Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)

Piggott T, Saadat P, Herrmann A et al.  Ann Intern Med. 2026 May 12. doi: 10.7326/ANNALS-25-04761. Epub ahead of print.

Abstract

GRADE framework for integrating planetary health in health guidelines.

Human health and natural systems are intrinsically linked—stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap.

Actual use of PROMs in asthma and rhinitis recommended by guidelines in clinical settings: PROMUSE respiratory study

Cherrez-Ojeda I, Bousquet J, Zuberbier T et al.   Front Allergy. 2026 Apr 24;7:1666241. doi: 10.3389/falgy.2026.1666241. 

Abstract

Rationale: Guidelines advise for the implementation of patient-reported outcomes (PROMs) to provide crucial insights into patients' perceptions of their disease burden, treatment needs, and quality of life. Despite their proven benefits in managing chronic respiratory diseases like asthma, allergic rhinitis (AR), and rhinosinusitis (RS), there is limited data on their adoption among physicians treating these conditions.

Objectives: Our objective is to identify the utilization patterns of PROMs, together with the reasons for their usage and the barriers to their adoption among practitioners managing patients with asthma, AR, and RS.

Methods: This was a cross-sectional observational study using a questionnaire encompassing all pertinent PROMs and disseminated to practitioners associated with the ARIA, UCARE, ADCARE, and ACARE networks. Individuals unfamiliar with PROMS or lacking prior experience with it were eliminated. Descriptive and analytical data were utilized, categorized by the frequency and type of PROMs applied. Stata 18.0 was utilized, with p < 0.05 indicating statistical significance.

Frequency of use of specific PROMs across asthma,
allergic rhinitis, and chronic rhinosinusitis

Results: A total of 439 practitioners participated, with PROMs predominantly utilized by physicians certified for over 30 years and by respiratory specialists (16.67% and 12.46%, respectively; p < 0.05). Pulmonologists exhibited the greatest utilization of asthma PROMs at 86%, while allergists predominantly employed AR and RS PROMs at 38.42% and 33.33%, respectively (p < 0.001). ACT (66.74%), RCAT (27.79%), and SNOTT22 (15.26%) were the predominant PROMs utilized primarily for asthma (79.19%), AR (51.23%), and RS (57.26%), respectively (p < 0.001). The foremost purposes for their application were disease control monitoring (93.39%) and evaluation of performance of therapy approaches (90.2%). The most significant barrier identified was time constraint, rated at 75.40% (p > 0.05 across all groups).

Conclusions: The use of PROMs is suboptimal, primarily due to time limitations. It is imperative that methods be swiftly implemented to include these techniques into the therapeutic environment to attain enhanced outcomes.

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Broad-Spectrum Grass Pollen Immunotherapy: Revisiting the Role of Species Diversity in Allergy Treatment

Feindor, M., Hewings, S., Goodman, J. et al. Curr Treat Options Allergy 13, 4 (2026). https://doi.org/10.1007/s40521-026-00412-8

Abstract

Purpose of Review

This review examines whether allergen immunotherapy (AIT) for grass pollen allergy should expand beyond the recent trend towards a mono-species approach based on Phleum pratense. It explores whether multi-species formulations better reflect natural exposure and could improve clinical outcomes.

Recent Findings

Group 5 homologues identified in individual extracts and a mixed
extract of 13 species of Poaceae family grasses, using a
monoclonal antibody

Research from aerobiology and immunology shows that grass pollen exposure involves diverse species with distinct flowering periods, influenced by climate and geography. Molecular analyses reveal species-specific allergen profiles, including unique peptides and variations in major allergens such as Group 1 and 5.https://media.springernature.com/w120/springer-static/cover-hires/journal/40521?as=webp

The era of advanced therapeutics for pediatric atopic dermatitis – can early systemic intervention reduce the type 2 inflammatory response and modify the atopic march?

Vroman F, de Graaf M.  Curr Opin Pediatr. 2026 May 7. doi: 10.1097/MOP.0000000000001576. 

Abstract

Purpose of review 

This figure demonstrateds the concept of disease modification
in pediatric atopic dermatitis showing the window of opportunity for
early systemic intervention to modify/attenuate the atopic march.

The recent development of advanced systemic treatment options for pediatric atopic dermatitis (AD) means that achieving long-term, off-therapy remission, so-called disease modification, has become a subject of discussion. Emerging evidence suggests that early intervention during a potential ‘window of opportunity’ could alter the natural course of AD. If such a window could be identified, early and targeted treatment might induce long-term disease remission and might reduce the risk of the development of highly burdensome atopic comorbidities.

Recent findings 

Among currently available therapies, dupilumab, targeting interleukin (IL)-4 and IL-13 signaling, provides the most compelling evidence for potential disease modification.

