Optimising allergic rhinitis management in primary care using the respiratory allergy optimiser: results from the AERO study

van Geer-Postmus, I., Ryan, D., Arling, C. et al.  npj Prim. Care Respir. Med. (2026). https://doi.org/10.1038/s41533-026-00551-0

Abstract

Digital tools may support healthcare professionals in providing guideline-directed management for patients with allergic rhinitis (AR). This study aimed to develop and implement the Respiratory Allergy Optimiser, a digital decision-support tool aligned with AR guideline recommendations, and evaluate its effect on symptom severity in primary care. The AERO study was an interventional study conducted in 11 general practices in the Netherlands (August-November 2025). Adult patients with a diagnosis of AR and/or allergic conjunctivitis and/or prescribed AR medication (past three years) were eligible. The Respiratory Allergy Optimiser assessed symptom severity using a visual analogue scale (VAS, 0–100 mm) and collected information on patient and disease characteristics, symptoms, medication use, adherence, and nasal spray technique.

CD4 CTLs in supercentenarians: Signs of adaptive expansion in healthy aging

Hashimoto K, Kojima-Ishiyama M, Inokuchi H et al. Cell Reports, 2026; 0

Highlights

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CD4 CTLs expand around age 100 without signs of exhaustion

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A CD27−CD28+ state marks the intermediate helper-to-killer transition

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Large private CD4 CTL clones suggest repeated antigen exposure

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Single clones diversify cytokine profiles after ex vivo stimulation

Summary

Graphical Abstract

Our previous study identified CD4 cytotoxic T lymphocytes (CD4 CTLs) as a hallmark of supercentenarians. CD4 CTLs have primarily been studied in disease contexts; however, their role in healthy aging remains unclear. Using single-cell immune profiling, we analyzed T cells from supercentenarians and found that CD4 CTLs begin to expand around the age of 100, characterized by sequential CD27/CD28 loss without exhaustion.

ARIA-EAACI 2025: Person-Centred, Digitally Enabled and Artificial Intelligence-Assisted Change Management in Airway Diseases

J. Bousquet, B. Sousa-Pinto, M. H. Shamji, et al. Clinical and Translational Allergy (2026): e70192, https://doi.org/10.1002/clt2.70192.

ABSTRACT

Person-centred, digitally enabled, AI-assisted care
pathways based on ARIA-EAACI guidelines
using MASK-air as a common tool:
 OECD Best Practice. AI, artificial intelligence;
AIT, allergen immunotherapy;
IPCRG, International Primary Care Respiratory Group;
IPF, International Pharmacist Federation;
OTC, over-the-counter.

Allergic Rhinitis and its Impact on Asthma (ARIA) was, up until 2017, a guideline using the best evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) and developed as a change management strategy. A second change management strategy—in collaboration with the European Academy of Allergy and Clinical Immunology (ARIA-EAACI)—was developed as a person-centred, digitally enabled, artificial intelligence-assisted care (person-centred care) with strong political involvement. The digital tools of ARIA are mainly based on MASK-air, an Organisation for Economic Co-operation and Development (OECD) Best Practice for integrated care for chronic diseases.

Maternal influences on infant gut microbiome and health

Sinha, T., Brushett, S., Fernández-Pato, A. et al.  Nature (2026). https://doi.org/10.1038/s41586-026-10922-9

Abstract

Mother-to-infant gut microbial transmission.

The establishment of the infant gut microbiome is critical for later health, yet how it is shaped by maternal and early-life factors remains unclear. Here we metagenomically sequenced 4,526 longitudinal faecal samples from 714 mother–infant pairs in the Dutch birth cohort Lifelines NEXT, spanning 12 weeks of pregnancy to 1 year postpartum. We integrated these data with 474 clinical and exposure variables, and with ultra-deep sequencing of breast milk and vaginal microbiomes. We observe that the maternal gut microbiome undergoes only subtle changes during pregnancy and postpartum, influenced by diet, infections and pre-pregnancy smoking.

Early and longitudinal response to sublingual immunotherapy across pediatric allergic multimorbidity patterns: A 3-year real-world cohort study

Gonzalez-Uribe V, Prieto-Gomez J, Moreno-Castro S et al.  Pediatr Allergy Immunol. 2026 Aug;37(8):e70462. doi: 10.1111/pai.70462. 

