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The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma., Competing Interests: DC: Serves as academic manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and as review editor at Frontiers in Allergy, rhinology section. MM: Honoraria for speaker and advisory boards: Sanofi, Glenmark, P&G, Immunotek, Cipla, Thermo-Scientific, Lancet laboratories. EUFOREA expert panel member. VB: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, AZ, ALK Abello and BORK-npc. GS: has received speakers fees from ALK-Abello, Meda and Glenpharm, and received honoraria for participation in an advisory group from ALK-Abello. MB-S: Speaker honorarium from GSK Spain, Viatris Spain, Sanofi Spain, WIDEX Spain, Bionorica, Germany. ED: Received fee for consultation, speaker activity, advisory board by Sanofi, Regeneron, GSK, Novartis and AstraZeneca. ZD: In the past 3 years, received speaker or consultant honoraria and/or served on advisory boards at: Antabio, Arcede, Biosion, Foresee Pharmaceuticals, Galenushealth, GlaxoSmithKline, Hippo-Dx, QPS-Netherlands, Sanofi-Genzyme-Regeneron, and Springer Media all outside the submitted work. From 2012 to 2020 she acted as Director Respiratory & Allergy Research at QPS-Netherlands; in 2019-ongoing, QPS-Netherlands received a European grant from ERA4TB and funding Foresee Pharmaceuticals for early respiratory studies. CH: Ad boards—GSK, Sanofi Regeneron, Lilly. MJ: Has received consulting fees (ALK-Abello, Stallergenes-Greer, Takeda, Zentiva); honoraria for lectures, presentations (ALK-Abello, Stallergenes-Greer, Takeda, Zentiva, Mundipharma, AstraZeneca, SOBI, Chiesi, CSL Behring, Novartis, Benela, Pfizer, Viatris); support for attending meetings and/or travel (ALK-Abello, Stallergenes-Greer, Takeda, Novartis, Sanofi Pasteur) and honoraria for participation on Advisory Boards (ALK-Abello, Stallergenes-Greer, Chiesi, Novartis, SOBI, Pfizer, Sanofi Genzyme/Pasteur). JK: Jasper Kappen reports grants and/or personal fees from ALK, Chiesi, GSK, Novartis, AstraZeneca, Sanofi, Boerhinger, Teva, Viatris, Stallergen, Abbot, all outside the submitted work. JM: Joaquim Mullol is or has been member of national and international scientific advisory boards, consulting, received fees for lectures, and grants for research projects or clinical trials from AstraZeneca, Genentech-Roche, Glenmark, GSK, LETI, Lilly, Menarini, MSD, Mitsubishi-Tanabe, NOUCOR/Uriach Group, Novartis, OPTINOSE, Proctor & Gamble, Regeneron Pharmaceuticals Inc., Sanofi-Genzyme, UCB Pharma, and Viatris/MEDA Pharma. DP: David Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; consultancy agreements with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Viatris, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Teva Pharmaceuticals; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. SQ: Speaking, lecture and consulting fees from Allergy Therapeutics, ALK, AstraZeneca, Chiesi, GSK, Mundipharma, Novartis, Sanofi-Genzyme, and Teva. SR: Has acted as a consultant and/or advisory board member for Sanofi, GSK, and Novartis. The department of Otorhinolaryngology and Head/Neck Surgery of the Amsterdam UMC has received research funding from Sanofi, GSK, and Novartis. ST-S: Reports consultancies for ALK-Abelló, AstraZeneca, ERT, GSK, Novartis, Sanofi, and Roche Products outside the submitted work, as well as grant of GSK outside the submitted work. BS: Lyra Therapeutics: consultant, Stryker: Consultant, Neurent: consultant, MCSP: consultant and American Rhinologic Society: VP of Development and Strategy. JT: Jacob Thyssen previously as an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, Pfizer, Regeneron, and Sanofi-Genzyme; a speaker for AbbVie, Almirall, Eli Lilly & Co, Pfizer, Regeneron, and Sanofi Genzyme; and received research grants from Pfizer, Regeneron, and Sanofi Genzyme. He currently holds a shared position between the university and LEO Pharma where he receives a salary and holds stock options. UW: Consulting for VIATRIS, lecture fees from ALK Germany. PH: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, Medtronic and Viatris. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Scadding, Gray, Conti, McDonald, Backer, Scadding, Bernal-Sprekelsen, De Corso, Diamant, Hopkins, Jesenak, Johansen, Kappen, Mullol, Price, Quirce, Reitsma, Toppila-Salmi, Senior, Thyssen, Wahn and Hellings.)

