ARIA WEBINAR N°3: 8th, 9th & 12th December 2025. ARIA 2024-2025 guidelines: Recommendations on oral and ocular treatments

AGENDA

ARIA 2024-2025 guidelines: Recommendations on oral and ocular treatments

Jean Bousquet:

- Presentation of the recommendations of oral antihistamines versus intranasal treatments for the ARIA 2024-2025 guidelines
- Why is it important to evaluate as-needed vs chronic treatment in allergic rhinitis?

- Why is it important to evaluate rhinitis alone and rhinitis+asthma in the treatment of allergic rhinitis?

Bernardo Sousa Pinto:

- Co-medication vs dose increase medication: Methods and preliminary results of the systematic review and Roadmap for developing recommendations
- As-needed vs chronic treatment in allergic rhinitis: Roadmap for developing recommendations

Emerging Therapeutics in COPD: Mapping Innovation to Treatable Traits

Cazzola M, McDonald VM, Stolz D, Rogliani P, Matera MG.  Lung 2025 Sep 3;203(1):92. doi: 10.1007/s00408-025-00844-0.

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a complex, heterogeneous condition characterized by diverse clinical phenotypes and underlying pathobiological mechanisms. Traditional “one-size-fits-all” management strategies have limited effectiveness in addressing this heterogeneity. The Treatable Traits (TTs) approach represents a precision medicine paradigm that targets specific, identifiable, and modifiable traits in individual patients, regardless of diagnostic labels. This paper explores the alignment between the TTs framework and emerging pharmacological therapies, with a particular focus on anti-inflammatory agents and bronchodilators currently under investigation. Each drug category is mapped to relevant TTs, such as eosinophilic or neutrophilic inflammation, corticosteroid resistance, chronic bronchitis, and frequent exacerbations.

Distribution and status of ragweed (Ambrosia spp.) in northwestern South America and its potential health and environmental impacts

Espinoza-Maticurena A, Vargas A, Rodas-Valero G et al. Sci Rep. 2025 Dec 9. doi: 10.1038/s41598-025-30840-6.

Abstract

Ambrosia species, commonly known as ragweed, are among the most problematic invasive weeds worldwide due to their aggressive spread and highly allergenic pollen. While extensively studied in North America, Europe, and Asia, there is limited research on their presence in tropical South America. This article focuses on the distribution, status, and potential impacts of Ambrosia in Colombia, Ecuador, and Peru.

Penicillin allergy assessment pathway versus usual clinical care for primary care patients with a penicillin allergy record in the UK (ALABAMA): an open-label, multicentre, randomised controlled trial

Sandoe, Jonathan A T, Bongard, Emily et al. The Lancet Primary Care, Volume 1, Issue 1, 100006

Summary

Background

Penicillin allergy labels in medical records are common, often incorrect, and associated with increased antibiotic use and worse health outcomes. We aimed to establish whether a penicillin allergy assessment pathway initiated in primary care could safely improve use of penicillins.

Methods

Trial profile

ALABAMA was a multicentre, open-label, randomised pragmatic trial with embedded process and cost-effectiveness evaluations. Participants came from 51 UK general practices and testing took place at four UK hospital sites (Leeds Teaching Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Cornwall Hospitals NHS Trust, and Bradford Teaching Hospitals NHS Foundation Trust). Eligible participants were aged 18 years or older, provided informed consent, had a record of penicillin allergy or sensitivity in their electronic medical records, had received an antibiotic prescription in the previous 24 months, and were outpatients at the time of recruitment.

Efficacy and safety of Depemokimab in asthma with eosinophilic phenotype: a systematic review and meta-analysis of randomized controlled trials

Gill, B.A., Ijaz, A., Fatima, N. et al. BMC Immunol (2025). https://doi.org/10.1186/s12865-025-00777-6

Abstract

Introduction

Asthma is a complex and heterogeneous disease that significantly impacts quality of life. Eosinophilic asthma, characterized by elevated eosinophil levels, leads to inflammation and hypersensitivity. Many patients remain inadequately managed, resulting in frequent exacerbations and hospitalizations despite standard treatment options. Depemokimab, a long-acting monoclonal antibody that targets IL-5, could offer a novel approach for managing severe eosinophilic asthma.

