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.

The prevalence of alpha-gal IgE among patients with confirmed Lyme serology result

Kadkhoda K, Schwaben A, Dee M. Int Arch Allergy Immunol. 2026 Apr 30:1-6. doi: 10.1159/000552320.

Abstract

Given the significant rise in the incidence of alpha-gal syndrome alongside the geographical expansion of ticks in recent years, it is crucial to conduct studies aimed at raising awareness—particularly among patients with a history of, or current diagnosis of, Lyme disease, to improve their quality of life. Our study is unique in addressing this important intersection. Two groups composed of 200 residuals de-identified samples originally collected during the peak of tick activity season in Northeast Ohio were tested for alpha-gal IgE. The first group (n=100) was from patients with Lyme IgG western blot positive results, and the remainder were from healthy subjects only tested for immune status. Of the 200 samples, 17 tested positive for α-Gal IgE: 15 from the Lyme-positive group and 2 from the control group.

ARIA 2024–2025 systematic reviews group. Treatment Dose Increase Versus Co-Medication in Allergic Rhinitis: Systematic Review With Dose-Response Network Meta-Analysis

Sousa-Pinto B, Vieira RJ, Gil-Mata S et al.  Allergy. 2026 May 1. doi: 10.1111/all.70372. 

ABSTRACT

Background

To achieve adequate symptom control, patients with allergic rhinitis (AR) often need to increase their medication dose or add other treatments (co-medication). We aimed to perform a systematic review to compare the efficacy and safety of AR medications for increased dose versus co-medication.

Methods

We searched four bibliographic databases and three trial databases for randomised controlled trials assessing the effect of intranasal and/or oral medications in patients of all ages with seasonal or perennial AR. We performed pairwise meta-analysis based on direct evidence to compare (i) non-standard versus standard treatment doses, and (ii) co-medication strategies versus monotherapy using standard doses. Furthermore, we fitted dose–response network meta-analysis (NMA) to obtain projected estimates for comparisons involving two times the standard dose of AR medications in monotherapy versus co-medication with the standard dose of the same medications. We assessed the certainty of evidence using GRADE for NMA.

Results

Comparison between doubling the dose of the medication
on each row versus adding the medication of each column

We included 262 studies. Co-medication schemes involving oral antihistamines (OAH) + intranasal corticosteroids (INCS) resulted in higher improvements of nasal symptoms and quality of life than doubling the dose of OAH.

TNF Pathway-Mediated Tolerogenic T-Cell Trajectory Driven by Allergen Immunotherapy

H. S.Charles, A. A.Gabr, S.-H.Wang, et al. Allergy (2026): 1–14, https://doi.org/10.1111/all.70367.

ABSTRACT
Background
Allergen immunotherapy (AIT) is a therapeutic approach to restore allergen tolerance and prevent asthma progression. Previous studies have shown exhaustion of T cells and the induction of T cells expressing IL-17 and FOXP3 early in AIT, which are relevant for the clinical outcome. This study aims to investigate the dynamic transition from type-3 immunity to a regulatory state observed in the first year during allergic inflammation, as well as the subsequent dysfunction of effector cells during AIT.

Methods
Human and experimental models of allergic airway inflammation were used to assess the impact of AIT on Treg, Tr17 and Th17 cell populations using flow cytometry and proliferation assays. Additionally, human blood samples were analysed using single-cell transcriptomics to characterise transcriptional signatures associated with the transition from pro-inflammatory to regulatory states.

Graphical Abstract

Results
AIT restored balance of Tr17 and Treg populations and increased their proliferative capacity, whereas Th17 cells remained functionally impaired. Single-cell transcriptomics identified Tr17 cells as intermediate states between pro-inflammatory and regulatory T-cell programs after AIT.

Effects of Live and Heat-Treated Bifidobacterium longumCECT 7347 in Adults With Allergic Rhinitis: A Randomised, Double-Blind, Placebo-Controlled Trial

A.Cardoso, M.Naghibi, E.Climent, et al. Allergy (2026): 1–13, https://doi.org/10.1111/all.70360.

ABSTRACT

Background

Allergic rhinitis (AR) is an increasingly common chronic inflammatory condition of the nasal mucosa. While conventional anti-allergy treatments are widely used, they can come with side effects and are not always effective. As a result, AR remains a significant concern for many millions of people worldwide, affecting quality of life and social functioning.

Objective

To investigate clinical evidence for the role of probiotics and postbiotics in reducing AR symptoms.

Graphical Abstract

Methods

In this single-centre, randomized, double-blind, placebo-controlled clinical trial, 72 adults aged 18–60 years with moderate–severe AR, taking first-line medication, were studied. The primary outcome of the trial was to determine the effects of supplementation with the probiotic Bifidobacterium longum CECT 7347 (PRO) and the heat-treated postbiotic of the same strain (POST) on symptoms associated with AR as assessed using the Combined Symptom and Medication Score (CSMS).

