allergic asthma, due to perennial allergens, who were treated for at least 5 years with omalizumab in one centre could be evaluated up to 10 years. The mean improvement in FEV1 from baseline was 13.4% in the first year and constantly remained high throughout the duration of the treatment. The ACT improved from baseline (12.4 points) to 16.4 in the first year and reached 18.8 after 5 years, followed by values nearly reaching 20 (19.2 in year 8). The rate of exacerbations decreased from 3.3 events in the last 12 months before omalizumab initiation to 0.4 in the first year and remained low (e.g., 0.2 after 5 years). The mean OCS use was 20.9 mg/day in 44/74 patients before the first injection of omalizumab and decreased to 5 mg/day in the same patients within the first year. Following 6 years of omalizumab treatment, OCSs were used by 22 patients, and by 12 patients after 8 years. Conclusions: The consistent improvement in lung function, asthma control, reduction in exacerbations, and OCS use throughout a minimum of five up to ten years confirms that omalizumab remains effective for many years. There were no signs of tolerance or tachyphylaxis against the biologic. Original Article Fri, 19 Jul 2024 00:00:00 GMT Karl-ChristianBergmann, TeresaHartung, SebastianKugler, KatarinaStevanovic, TorstenZuberbier, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100947 https://www.explorationpub.com/Journals/eaa/Article/100948 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. Review Mon, 22 Jul 2024 00:00:00 GMT GualtieroLeo, CristoforoIncorvaia, StefaniaArasi, Mon, 22 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100948 https://www.explorationpub.com/Journals/eaa/Article/100949 Aim: This study investigated changes in pediatric respiratory health resulting from the easing of COVID-19-related social restrictions, following a noted decrease in respiratory infections during the lockdown. The COVID-19 restrictions have inadvertently influenced the epidemiology of other viruses and contributed to changes in patterns of recurrent respiratory infections (RRIs) in children. Methods: This cross-sectional study analyzed the records of children who underwent at “Respiratory Diseases of Pediatric Interest Unit” at the University Hospital “Luigi Vanvitelli” in Naples, Italy, between October 2022 and June 2023. The study aimed to assess associations with RRIs, the occurrence of febrile episodes, and antibiotic usage. Results: Out of 262 patients (38.2% females, median age 6 years), 81.7% experienced at least one respiratory infection over six months, and 23.7% suffered from RRIs [RRIs in the last six months (RRIS)]. Notably, being underweight was significantly associated with RRIs in the last six months (P-value 0.043), resulting in a 47% increased incidence of respiratory infections (P-value 0.012). No significant associations were observed with sex or age. With increasing age, there was a decreasing incidence rate of 3% for the number of RRIs (P-value 0.019), 4% for febrile episodes (P-value 0.031), and 7% for the number of antibiotic courses (P-value < 0.001). Conclusions: The study emphasizes age and weight’s role in children’s post-COVID-19 RRI prevalence. It signifies the need for proactive preparedness, targeting younger underweight populations and tailored interventions for recurrent cases. Original Article Wed, 24 Jul 2024 00:00:00 GMT CristianaIndolfi, Lorena FortunaIzzo, MargheritaLuciano, MichelangeloMercogliano, AngelaKlain, GiulioDinardo, FabioDecimo, Michele Miraglia delGiudice, Wed, 24 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100949 https://www.explorationpub.com/Journals/eaa/Article/100950 Multiple chemical sensitivity (MCS) is an unexplained acquired medical condition that includes multiple, vague, recurrent, and non-specific symptoms in different organs. They are attributed to exposures to various and structurally unrelated environmental chemicals at concentration levels that are well tolerated by the majority of people and normally considered not to have toxic effects in humans. The aim of this review is to examine the multiple explanatory hypotheses for the pathophysiology of MCS: genetic, metabolic, neurological, immunological, and psychological. Several publications suggest a neurological and immunological activation. However, this neurological and immunological hyperresponse is not always observed when performing challenge tests. This suggests that behavioral conditioning could be an important mechanism in the pathogenesis of MCS. Even if psychiatric conditions appear not to be a major cause of MCS, in the case of genuine psychiatric disease, psychotherapeutic therapy is mandatory. Because of the complexity of the pathophysiology, there is no specific drug to treat MCS. However, the use of cognitive behavioral therapy is encouraged, as it has a significant positive impact on patients’ perception of their illness. Review Mon, 29 Jul 2024 00:00:00 GMT Cătălina ElenaLavric, NicolasMigueres, Frédéricde Blay, Mon, 29 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100950 https://www.explorationpub.com/Journals/eaa/Article/100951 Aim: The impact of complete bilateral nasal obstruction [nasal polyp score (NPS) = 8/8] on treatment outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) is unclear. This post hoc analysis assessed disease burden and dupilumab efficacy in patients with severe CRSwNP and baseline NPS = 8 in SINUS-24/-52 (NCT02912468/NCT02898454). Methods: Efficacy outcomes assessed: NPS, peak nasal inspiratory flow (PNIF), Lund-Mackay computed tomography (LMK-CT), nasal congestion/obstruction (NC), loss of smell (LoS), rhinosinusitis visual analog scale (rhino-VAS), University of Pennsylvania Smell Identification Test (UPSIT), 22-item Sinonasal Outcome Test (SNOT-22) in patients receiving dupilumab 300 mg or placebo every 2 weeks. Responder analyses evaluated clinically meaningful improvements [≥ 1 (NPS, NC, LoS); ≥ 5 (LMK-CT); ≥ 8 (UPSIT); ≥ 8.9 (SNOT-22); ≥ 20 L/min (PNIF)]. Results: Ninety-eight patients were included [59% prior NP surgery, 84% systemic corticosteroids (SCS) use in the previous 2 years, 60% coexisting asthma, 91% anosmic, 97% impaired nasal airflow]. Least squares (LS) mean differences [dupilumab vs. placebo (95% CI)] in change from baseline at week (W) 24: NPS, −2.04 (−2.67, −1.40); PNIF, 65.9 (39.4, 92.4) L/min; LMK-CT, −4.97 (−6.50, −3.44); NC, −1.30 (−1.72, −0.89); LoS, −0.96 (−1.39, −0.54); Rhino-VAS, −3.37 (−4.67, −2.07); UPSIT, 8.55 (4.91, 12.20); SNOT-22, −25.3 (−34.1, −16.4) (all P < 0.0001). For all outcomes, significantly greater proportions of dupilumab vs. placebo patients achieved clinically meaningful improvements at W24. Fewer dupilumab vs. placebo patients required SCS and/or surgery through W24 (11.8% vs. 36.7%; P = 0.0005). Efficacy outcomes were similar at W52 (SINUS-52; n = 39) with P values vs. placebo of < 0.0001 for NPS and NC; 0.0002 for LMK-CT; 0.0031 for LoS; 0.0014 for rhino-VAS; 0.0013 for UPSIT; 0.0012 for SNOT-22. Conclusions: In patients with CRSwNP with complete bilateral nasal obstruction, dupilumab treatment resulted in clinically significant improvements in NPS, LMK-CT, PNIF, symptoms, and health-related quality of life. Original Article Wed, 31 Jul 2024 00:00:00 GMT MartinWagenmann, ClausBachert, ClaireHopkins, MarkCorbett, JérômeMsihid, ScottNash, YamoDeniz, Paul J.Rowe, HarrySacks, Juby A.Jacob-Nara, Wed, 31 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100951 https://www.explorationpub.com/Journals/eaa/Article/100952 Atopic dermatitis (AD) represents the most common inflammatory skin disease with a highly intricated immune fingerprint. Until recently, AD management mostly relied on topical corticosteroids, calcineurin inhibitors, and systemic immunosuppressants, with a range of safety and tolerability concerns including toxicity, drug interactions, and contraindications. With the onset of biologics, safer and more targeted therapeutics have become available, displaying various degrees of success in treating AD, but not yet able to meet all the needs of AD patients. Some of the challenges encountered included variability of responses among patients, long-term safety, and limited access due to prohibitive costs. As the pathophysiology of AD has been increasingly understood within the last years, new approaches are explored, leading to an unprecedented diversification of therapeutic options to address these hurdles. This review highlights current immunotherapeutic strategies developed towards AD, whether already in the clinical pipeline or still in preclinical exploration. Review Fri, 09 Aug 2024 00:00:00 GMT Gael TchokomeniSiwe, Emmanuel AdebowaleFajemisin, MasalaMugeri, KrupaNaran, StefanBarth, Fri, 09 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100952 https://www.explorationpub.com/Journals/eaa/Article/100953 Asthma is a common chronic inflammatory disease of the airways that affects more than 330 million people globally. Severe asthma, despite being 5–10% of the total asthmatic population presents significant morbidity and high cost due to health care utilization. The management of severe asthma has dramatically changed with the use of biologics. However, biologics have been approved only for patients with severe asthma with type-2 mediated inflammation. Eosinophils are central in the T2 inflammatory process in asthma and this stands true for the severe form of the disease as well. In this review, we discuss basic insights into the pathogenesis of severe asthma related to eosinophilic inflammation and the pivotal role of T2 cytokines which have also become along with eosinophils the target of biologics. Novel biologics such as tezepelumab have demonstrated efficacy regardless of the blood eosinophil count and have shown promise for T2 low asthma, although to a lesser degree. Review Tue, 13 Aug 2024 00:00:00 GMT AgamemnonBakakos, NektariosAnagnostopoulos, PetrosBakakos, Tue, 13 