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"Epidemiology of comorbidities and their association with asthma control" (Tomisa, G., Horváth, A., Sánta, B. et al. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol 17, 95 (2021). https://doi.org/10.1186/s13223-021-00598-3) is an interesting paper reflecting data collection from more than 12,000 asthmatic patients in Hungary regarding their condition and associated comorbidities. We found it valuable that the paper provides an overview of asthma comorbidities not usually considered in similar reports. Nevertheless, we believe that chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP or CRSsNP) should have been listed due to its high incidence and prevalence, its association with asthma which is also endorsed in both GINA and EPOS, as well as in several peer-reviewed scientific papers, and to reflect the role of this comorbidity in poor control and a most severe presentation of asthma for the patient. Consequently, several targeted therapies (especially monoclonal antibodies) used for several years in severe forms of asthma are now indicated also for the effective treatment of nasal polyps. [ABSTRACT FROM AUTHOR]

Background: A subset of individuals with allergic asthma develops a late phase response (LPR) to inhaled allergens, which is characterized by a prolonged airway obstruction, airway inflammation and airway hyperresponsiveness. The aim of this study was to identify changes in the plasma proteome and circulating hematopoietic progenitor cells associated with the LPR following inhaled allergen challenge.Methods: Serial plasma samples from asthmatics undergoing inhaled allergen challenge were analyzed by mass spectrometry and immunosorbent assays. Peripheral blood mononuclear cells were analyzed by flow cytometry. Mass spectrometry data were analyzed using a linear regression to model the relationship between airway obstruction during the LPR and plasma proteome changes. Data from immunosorbent assays were analyzed using linear mixed models.Results: Out of 396 proteins quantified in plasma, 150 showed a statistically significant change 23 h post allergen challenge. Among the most upregulated proteins were three protease inhibitors: alpha-1-antitrypsin, alpha-1-antichymotrypsin and plasma serine protease inhibitor. Altered levels of 13 proteins were associated with the LPR, including increased factor XIII A and decreased von Willebrand factor. No relationship was found between the LPR and changes in the proportions of classical, intermediate, and non-classical monocytes.Conclusions: Allergic reactions to inhaled allergens in asthmatic subjects were associated with changes in a large proportion of the measured plasma proteome, whereof protease inhibitors showed the largest changes, likely to influence the inflammatory response. Many of the proteins altered in relation to the LPR are associated with coagulation, highlighting potential mechanistic targets for future treatments of type-2 asthma. [ABSTRACT FROM AUTHOR]

Introduction: SYNAPSE, a Phase III, randomised, doubleblind trial, assessed the efficacy of mepolizumab in severe chronic rhinosinusitis with nasal polyps (CRSwNP) (Han JK, et al. Lancet Respir Med 2021; S2213-2600(21)00097-7). Aim: To assess the clinical response to mepolizumab in severe CRSwNP. Method: In SYNAPSE, patients received standard of care plus mepolizumab (100 mg subcutaneous) or placebo for 52 weeks. This post hoc, descriptive analysis, classified patients in the intent-totreat (ITT) population without sinus surgery during the study period as responders, using 5 modified European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) criteria (Bachert C, et al. JACI, 2021;147:29). Results: In the ITT population (n=407), 381 and 343 patients had not had sinus surgery by Weeks 24 and 52, respectively. For each EUFOREA criterion (reduced nasal polyp size and nasal obstruction, improved sense of smell, improved quality of life, improved overall symptoms) proportion of patients classified as responders was higher with mepolizumab than placebo at Weeks 24 and 52. The proportion of patients who met =3 criteria was 55% with mepolizumab vs 35% with placebo at Week 24, and 67% vs 49% at Week 52. Conclusion: Clinical response, as defined by the modified EUFOREA criteria, was greater with mepolizumab than placebo and increased from Week 24 to Week 52, suggesting a sustained, progressive response in patients with severe CRSwNP without sinus surgery during the study. [ABSTRACT FROM AUTHOR]