Evaluation of Itch Intensity Scales in Atopic Dermatitis: Differential Measurement Properties and Associations with Relevant Cytokines

Witte F, Wiegmann H, Teitge E et al. J Invest Dermatol. 2026 Apr 20:S0022-202X(26)01046-8. doi: 10.1016/j.jid.2026.04.005.

Abstract

Improvement and comparison of itch intensity scales.
Worst itch intensity scales demonstrated significant improvement in itch after dupilumab
therapy in ADpatients (left: initial assessment/IA, right: follow up/FU, respectively).
The worst itch numerical rating scale/24h and visual analogue scale/4 weeks
reached significantly higher ratings than the visual analogue scale/24h at IA and FU.

Itch is the cardinal symptom contributing to patient burden in atopic dermatitis (AD). Multiple validated itch scales are used in clinical trials, generating heterogeneous data sets. In addition, recent studies suggest an association between cytokine levels and disease severity in AD. This study aimed to compare the performance of different validated itch instruments and their relationship to blood cytokine profiles. 49 adults with severe AD and severe itch were treated with dupilumab 300mg for 16 weeks. At initial assessment and after treatment, itch intensity and quality of life were evaluated using various assessment tools.

Biomarkers in Bronchiectasis - Infographic

Biomarkers are important to describe inflammatory and molecular endotypes that pave the way for individualized therapeutic targets. This infographic from the Bronchiectasis Section of the CHEST Airways Disorders Network describes biomarkers in bronchiectasis.

Learn more: https://hubs.la/Q04drBQf0

Long-Term Dupilumab Treatment Is Not Associated with an Increased Overall Risk of Infections in Adults with Moderate-to-Severe Atopic Dermatitis: Results from an Open-Label 5-Year Extension Study

Beck, L.A., Simpson, E.L., Thaçi, D. et al.  Adv Ther (2026). https://doi.org/10.1007/s12325-026-03582-8

Abstract

Introduction

Patients with atopic dermatitis (AD) are at an increased risk for infections. Here, we report a confirmatory follow-up study analyzing the incidence of infections in adults with moderate-to-severe AD treated with dupilumab for up to 5 years.

Methods

Infections in adults with moderate-to-severe AD treated with dupilumab 300 mg weekly (qw) or every 2 weeks (q2w; approved regimen) were assessed for up to 5 years in the open-label extension study, LIBERTY AD OLE. Topical corticosteroids (TCS) and calcineurin inhibitors (TCI) were permitted. Exposure-adjusted incidence rates [number of patients with at least one event per 100 patient-years (nP/100 PY)] are reported. Since the OLE had no control arm, safety results from the placebo + TCS arm of the 1-year LIBERTY AD CHRONOS study are included for comparisons.

Results

Of the 2677 patients included, 2207 (82.4%) completed up to week 52, 557 (20.8%) up to week 148, and 334 (12.5%) up to week 260; 226 patients (8.4%) switched from qw to q2w during the trial due to a protocol amendment.

Asthma Impairment and Risk Questionnaire predicts short- and long-term exacerbation occurrence across asthma severities

McCann WA, Chipps BE, Beuther DA et al. Ann Allergy Asthma Immunol. 2026 Mar 22:S1081-1206(26)00120-1. doi: 10.1016/j.anai.2026.03.014. 

Abstract

Background

The Asthma Impairment and Risk Questionnaire (AIRQ) predicts 12-month exacerbation occurrence for patients aged ≥12 years.

Objective

To assess the short- and long-term exacerbation prediction ability of the AIRQ in patients with mild-to-moderate and severe asthma.

Methods

This post hoc analysis from the AIRQ longitudinal study classified patients with asthma aged ≥12 years as having mild-to-moderate or severe disease based on prescribed pharmacotherapy. Participant-reported severe asthma exacerbations were assessed monthly over 12 months. For both severity groups and relative to baseline AIRQ control category, exacerbation occurrence was assessed via logistic regression and Kaplan–Meier time-to-first event analyses for the overall 12-month period, months 0-3 (short-term), and months 4-12 (long-term) post-enrollment.

Results

Proportion of patients in the total population (A), with mild-to-moderate
(B) and severe asthma (C) who experienced ≥1 exacerbation over the
short-term (months 0-3) and long-term (months 4-12) follow-up periods
relative to AIRQ control category. AIRQ,
Asthma Impairment and Risk Questionnaire;
NWC, not well-controlled; VPC, very poorly controlled;
WC, well-controlled.

Of 1070 patients who completed ≥1 follow-up assessment, 374 (35.0%) had mild-to-moderate and 696 (65.0%) had severe asthma.

Enhanced Early Detection of Allergic Rhinitis: A Prospective Study on a Symptom-Based Predictive Model

K.-Z.Zhu, C.He, S.-Z.Zhu et al. World Journal of Otorhinolaryngology - Head and Neck Surgery 0 (2026): 1–12. https://doi.org/10.1002/wjo2.70109.