Extracellular Vesicles in Allergy: From Cellular Communication to Clinical Implications

Sysak, A., Górska, S.  Clinic Rev Allerg Immunol 69, 38 (2026). https://doi.org/10.1007/s12016-026-09161-7

Abstract

Extracellular vesicles (EVs) are lipid bilayer-enclosed particles released by both eukaryotic and prokaryotic cells and represent an evolutionarily conserved system of intercellular communication. By transporting bioactive cargo, including proteins, lipids, microRNAs, EVs enable the transfer of molecular signals between cells, thereby regulating immune homeostasis and inflammatory responses. In allergic diseases, EVs have emerged as key mediators linking epithelial barriers, immune cells, and the microbiome. EVs derived from epithelial, immune, and microbiota-associated cells may contribute to the initiation, amplification, and persistence of allergic inflammation by modulating barrier integrity, immune cell polarization, and cytokine signaling pathways.

EVs derived from asthmatic patients contribute
to the progression of the disease.

Disease-specific alterations in EV cargo reflect underlying pathogenic mechanisms, positioning EVs as promising non-invasive biomarkers for disease diagnosis, stratification, and monitoring.

Trace Elements in Allergy: Narrative Review

M.Ordak, M.Zemelka-Wiacek, A.Kosowska, et al., Allergy (2026): 1–18, https://doi.org/10.1111/all.70383.

ABSTRACT

Conceptual overview of major mechanistic pathways
linking trace elements to allergic diseases.

Allergic diseases are increasing worldwide and reflect a complex interplay between genetic susceptibility and environmental exposures. Among environmental determinants, trace elements contribute to epithelial barrier dysfunction, tissue remodeling, redox homeostasis, and immune regulation and may influence the development and severity of allergic diseases. This narrative review summarizes current mechanistic, epidemiological, and clinical evidence on the role of essential and non-essential trace elements in allergy.

Effects of pre- and postnatal probiotic and ω-3 fatty acid supplementation on cytokine and chemokine responses to allergens and TLR ligands during infancy

Fontes-Oliveira, C.C., Nylén, A., Ljung, J. et al.  Allergy Asthma Clin Immunol 22, 27 (2026). https://doi.org/10.1186/s13223-026-01036-y

Abstract

Background

Reduced intensity and diversity of microbial stimulation and decreased intake of anti-inflammatory ω-3 polyunsaturated fatty acids (PUFAs) in Western diets may contribute to impaired postnatal immune development and increased allergy risk. Here, we hypothesize that early supplementation with probiotics and ω-3 PUFAs, starting during pregnancy and continuing during infancy, may promote appropriate immune maturation and thereby potentially prevent allergy development.

Methods

Schematic overview of the PROOM-3 study
(PRObiotics and OMega-3, ClinicalTrials.gov-ID: NCT01542970)

In this study, 117 mother‒baby pairs were randomized into four groups receiving the following supplements: Limosilactobacillus reuteri (L. reuteri), ω-3 PUFA, double supplementation, or placebo. Supplementation started from gestational week 20 until 3 months of age (3 mo) for ω-3 PUFA and continued until 12 mo for L. reuteri. Peripheral blood mononuclear cells (PBMCs) from infants were isolated at birth and at 6, 12, and 24 mo, and stimulated ex vivo with several allergens and ligands of Toll-like receptors (TLRs).

Allergic rhinitis in Latin America: knowledge, attitudes, and clinical practices of specialists in allergy and clinical immunology— CAPRA-SLAAI study

Kuschnir, F , Mérida-Palacio, J , Arruda-Chaves, E et al. Allergologia Et Immunopathologia, 54(3), 141-154. https://doi.org/10.15586/aei.v54i3.1659

Abstract

Allergic rhinitis (AR) is highly prevalent in Latin America (LA), impairing quality of life and often coexisting with asthma. In spite of dissemination of international guidelines, regional differences in diagnosis and management persist. The “Conductas, Actitudes y Prácticas de la Sociedad Latinoamericana de Alergia e Inmunología” (CAPRA–SLAAI) study aimed to assess the knowledge, attitudes, and practices on AR of allergists and clinical immunologists affiliated with SLAAI. Between November 2022 and March 2023, a standardized ARIA-adapted questionnaire (validated in Spanish/Portuguese) was distributed online to specialists from 24 countries; 784 were eligible for analysis. Nearly three-quarters were from Brazil (49.7%) and Mexico (25.8%), with a mean age of 50 years. Awareness of ARIA guidelines was almost universal; however, only 41% knew the MASK-air® digital tool, and fewer than 12% reported regular use, with low uptake in Brazil. 

Multivariate analysis of the main knowledge about ARIA guidelines/mask-air according to the study groups

Brazilian (BR) specialists more often reported extra-nasal symptoms and greater impact on daily activities, suggesting differences in presentation or reporting.