AbstractBackgroundDigital health, digital medicine, and digital therapeutics integrate advanced computer technologies into healthcare, aiming to improve efficiency and patient outcomes. These technologies offer innovative solutions for the management of allergic diseases, which affect a significant proportion of the global population and are increasing in prevalence.BodyThis review examines the current progress and future potential of digital health in allergic disease management. It highlights key advancements, including telehealth, mobile health (mHealth), artificial intelligence, clinical decision support systems (CDSS), and digital biomarkers, with a focus on their relevance to allergic disease management. The role of digital tools in improving treatment adherence, enabling remote care, and integrating environmental and patient data into personalized care models is discussed. Challenges such as data privacy, interoperability, and equitable access are addressed, alongside potential strategies to overcome these barriers.ConclusionDigital therapy will play an important role in allergic diseases, and the further development of digital therapies will effectively promote the development of clinical research, digital biomarkers, hypoallergenic environments and digital twins. More research is needed to support the progress of digital therapy for allergic diseases.

Asthma is currently one of the most common of respiratory diseases, severely affecting the lives of patients. With the in-depth study of the role of the nervous system and sex hormones on the development of asthma, it has been found that the nervous system and sex hormones are related to each other in the pathway of asthma. To investigate the effects of sex hormones and the nervous system on the development of asthma. In this review, we searched for a large number of relevant literature to elucidate the unique mechanisms of sex hormones and the nervous system on asthma development, and summarized several common targets in the pathways of sex hormones and the nervous system on asthma. We summarize several common important targets in the pathways of action of sex hormones and the nervous system in asthma, provide new directions and ideas for asthma treatment, and discuss current therapeutic limitations and future possibilities. Finally, the article predicts future applications of several important targets in asthma therapy.

Seasonal allergic rhinitis (AR) impacts public health by affecting work productivity and quality of life. The Swedish tree pollen season starts in February with alder and hazel pollination, followed by birch and ends with oak in May. Systemic corticosteroids are often prescribed when topical treatments fail, despite limited evidence supporting their efficacy. To compare the effectiveness of prednisolone tablets versus antihistamine tablets in reducing symptoms and medication usage in patients with moderate to severe tree pollen-induced AR. This interventional single-center, double-blinded randomized trial included 34 patients. Treatment was initiated, and symptoms were registered during the tree pollen season. The two groups received either prednisolone tablets (20mg) or ebastine tablets (20mg) for 7days. Treatment effects were evaluated by comparing daily symptom scores, use of topical medication, and a combined symptom-medical score between the groups. Quality of life was recorded at the start and after 3weeks. Both interventions demonstrated efficacy in enhancing quality of life metrics. The area under the curve (AUC) for the combined symptom severity and medication usage score averaged 34.0 (SD=19.1, 95% CI=24.5-43.4) in the group treated with prednisolone. This was marginally lower than the control group, with an AUC of 32.6 (SD=13.2, 95% CI=25.6-39.7). The difference was not statistically significant (p=0.80). Both groups exhibited only mild adverse events, which were statistically comparable in frequency and severity. Prednisolone tablets did not show superior efficacy over antihistamine tablets in reducing symptoms or medication usage in tree pollen-induced AR. These results suggest that systemic corticosteroids may not provide additional benefits over antihistamines, and clinicians should prioritize individualized treatment based on patient preferences and tolerability.