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinus cavities that significantly affects well-being and social function, particularly in young adults and middle-aged populations. CRSwNP is a common health condition in the Western world, with an estimated prevalence of 3%. Despite worldwide evidence-based treatment guidelines such as the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 and the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) chronic rhinosinusitis (CRS) pocket guide, a significant number of patients remain undiagnosed and/or uncontrolled with repeated oral corticosteroids (OCS) treatments and/or (multiple) endoscopic sinus surgeries (ESS)., Competing Interests: DMC: Serves as academic manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and as review editor at Frontiers in Allergy, rhinology section. GKS: Honoraria for articles, speaker and advisory boards: ALK, Bayer, GlaxoSmithKline, Haleon, Noucor, Sanofi-Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Board member and AR lead for EUFOREA, and Chair/member Data Monitoring Committees on SLIT for ALK. MM: Honoraria for speaker and advisory boards: Sanofi, Glenmark, P&G, Immunotek, Cipla, Thermo-Scientific, Lancet laboratories. EUFOREA expert panel member. PWH: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, Medtronic and Viatris. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Teeling, Djouder, Laurens, Preyra, Shire, Van Staeyen, Conti, Scadding and Hellings.)

Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with disability. Significant efforts are made by organizations such as WHO in improving the diagnosis, treatment and monitoring of asthma. However asthma prevention has been less studied. Currently there is a concept of pre- diabetes which allows a reduction in full blown diabetes if diet and exercise are undertaken. Similar predictive states are found in Alzheimer's and Parkinson's diseases. In this paper we explore the possibilities for asthma prevention, both at population level and also investigate the possibility of defining a state of pre-asthma, in which intensive treatment could reduce progression to asthma. Since asthma is a heterogeneous condition, this paper is concerned with allergic asthma. A subsequent one will deal with late onset eosinophilic asthma., Competing Interests: GKS: Honoraria for articles, speaker and advisory boards: ALK, Bayer, GlaxoSmithKline, Haleon, Noucor, Sanofi- Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Board member and AR lead for EUFOREA, and Chair/ member Data Monitoring Committees on SLIT for ALK. MM: Honoraria for speaker and advisory boards: Sanofi, Glenmark, P&G, Immunotek, Cipla, Thermo-Scientific, Lancet laboratories. EUFOREA expert panel member. VB: Is recipient of consultancy/llecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, AZ, ALK Abello and BORK-npc. GS: GWS has received speakers fees from ALK-Abello, Meda and Glenpharm, and received honoraria for participation in an advisory group from ALK-Abello. MB-S: Speaker honorarium from GSK Spain, Olympus Europe, Viatris Spain, Sanofi Spain. Editor-in-Chief Eur.Arch.ORL-HNS. ED: Received fee for consultation, speaker activity, advisory board by Sanofi, Regeneron, GSK, Novartis and Astrazeneca. ZD: In the past 3 years, ZD received speaker or consultant honoraria and/or served on advisory boards at: Antabio, Foresee Pharmaceuticals, GlaxoSmithKline, Hippo-Dx, QPS-Netherlands, Sanofi-Genzyme-Regeneron, and Springer Media all outside the submitted work. From 2012 to 2020 she acted as Director Respiratory & Allergy Research at QPS-Netherlands; in 2019-ongoing, QPS-Netherlands received a European grant from ERA4TB and funding Foresee Pharmaceuticals for early respiratory studies. CH: Ad boards - GSK, Sanofi Regeneron, Lilly. MJ: Has received consulting fees (ALK-Abello, Stallergenes-Greer, Takeda, Zentiva); honoraria for lectures, presentations (ALK-Abello, Stallergenes-Greer, Takeda, Zentiva, Mundipharma, AstraZeneca, SOBI, Chiesi, CSL Behring, Novartis, Benela, Pfizer, Viatris); support