Methodology for the Development of the Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI 2024–2025 Guidelines: From Evidence-to-Decision Frameworks to Digitalised Shared Decision-Making Algorithms

J. Bousquet, B. Sousa-Pinto, R. J. Vieira, et al. Allergy (2025): 1–27, https://doi.org/10.1111/all.70100.

ABSTRACT

The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines produced their first edition in 1999, with subsequent revisions in 2008, 2010, 2016 and 2019. A new iteration of ARIA—ARIA 2024–2025—in collaboration with EAACI is currently being developed, focusing on the management of allergic rhinitis. ARIA 2024–2025 follows the GRADE framework and is endorsed by the European Academy of Allergy and Clinical Immunology (EAACI). A set of approaches has been used to develop guideline questions, including surveying key opinion leaders and using artificial intelligence (AI)-based tools to analyse web searches on allergic rhinitis and to generate questions. Each prioritised guideline question is assessed through an Evidence-to-Decision (EtD) framework. EtDs support the systematic and transparent formulation of recommendations, comprising 12 criteria for which the best available evidence should be sought. In the context of ARIA-EAACI 2024–2025, such evidence is derived not only from randomised controlled trials but also—among others—from patient-generated data sources that better reflect the affected individuals' perspectives.

Staphylococcus aureus nasal carriage is associated with faster symptom resolution following nasal allergen challenge in ragweed-allergic participants: a subset of the Allergic Rhinitis Microbiome Study

Linton, S., Hossenbaccus, L., Davis, A. et al. Allergy Asthma Clin Immunol 21, 48 (2025). https://doi.org/10.1186/s13223-025-00990-3

Abstract

Clinical outcomes during nasal allergen challenge in ragweed-allergic
participants with (carriers) and without (non-carriers) nasal
Staphylococcus aureus.

In this letter, we report that ragweed-allergic participants with nasal Staphylococcus aureus carriage (n = 7) exhibited significantly smaller reductions in Peak Nasal Inspiratory Flow from baseline at 3 h (P = 0.013) and 5 h (P = 0.008) post–nasal allergen challenge compared to non-carriers (n = 12).

“ “Super-Responders” to Dupilumab Treatment in Patients With Primary Diffuse Chronic Rhinosinusitis With Nasal Polyps

P. E. Vonk, J. J. Otten, H. B. E. Elzinga, et al.  Allergy (2025): 1–10, https://doi.org/10.1111/all.70151.

Graphical Abstract

ABSTRACT

Background

Dupilumab is effective in treating patients with type-2 dominant chronic rhinosinusitis with nasal polyps (T2-CRSwNP). Dosing starts at an interval of 1×/2 weeks (Q2W) with possible tapering upon disease control. Prolonging the interdose interval reduces patient burden and side effects and improves cost-effectiveness.

Objectives

(1) Analyze how many patients successfully reach and maintain extended tapering of at least 1×/12 weeks (Q12W), (2) evaluate differences in baseline characteristics and clinical measurements between patients who maintain disease control on ≥ Q12W (“super-responders”) and patients who do not; (3) compare characteristics of “super-responders” to patients reaching Q12W but losing disease control on that dose (“excellent responders”).

Key Predictors of Adherence to a Mobile Health App for Managing Chronic Spontaneous Urticaria

Viegas H, Sousa-Pinto B, Vieira RJ, et al. Clin Transl Allergy. 2025 Nov;15(11):e70110. doi: 10.1002/clt2.70110.

ABSTRACT

Background

Mobile health technologies may improve the management of chronic diseases, such as chronic spontaneous urticaria. However, effectiveness of mHealth tools largely depends on patient adherence, which can be influenced by various demographic, clinical, behavioural, psychosocial factors, and apps characteristics (appealing and simplicity of use). Understanding these adherence patterns is crucial for optimizing mHealth interventions. In this study, we aimed to assess adherence patterns associated to the use of CRUSE, a mHealth app designed for patients with CSU.

Methods

We assessed users of the CRUSE app with self-reported CSU or suggested by a physician. For each user, we evaluated the number of days they completed the CRUSE daily monitoring questionnaire (app adherence) within the first 3 months after installation. We constructed univariable and multivariable ordered beta regression models to identify predictors of 3-month adherence to the app.

