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Javier Dominguez-Ortega,1 Vicente Plaza,2 Antonio Nieto,3 Julio Delgado Romero,4 Julio Ancochea,5– 7 Natalia Mejia,8 Mariano Pastor,9 Marina Blanco-Aparicio10 1Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain; 2Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; 3Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain; 4Allergology Clinical Management Unit, Hospital Virgen Macarena, Sevilla, Spain; 5Pneumology Department, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain; 6Pneumology Department, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; 7Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; 8Medical Department, Novartis Farmacéutica, Barcelona, Spain; 9Fundación Española de Asociaciones de Pacientes Alérgicos y con Enfermedades Respiratorias (FENAER), Madrid, Spain; 10Pneumology Department, A Coruña University Hospital, A Coruña, SpainCorrespondence: Javier Dominguez-Ortega, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain, Tel +34 616 719 390, Email javier.dominguez@salud.madrid.orgPurpose: ATLAS ASMA described the psychosocial impact of asthma on patients’ daily life from patients’ perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life.Patients and Methods: This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥ 18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients’ data are included.Results: A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤ 19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p< 0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p< 0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%).Conclusion: The study reported important insights on psychosocial impact of asthma on patients’ daily life from patients’ perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors.Keywords: patient survey, psychosocial impact, health-related quality of life, healthcare resources utilization, Asthma Control Test, Mini-AQLQ

Alicia Habernau Mena,1,&ast; Ismael García-Moguel,2,3,&ast; María Vazquez de la Torre Gaspar,4 Victoria Mugica,5 Maria Isabel Alvarado Izquierdo,6 Maria Aranzazu Jimenez Blanco,7 Mar Gandolfo-Cano,8 Mar Jiménez Lara,9 Ana Gonzalez Moreno,10 Pilar Saura Foix,11 Ana Navarro-Pulido,12 Cristina Martin-Arriscado Arroba,13 Julio Delgado Romero,14 Javier Dominguez-Ortega15 On behalf of Asthma Committee of SOCIEDAD ESPAÑOLA DE ALERGOLOGÍA E INMUNOLOGÍA CLÍNICA (SEAIC)1Department of Allergy. Complejo Hospitalario de Mérida, Mérida, Spain; 2Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain; 3Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Madrid, Spain; 4Department of Allergy, Hospital Universitario Infanta Leonor, Madrid, Spain; 5Department of Allergy, Hospital de la Princesa, Madrid, Spain; 6Department of Allergy, Hospital Universitario de Cáceres, Cáceres, Spain; 7Department of Allergy, Hospital Cruz Roja, Madrid, Spain; 8Department of Allergy, Hospital Universitario de Fuenlabrada, Madrid, Spain; 9Department of Allergy, Hospital de Toledo, Toledo, Spain; 10Department of Allergy, Fundación Hospital Alcorcón, Madrid, Spain; 11Department of Allergy, Consorci Sanitari de Terrassa, Terrassa, Spain; 12Allergology Clinical Management Unit (UGC), El Tomillar Hospital, Sevilla, Spain; 13Research and Science Support Unit, Instituto de investigación Biomédica del Hospital Universitario 12 de Octubre I+12, Madrid, Spain; 14Department of Allergy, Hospital Universitario Virgen Macarena, Sevilla, Spain; 15Department of Allergy, Hospital Universitario La Paz. Instituto de Investigación (idiPaz), Madrid, Spain&ast;These authors contributed equally to this workCorrespondence: Ismael García-Moguel, Department of Allergy, Hospital Universitario 12 de Octubre, Av de Córdoba s/n, Zip code 28005, Madrid, Spain, Tel +34-645852229, Email Ismaelgmoguel@gmail.comPurpose: The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a high impact on patients with chronic diseases. In the literature, there are different perspectives on asthma as comorbidity or risk factor on COVID-19 severity.Patients and Methods: The aim of this retrospective study across 13 allergy departments in Spain was to determine the severity of COVID-19 in asthmatic adults followed in allergy departments and its relationship with atopy, clinical and demographic characteristics, phenotypes and laboratory data. In addition, lung function test and asthma control test (ACT) before and after COVID-19 were analyzed. Data was obtained from electronic medical records from March 2020 to April 2021.Results: Two hundred one asthmatic patients were diagnosed with COVID-19 infection by validated detection test. About 30% of the patients were admitted for bilateral pneumonia. Advanced age, elevated D-dimer, lower numbers of lymphocytes and eosinophils, heart diseases and hypertension were associated with severe COVID-19. Allergic and mixed allergic/eosinophilic phenotype and their biomarkers (total IgE, aeroallergens sensitizations, allergic rhinitis, and blood eosinophilia) were related to fewer hospital admissions. Poor control and lower forced expiratory volume in the first second (FEV1) were related to worse prognosis of COVID-19.Conclusion: Asthmatic patients with allergic and eosinophilic phenotype have a better evolution of COVID-19 and lower risk of admissions. Older patients, cardiovascular comorbidities, AERD and eosinopenia are related to severity COVID-19.Keywords: COVID-19, allergic asthma, eosinophils, asthma phenotype, SARS-CoV-2