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100953 https://www.explorationpub.com/Journals/eaa/Article/100954 A granulomatous vasculitis of the medium and large vessels, giant cell arteritis (GCA) is a persistent, idiopathic condition. The overlapping phenotypes of this condition include conventional cranial arteritis and extra-cranial GCA, also known as large-vessel GCA. Vascular problems linked with considerable vessel involvement may partly be caused by delayed diagnosis, emphasizing the necessity of early detection and the fast beginning of appropriate therapy. The cornerstone of treatment for GCA is glucocorticoids, but using them for an extended period has numerous, often severe, side effects. We aim to explore the most recent literature on GCA therapies to investigate the current and potential therapeutic options for induction and maintaining treatment in GCA. By now, only tocilizumab is approved for GCA treatment, but several other biological drugs may be efficient and safe for GCA patients, like abatacept, baricitinib and upadacitinib, mavrilimumab, secukinumab, ustekinumab, and anakinra. Review Wed, 21 Aug 2024 00:00:00 GMT GiuliaCostanzo, Andrea GiovanniLedda, Wed, 21 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100954 https://www.explorationpub.com/Journals/eaa/Article/100955 Allergic and immunologic skin diseases are becoming increasingly common and this requires clinicians to be able to recognize and diagnose them. A joint meeting (GET TOGETHER 2022) of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to review the current knowledge on the differential diagnosis of contact dermatitis, atopic dermatitis, hereditary angioedema, urticaria, and cutaneous mastocytosis. The most important aspects to take into consideration when faced with a new cutaneous manifestation are the clinical features of the lesions, their distribution, age of onset, and comorbidities/aggravating factors. The document does not aim to provide an exhaustive and comprehensive description of all allergic and immunologic skin diseases. Instead, it should be a reference tool for the clinician who is faced with the onset of a new skin manifestation and its differential diagnosis. Review Mon, 26 Aug 2024 00:00:00 GMT EdoardoCataudella, MargheritaPerlato, LorenzoSalvati, EsterDi Agosta, AriannaRomaldi, DonatoPaolino, FrancescaAmbrogio, RossellaMarietti, StefaniaMagistà, NataleSchettini, MartaTramontana, Luca DiBartolomeo, MariaPassante, Marina DiPino, Aurora DeMarco, LucaPotestio, LuisaAngilieri, RossanaCannas, IlariaMormile, IlariaTrave, Maria ElisabettaConte, SilviaFerrucci, RosellaGallo, AndreaZancanaro, ElisaBoni, AlessandroBuonomo, DomenicoBonamonte, MaddalenaNapolitano, MariaBova, Tiziana DePasquale, FabrizioGuarneri, CataldoPatruno, KatharinaHansel, Francesca LareseFilon, IppolitaZaza, SergioTesti, SebastianoGangemi, CaterinaFoti, LucaStingeni, EustachioNettis, MonicaCorazza, OlivieroRossi, Mon, 26 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100955 https://www.explorationpub.com/Journals/eaa/Article/100956 Atopic dermatitis (AD) is a chronic inflammatory skin disease that primarily affects the barrier function of the skin in patients. The condition has been documented to cause xerosis in patients from birth onwards. In order to protect the skin barrier in AD, it is of the utmost importance to moisturize the skin. Moisturizers and emollients play a pivotal role in the prevention and treatment of AD. Concordantly, the use of moisturizers and emollients can facilitate the reduction in the necessity for the application of topical treatments such as corticosteroids. An understanding of the use of moisturizers and emollients, in conjunction with an appreciation of the pathophysiology of the skin barrier, will prove invaluable in the treatment of AD. Review Tue, 27 Aug 2024 00:00:00 GMT SerapMaden, Tue, 27 Aug 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100956 https://www.explorationpub.com/Journals/eaa/Article/100957 Aim: Few reports on atopic dermatitis (AD) in adults from Africa exist in the literature. AD in adults can occur as childhood-onset, in which AD begins in childhood and continues till adulthood, or adult-onset, in which AD develops in adulthood. Typical appearance of AD includes acute or chronic eczematous lesions recurring or chronic in nature that is symmetrically distributed on flexural body surfaces. Atypical clinical patterns and morphology are commonly described among the adult population. The purpose of this study is to describe the frequency, clinical pattern, and contact sensitization of adults with AD. Methods: A prospective study of patients seen at the dermatology clinic of a tertiary referral center in Abuja, Nigeria, between September 2020 and September 2022. Adult patients who fulfilled at least three major and three minor criteria of the Hanifin and Rajka guidelines were recruited. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index for black skin was used to determine AD severity. Contact sensitivity was assessed using a modified European baseline series and skin prick testing of common aeroallergens was also done. Results: Out of a total of 2,177 patients, only 38 adults were diagnosed with AD. Two-thirds of them had adult-onset AD. The majority (63.2%) had chronic eczema at presentation, 23.7% had perifollicular accentuations, and 13.2% had acute eczema. The mean SCORAD index was 20.5 (16.4 to 24.6). The mean eosinophil count was 5.9 ± 3.4 cells/dL. The skin prick test revealed sensitization to at least one allergen in 68.8% of the patients. Contact sensitivity to methyldibromoglutaronitrile, lanolin, and paraben was highly observed. Conclusions: Adult-onset AD is more common than childhood-onset AD in adults. The morphology and distribution of eczema did not differ from other studies. Adult AD individuals tend to develop contact sensitivity to preservatives. Original Article Fri, 06 Sep 2024 00:00:00 GMT Perpetua U.Ibekwe, EnoEkop, TheresaOtu, PeterBassi, Bob A.Ukonu, Fri, 06 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100957 https://www.explorationpub.com/Journals/eaa/Article/100960 Asthma is a complex inflammatory airway disease affecting a significant global population, spanning from childhood through adulthood. Despite advances in treatment modalities, a significant subset of patients, approximately 10%, grapple with severe asthma, characterized by increased healthcare utilization and diminished quality of life. Tezepelumab, a monoclonal antibody targeting thymic stromal lymphopoietin (TSLP), offers promising therapeutic potential. TSLP is a protein released by a variety of cells, with a predominance of epithelial cells, in reaction to plenty of stimuli, such examples as viruses, aeroallergens, and others. Its action is upstream and pertains to initiating numerous subsequent innate and adaptive immune reactions, contributing to the continuation of asthma pathophysiological processes. Tezepelumab’s unique efficacy spans diverse severe asthma phenotypes, significantly reducing exacerbation rates across eosinophilic and non-eosinophilic subtypes. Its favorable safety profile and clinically meaningful improvements in asthma control, accompanied by reductions in cytokine levels and baseline biomarkers, underscore its broad impact on asthma inflammation. Its efficacy, irrespective of type 2 (T2) endotype, reinforces the idea that TSLP blockade broadly inhibits pathways crucial to asthma pathophysiology, rather than narrowly focusing on individual downstream factors, as previous biological treatments have. This review discusses the rationale for TSLP blockade and the efficacy of tezepelumab in severe asthma using data from key trials. Review Mon, 23 Sep 2024 00:00:00 GMT ArgyriKlironomou, GeorgiaPapaiakovou, AgamemnonBakakos, NektariosAnagnostopoulos, EvangeliaKoukaki, EfthymiaTheofani, MariaSemitekolou, NikolettaRovina, Mon, 23 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100960 https://www.explorationpub.com/Journals/eaa/Article/100959 Chronic rhinosinusitis (CRS) is an inflammatory disorder of the paranasal sinuses and the nasal cavity lasting longer than 12 weeks. This disease is a common clinical syndrome with significant monetary burden due to the high costs of medical visits, diagnostic tests, medications, and surgical therapies. CRS without nasal polyposis (CRSsNP) is the most common subtype of CRS, accounting for about 70% of all patients. Other subtypes include CRS with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). CRSwNP has the worldwide prevalence of 2% to 4% and is often accompanied by type 2 inflammation and asthma as a comorbid condition. Pediatric chronic sinusitis is distinct from adult chronic sinusitis and is currently considered an infectious process, characterized by persistent inflammation representing an exaggerated immune response to an external stimulus. The medical and surgical management of CRS has been remarkably modified in the past two decades. The aim of this study was to present an update on CRS based on the recent years’ literature. Review Fri, 20 Sep 2024 00:00:00 GMT SepidehDarougar, MasoumehHematyar, Pantea BozorgSavoji, Fri, 20 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100959 https://www.explorationpub.com/Journals/eaa/Article/100961 Bronchiectasis is a heterogeneous chronic lung disease, characterised by irreversible dilatation of the airways and attributed to a wide spectrum of other underlying conditions, usually underdiagnosed and inadequately treated with a high burden for both the patients and the healthcare system. The way bronchiectasis is viewed by physicians has drastically changed over the last decades, with the topic of eosinophilia in the context of the disease being one of the substantially highlighted. Eosinophilia was traditionally considered as a means for distinguishing bronchiectasis from asthma, whereas bronchiectasis was primarily associated with neutrophilic inflammation. However, eosinophilic