ABSTRACT

Introduction

Allergic rhinitis (AR) and non-allergic rhinitis (NAR) share overlapping symptoms but differ in pathophysiology and treatment. Current AR diagnosis relies on skin prick testing (SPT) and serum IgE quantification, both of which are complex. This study aimed to develop a symptom-based model for early AR detection, explore allergen-symptom relationships, and evaluate its performance.

Material and Methods

A prospective cohort study was conducted at Wuhan Tongji Hospital between June 2024 and October 2024, enrolling 1150 patients with clinically suspected AR. Participants completed a visual analogue scale (VAS) questionnaire evaluating nasal symptoms (itching, congestion, sneezing, rhinorrhea), ocular symptoms, and overall discomfort, and the final diagnosis of AR was confirmed by SPT.

Intranasal delivery of bryostatin-1 using surface charge-engineered lipid nanoparticles to modulate mucosal defense for allergic rhinitis treatment

Li, J., Morita, N., Miura, R. et al.  Sci Rep (2026). https://doi.org/10.1038/s41598-026-43174-8

Abstract

Allergic rhinitis (AR), driven by immune imbalance and excessive IgE production, manifests with symptoms that significantly impair the patient’s quality of life. Current therapies mainly provide symptomatic relief without correcting the underlying immune dysregulation. Bryostatin-1 (bryo-1) is a promising candidate for the causal treatment of AR. It potently inhibits IgE-mediated allergic responses while enhancing nasal mucosal defense through the selective induction of IgA antibodies upon intranasal administration. However, the intranasal delivery of bryo-1 faces challenges, including high cost, chemical instability, and limited permeability across the nasal mucosal barrier. In this study, bryo-1 was incorporated with liposomes with varying surface charges. 

Schematic illustration of bryostatin-1-mediated

selective class-switching to IgA, which can prevent

allergic responses and enhance mucosal defense

against antigens.

These LNPs exhibited stronger interactions with antigen-presenting cells and enhanced cellular uptake and delivery efficiency of bryo-1 in vitro. Notably, anionic LNPs achieved superior bryo-1 delivery to B cells, selectively promoting IgA class switching while suppressing IgE expression.

Olopatadine plus mometasone for seasonal allergic rhinitis treatment: A pooled analysis of clinical trials

Nakanishi M, Carbone LFB, Aggarwal V t al. Braz J Otorhinolaryngol. 2026 Apr 14;92(4):101817. doi: 10.1016/j.bjorl.2026.101817. 

Highlights

• First pooled analysis of Olopatadine/Mometasone FDC.

• Reinforces significant improvements compared to mometasone and olopatadine.

• Compiled safety data demonstrate low AEs and high adherence to treatment.

Abstract

Objective

This study was conducted to analyze the efficacy and safety of a fixed-dose combination of olopatadine HCl (antihistamine) and mometasone furoate (corticosteroid) (Olo/Mom, GSP301) for the treatment of Seasonal Allergic Rhinitis (SAR).

Methods

Efficacy data from one phase II (NCT02318303 [GSP301-201]) and two pivotal phase III double-blind, randomized, active, placebo-controlled (NCT02631551 [GSP301-301] and NCT02870205 [GSP301-304]) clinical trials were collated and analyzed. These studies investigated Olo/Mom (administered twice daily/BID) compared with placebo and its monotherapy constituents for the treatment of SAR in patients aged ≥12-years.

Treatment of allergic rhinitis with allergen immunotherapy in children and adolescents - Adherence, rhinitis severity, and asthma onset

Hedman AM, Lundholm C, Konradsen JR et al. Pediatr Allergy Immunol. 2026 Apr;37(4):e70304. doi: 10.1111/pai.70304.

Abstract

Background

Sublingual immunotherapy (SLIT) has been used to reduce symptoms in allergic rhinitis and to prevent asthma onset. Many studies lack level of adherence and standardized endpoints based on international guidelines.

Objective

We aimed to study the long-term outcomes of allergic rhinitis severity and asthma onset by adherence of SLIT to grass and birch allergens in children and adolescents with allergic rhinitis.

Methods

In a population-based register study, we included all children 5–17 years, with initiation of SLIT between 1 July 2006 and 30 June 2022. Allergic rhinitis severity and asthma onset were based on diagnosis and treatment. Adherence was measured for one, two, and 3 years and divided into low, moderate, and high and compared to only one prescription (reference).

Lipid metabolic regulation of pathogenic type 2 immunity in the airway

Hiroyuki Yagyu, Masahiro Kiuchi, Kiyoshi Hirahara.  International Immunology, 2026;, dxag015, https://doi.org/10.1093/intimm/dxag015

Abstract

IL-33-mediated activation of innate and adaptive type 2 immune cells.

Immune memory is central to host protection against pathogens and contributes to the pathogenesis of chronic inflammatory diseases. Beyond canonical cytokines and antigenic stimuli, metabolic signals have emerged as pivotal regulators of T-cell activation, differentiation, and memory formation. However, the mechanisms by which metabolic and tissue-derived cues imprint pathogenic features on T cells remain poorly understood.