Pilar Barranco,1 Elsa Phillips-Angles,2 Javier Dominguez-Ortega,1 Santiago Quirce1 1Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; 2Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain Abstract: Severe asthma constitutes illness in a relatively small proportion of all patients with asthma, but it is a major public health problem – with considerable effect on morbidity, mortality, as well as a high burden on health care resources. Regardless of effective treatments being widely available and the existence of treatment guidelines, a large population of severe asthma cases remain uncontrolled. Achieving and maintaining asthma control in this group of patients is, therefore, of utmost importance. The recognition of distinct inflammatory phenotypes within this population has driven the development of targeted biological therapies – particularly, selective targeted monoclonal antibodies (mAbs). It is noteworthy that in approximately 50% of these patients, there is strong evidence of the pathogenic role of T helper type-2 (Th2) cytokines, such as interleukin (IL)-4 and IL-13, orchestrating the eosinophilic and allergic inflammatory processes. Among the recently developed antiasthma biologic drugs, the mAb dupilumab is very promising given its ability to inhibit the biological effects of both IL-4 and IL-13. In this review, we focused on IL-4 and IL-13, as these interleukins are considered to play a key role in the pathophysiology of asthma, and on dupilumab, an anti-IL-4 receptor human mAb, as a forthcoming treatment for uncontrolled severe asthma in the near future. Keywords: dupilumab, asthma, interleukin-4, interleukin-13, monoclonal antibodies, treatment

Ismael García-Moguel,1,2 Ana Rosado,3 Aída Gómez-Cardeñosa,4,5 Mar Gandolfo-Cano,6,7 Teresa Robledo Echarren,8 Maria del Mar Moro Moro,9 Mª del Mar Reaño Martos,10 Rafael Pineda-Pineda,11 Marcela Valverde-Monge,4,5 Cristina Martin-Arriscado Arroba,12 Javier Domínguez-Ortega13 On behalf of the AIRE Group1Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain; 2Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; 3Department of Allergy, Hospital Universitario Fundación Alcorcón, Madrid, Spain; 4Department of Allergy, University Hospital Fundación Jiménez Díaz, Madrid, Spain; 5Centro de investigación biomédica en enfermedades respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain; 6Department of Allergy, Hospital Universitario de Fuenlabrada, Madrid, Spain; 7RETIC ARADyAL, Instituto de Salud Carlos III, Madrid, Spain; 8Department of Allergy, Hospital Clinico San Carlos (HCSC), Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain; 9Department of Allergy, Complejo Hospitalario de Toledo, Toledo, Spain; 10Department of Allergy, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; 11Department of Allergy, Hospital Universitario del Sureste, Madrid, Spain; 12Research and Science Support Unit, Instituto de investigación Biomédica del Hospital Universitario 12 de Octubre I+12, Madrid, Spain; 13Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, SpainCorrespondence: Ismael García-Moguel, Tel +34 645852229, Email Ismaelgmoguel@gmail.comIntroduction: The increase in drugs available for severe uncontrolled asthma and the lifestyle of these patients make it necessary to implement self-administration programs of these therapies at home. Benralizumab, a monoclonal antibody targeting IL5R, was authorized in Spain for poorly controlled severe eosinophilic asthma. The possibility of administration at home was approved in March 2020 in Spain. The aim of the Auto-Benra study was to evaluate the usability and satisfaction of the benralizumab prefilled syringe and autoinjector and assessing the effectivity of these devices in uncontrolled severe eosinophilic asthma (SEA) in home-self administration.Methods: This is a retrospective, observational multicenter study uncontrolled SEA patients treated with benralizumab at least with 3 doses self-administered at home before April 30, 2021. Reliability and satisfaction with benralizumab at home were evaluated with subcutaneous administration assessment questionnaire (SQAAQ) and visual analogic scales (VAS). Effectiveness was evaluated in all patients with asthma control test (ACT), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), annual exacerbation rate, oral corticosteroid treatment (OCS) and asthma-related hospitalizations and emergency visits.Results: Fifty-four patients across 9 hospitals in Spain were included. The mean SQAAQ score was 6.89 (± 0.16) points. Patients and their caregivers and doctors report excellent satisfaction by VAS, with no differences between benralizumab devices used (prefilled syringe and autoinjector). Severe exacerbation rate decreased by 65% (p = 0.0007) after benralizumab treatment. ACT score improved on average 6.27 ± 5.35 points (p < 0.0001) and the mean MiniAQLQ increased up to 1.58 ± 1.47 points (p < 0.0001). Twenty-four patients were OCS-dependent and at the end of study 14 patients get complete OCS withdrawal.Conclusion: AUTO-BENRA study supports the use of benralizumab at home given the excellent results of satisfaction and usability by patients and their caregivers.Keywords: benralizumab, severe eosinophilic asthma, self-administration, severe asthma, eosinophilic asthma