for attending meetings and/or travel (ALK-Abello, Stallergenes-Greer, Takeda, Novartis, Sanofi Pasteur) and honoraria for participation on Advisory Boards (ALK-Abello, Stallergenes-Greer, Chiesi, Novartis, SOBI, Pfizer, Sanofi Genzyme/Pasteur). JK: Jasper Kappen reports grants and/or personal fees from ALK, Chiesi, GSK, Novartis, AstraZeneca, Sanofi, Boerhinger, Teva, Viatris, Stallergen, Abbot, all outside the submitted work. JM: Joaquim Mullol is or has been member of national and international scientific advisory boards, consulting, received fees for lectures, and grants for research projects or clinical trials from AstraZeneca, Genentech-Roche, GSK, LETI, Lilly, Menarini, MSD, Mitsubishi-Tanabe, NOUCOR/Uriach Group, Novartis, OPTINOSE, Proctor & Gamble, Regeneron Pharmaceuticals Inc., Sanofi-Genzyme, UCB Pharma, and Viatris/MEDA Pharma. DP: David Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; consultancy agreements with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Viatris, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Teva Pharmaceuticals; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. SQ: Speaking, lecture and consulting fees from Allergy Therapeutics, ALK, AstraZeneca, Chiesi, GSK, Mundipharma, Novartis, Sanofi-Genzyme, and Teva. SR: Has acted as a consultant and/or advisory board member for Sanofi, GSK, and Novartis. The department of Otorhinolaryngology and Head/Neck Surgery of the Amsterdam UMC has received research funding from Sanofi, GSK, and Novartis. SS: Reports consultancies for ALK-Abelló, AstraZeneca, ERT, GSK, Novartis, Sanofi, and Roche Products outside the submitted work, as well as grant of GSK outside the submitted work. BS: Lyra Therapeutics: consultant, Stryker: Consultant, Neurent: consultant, MCSP: consultant and American Rhinologic Society: VP of Development and Strategy. JT: Jacob Thyssen previously as an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, Pfizer, Regeneron, and Sanofi-Genzyme; a speaker for AbbVie, Almirall, Eli Lilly & Co, Pfizer, Regeneron, and Sanofi Genzyme; and received research grants from Pfizer, Regeneron, and Sanofi Genzyme. He currently holds a shared position between the university and LEO Pharma where he receives a salary and holds stock options. UW: Consulting for VIATRIS, lecture fees from ALK Germany. PH: Is recipient of consultancy/llecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, Medtronic and Viatris. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Scadding, McDonald, Backer, Scadding, Bernal-Sprekelsen, Conti, De Corso, Diamant, Gray, Hopkins, Jesenak, Johansen, Kappen, Mullol, Price, Quirce, Reitsma, Salmi, Senior, Thyssen, Wahn and Hellings.)

Introduction: Aspirin desensitization (AD) and aspirin therapy after desensitization (ATAD) are therapeutic interventions for patients with aspirin-exacerbated respiratory disease (AERD). Our aim is to investigate whether its addition to endoscopic sinus surgery (ESS) improves the overall prognosis of the disease., Methods: A systematic review of the current literature including adult patients with a positive diagnosis of AERD undergoing endoscopic sinus surgery (ESS) in the context or in absence of upper airway comorbidity, prior to AD + ATAD., Conclusion: This review concludes that the surgical approach is beneficial in AERD, but its effects are short-lived. Surgery should be considered initially with subsequent AD + ATAD in AERD patients, due to the sustained improvement achieved compared to those receiving ESS alone., Competing Interests: GS: Honoraria for articles, speaker and advisory boards: ALK, AstraZeneca, Capnia, Church & Dwight, Circassia, Noucor, GSK, Meda/Mylan/Viatris, Merck, Sanofi- Regeneron, Stallergenes. Scientific Chief Editor, Rhinology Section, Frontiers in Allergy. Board Member, Lead for Allergic Rhinitis, EUFOREA. Chair of Data Monitoring Board for Paediatric AR trials of HDM SLIT. The remaining author(s) declare(s) that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Conti, Correa and Scadding.)