Chronic spontaneous urticaria (CSU) is a disease with a high impact on the quality of life of patients. There are some evaluations of the economic cost of the disease in developed countries, but there is little information about the economic cost of the disease in developing countries. Our aim was to assess the economic diagnostic and therapeutic expenses of CSU in five Latin American (LA) countries. A noninterventional multicenter cross-sectional study was conducted in five LA countries: Brazil, Colombia, Ecuador, Mexico, and Peru. To determine the frequency of medical interventions as well as clinical and sociodemographic characteristics of CSU patients, questionnaires were administered to patients, primary care physicians, allergists, and dermatologists. In each country, diagnostics and therapeutic expenses were calculated by reviewing medical records, health insurance, and interviews. The main outcome was the yearly economic burden from the healthcare insurance perspective in each country. According to the projected costs, Brazil had the highest urticaria cost per patient/year (7009.4 USD), followed by Mexico (3695.1 USD), Ecuador (3132.8 USD), Peru (2693.9 USD), and Colombia (2392.8 USD); the cost and the frequency of use of omalizumab and antihistamines explain the total cost differences between countries. Interventions such as medical visits and exams had similar costs between countries and represented less than 10% of total urticaria cost analysis in the five countries. The cost of the CSU in LA varies widely based on the health insurance coverage, the cost of the therapies, and the frequency of therapies used. Strengthening national health systems, as well as following the recommendations of international guidelines, seems to reduce the cost of CSU and improve the quality of patients.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a recurrent inflammatory disease associated with several comorbidities and a significant disease burden for patients. Treatments include corticosteroids and sinonasal surgery, but these can be associated with the risk of adverse events and nasal polyp recurrence. Biologic treatments such as mepolizumab can be used as an add-on treatment and are effective at reducing surgery and corticosteroid use. Patients with CRSwNP may be seen by a specialist in one of several different areas and often experience delayed diagnosis due to the need to see multiple physicians, as well as misdiagnosis resulting from lack of sufficient expertise within any one speciality. Multidisciplinary team (MDT) approaches have been shown to be effective in optimising the treatment and clinical management of other respiratory diseases, such as aspirin-exacerbated respiratory disease and severe asthma. In CRSwNP, an MDT approach may reduce diagnostic delays, mitigate secondary disease burden, and reduce overprescription of corticosteroids and antibiotics. This article provides an overview of the patient perspective of MDTs, existing approaches and barriers to adoption, lessons learnt from allied and rare diseases, how to address under-recognised aspects of CRSwNP, and other key considerations for developing an MDT approach.

AbstractBackgroundPatient‐reported outcome measures (PROMs) help to assess disease control and quality of life (QoL) in chronic spontaneous urticaria (CSU) and recurrent angioedema (RA). This study aimed to assess the correlation between two different concepts: disease control and QoL, using disease‐specific PROMs.MethodsWe analyzed data from 445 CSU and 330 RA patients who completed both a disease control and QoL PROM as part of the clinical routine. We included the UCT and CU‐Q2oL for CSU and AECT and AE‐QoL for RA.ResultsIn CSU and RA, disease control scores positively correlated with QoL scores (Spearman's rho correlation coefficient (CR) −0.757, −0.735; p < 0.001) with better disease control corresponding to better quality of life. However, 5.9% of CSU patients and 28% of RA patients with complete disease control had impaired QoL. In CSU, QoL was impaired in 69.2% of patients based on the CU‐Q2oL and in 62.7% of patients based on a single numeric question from the UCT, with a mismatch in 89/445 patients. In RA, QoL was impaired in 58.5% using the AE‐QoL and in 52.7% using a single numeric question from the AECT30mo, with a mismatch in 69/330 patients. Different domains of the QoL PROMs showed different degrees of influence on disease control, with “Itching/Embarrassment” showing the strongest correlation with the UCT (CR −0.804; p < 0.001) and “Functioning” with the AECT3mo (CR −0.824; p < 0.001).ConclusionAlthough most patients with controlled disease have better quality of life, unexpectedly, quality of life remains impaired in up to one‐fourth of patients with completely controlled CSU and RA. Reasons behind this should be investigated in further studies.

Most patients with severe asthma are sensitized to at least one allergen. Whether local immunoglobulin E (IgE) in induced sputum reflects asthma control status has not been investigated. Patients with asthma were classified as well controlled, partly controlled, and uncontrolled asthma (UCA) according to Global Initiative for Asthma 2022 guidelines. Lung function and fractional exhaled nitric oxide (FeNO) were evaluated. Induced sputum was collected and total IgE and Phadiatop (IgE to common inhalant allergens) measurements were performed. General clinical characteristics and pulmonary inflammation indicators were analyzed between the three groups of asthmatic patients. Univariate and multifactor ordinal logistic regression were used to model the relationship between pulmonary inflammation indicators and asthma control status. The ability of sputum total IgE in identifying different levels of asthma control was assessed by receiver operating characteristic curve (ROC). Patients with UCA had worse lung function and airway inflammation as indicated by lower levels of forced expiratory volume in 1s (FEV1)%pred, FEV1/FVC, MEF75%pred, MEF50%pred and MEF25%pred, and higher levels of FeNO and sputum eosinophil% compared with the WCA group. In addition, higher levels of total sputum IgE and Phadiatop were found in patients with UCA than in patients with WCA and PCA. Univariate and multifactor ordinal logistic regression analysis indicated that sputum total IgE was the unique significant risk factor for poor asthma control (adjusted odds ratio=6.25; 95% CI, 1.07-36.55; p<0.05) among pulmonary inflammation indicators including different indices of pulmonary function test, sputum IgE and FeNO. Sputum total IgE levels showed a significant correlation with asthma control scores (r=0.53, p<0.001). Moreover, ROC analysis showed that the predictive value of sputum total IgE for patients with UCA was 0.82 (95% CI, 0.74-0.9). Sputum total IgE reflects levels of asthma control, and can be used as an indicator of UCA.