Javier Domínguez-Ortega,1,2 Silvia Sánchez-García,3 Carlos Melero Moreno4 1Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; 2CIBER of Respiratory Diseases (CibeRes), Madrid, Spain; 3Department of Allergy, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; 4Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Madrid, SpainCorrespondence: Carlos Melero Moreno, Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Av. de Córdoba, S/N, Madrid, 28041, Spain, Tel +34 913908000/ext. 4646, Email cmelero@separ.es; cmelero.imas12@h12o.es

Ignacio Esteban-Gorgojo,1 Darío Antolín-Amérigo,2 Javier Domínguez-Ortega,3,4 Santiago Quirce3,4 1Department of Allergy, Hospital General de Villalba, Madrid, Spain; 2Department of Allergy, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; 3Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), 4CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain Abstract: Although non-eosinophilic asthma (NEA) is not the best known and most prevalent asthma phenotype, its importance cannot be underestimated. NEA is characterized by airway inflammation with the absence of eosinophils, subsequent to activation of non-predominant type 2 immunologic pathways. This phenotype, which possibly includes several not well-defined subphenotypes, is defined by an eosinophil count

Background: The risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients who experience asthma exacerbations. We also assessed potential triggers of exacerbations and possible predictors of hospitalization., Methods: A retrospective, noninterventional cohort study was conducted in adult patients who attended the emergency department of a tertiary hospital with an asthma exacerbation during 2014., Results: The study population comprised 831 patients (888 events). Most episodes occurred in January and May. Respiratory infection was the trigger in 523 events. In 34.21% of cases, the eosinophil count was ≥260/mm3 (≥400/mm3 in 20.7%), which was significantly associated with allergic asthma (P<.0001). The risk factors for hospitalization were older age (OR, 1.58; 95%CI, 1.46-1.71), no previous diagnosis of asthma (OR, 1.40; 95%CI, 1.06-1.86), poorly controlled asthma (OR, 1.78; 95%CI, 1.10-2.88), respiratory infection (OR, 2.65; 95%CI, 1.95-3.62), and severe exacerbation with more treatment requirements. The rate of hospitalization was significantly lower in patients with ≥400 eosinophils/mm3 (P<.001)., Conclusions: Older age, absence of a previous asthma diagnosis, uncontrolled disease, and concomitant chronic obstructive pulmonary disease are frequent among patients presenting at the emergency department with asthma exacerbations. Various features were associated with a higher risk of admission. Blood eosinophilia should be considered a marker of asthma, but not a predictor of hospitalization.

