Neurological networks interact with the immune system to maintain homeostasis, but dysregulation of these neuroimmunological interactions can cause overstimulation of the immune system and contribute to allergy pathophysiology.1 A review by Konstantinou and colleagues details the complex neuroimmunological inflammation in AR involving various cells in the nervous and immune systems.1 This insight into allergic pathways provides directions to focus on specialised treatments and patient-centric medicine.1

Recently, global experts in AR gathered to find areas of consensus on AR classification and treatment.3 According to the experts, the visual analogue scale (VAS) was the most reliable scale for classification – beating Allergic Rhinitis and its Impact on Asthma (ARIA) classification and categorisation based on own clinical judgement, and taking less than 2 minutes to classify patients’ severity.3 Dr Williams is joined by Dr Jumy Fadugba, the head of Allergy at Penn, and Dr Tiffany Dharia to discuss allergic rhinitis and how it is best managed in primary care. This podcast from the University of Pennsylvania covers diagnosing allergic vs non-allergic rhinitis, the treatment of AR and the efficacy and safety of INCS.5 The experts also found that AR treatment could be further simplified, allowing a patient switching from oral antihistamines (OAH) to intranasal corticosteroids (INCS) to remain on the treatment for 3 months without interim review given that the patient remains controlled.3

The effects of new inhaled corticosteroid (ICS) treatment on growth in children is a concern that lacks long-term data.4 This study evaluated the safety of one such ICS, fluticasone furoate (FF), and found that over 1 year, FF 50 μg once daily had a minimal effect on growth velocity (n=231) vs placebo (n=226), with no new safety signals.††4 These findings may support the use of FF in children with asthma.

A retrospective cohort study of 8,689 preschool children in Changsha, China, found that pre-conception exposure to home environmental factors, such as indoor air pollution from renovation or dampness related allergens, played a more important role in AR development than exposure during the first year of life.2 It also noted a significant association with birth during cold seasons and AR, although the reasons behind this were not detailed.2 These results suggest that efforts should be taken to reduce allergen and pollution exposure not only in children, but also in prospective parents before conception and during pregnancy.2

This study interviewed 81 patients with severe Type 2 inflammation and comorbidities, providing insight into the unmet needs from a patient perspective.4 Patients reported that a lack of coordination in care and a real cure were the most frustrating unmet needs, and suggested improvements such as better educational programmes for healthcare providers and patients.4 This paper also provides more insights from patients on how better care can be implemented.

This paper examines several factors that contribute to the hyperresponsiveness of the lower airways, such as the rhinopulmonary reflex, lower airway drainage of allergens and nasal obstruction.3 Until now, the mechanism of propagation of inflammation via the systemic circulation has been a common view.3 This review suggests various other mechanisms and provides direction for future research on AR.3

Do patients and physicians have differing knowledge of and attitudes towards AR and its treatment? To answer this question, the KAPPA study surveyed 1,436 patients and 1,637 physicians from eight countries.1 Results from KAPPA suggest that although patients and doctors agree that AR symptoms can be controlled with treatment, their views about the severity of the symptoms and the optimal choice of treatments differ.1 KAPPA uncovered a need for improved education and communication within and between these groups.1

While INCS are recommended by guidelines as a first-line therapy for children with moderate-severe AR, its use may be limited by the potential for adverse events.2–5 To evaluate the safety profile of INCS, experts reviewed 20 randomised clinical trials conducted on children with AR and treated with INCS.5 According to the experts’ assessment, INCS are generally tolerable at recommended doses in the paediatric populations.‡‡5 While the experts advised caution for those with ocular disorders, 2nd generation INCS display a favourable pharmacokinetic profile and minimal systematic adverse effects.‡‡5

FF/VI is an inhaled therapy for the treatment of asthma, with a prolonged duration of antiinflammatory and bronchodilatory action.6 This study investigated the global metabolomic and lipidomic profile following treatment with FF/ VI or placebo and assessed whether changes correlated with exhaled nitric oxide levels as a measure of airway inflammation.6 Despite the prolonged airway antiinflammatory action, this study detected only a subtle systemic metabolomic and lipidomic changes with FF/VI treatment.6

To date, LAR appears to be a debated and complex entity.7 According to Melone and colleagues, the story of LAR can be traced back to 1975, when Huggins et al. studied a group of patients with typical symptoms of AR to house dust mites but with negative skin-prick tests and serum immunoglobin E (IgE).7 Click on the link below to read a comprehensive review by Melone and colleagues summarizing the pathophysiological, diagnostic and therapeutic aspects of LAR.7

In keeping with the times, a new focus on the digital space is driving the rise of mHealth in allergy management. Dr Paolo Matricardi shared about the evolving landscape of applications geared towards monitoring patients’ allergy symptoms, and how these applications can be useful in AR diagnosis and management.2 Here’s an EAACI position paper on this topic published in 2019.

We noted that there was a strong focus on climate change, with many presentations addressing allergens and pollution. The presentation by Dr Guillermo Guido Fogelbach was particularly interesting as the talk focused on the impact of air pollution on health, which was associated with an increase in asthma symptoms, exacerbations, and hospitalisations.1 The figure above is a graphical summary of the presentation.

In response to the findings from an Australian online survey and focus group sessions of 11–25 year olds, a website was developed by the National Allergy Strategy for the estimated 250,000 Australian teens and young adults who live with severe allergies.8 Called 250K – a hub for the 250,000 young Australians living with severe allergies – aims to provide age-appropriate information and resources to assist young people who are living with severe allergies.8

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