Abstract

Background

The timing of clinically meaningful benefit after pediatric sublingual immunotherapy (SLIT) across allergic multimorbidity patterns remains uncertain. We evaluated early and longitudinal response to SLIT in routine care.

Methods

This retrospective longitudinal cohort included patients aged 3–17 years who received individualized liquid‐drop SLIT and met prespecified adherence and treatment‐persistence criteria. Assessments were performed at baseline and months 6, 12, 18, 24, and 36. The primary outcome was achievement of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) minimal clinically important difference (MCID; increase ≥0.5 points) at month 6.

Results

Among 1208 patients, 1095 had asthma and 954 allergic rhinitis. Overall, 666/1095 (60.8%) achieved month‐6 PAQLQ MCID: 515/671 (76.8%) with asthma plus allergic rhinitis (Asthma+AR), 103/254 (40.6%) with allergic asthma without AR, and 48/170 (28.2%) with asthma, AR, and atopic dermatitis (Asthma+AR + AD).

Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta-analysis

Thomander T, Gil-Mata S, Riera-Serra P  et al. Pediatr Allergy Immunol. 2026 Aug;37(8):e70431. doi: 10.1111/pai.70431. 

Abstract

Background

Allergic rhinitis is the most common chronic disease in children. Information on efficacy and safety of oral allergic rhinitis treatments in children is scarce. We aimed to comprehensively evaluate the efficacy and safety of oral medications for allergic rhinitis in children.

Methods

We performed a systematic review, searching three bibliographic databases and clinicaltrials.gov for randomized controlled trials assessing the use of oral antihistamines (OAH) or leukotriene receptor antagonists (LTRA) in children (<12 years old) with seasonal or perennial allergic rhinitis. Evaluated outcomes included the Total Nasal Symptom Score (TNSS), the Total Ocular Symptom Score (TOSS), the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ), development of adverse or serious adverse events, and withdrawals due to adverse events. We performed network meta-analysis at both class and individual treatment levels. Certainty in the body of evidence was assessed using the GRADE approach for network meta-analysis.

Results

We included eight primary studies with 906 participants. Overall, OAH were more effective against placebo in improving the TNSS (mean difference (MD) = −1.60; 95%CI = −2.25 to −0.95).

Criteria for Control and Remission of Respiratory Allergic Disease With Allergen Immunotherapy: A Delphi Consensus

E. González-Mancebo, J. M. Beitia Mazuecos, A. I. Tabar Purroy, et al. Clinical and Translational Allergy
(2026): e70191, https://doi.org/10.1002/clt2.70191.

ABSTRACT

Background

Allergic rhinitis, conjunctivitis and asthma are prevalent IgE-mediated respiratory diseases that frequently coexist and impair quality of life. Allergen immunotherapy (AIT) has clinical benefits and potential disease-modifying effects. Until recently, standardised definitions of disease control and remission were lacking in routine clinical practice, particularly for allergic rhinitis and conjunctivitis. This study aimed to propose preliminary definitions of control and remission in patients receiving AIT and to assess expert consensus using the Delphi methodology.

Methods

A scientific committee developed a survey based on a literature review and expert input, addressing symptoms, medication use, quality of life, exacerbations and tools for objective and subjective assessment. Forty allergists participated in a two-round Delphi study. Consensus was predefined as ≥ 70% agreement on a 9-point Likert scale.

Results

Criteria for allergic conjunctivitis control and remission achieved with AIT.

Consensus was achieved for all items after two rounds.

Guideline-recommended inflammatory testing in symptomatic dermographism: a real-world study

Bizjak-Suran M and Stojanovič L (2026) Front. Immunol. 17:1901562. doi: 10.3389/fimmu.2026.1901562

Abstract

Introduction: Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria and is increasingly recognized as a burdensome disease. The 2026 international urticaria guideline recommends eliciting dermographism and threshold testing for diagnosis and includes differential blood count and erythrocyte sedimentation rate or C-reactive protein (CRP) as an extended diagnostic work-up in patients with SD. However, the clinical usefulness of these inflammatory tests in SD remains incompletely characterized.

Methods: In this retrospective real-world cohort study, we examined whether routine inflammatory markers provide interpretable signals in SD, using chronic spontaneous urticaria (CSU) as a reference comparator and serum protein electrophoresis-derived markers, including the inflammatory protein ratio (IPR) ([alpha-1 + alpha-2]/albumin × 100), as exploratory measures of inflammation.