To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence)., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain., Methodology: This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed., Results: Out of a cohort of 1,012,257 patients (≤18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease., Conclusions: Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO 2 , SO 2 , O 3 , and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO 2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence)., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Pru p 7 has been reported as a major allergen in peach allergy, associated with severe clinical symptoms and related to IgE sensitisation to cypress pollen. The main objective of this study was to prospectively evaluate the frequency of sensitisation to Pru p 7 and its clinical relevance amongst pediatric patients with peach allergy in Madrid (Spain)., Methods: Patients with a history of IgE-mediated symptoms (oral allergy syndrome, urticaria/angioedema, rhinoconjunctivitis/asthma, gastrointestinal symptoms, or anaphylaxis) occurring within 2 h after peach intake or contact were prospectively recruited from February 2020 to September 2021. Skin tests, sIgE by ImmunoCAP® (Pru p 1, Pru p 3, Pru p 4, Pru p 7, and Cupressus arizonica) and oral food challenge (OFC) were performed. The study was approved by the local Ethics Committee (PI-4513)., Results: Ninety-two patients were included (53.3% male); median age, 10 (IQR 6.0-14.75) years. Seventy-four (80.4%) patients had a reaction after ingestion of fresh peach (25.0% from peel, 23.9% from pulp, and 44.6% from both). Fifteen (16.3%) patients were sensitised to Pru p 7. Upper airway symptoms, anaphylaxis, and grade 2 reactions were statistically more frequent in patients sensitised to Pru p 7. Seven (7.9%) patients presented with exercise as a cofactor, four of whom were sensitised to Pru p 7 (p = .001). Patients sensitised to Pru p 7 were significantly more likely to have a positive OFC result than patients who were not (p = .008). Four patients who reacted to peach at OFC were sensitised to Pru p 7. Specific IgE against Cupressus arizonica pollen was positive in 25 (62.5%) patients., Conclusions: Pru p 7 sensitisation was observed in 16.3% of our population and was related to severe reactions, upper airway symptoms, anaphylaxis, and the presence of an eliciting cofactor., (© 2023 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Limited number of studies have focused on the impact of pollen exposure on asthma. As a part of the EAACI Guidelines on Environment Science, this first systematic review on the relationship of pollen exposure to asthma exacerbations aimed to bridge this knowledge gap in view of implementing recommendations of prevention. We searched electronic iPubMed, Embase, and Web of Science databases using a set of MeSH terms and related synonyms and identified 73 eligible studies that were included for systemic review. When possible, meta-analyses were conducted. Overall meta-analysis suggests that outdoor pollen exposure may have an effect on asthma exacerbation, but caution is needed due to the low number of studies and their heterogeneity. The strongest associations were found between asthma attacks, asthma-related ED admissions or hospitalizations, and an increase in grass pollen concentration in the previous 2-day overall in children aged less than 18 years of age. Tree pollen may increase asthma-related ED visits or admissions lagged up to 7-day overall in individuals younger than 18 years. Rare data show that among subjects under 18 years of age, an exposure to grass pollen lagged up to 3 days may lower lung function. Further research considering effect modifiers of pollen sensitization, hay fever, asthma, air pollution, green spaces, and pre-existing medications is urgently warranted to better evaluate the impacts of pollen on asthma exacerbation. Preventive measures in relation to pollen exposure should be integrated in asthma control as pollen increase continues due to climate change., (© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Patients with asthma exacerbations and frequent relapses that require admission to the emergency department (ED) often have more severe disease, worse quality of life, and higher use of health care resources., Objective: The aim of this study was to identify potential predictors of relapse after patients are treated in an ED for an asthma exacerbation., Methods: A retrospective, noninterventional cohort study was conducted in adult patients who attended the ED of a tertiary hospital in 2014 for an asthma exacerbation. We analyzed the subpopulation who experienced at least one relapse (returned to the ED < 15 days after the previous event)., Results: Fifty-two of 831 patients experienced 66 relapses after going to the ED (mean ± standard deviation [SD] age, 58.5 ± 23.4 years). The average ± SD probability of a relapse was 6 ± 0.8%. The frequency of episodes was higher in May and November. Twenty-four patients had ≥260 blood eosinophils/μL, including 17 who had ≥400 eosinophils/μL. Only 15% of the patients were referred to an asthma specialist at discharge. Factors related to a higher probability of relapse were the following: having multiple visits to the ED in 1 year, uncontrolled asthma, wheezing in the pulmonary auscultation, peripheral eosinophilia with ≥400 eosinophils/ μL, and being discharged in the first visit to the ED (p < 0.01 for all)., Conclusion: In this population, patients who had multiple ED visits in 1 year, those with uncontrolled asthma, wheezing, ≥400 blood eosinophils/μL, or who had been discharged at the first ED visit are at higher risk of relapse.