Results

Directed acyclic graph (DAG) to select the independent variables
to include in multivariable models

We analysed data from 2085 patients (66,114 days). Median adherence to the CRUSE app was of 22 days (24.4% of 90 days).

Evaluation of the relationship between multiple inflammatory markers, disease severity and antihistamine response in chronic spontaneous urticaria

Atik Ö, Can A.  Alergologia Polska - Polish Journal of Allergology. 2025. doi:10.5114/pja.2025.156073.

Introduction

Chronic spontaneous urticaria (CSU) is a skin condition marked by excessive immune system inflammation. The C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), eosinophil/neutrophil ratio (ENR), and eosinophil/lymphocyte ratio (ELR) are recent biomarkers that indicate systemic inflammation.

Aim

This study aims to examine the role of these inflammatory markers in assessing the severity of CSU and predicting the response to antihistamine treatment.

Material and methods

The study included 246 CSU patients from our outpatient clinic.

Transepidermal Water Loss in Oral Food Challenges in Children With Peanut Allergy. A Randomized Clinical Trial

Freigeh GE, O’Shea KM, Troost JP et al JAMA Netw Open. 2025;8(11):e2543371. doi:10.1001/jamanetworkopen.2025.43371

Key Points

• Question  Can transepidermal water loss (TEWL) as a measure of skin barrier function be used to reduce anaphylaxis rates and severity during oral food challenges in children with peanut allergy?
• Findings  In this randomized clinical trial that included 40 children aged 6 months to 5 years with peanut allergy, the anaphylaxis rate among participants with an allergic reaction during a peanut oral food challenge was lower in the group for which TEWL was used as a stopping criterion (63%) than in the control group (100%).
• Meaning  The findings suggest TEWL can augment anaphylaxis prediction during oral food challenges.

Abstract

Visual Abstract.

Importance  Food allergy is a prevalent chronic medical condition in children, with limited diagnostic options. Transepidermal water loss (TEWL) is a measure of skin barrier function with emerging utility in atopy and food allergy.

Objective  To determine whether use of TEWL as a stopping criterion can prevent anaphylaxis during a peanut oral food challenge (OFC).

Design, Setting, and Participants  This was a single-center randomized clinical trial of children aged 6 months to 5 years with a history of a clinical peanut allergic reaction and positive peanut skin prick and/or serum immunoglobulin E testing.

Exploring the Disease Duration of Urticaria and Associated Determinants in Primary Care

R. Soegiharto, B. J. Hengevelt, N. Boekema-Bakker, et al.  Clinical & Experimental Allergy (2025): 1–4, https://doi.org/10.1111/cea.70170.

Summary

• Most patients (75%) with new-onset urticaria in general practice recover within 1 week.
• Chronic urticaria (17%) was associated with higher age at onset, high BMI and early prednisolone prescriptions, the latter likely reflecting higher disease severity.

Determinants of longer disease duration.

To the editor,

Most patients presenting with new-onset urticaria are expected to have short-lived symptoms, acute urticaria (AU). Initial treatment of urticaria is therefore generally limited to a wait-and-see approach and second-generation (low dose) H1-anthistamines [1]. However, it is estimated that 0%–39% of patients develop chronic urticaria (CU), mainly based on outdated studies that focused on children with a follow-up time of up to 2 years [2]. Determining the exact proportion of CU patients is essential, because...

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REAL WORLD DATA ON THE EFFECTIVENESS OF EPINEPHRINE NASAL SPRAY IN CLINICAL PRACTICE-UPDATE

Casale, T. et al. Annals of Allergy, Asthma & Immunology, Volume 135, Issue 5, S2

Abstract

Introduction

Intranasal epinephrine spray 2 mg (IN) is the first FDA-approved needle-free epinephrine product for the treatment of severe allergic reactions, including anaphylaxis. Intranasal epinephrine efficacy and safety are supported by extensive pharmacokinetic and pharmacodynamic data, a Phase 3 study in Oral Food Challenge (OFC) patients, and a series of case reports. To evaluate “real world” performance, health care providers (HCP) were surveyed regarding treatment outcomes following IN use.

Methods

Product was provided through an experience program to HCPs for use in their clinics and were surveyed regarding 1) the number of patients dosed; 2) the number of patients requiring a second dose of epinephrine to treat their allergic reactions; and 3) ease of use on a scale of 1-7. Data was collected by the company.