bronchiectasis is nowadays identified as a distinct disease endotype and is associated with a specific clinical course and response to treatment. Further research is needed to better characterise this endotype and improve its personalised investigation and management in daily clinical practice. Commentary Mon, 23 Sep 2024 00:00:00 GMT Andreas M.Matthaiou, NikoletaBizymi, GeorgiosHillas, AdamantiaLiapikou, Mon, 23 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100961 https://www.explorationpub.com/Journals/eaa/Article/100962 Aim: Epidemiological surveys show substantial modification over time of pollens sensitization profiles, with relevant difference across geo-climatic zone. Climate changes can affect the onset, duration and production of the pollen season. Aim of the present study has been to assess the evolution over 33 years of the patients’ sensitization profile, together with pollen count and climate in a resident population of the Po Valley. Methods: Retrospective study of primary sensitizations to 6 major pollens (grass, pellitory, birch, olive, ragweed mugwort) from 1986 to 2019 on patients aged 12 years or older with respiratory allergic diseases living in Mantua suburbs. Pollen counts and season durations were recorded by the monitoring station of Parma. Meteorologic data have been downloaded from the historical archive of Mantua monitoring station. Results: A population of 3,489 patients who tested positive to pollens have been considered (34% to one pollen only; 66% poly-sensitized, 68% out of them to two or more pollens). Average annual temperature has risen of 1.4°C. An overall trend for extension of seasons duration and increase of pollen load has been observed. Sensitization rate to grass remained stable over time when pellitory showed a sudden decline. Sensitization rates to birch, olive and ragweed displayed a sharp increase. Conclusions: The present study proves that significant change on phenological phases of main allergenic plants, pollen load and sensitization profile of patients have occurred over the last decades. Global warming seems to be one of the main causes for these changes. More epidemiological studies differentiated by regional geo-climatic zone and a multidisciplinary approach to research on topic are needed. Original Article Sun, 29 Sep 2024 00:00:00 GMT AndreaAntico, ClaraBocchi, RenatoAriano, Sun, 29 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100962 https://www.explorationpub.com/Journals/eaa/Article/100965 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. Review Fri, 10 Jan 2025 00:00:00 GMT AlbertoVidal, Fri, 10 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100965 https://www.explorationpub.com/Journals/eaa/Article/100966 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). Review Tue, 14 Jan 2025 00:00:00 GMT Luis AngelHernández-Zárate, Carlos AndrésGómez-Núñez, StefanNarváez-Labuhn, GerardoMorales-Velázquez, VíctorGonzález-Uribe, Tue, 14 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100966 https://www.explorationpub.com/Journals/eaa/Article/100968 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. Letter to the Editor Sat, 18 Jan 2025 00:00:00 GMT ThierryBatard, StéphaneDreux, KarineJain, DelphineBaveux, ChristellePéguillat, SylvieVillardsaussine, HenriChabre, MélanieBilong, ChristelDayang, LaurentMascarell, Sat, 18 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100968 https://www.explorationpub.com/Journals/eaa/Article/100967 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. Review Thu, 16 Jan 2025 00:00:00 GMT CourtneyLehman, Ray StokesPeebles, Thu, 16 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100967 https://www.explorationpub.com/Journals/eaa/Article/100969 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. Original Article Mon, 20 Jan 2025 00:00:00 GMT SamanthaHarrison, EmmaGoulding, JulieRead, SudipGhosh, Mon, 20 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100969 https://www.explorationpub.com/Journals/eaa/Article/100970 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. Case Report Fri, 24 Jan 2025 00:00:00 GMT LouiseGuyot, CélineBeauvillain, VéroniqueLemeunier, DelphineBourneau-Martin, MartineMorisset, Fri, 24 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100970 https://www.explorationpub.com/Journals/eaa/Article/100971 Not applicable. Editorial Sat, 08 Feb 2025 00:00:00 GMT MarioDi Gioacchino, SergioBonini, StefanoDel Giacco, Giorgio WalterCanonica, Sat, 08 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100971 https://www.explorationpub.com/Journals/eaa/Article/100972 Not applicable. Consensus Statement Sat, 08 Feb 2025 00:00:00 GMT MarioDi Gioacchino, VincenzoPatella, SergioBonini, StefanoDel Giacco, Giorgio WalterCanonica, Sat, 08 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100972 https://www.explorationpub.com/Journals/eaa/Article/100973 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. Review Sat, 08 Feb 2025 00:00:00 GMT AntaraBaidya, UlaganathanMabalirajan, Sat, 08 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100973 https://www.explorationpub.com/Journals/eaa/Article/100964 Aim: To determine temporal changes in the frequency of asthma and mental illness in California emergency department (ED) visits and examine predictors of both asthma diagnosis and non-routine discharge from asthma visits. Methods: Public-use, all-payer ED data from non-federal, acute-care hospitals (2005–2014) were obtained for cross-sectional analysis. Due to substantial missing data, we used fully conditional specification multiple imputation with discriminant functions for age group, sex, race, and ethnicity. Multivariable logistic regression was used to examine asthma diagnosis (yes/no) among all ED visits and non-routine discharge (sent home vs. all else) among visits with asthma diagnosis. Primary independent variables were mental illness and the 3-digit zipcode of the patient’s residence. Covariates included demographics, payer type, and hospital characteristics. Results: During 2005–2014 there were 96,180,176 visits at 349 hospitals, and asthma diagnosis increased from 3.3% of ED visits in 2005 to 5.9% in 2014. However, asthma as a primary diagnosis decreased from 1.7% to 1.4% of ED visits. Among visits with asthma diagnosis (n = 4,419,629), co-occurring mood disorders increased from 2.1% in 2005 to 9.2% in 2014. Predictors of asthma diagnosis included attention deficit/conduct disorders [adjusted odds ratio (AOR) 1.41, 95% confidence interval (1.40–1.42)] and mood disorders [AOR 1.37, (1.36–1.37)]. Compared to Los Angeles, cities/areas most associated with asthma diagnosis were Richmond [zipcode 948, AOR 1.22 (1.20–1.24)], Bakersfield [933, AOR 1.21 (1.19–1.24)], and San Bernardino [924, AOR 1.20 (1.19–1.22)]. Ninety-six percent of ED visits with asthma resulted in routine discharge. Predictors of non-routine discharge included suicide/self-harm [AOR 4.74 (4.67–4.81)], schizophrenia [1.97 (1.94–1.99)], and mood disorders [1.35 (1.34–1.36)]. Areas associated with non-routine discharge included the Bakersfield vicinity [932, 1.29 (1.17–1.41)] and Ventura [930, 1.23 (1.10–1.38)]. Conclusions: Increased co-occurring mental illness among asthma-related ED visits suggests a need to improve care among those having co-occurrence. Understanding regional differences in asthma-related ED visits and hospitalization may improve interventions. Original Article Mon, 04 Nov 2024 00:00:00 GMT Jim E.Banta, Ivie CEgiebor, ChanellGrismore, MacyWestbrook, James M.Banta, Mon, 04 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100964 https://www.explorationpub.com/Journals/eaa/Article/100974 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. Review Mon, 10 Mar 2025 00:00:00 GMT Andrea GiovanniLedda, OzgeCan Bostan, StefanoDel Giacco, Mon, 10 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100974 https://www.explorationpub.com/Journals/eaa/Article/100975 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. Case Report Fri, 21 Mar 2025 00:00:00 GMT DiegoBagnasco, BenedettaBondi, VeronicaCapuano, Frank Rikki MauritzCanevari, CesareDe Tomaso, SaraFedele, VincenzoMilano, MarcelloMincarini, MichelaRobbiano, MelaniaBertolini, FulvioBraido, Fri, 21 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100975 https://www.explorationpub.com/Journals/eaa/Article/100976 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. Original Article Wed, 09 Apr 2025 00:00:00 GMT NassibaBahra, BouchraAmara, SoukainaEl Yaagoubi, HindBourkhime, NadaOthmani, NabilTachfouti, MohamedBerraho, MouniaSerraj, Mohamed ChakibBenjelloun, SamiraEl Fakir, Wed, 09 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100976 https://www.explorationpub.com/Journals/eaa/Article/100977 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. Case Report Tue, 15 Apr 2025 00:00:00 GMT AlessandroDorato, RosaBuonagura, MelissaBorrelli, CristinaFontanella, AdeleCorcione, Amatode Paulis, FrancescaSantamaria, AikateriniDetoraki, Tue, 15 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100977 https://www.explorationpub.com/Journals/eaa/Article/100978 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. Original Article Wed, 16 Apr 2025 00:00:00 GMT AkihiroKanaya, ElvedinLuković, CharlesEmala, MayaMikami, Wed, 16 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100978 https://www.explorationpub.com/Journals/eaa/Article/100980 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. Case Report Sun, 27 Apr 2025 00:00:00 GMT DiegoBagnasco, RiccardoPicasso, BenedettaBondi, VeronicaCapuano, ElisaTestino, CarloMartinoli, FulvioBraido, Sun, 27 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100980 https://www.explorationpub.com/Journals/eaa/Article/100979 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. Review Sun, 27 Apr 2025 00:00:00 GMT MelvinLee Qiyu, Sun, 27 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100979 https://www.explorationpub.com/Journals/eaa/Article/100981 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. Review