Methods

A systematic search was conducted across the PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and Scopus databases up to January 2025.

Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines—2024–2025 Revision: Part I—Guidelines on Intranasal Treatments

B. Sousa-Pinto, J. Bousquet, R. J. Vieira, et al. Allergy (2025): 1–23, https://doi.org/10.1111/all.70131.

ABSTRACT

Background

Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024–2025). This manuscript presents the ARIA 2024–2025 recommendations for intranasal treatments, one of the mainstays for AR management.

Methods

The ARIA 2024–2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework.

Evaluation of the Quality and Reliability of ChatGPT-4's Responses on Allergen Immunotherapy Using Validated Instruments for Health Information Quality Assessment

Cherrez-Ojeda I, Zuberbier T, Rodas-Valero G, Sanchez J, Rudenko M, Dramburg S, Demoly P, Caimmi D, Gómez RM, Ramon GD, Fouda GE, Quimby KR, Chong-Neto H, Llosa OC, Larco JI, Monge Ortega OP, Faytong-Haro M, Pfaar O, Bousquet J, Robles-Velasco K.  Clin Transl Allergy. 2025 Dec;15(12):e70130. doi: 10.1002/clt2.70130.

ABSTRACT

Background

Chat Generative Pre-Trained Transformer 4 (ChatGPT-4) represents an advancing large language model (LLM) with potential applications in medical education and patient care. While Allergen Immunotherapy (AIT) can change the course of allergic diseases, it can also bring uncertainty to patients, who turn to readily available resources such as ChatGPT-4 to address these doubts. This study aimed to use validated tools to evaluate the information provided by ChatGPT-4 regarding AIT in terms of quality, reliability, and readability.

Methods

In accordance with EAACI clinical guidelines about AIT, 24 questions were selected and introduced in ChatGPT-4. Independent reviewers evaluated ChatGPT-4 responses using three validated tools: the DISCERN instrument (quality), JAMA Benchmark criteria (reliability), and Flesch-Kincaid Readability Tests (readability).

Emerging Role and Function of Th9 Cells in Allergic Inflammation

Kaminuma O, Kitamura N, Gotoh M.  J Inflamm Res. 2025 Nov 22;18:16385-16397. doi: 10.2147/JIR.S546234.

Abstract: 

Th9 cells have emerged as pivotal orchestrators of allergic inflammation across the airway, skin, and nasal mucosa, constituting a mechanistically distinct axis beyond canonical Th2 immunity. This review specifically highlights: (i) the Th9 axis as a unifying driver in asthma, atopic dermatitis, and allergic rhinitis; (ii) key mechanistic programs, including signal transducer and activator of transcription (STAT) 5/STAT6 licensing of the IL9 locus, peroxisome proliferator-activated receptor (PPAR) γ-mammalian target of rapamycin complex (mTORC) 1 metabolic wiring, and the IL-9-monocarboxylate transporter (MCT) 1 feedback loop; (iii) organ-level phenotypes such as eosinophil-independent bronchial hyperresponsiveness (BHR) and variable steroid responsiveness; and (iv) therapeutic implications, including biomarker-guided endotyping, Janus kinase (JAK) inhibition, TNF-like ligand (TL) 1A/death receptor (DR) 3 blockade, and metabolic or airway smooth muscle (ASM) tone modulation. Differentiating under the combined influence of interleukin (IL)‑4 and tumor growth factor (TGF)-β, Th9 cells secrete IL‑9, a pleiotropic cytokine that drives mast‑cell proliferation, goblet cell metaplasia, and airway remodeling. Their transcriptional program is epigenetically licensed by STAT5/STAT6, which opens chromatin at the IL9 locus and is metabolically sustained by a PPARγ-mechanistic/mTORC1-dependent glycolytic state. This bioenergetic wiring establishes an IL‑9-MCT1 feedback loop that reinforces effector function and durability. 

Th9 Axis Across Allergic Diseases: Pathobiology,
Biomarkers, and Therapeutic Implications

Clinically, Th9 signatures align with BHR, which can be eosinophil-independent and variably responsive to inhaled corticosteroids; experimental models further demonstrate that Th9‑mediated BHR persists in eosinophil-deficient contexts and displays relative glucocorticoid resistance.