In March 2023, the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual Summit in Brussels with expert panel members of EUFOREA, representatives of the EUFOREA patient advisory board, and the EUFOREA board and management teams. Its aim was to define the research, educational and advocacy initiatives to be developed by EUFOREA over the next 2 years until the 10th anniversary in 2025. EUFOREA is an international non-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic allergic and respiratory diseases via research, education, and advocacy. Based on its medical scientific core competency, EUFOREA offers an evidence-supported platform to introduce innovation and education in healthcare leading to optimal patient care, bridging the gap between latest scientific evidence and daily practice. Aligned with the mission of improving health care, the expert panels of asthma, allergic rhinitis (AR), chronic rhinosinusitis (CRS) & European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), allergen immunotherapy (AIT) and paediatrics have proposed and elaborated a variety of activities that correspond to major unmet needs in the allergy and respiratory field. The current report provides a concise overview of the achievements, ambitions, and action plan of EUFOREA for the future, allowing all stakeholders in the allergy and respiratory field to be up-dated and inspired to join forces in Europe and beyond., Competing Interests: HPW: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, Medtronic and Viatris. LS: Honoraria by Allergopharma, DBV Technologies, Sanofi-Aventis, Leti, Nutricia. AD-Boards: Leo-Pharma, GSK, Sanofi-Aventis. SGK: Honoraria for articles, speaker and advisory boards: ALK, Bayer, GlaxoSmithKline, Haleon, Noucor, Sanofi- Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Board member and AR lead for EUFOREA, and Chair/ member Data Monitoring Committees on SLIT for ALK. BV: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, AZ, ALK Abello and BORK-npc. CAM: Grants, speaker honoraria, consultancy or advisory fees and/or research support all via Technical University of Munich from Allergopharma, ALK Abello, AstraZeneca, Bencard/Allergen Therapeutics, Immunetek, GSK, Novartis, LETI, Roche, Zeller, Sanofi Genzyme, Regeneron, European Institute of Technology, Federal German Ministery of Research and Education. Travel support by EUFOREA, EAACI and DGAKI. DCE: Lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Regeneron, Astrazeneca. DR: No conflict of interest to declare related to this work, but declares a general COI arising out of consulting pharmaceutical companies (GlaxoSmithKline, Sanofi, Kymab and Synairgen) and honoraria for speaking (GlaxoSmithKline). FW: The department of Otorhinolaryngology of the Amsterdam University Medical centre, location AMC received grants for research in Rhinology from ALK, AllergyTherapeutics, Novartis, EU, GSK, MYLAN, Sanofi-Aventis, and Zon-MW. WF: Received consultation and/or speaker fees from Dianosic, GSK, Novartis and Sanofi-Aventis/Regeneron. GP: Has participated in advisory boards and received speaker fees from ALK-Abelló, Argenx, AstraZeneca, Genentech, GSK, Novartis, Regeneron, Roche, Sanofi Genzyme, and Stallergenes- Greer. HJK: Research consultant for Sanofi, Regeneron, GlaxoSmithKline, and AstraZeneca. HLG: Has received grant funding, participated in advisory boards and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Hoffmann la Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grants from MedImmune, Novartis UK, Roche/ Genentech Inc, and Glaxo Smith Kline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine and Vitalograph; he has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; he has also taken part in asthma clinical trials sponsored by AstraZeneca, Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he is the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen. JM: Declares a general COI arising out of consulting pharmaceutical companies (BerlinChemie Menarini, AstraZeneca, Chiesi, Stallergenes-Greer, ALK, Novartis) and honoraria for speaking (BerlinChemie Menarini, Chiesi, Stallergenes-Greer, Sanofi, Takeda, Novartis). ME: Has received lecture and/or advisory board fees from Airsonett, ALK, AstraZeneca, Chiesi, Novartis and Sanofi outside the submitted work. MJ: Grants from Mylan Pharma, Noucor/Uriach Group, and GSK. Personal and advisory board fees from Sanofi-Genzyme & Regeneron, Novartis, Mylan Pharma, Noucor/Uriach Group, Mitsubishi-Tanabe, Menarini, UCB, AstraZeneca, GSK, and MSD. RS: Declares a general COI arising out of consulting pharmaceutical companies and/or advisory boards (GlaxoSmithKline, Sanofi, Novartis). SG: Have received speaker fees from ALK-Abello, Meda, Glenmark and funding to attend a conference from GSK and Mylan/Meda. WU: Has received honoraria for advising and lecturing from Viatris, Stallergenes, and ALK. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Hellings, Lau, Scadding, Bjermer, Backer, Chaker, Conti, De Corso, Diamant, Djukanovic, Fokkens, Gevaert, Gray, Han, Heaney, Hoffmann, Jesenak, Johansen, Kumaran, McDonald, Melén, Mullol, Reitsma, Ryan, Scadding, Schmid-Grendelmeier, Teeling, Odemyr and Wahn.)