Thu, 08 May 2025 00:00:00 GMT TeresaGarriga-Baraut, PaulaMéndez-Brea, OlayaAlvarez-García, PaulaCabrera-Freitag, SaraFernández-Cortés, Maria EugeniaSanchís-Merino, MargaritaTomás-Pérez, Thu, 08 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100981 https://www.explorationpub.com/Journals/eaa/Article/100982 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. Short Communication Thu, 15 May 2025 00:00:00 GMT SonilaBorici, BrunildaHyseni, IlirAkshija, Thu, 15 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100982 https://www.explorationpub.com/Journals/eaa/Article/1009121 Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a respiratory illness characterized by chronic eosinophilic airway inflammation. Although a typical clinical history of asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and respiratory reactions to NSAIDs may strongly suggest the diagnosis, history alone is often unreliable due to NSAID avoidance, atypical reactions, or incomplete symptom recognition. In this context, aspirin provocation tests remain the diagnostic gold standard for confirming N-ERD. Beyond diagnostic confirmation, aspirin provocation testing provides critical insights into disease heterogeneity and phenotyping. Different challenge routes—nasal, bronchial, and oral—allow assessment of organ-specific sensitivity and inflammatory dominance. Nasal aspirin provocation primarily reflects upper airway involvement and is particularly informative in patients with severe CRSwNP, whereas inhalational lysine-aspirin challenges highlight lower-airway bronchial hyperresponsiveness. Oral aspirin provocation, through systemic exposure, captures the full spectrum of respiratory and extra-respiratory responses and therefore best reflects global disease severity. The pattern, timing, and intensity of reactions observed during provocation testing contribute to the identification of clinically relevant N-ERD subphenotypes, such as upper-airway-dominant disease, bronchial-predominant disease, or blended reactions involving both compartments. These phenotypic distinctions have direct therapeutic implications, influencing the selection of targeted treatments, including aspirin desensitization, biologic therapies, or surgical interventions. Moreover, provocation testing remains essential prior to aspirin desensitization to ensure both diagnostic accuracy and patient safety. Aspirin provocation tests are not merely confirmatory tools but represent a cornerstone of precision-based evaluation of N-ERD, enabling refined phenotyping, risk stratification, and individualized treatment planning in this complex and heterogeneous disease. Review Tue, 07 Apr 2026 00:00:00 GMT NilayOrak Akbay, Gülfem ElifÇelik, Tue, 07 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009121 https://www.explorationpub.com/Journals/eaa/Article/100983 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. Mini Review Fri, 30 May 2025 00:00:00 GMT Darrell O.Ricke, Fri, 30 May 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100983 https://www.explorationpub.com/Journals/eaa/Article/100984 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. Review Tue, 01 Jul 2025 00:00:00 GMT NadiaMuzaffar, MuhammadBaber, HafizaIqra Malik, Tue, 01 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100984 https://www.explorationpub.com/Journals/eaa/Article/100985 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, PM2.5, 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. Review Thu, 03 Jul 2025 00:00:00 GMT DichapongKanjanawasee, NathachitLimjunyawong, PongsakornTantilipikorn, Thu, 03 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100985 https://www.explorationpub.com/Journals/eaa/Article/100986 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. Perspective Tue, 08 Jul 2025 00:00:00 GMT NhanPham-Thi, PascalDemoly, Tue, 08 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100986 https://www.explorationpub.com/Journals/eaa/Article/100987 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. Mini Review Wed, 23 Jul 2025 00:00:00 GMT LisaVitry, Wed, 23 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100987 https://www.explorationpub.com/Journals/eaa/Article/100988 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. Review Wed, 30 Jul 2025 00:00:00 GMT MalikSallam, HusseinNaji, Amar AlShibli, MohammedSallam, Wed, 30 Jul 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100988 https://www.explorationpub.com/Journals/eaa/Article/100989 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. Case Report Tue, 05 Aug 2025 00:00:00 GMT ShaonieTon-Leclerc, FlorianStehlin, Ana MariaCopaescu, GhislaineIsabwe, Tue, 05 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100989 https://www.explorationpub.com/Journals/eaa/Article/100990 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. Original Article Tue, 19 Aug 2025 00:00:00 GMT ShuichiroMatsumoto, YosukeKamide, NaoyaFujino, MitsuhiroYamada, YoshinaoOno, SeiichiKobayashi, TeruyukiSato, KiyoshiSekiya, TakutoEndo, TsutomuTamada, TomohiroIchikawa, HiroyukiAizawa, HirohitoSano, YorihikoKyogoku, TakuyaSaito, ShuichiKonno, ManamiSuzuki, KojiOkutomo, MasamiTaniguchi, HisatoshiSugiura, Tue, 19 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100990 https://www.explorationpub.com/Journals/eaa/Article/100991 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. Review Thu, 21 Aug 2025 00:00:00 GMT DavidEl-Qutob, MartinMaillo, Thu, 21 Aug 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100991 https://www.explorationpub.com/Journals/eaa/Article/100994 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. Case Report Tue, 14 Oct 2025 00:00:00 GMT Daniela de Abreu e SilvaMartinez, Sérgio DuarteDortas Junior, FabianaChagas da Cruz, GloriaBarreiros, AdrianaCaroli-Bottino, Solange Oliveira RodriguesValle, Priscila NovaesFerraiolo, Tue, 14 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100994 https://www.explorationpub.com/Journals/eaa/Article/100993 Not applicable. Editorial Sat, 11 Oct 2025 00:00:00 GMT MarioDi Gioacchino, LorenzoCosmi, SebastianoGangemi, VincenzoPatella, Giorgio WalterCanonica, Sat, 11 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100993 https://www.explorationpub.com/Journals/eaa/Article/100995 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. Original Article Mon, 20 Oct 2025 00:00:00 GMT Seyed HesamedinNabavizadeh, MozhganMoghtaderi, ZahraKanannejad, KianDarabi, NajmehSepahi, Mon, 20 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100995 https://www.explorationpub.com/Journals/eaa/Article/100996 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. Original Article Thu, 30 Oct 2025 00:00:00 GMT AlessandroCinquantasei, StefanoPalazzo, NadaChaoul, FrancescoRussano, Maria PiaRossi, Lucia AnnaGiliberti, MarcelloAlbanesi, Thu, 30 Oct 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100996 https://www.explorationpub.com/Journals/eaa/Article/100997 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. Original Article Thu, 06 Nov 2025 00:00:00 GMT NayantrishnaNath, RimleeDutta, LalitaMehra, RajniYadav, PrasenjitDas, Thu, 06 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100997 https://www.explorationpub.com/Journals/eaa/Article/100998 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. Review Thu, 13 Nov 2025 00:00:00 GMT AdriannaWierzbicka, AndrewUkleja, Thu, 13 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100998 https://www.explorationpub.com/Journals/eaa/Article/100999 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. Case Report Fri, 14 Nov 2025 00:00:00 GMT Christian PaoloRatti, AlessandraChiei Gallo, FrancescaBarei, PaoloCalzari, Angelo ValerioMarzano, Silvia MarielFerrucci, Fri, 14 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/100999 https://www.explorationpub.com/Journals/eaa/Article/1009100 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. Case Report Fri, 21 Nov 2025 00:00:00 GMT EdytaJura-Szołtys, JoannaGlück, RadosławGawlik, Fri, 21 Nov 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009100 https://www.explorationpub.com/Journals/eaa/Article/1009101 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. Original Article Tue, 02 Dec 2025 00:00:00 GMT VesnaTrajkova, Natasa TeovskaMitrevska, EmekKocatürk, DariaFomina, HristinaBreshkovska, Daniela BuklioskaIlievska, IrenaDimitrovska, Ana RistovskaDimitrovska, IvanaTusheva, SofijaPeshova, Kristina TrpchevaStojkov, Tue, 02 Dec 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009101 https://www.explorationpub.com/Journals/eaa/Article/1009102 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. Commentary Tue, 02 Dec 2025 00:00:00 GMT AlbertoVidal, PedroCortez, Tue, 02 Dec 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009102 https://www.explorationpub.com/Journals/eaa/Article/1009103 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. Review Fri, 12 Dec 2025 00:00:00 GMT Silvina MonicaAlvarez, María EugeniaCiminari, Veronica SilvinaBiaggio, Nidia NoemiGomez, Fri, 12 Dec 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009103 https://www.explorationpub.com/Journals/eaa/Article/1009104 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. Systematic Review Mon, 22 Dec 2025 00:00:00 GMT AlexandruCorlateanu, CristinaToma, Mon, 22 Dec 2025 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009104 https://www.explorationpub.com/Journals/eaa/Article/1009115 Background: Adolescence is a vulnerable and constantly changing stage of life. Experiencing chronic illnesses such as bronchial asthma during this period can lead to heightened physical, psychological, and social problems in addition to the wide scope of challenges that coincide with the stage. The objective of this research was to identify risk and protective factors for mental health disorders, as well as the preventive and treatment strategies recommended to preserve mental health in adolescents with asthma (AA). Methods: A search was conducted in Medline, Web of Science, EBSCO