Gut microbial involvement has been speculated in chronic spontaneous urticaria (CSU). The aim of the study was to compare the gut microbiome composition and diversity in CSU patients uncontrolled with second-generation antihistamines (sgAHs) and healthy individuals, as well as to explore any association between gut microbiome and disease characteristics. A cross-sectional case-control study including 20 CSU patients unresponsive to standard doses of sgAHs, and 15 age-and-sex matched healthy controls was conducted. Clinico-demographic profile, laboratory investigations and stool analysis were conducted in all study participants. 16S RNA gene sequencing and DNA isolation was performed for all stool samples, followed by bioinformatic analysis. The CSU patients (mean age 39.5±9.3, M:F 1:4) and healthy controls (mean age 35±13, M:F 1:2) were statistically comparable. The median (IQR) duration of CSU was 42months (7-81). Concomitant angioedema and concomitant symptomatic dermographism were present in 30% and 20% CSU patients, respectively. At inclusion, 60% patients were receiving add-on omalizumab, while the remaining 40% were on up-dosed sgAHs. Stool microbial analysis revealed increased diversity and higher microbial richness in CSU patients compared with healthy individuals. CSU patients showed reduced load of short-chain fatty acid (SCFA) producing microbiota and increased load of opportunistic pathogens. The Firmicutes/Bacteroides (F/B) ratio was higher in CSU patients. Among CSU patients, higher Bacteroides and reduced Firmicutes count were associated with higher disease activity and poor control; however, there was no link with the type of therapy. Gut microbial dysbiosis is seen in CSU and is linked with disease control.

AbstractBackgroundRecent studies have highlighted the importance of routine screening for the somatic missense KIT p.D816V variant in peripheral blood leukocytes (PBL), and its association with severe sting anaphylaxis. Our study aimed to evaluate the clinical relevance of KIT p.D816V detected in PBL on systemic adverse events (SAEs) and the efficacy of venom immunotherapy (VIT).MethodsThis retrospective study included 839 patients receiving VIT. The KIT p.D816V variant was assayed with a highly sensitive, allele‐specific, quantitative PCR.ResultsKIT p.D816V was detected in the PBL of 125 (15%) of 839 VIT patients. The majority (70%, 88/125) of these individuals had normal BST levels. Notably, half of the KIT‐positive patients receiving honeybee venom immunotherapy had SAEs during treatment (48%, 18/37; p = 0.0136), and the KIT p.D816V allele burden was higher than 0.01% in the majority of those patients (61%, 11/18). Furthermore, a significant difference was observed between KIT‐positive and KIT‐negative patients treated with VIT in the past and who experienced a recurrent reaction to a sting after treatment termination (VIT failure). KIT‐positive patients with VIT failure had a higher allele burden than those with successful VIT (80% vs. 40% with a KIT p.D816V higher than 0.01%; p = 0.0019). KIT p.D816V was a predictor of SAEs during honeybee VIT (univariate; OR = 2.43, p = 0.012/multivariate; OR = 2.26, p = 0.033) and a strong predictor of VIT failure in patients treated with wasp venom (univariate; OR = 4.1, p = 0.002/multivariate; OR = 3.54, p = 0.008).ConclusionOur study revealed the high clinical relevance of KIT p.D816V detected in PBL. KIT p.D816V was a significant predictor of SAEs during honeybee VIT and a significant predictor of VIT failure after completing wasp VIT.