Host, PsycINFO, ScienceDirect, and Scopus for articles published in English between 2020 and 2025 using the following search terms: i) asthma in adolescents and ii) psychosocial or emotional problems. The items were checked using the PRISMA checklist. Results: Thirty-eight articles were found: eight on mental health problems, fourteen on biopsychosocial risk factors, ten on biopsychosocial protection factors, and six on biopsychosocial interventions in AA. Discussion: Internalizing problems such as anxiety and depression, or externalizing problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorders, are prevalent in AA. Several biopsychosocial risk factors, both individual and familial, have been identified as being related to mental health problems in AA. Protective biopsychosocial factors have also been found in AA, such as certain personal characteristics, family types or structures, friends, or schoolmates. Prevention or treatment strategies for mental health problems in AA should consider a personalized approach, taking into account the family system, friendships, and the school environment. Systematic Review Tue, 10 Mar 2026 00:00:00 GMT AlbertoVidal, MarcelaMatamala, Tue, 10 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009115 https://www.explorationpub.com/Journals/eaa/Article/1009105 The symptoms of atopic dermatitis (AD), a chronic, recurrent inflammatory skin condition, include immunological dysregulation, severe pruritus, and malfunctioning of the epidermal barrier. Recent developments in our understanding of AD’s molecular and immunological pathways have shed light on the functions of cytokines, including interleukin (IL)-4, IL-13, IL-31, and IL-22, as well as the impact of genetic mutations in filaggrin and other barrier proteins. Inflammation and barrier dysfunction are further aggravated by microbial dysbiosis, especially colonisation of Staphylococcus aureus. Treatment options include topical corticosteroids, topical calcineurin inhibitors, targeted biologics, and small-molecule inhibitors that alter the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and phosphodiesterase 4 (PDE4) pathways, as well as Mn- and Fe-porphyrin ring-based topical formulations. Even with these advancements, tailored treatment and long-term illness control are still challenging to achieve. New strategies that emphasise gene therapy and microbiome restoration can potentially improve the accuracy and comprehensiveness of AD treatment. Mini Review Thu, 08 Jan 2026 00:00:00 GMT AmritaSahu, RemyaSreedhar, SomasundaramArumugam, Thu, 08 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009105 https://www.explorationpub.com/Journals/eaa/Article/1009106 Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with a prevalence of up to 7.5%. However, accurate diagnosis in primary care remains difficult due to overlapping symptoms with common infant behaviours and limited access to specialist allergy testing. Consequently, CMA is frequently over diagnosed, leading to unnecessary elimination diets, nutritional deficiencies, and increased parental anxiety. This paper introduces the EATERS-X framework, an enhanced, structured approach to obtaining an allergy-focused clinical history (AFCH) that aims to improve diagnostic precision and clinical decision-making in CMA. The tool expands upon the traditional EATERS method—comprising Environment, Allergen, Timing, Exposure, Reproducibility, and Symptoms—by incorporating an additional element, X, denoting treatment and healthcare response. Through clinical scenarios, we demonstrate how EATERS-X can be applied to distinguish between IgE-mediated, non-IgE-mediated, and mixed-type CMA, including subtypes such as food protein-induced enterocolitis syndrome (FPIES). While EATERS-X provides a practical and systematic framework for history-taking, its effectiveness is dependent on clinician training and appropriate clinical interpretation. In addition, the framework has not yet undergone formal validation against gold-standard diagnostic tests such as oral food challenges. Future prospective studies should evaluate the diagnostic reliability, inter-observer consistency, and clinical impact of EATERS-X across different healthcare settings. Integration of the EATERS-X approach in primary care aligns with current BSACI and EAACI guidelines and promotes structured, evidence-based, and patient-centred care. Future research should focus on validating the framework’s diagnostic reliability and exploring its applicability across a wider spectrum of allergic conditions. Commentary Fri, 23 Jan 2026 00:00:00 GMT MelvinLee Qiyu, IsobelRobertson, Ann-MarieO’Neill, Sally-AnnDenton, MinalGandhi, RosanMeyer, MichErlewyn-Lajeunesse, Fri, 23 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009106 https://www.explorationpub.com/Journals/eaa/Article/1009107 There is unequivocal evidence that the climate is changing, and it is generally accepted that the trend will continue. Climate change is relevant to public health, as it can lead to alterations in the distribution and flowering phenology of plants and to changes in pollen exposure, with subsequent impacts on human health. The primary objective of this paper was to provide a quantitative synthesis of the available literature on the evolution of pollen season intensity and timing in plants with a higher allergenic potential. Six botanical families have been studied: Betulaceae (birch, hazel, alder), Cupressaceae, Oleaceae (olive, ash), Poaceae, Urticaceae, and Asteraceae (mugwort, ragweed). Three main indicators of the potential impact of climate change on pollination have been retained: the pollen integral, the start date of the pollen season, and the duration of the pollen season. The outcome is a dominant trend toward earlier and more abundant pollen seasons, particularly for trees that flower in winter and spring. In contrast, trends for grass or weeds that pollinate later are less consistent and often region-specific. The variations recorded are taxon-, site-, and period-dependent, with some species even showing opposing trends within the same botanical family, illustrating the complex interactions between biological adaptation and climatic variability. While the current influence of climate change on pollen production and phenology is well established, the magnitude of its future impact remains uncertain, and the diversity of methodologies and study durations limits the comparability of available data. Nevertheless, most projections support a continued, though possibly attenuated, increase in pollen intensity and season advancement. In any case, when combined with likely qualitative and quantitative changes in the concentration of allergens in pollen grains, the identified trends may already have, and will very likely continue to have, an impact on both allergic sensitizations, the prevalence of seasonal symptoms, and their severity, thus affecting their diagnosis, prevention, and treatment. Review Thu, 29 Jan 2026 00:00:00 GMT Jean-PierreBesancenot, LaurentMascarell, Thu, 29 Jan 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009107 https://www.explorationpub.com/Journals/eaa/Article/1009108 Aim: Woodworking exposes carpenters to a higher risk of developing asthma or worsening pre-existing asthma. The objective of this study was to determine the prevalence of and factors associated with work-related asthma (WRA) among carpenters in Parakou in 2024. Methods: This was a cross-sectional, descriptive, and analytical study with prospective data collection conducted from June to September 2024. Following a voluntary survey, the included carpenters were interviewed using the Occupational Asthma Screening Questionnaire-11 (OASQ-11) to assess the relationship between asthma symptoms and the occupational environment. Peak expiratory flow (PEF) variability and spirometry were also measured. Data were analyzed using R software version 4.4.1. Factors associated with WRA were identified using simple and multiple logistic regression analyses. Results: Out of 153 carpenters/apprentices in 117 workshops, 144 (94.1%) were included, all of whom were male. The mean age was 35.9 ± 12.1 years. Among them, 15 (10.4%) had a WRA profile, including 10 (6.9%; 95% CI: 3.8–12.3) with occupational asthma and 5 (3.5%; 95% CI: 1.5–7.9) with work-aggravated asthma. Asthma was confirmed in 7 of the 15 carpenters suspected of having WRA through PEF variability measurement and spirometry. Simple and multiple logistic regression analyses identified a history of allergic rhinitis (aOR = 3.90; p = 0.033) and urticaria (aOR = 8.21; p = 0.002) as factors significantly associated with WRA. Conclusions: The prevalence of WRA among carpenters in Parakou is not negligible, particularly occupational asthma. Awareness campaigns, education for carpenters, regular monitoring of working conditions, and systematic medical follow-up of exposed workers could help preserve their respiratory health. Original Article Tue, 03 Feb 2026 00:00:00 GMT MarianoEfio, SergeAde, IbrahimMama Cisse, DavidAwonon, Ablo PrudenceWachinou, GildasAgodokpessi, Tue, 03 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009108 https://www.explorationpub.com/Journals/eaa/Article/1009109 Aim: This study aimed to assess the effectiveness of mepolizumab in enhancing asthma control, achieving clinical remission, and alleviating upper airway symptoms in patients with severe eosinophilic asthma (SEA) with comorbid nasal polyps and/or chronic rhinosinusitis (CRS). Additionally, it aimed to identify clinical and laboratory predictors of remission. The findings are based on real-world data from a single center. Methods: This retrospective, single-center, real-world study included 99 patients diagnosed with SEA. Patients were categorized into three groups based on the presence or absence of nasal polyps and CRS. Treatment response was evaluated using the asthma control test (ACT), spirometry, laboratory biomarkers, computed tomography (CT) scores, and nasal polyp scores. Remission was defined as the absence of asthma exacerbations and systemic corticosteroid use, along with improvements in both forced expiratory volume in 1 second (FEV1) and ACT scores. Results: After 12 months of mepolizumab therapy, there were significant improvements in FEV1 values, asthma exacerbation frequency, systemic corticosteroid requirements, and nasal symptom scores. The overall remission rate was 30.6%. Patients with higher baseline FEV1 and no prior exposure to omalizumab were more likely to achieve remission. Conclusions: This real-world evidence suggests that mepolizumab provides meaningful clinical, functional, and radiological improvements in patients with SEA, regardless of comorbid nasal polyps or CRS. Furthermore, the study highlights independent predictors associated with treatment-induced remission in this population. Original Article Tue, 10 Feb 2026 00:00:00 GMT MariyeDoğru, EmelAtayik, AbdulkadirBasturk, Tue, 10 Feb 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009109 https://www.explorationpub.com/Journals/eaa/Article/1009114 Aim: To describe the first major epidemic thunderstorm asthma (ETSA) event detected in France in June 2023. Methods: Data on local meteorology, visits to the emergency room (ER) for asthma and hospitalization after a visit, aerobiological composition of the atmosphere (pollens and spores), phenological information on the flowering of grasses, and regional air pollution were collected, aggregated, and analyzed. Results: The ETSA was centered on the Paris region. An excess of 1,900 emergency visits for asthma was recorded over the period 10, 11, and 12 June. The people most affected were men aged 14 to 44. The hospitalization rate following a visit to the ER for asthma increased to 13%. ER visits for asthma began at around 6 pm on 10 June, just after an intense gust (15 m/s) triggering a PM10 resuspension episode, and peaked at around 10 pm on 11 June. Concentrations of mold spores (Cladosporium and Ascosporium) rose sharply during the night of 10–11 June, at the same time as the intake peak. The ETSA occurred during the grass and Urticaceae pollen season, with pollen concentrations lower (< 100 pollen grains/m3) compared to the days preceding the event (> 200 pollen grains/m3). A fraction of the pollen was observed without cytoplasm, but there was no apparent link with the ETSA. Phenological observations in the Paris pollinarium showed that the ETSA coincided with the start of the Lolium perenne (ryegrass) pollen season. Conclusions: Although the data collected did not allow the identification of a single cause for the occurrence of the ETSA, they pointed to multifactorial causes such as the occurrence of an ozone pollution episode, strong winds before the storm, an episode of resuspension of PM10 particles, the presence of broken pollen, and the significant increase in mold spores just after the stormy episode. Original Article Tue, 03 Mar 2026 00:00:00 GMT NicolasVisez, ValériePontiès, Annie-ClaudePaty, MarcoConte, Clarisse LeGuiff, SaloméPasquet, NajihaAzarkan, MarieChoël, ProsunRoy, AntonioSpanu, RomainCourault, Tue, 03 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009114 https://www.explorationpub.com/Journals/eaa/Article/1009111 This review describes the eosinophil journey through the various physiological and pathophysiological phases, from production, maturation, and activation by chemokines and cytokines [especially eotaxin, interleukin (IL)-5, IL-3, and granulocyte-macrophage colony-stimulating factor (GM-CSF)], to interaction with the innate and adaptive immune system and tissue homing. Excessive production and activation of eosinophils lead to the release of granule proteins, such as major basic protein, eosinophil cationic protein, eosinophil peroxidase, and others, resulting in inflammation, cell cytotoxicity, and oxidative stress. The pathogenesis, clinical features, diagnostic processes, and the latest therapeutic approaches to the resulting diseases—which affect the upper and lower airways, gastrointestinal tract, skin, myocardium, and may occur systemically—are discussed. Review Tue, 03 Mar 2026 00:00:00 GMT MarioDi Gioacchino, DiegoBagnasco, FulvioBraido, FedericaButa, PasqualeCaponnetto, Roberto GiovanniCarbone, MarioCazzola, Willem van deVeen, Camilla DeVitis, LinhongDeng, Nelson RosarioFilho, Eva RebeloGomes, GiuseppeGuida, DichapongKanjanawasee, NathachitLimjunyawong, MauroManiscalco, MárioMorais-Almeida, GiuseppeMurdaca, JayoungOh, GiovanniPaoletti, VincenzoPatella, Ana MargaridaPereira, Graziella ChiaraPrezzavento, FrancescoPuppo, Chae-SeoRhee, ErminiaRidolo, MatijaRijavec, NikolettaRovina, FranziskaRoth-Walter, PongsakornTantilipikorn, ArzuYorgancıoğlu, Garry MichaelWalsh, TorstenZuberbier, Giorgio WalterCanonica, Tue, 03 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009111 https://www.explorationpub.com/Journals/eaa/Article/1009112 Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus that has emerged as a major cause of esophageal dysfunction in all ages. Over the past two decades, its frequency has increased worldwide, reflecting both heightened recognition and a rise in occurrence. EoE predominantly affects males and frequently coexists with atopic conditions, underscoring its relationship with allergy. The pathogenesis involves genetic susceptibility, epithelial barrier dysfunction, and dysregulated type 2 immune responses. Variants in genes related to epithelial integrity and immune signaling, such as TSLP and CAPN14, predispose susceptible individuals to aberrant immune responses to food antigens, leading to eosinophil recruitment, mast cell activation, and chronic inflammation, which in turn promotes tissue remodeling and progression toward fibrostenotic disease. Clinical presentation varies with age. Infants and younger children often exhibit feeding difficulties, vomiting, and abdominal pain, whereas older children and adolescents usually present with dysphagia and food impaction. Diagnosis requires integration of clinical symptoms with histologic confirmation of esophageal eosinophilia (≥ 15 eosinophils per high-power field) and exclusion of alternative causes. Management of pediatric EoE aims to achieve and maintain clinical and histologic remission while preventing long-term complications and preserving quality of life. First-line therapeutic options include proton pump inhibitors, swallowed topical corticosteroids, and dietary elimination strategies. Biologic therapy has expanded treatment options for severe or refractory disease. Because symptom improvement alone does not reliably reflect disease control, objective reassessment with endoscopy and biopsies is recommended after treatment and during follow-up. Long-term outcomes of EoE are strongly influenced by diagnostic timing and adequacy of treatment. Early diagnosis, sustained anti-inflammatory therapy, and transition from pediatric to adult care are critical components of an appropriate management. Future directions include the development of precision medicine, identification of biomarkers to guide therapy selection, non-invasive tools for disease monitoring, and strategies aimed at disease modification. Review Tue, 03 Mar 2026 00:00:00 GMT AlbertoRavelli, Tue, 03 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009112 https://www.explorationpub.com/Journals/eaa/Article/1009113 Scombroid syndrome is a frequent cause of fish poisoning and typically presents with mild, self-limiting symptoms. Severe anaphylaxis-like reactions are uncommon, and a biphasic clinical course has not previously been reported. We describe the case of a 19-year-old woman who developed flushing, headache, generalized urticaria, facial edema, dyspnea, and hypotension approximately 30 minutes after ingesting raw amberjack tartare. Emergency treatment with adrenaline, antihistamines, corticosteroids, and intravenous fluids led to initial clinical improvement; however, three hours later, she experienced a recurrence of cutaneous, respiratory, and gastrointestinal symptoms, consistent with a biphasic reaction. The patient subsequently developed chest pain associated with transient electrocardiographic changes and mild troponin elevation, prompting further evaluation for suspected Kounis syndrome. Allergy assessment, including specific IgE testing and skin-prick testing with fresh fish, was negative, supporting a toxic rather than IgE-mediated mechanism. This case expands the clinical spectrum of scombroid syndrome by documenting a biphasic anaphylaxis-like presentation and underscores the importance of considering histamine fish poisoning in the differential diagnosis of severe food-related reactions. Careful evaluation is essential to prevent misdiagnosis and unnecessary long-term dietary restrictions. Case Report Tue, 03 Mar 2026 00:00:00 GMT Christian P.Ratti, MatteoCavara, AliceBotta, AlessandraChiei Gallo, EleonoraBono, LeaCaron, Valeria G.R.Ortolani, EnricoIemoli, Tue, 03 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009113 https://www.explorationpub.com/Journals/eaa/Article/1009110 Peanut allergy (PA) is a significant public health problem in Western countries; however, while some previous work has been conducted in Mexico among specific subgroups, the national prevalence of PA in the Mexican population remains unknown. This ENRADAL-MEX study aimed to estimate the prevalence of PA among Mexican schoolchildren. A total of 4,269 children aged 6–12 years were included (mean age: 8.7 years; 51.7% male). The national prevalence of adverse food reactions was 9.5%; among these, 16 cases (0.37%) were associated with peanut consumption, but only 11 presented symptoms within the first hour after ingestion, yielding a PA prevalence of 0.26% (95% CI: 0.14–0.47%). Five cases corresponded to convincing non-severe reactions, and the other five to convincing severe reactions (prevalence of 0.12%; 95% CI: 0.06–0.28%, each). Oral symptoms occurred in 54.5% of cases, and 63.6% also had tree nut allergy, with no reactions to other legumes. Since this national study is the first of its kind and indicates that PA is not currently a public health problem among Mexican schoolchildren, further research is encouraged for more comprehensive results. Short Communication Mon, 02 Mar 2026 00:00:00 GMT MartínBedolla-Barajas, Ma. Gracia BelindaGuerrero-Núñez, Blanca MaríaMorfin-Maciel, German AgustínRico-Solís, JavierDomínguez-Morales, AlejandroGarcía-Aguirre, MartínRamírez-Soto, Edna AraceliSantos-Valencia, DanielaRivero-Yeverino, SandraChávez-González, Ileana MaríaMadrigal-Beas, JaimeMorales-Romero, Mon, 02 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009110 https://www.explorationpub.com/Journals/eaa/Article/1009117 APPaRENT2 was a multi-country, cross-sectional, online survey of patients with asthma and physicians conducted in five countries (Argentina, Brazil, France, Mexico, and Italy), aimed at assessing physicians’ and patients’ preferred treatment strategies and goals. Education level, age, and place of residence differed between European and Latin American patients; furthermore, most Italian doctors worked within the Public Health Service. For the purpose of identifying the critical issues in the management of asthma in Italy, the data were analysed in greater detail, comparing those collected in Italy with those from Latin American countries and those provided by Italian patients and doctors. The data are reported as frequencies or means. The differences found in comparing data were not analysed for statistical significance, given the absence of any a priori hypothesis in the original paper. The Italian results were consistently within the range of the Latin American countries’ results. In Italy, despite the physicians’ prioritization of symptom control, many patients had poor asthma control but gave a surprisingly optimistic evaluation of their disease, given the high frequency of symptoms and limitations in everyday life. Physicians and patients had quite different evaluations of symptoms and outcomes of asthma. Finally, the combination of ICS/LABA with SABA as needed was the preferred treatment compared with the maintenance and reliever therapy (MART) strategy, suggested as preferential in the Global Initiative for Asthma (GINA) document. In conclusion, the absence of shared assessments and expectations between doctors and patients appears to be the primary issue to address in order to improve asthma treatment in Italy. Commentary Thu, 12 Mar 2026 00:00:00 GMT RiccardoPistelli, DeborahVannucci, FabioArpinelli, CorradoD’Andria, Giorgio WalterCanonica, Thu, 12 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009117 https://www.explorationpub.com/Journals/eaa/Article/1009116 Allergic conjunctivitis (AC) is an inflammatory disorder of the ocular surface caused by allergic reactions to environmental substances. It presents with symptoms such as itching, redness of the eye, excessive tearing, and swelling/irritation in the eyes and eyelids. While many AC episodes occur on their own and go away, some forms of this disease are present in a chronic fashion or have the potential to cause serious loss of vision. In recent years, AC has been viewed as primarily an episodic irritative condition to a mucosal inflammatory condition in which the ocular surface provides an environment for the initiation and perpetuation of local immune responses. The molecular basis of AC represents a phase-linked inflammatory cascade: an immediate (minutes) mediator-driven response followed by a late (6–12 hours) cytokine/chemokine-driven cellular recruitment phase that can sustain symptoms and, in severe phenotypes, contribute to tissue remodeling. The initial response is due to the activation of mast cells via IgE-dependent pathways, producing the early phase response. The sustained response seen in the late phase of the disease is mediated by the action of lipid mediators and cytokines/chemokines involved in the recruitment of eosinophils and Th2-associated leukocytes. This narrative review synthesizes evidence on epithelial “alarmins” (TSLP, IL-33, IL-25) as upstream signals that may amplify type-2 inflammation in a phenotype-dependent manner, particularly in more severe or chronic disease, alongside established IgE/mast-cell biology. Further, we discuss neuroimmune mechanisms implicated in histamine-independent itch and symptom persistence, while noting that their clinical contribution likely varies across AC phenotypes. Finally, we will discuss how the mechanistic pathways relate to current limitations and to developing new therapeutic approaches. Review Tue, 10 Mar 2026 00:00:00 GMT TanmaySinghal, AlexJemelian, HarleenMaitla, JeraldjonJianoran, VikrantRai, Tue, 10 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009116 https://www.explorationpub.com/Journals/eaa/Article/1009118 The composition and biophysical characteristics of the plasma membrane are pivotal in regulating mast cell immune functions by influencing receptor distribution, activation, and intracellular signaling pathways. This article highlights the impact of plasma membrane components, such as cholesterol and lipid rafts, on the function of the Mas-related G protein-coupled receptor X2 (MRGPRX2), a key mediator of IgE-independent mast cell activation and pseudoallergic reactions. We discuss how variations in membrane fluidity, lipid composition, and microdomain organization influence MRGPRX2 conformational dynamics, ligand accessibility, and downstream signaling efficiency. These membrane-driven effects may help explain the heterogeneity of mast cell responsiveness across tissues and disease states. Integrating insights from structural biology, biophysics, and clinical immunology emphasizes that plasma membrane composition and dynamics regulate MRGPRX2-mediated signaling, positioning the membrane environment as a promising therapeutic target for modulating mast-cell hyperreactivity. By outlining this conceptual framework, we introduce a unifying hypothesis that membrane-driven regulation is a critical, yet underrecognized, determinant of MRGPRX2 responsiveness in different tissues and disease states. Commentary Mon, 23 Mar 2026 00:00:00 GMT LironLerner, MagdaBabina, TorstenZuberbier, KatarinaStevanovic, Mon, 23 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009118 https://www.explorationpub.com/Journals/eaa/Article/1009119 Climate change is reshaping the aeroallergen landscape, with rising temperatures, elevated CO2, shifting precipitation, and land-use change extending pollen seasons, increasing pollen loads and allergenicity, and expanding the geographic range of allergenic plants. These changes are accompanied by escalating air pollution from fossil fuel combustion and wildfires that act as an adjuvant with co-exposure with allergen exacerbate allergic airway disease. Vulnerable populations—particularly those in socioeconomically disadvantaged and marginalized communities in the US—experience disproportionate exposure to pollutants and allergens due to structural inequities that result in some populations being exposed to more environmental hazards than other groups. Climate-amplified aeroallergen exposure and air pollution are associated with higher sensitization, symptom burden, exacerbations, and healthcare use. Structural inequities magnify exposures to allergens and air pollution, while also influencing the social environment through concentration of poverty and diminished access to resources. This review synthesizes evidence linking climate change-related effects on aeroallergens and air pollution with allergic disease risk and the modification of this relationship by social vulnerability, with a focus on Europe and North America. We also highlight established and emerging strategies to mitigate the effects of climate change on allergic disease prevalence and morbidity, including anticipatory guidance, digital forecasting, community adaptation measures, and local, regional, and national policies that promote responsible land use, healthy housing, and equity-focused public health initiatives. Review Fri, 27 Mar 2026 00:00:00 GMT Matthew C.Bell, Collette M.Tilly, Allison J.Burbank, Fri, 27 Mar 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009119 https://www.explorationpub.com/Journals/eaa/Article/1009120 Occupational allergens are an important cause of diseases emerging in the workplace, both indoor and outdoor, causing conditions such as allergic asthma, dermatitis, and rhinitis. Numerous national and international institutions focus on sensitizing agents able to induce allergies in workplaces, which are also considered by the International Classification of Diseases (ICD)-11, underlining their increasing worldwide importance. There is thus the need to develop and implement new, multidisciplinary approaches to study and monitor these agents, taking into account different sources of exposure, environmental concentrations, co-factors of exposure, and individual susceptibility. This includes the integration between traditional and innovative methodologies applied to environmental and biological matrices, as well as the use of “omic” techniques. In this picture, information, training, and communication emerge as fundamental for workers. This kind of approach will permit us to attain a better management of exposure to allergens in the workplace, improving the well-being of workers worldwide. Short Communication Wed, 01 Apr 2026 00:00:00 GMT Maria ConcettaD’Ovidio, PasqualeCapone, DanielaPigini, AndreaLancia, LorenzoCecchi, IsabellaAnnesi-Maesano, GennaroD’Amato, Wed, 01 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009120 https://www.explorationpub.com/Journals/eaa/Article/1009124 Obesity is a determinant of the risk of developing various diseases, including asthma. It can also contribute to asthma severity. Obvious determinants of the risk of developing obesity and conditions associated with obesity are the diet an individual consumes and their energy expenditure, as determined by activity. Therefore, diet and exercise are important non-pharmacological components in the management and prevention of many diseases. Several individual elements in diet, including certain fatty acids and vitamins, as well as types of diets, notably the Mediterranean diet, have been studied in asthmatic patients, but the literature is not consistent. This review explores the relationship between asthma and obesity, exercise, and multiple dietary components and regimens, including the Mediterranean diet; polyunsaturated fats; vitamins A, C, D, and E; flavonoids; probiotics; and sodium intake in the published randomized clinical trials. Overall, the data have many shortcomings, but there is no single component of diet that is consistently associated with improved asthma outcomes, nor any component found to be clearly harmful. However, a diet that helps an individual lose weight may indirectly improve their lung function and asthma control, even if the diet itself does not impact asthma outcomes. Exercise, now known to be safe and widely recommended in asthma, has various forms. This review looked at meta-analyses, as well as recently published data addressing this question, categorizing exercise as aerobic activity, pulmonary rehabilitation, and yoga. The most evidence for benefit is for aerobic exercise, but yoga also has potential for modest improvement in asthma symptoms. There is conflicting data as to whether supervised exercise programs are superior to unsupervised physical activity. Overall, exercise is helpful in asthma, but it is still unclear how much exercise should be done, and this should be tailored to each individual. Review Tue, 21 Apr 2026 00:00:00 GMT AmandaStanton, Stephen K.Field, Tue, 21 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009124 https://www.explorationpub.com/Journals/eaa/Article/1009122 Aim: Dysfunctional breathing (DB) is a common comorbidity in asthma, yet its objective characterisation remains challenging due to reliance on subjective questionnaires. This study aimed to determine whether quantifiable breathing pattern parameters can be used to characterise asthma patients with perceived DB from those without DB. Methods: This observational cross-sectional study involved 122 adults with physician-diagnosed asthma (GINA Steps 2–5). Participants completed the Nijmegen Questionnaire (NQ) to determine DB (NQ > 23) or non-DB (NDB). Resting breathing was recorded for 5 minutes using structured light plethysmography (SLP), a contactless optical motion-analysis system that quantifies thoracoabdominal displacement. Extracted parameters included respiratory rate (RR), inspiration time (Ti), expiration time (Te), Ti/total breath cycle duration (Ttot), and the ratio of ribcage to abdominal displacement during the inspiration phase (RCampinsp/ABampinsp). Both absolute values and within-subject variability [coefficient of variation expressed in percentage (CoV%)] were estimated. Between-group comparisons used Mann-Whitney U tests. Two binary logistic regression models evaluated the predictive value of mean parameters and their variability for characterising DB. Results: Of the 122 participants, 38 asthmatic patients were determined with DB. The DB group showed significantly higher RR and lower Ti and Te, but no differences in Ti/Ttot or RCampinsp/ABampinsp. In contrast, within-subject variability across all parameters was significantly greater in the DB group. The regression model using absolute values showed limited predictive power (R2 = 0.251). The model incorporating variability demonstrated substantially improved predictive power (R2 = 0.540), with CoV% RR, Te, Ti/Ttot, and RCampinsp/ABampinsp emerging as significant predictors. Conclusions: Asthma patients with DB exhibit breathing-pattern alterations, most notably increased within-subject variability of timing and TA movement parameters. Breathing pattern variability may be a promising surrogate marker to characterise DB, highlighting the value of dynamic objective physiological assessment of breathing beyond conventional symptom-based assessments of DB. Original Article Fri, 17 Apr 2026 00:00:00 GMT PanagiotisSakkatos, Fri, 17 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009122 https://www.explorationpub.com/Journals/eaa/Article/1009123 Pollen-related allergic diseases, including allergic rhinoconjunctivitis and asthma, affect a growing proportion of the population and have substantial consequences for quality of life and healthcare systems. Conventional pollen forecasts, which rely on fixed pollen traps and meteorological data, are limited in spatial granularity, real-time responsiveness, and individual relevance. Recent advances in artificial intelligence (AI) and machine learning (ML) offer a paradigm shift in the modelling of pollen release, forecast exposure, and alert allergic patients. This article provides a comprehensive overview of ML-based pollen forecasting systems, clarifying their underlying principles in accessible terms for clinicians and presenting practical and published tools that allergologists can integrate into routine practice. By combining aerobiological data, meteorological models, and patient-reported outcomes, ML enables more personalized, precise, and timely allergy management. We review the fundamental mechanisms of pollen release and dispersion and illustrate how ML models can improve predictive accuracy. Key platforms are compared in terms of clinical usability. We present real-world use cases showing how ML-driven alerts can help optimize treatment plans and support patient education. Practical insights are provided on the evaluation, implementation, and limitations of these tools. ML is not a distant technology—it is already transforming pollen forecasting and allergy alerts. This article aims to equip allergologists with the knowledge needed to evaluate and adopt these tools, enabling a more proactive and personalized approach to managing pollen allergies. Review Tue, 21 Apr 2026 00:00:00 GMT JeremyCorriger, MarcinTrzmielewski, PhilippeAuriol, JulietteCharpy, NathanDe Morais, JulienBonnac, NicolasVisez, YannickChantran, Jeroen-TitusButers, IsabellaAnnesi-Maesano, JulienGoret, Tue, 21 Apr 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009123 https://www.explorationpub.com/Journals/eaa/Article/1009125 Netherton syndrome (NS) is a rare autosomal recessive disorder caused by SPINK5 mutations, leading to impaired skin barrier function and severe atopic manifestations. Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is a rare autosomal dominant disorder characterised by recurrent bradykinin-mediated angioedema. Their coexistence has not previously been reported, and evidence on combined biologic therapy is lacking. We report a 30-year-old woman with confirmed NS and long-standing HAE-C1-INH presenting with severe pruritus, xerosis, widespread eczema, elevated IgE, eosinophilia, and trichorrhexis invaginata. Dupilumab was initiated to target T helper (Th)2-mediated inflammation. Due to persistent angioedema attacks despite prior prophylaxis, lanadelumab was introduced. Dupilumab improved eczema severity, hyperkeratosis, and hair abnormalities over 13 months. Lanadelumab reduced angioedema attacks by 88.50%, allowing dose spacing while maintaining disease control. No adverse effects or drug interactions were observed. This is the first reported case of NS and HAE-C1-INH successfully treated with dual biologic therapy. Targeting distinct immunological pathways simultaneously may represent an effective and safe strategy for complex rare disease phenotypes. Case Report Fri, 08 May 2026 00:00:00 GMT Mario BrunoGuanti, SilvioSartorio, MarcoRivi, AndreaZanichelli, Fri, 08 May 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009125 https://www.explorationpub.com/Journals/eaa/Article/1009126 Aim: This study aimed to assess the prevalence and patterns of aeroallergen sensitisation in steroid-naïve, newly diagnosed adult patients with bronchial asthma using skin prick test (SPT), and to examine its association with lung function parameters measured by oscillometry and spirometry. Methods: Consecutive adult patients with bronchial asthma who were naïve to systemic and inhaled corticosteroids were recruited. Following a detailed clinical history and blood investigations, lung function was assessed using oscillometry and spirometry. SPT was performed using a panel of 13 aeroallergens in accordance with established guidelines. Based on SPT results, patients were stratified into two groups: atopic asthma (sensitisation to ≥ 1 allergen) and non-atopic asthma (no sensitisation). Demographic characteristics, blood parameters, and lung function parameters were compared between the two groups. Results: Of 257 patients screened, 205 were enrolled (59% men; mean age 36.9 years). Allergic rhinitis was present in 58% of patients, and 69.8% had atopic asthma (95% CI 62.9–75.6). Sensitisation was most common to house dust mites (47.8%), followed by cockroach (37.6%) and weed pollen (29.8%). Atopy was more prevalent in men than in women and was associated with higher serum total IgE levels. Peripheral blood eosinophil counts, oscillometric parameters, severity of airflow obstruction, and bronchodilator responses did not differ significantly between atopic and non-atopic patients. Conclusions: The majority of asthma patients exhibited sensitisation to one or more aeroallergens. Despite differences in immunopathogenesis, no significant differences in oscillometric parameters were observed between atopic and non-atopic asthma, suggesting that atopic status has a limited influence on the severity of small airway dysfunction. Original Article Fri, 15 May 2026 00:00:00 GMT SajalDe, AditiMaheshwari, Fri, 15 May 2026 00:00:00 GMT https://www.explorationpub.com/Journals/eaa/Article/1009126