Organ-specific allergen challenges in airway allergy: Current utilities and future directions

Atopy has been long used as the screening method for airway allergy. Nevertheless, aeroallergens can trigger respiratory symptoms not only in atopic patients (atopic res piratory allergy, ARA), but also in non-atopic subjects (local respiratory allergy, LRA). Moreover, ARA and LRA can coexist in the same patient, and this clinical scenario has been called dual respiratory allergy (DRA). When the clinical history cannot determine the relevance of sensitizations in ARA patients, nasal, conjunctival or bronchial aller gen challenges (NAC, CAC, and BAC, respectively) should be conducted. Moreover, these tests are required to identify patients with LRA and DRA. The clarification of the allergic triggers of airway diseases has a profound impact on the management strategies the patients can be offered. Importantly, allergen immunotherapy (AIT) remains as the only disease-modifying intervention for ARA. Recent data indicate that AIT might have a similar effect on LRA patients. Nevertheless, AIT success relies largely on the correct phenotyping of allergic individuals, and NAC, CAC, and BAC are very helpful tools in this regard. In this review, we will summarize the main indications and methodology of CAC, NAC, and BAC. Importantly, the clinical implementation of these tests might translate into precision medicine approaches and better health outcomes for patients with airway allergy.Consejería de Salud, Junta de Andalucía, Grant/Award Number: P20_00405; Instituto de Salud Carlos III, Grant/Award Number: PI20/01715, RD21/0002/0008, CM21/00262, CM20/00160, JR22/00048 and JR19/00029. Funding for open access charge: Universidad de Málaga / CBUA

Allergen exposure boosts peripheral Th9 responses in patients with local allergic rhinitis

Key points ∙ Intranasal allergen exposure increases peripheral total Th2 and Th9 cells in patients with local allergic rhinitis (LAR). ∙ Peripheral T-cell response seems dominated by Th9 cells in patients with LAR, whereas Th2 responses prevail in patients with allergic rhinitis. ∙ Our results identify Th9 cells as potential therapeutic targets for patients with LAR.Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Science and Competitiveness, Grant/Award Number: PI20/01715; Regional Ministry of Health of Andalucia through research projects, Grant/Award Numbers: PI-0346-2016, PI-0176-2018; Regional Ministry of Education of Andalucia through a research project, Grant/Award Number: P20-00405; Francisca Palomares holds a Senior Postdoctoral Program contract, Grant/Award Number: RH-0028-2021; Almudena Testera-Montes a “Rio Hortega” contract, Grant/Award Number: CM20/00160; Carlos Jose Aranda a “Sara Borrell” contract, Grant/Award Number: CD21/00034; Carmen Alba-Linero a “Río Hortega” contract, Grant/Award Number: CM21/00262; Ibon Eguiluz-Gracia a “Juan Rodes” contract, Grant/Award Number: JR19/00029; Cristobalina Mayorga holds a “Nicolas Monardes” contract, Grant/Award Number: RC-0004-2021; Asma, ReaccionesAdversas y Alérgicas-ARADyAL, Grant/ Award Number: RD16/0006/0001; Redes de InvestigacionCooperativaOrientadas al Resultado en Salud: Enfermedades Inflamatorias, Grant/Award Number: RD21/0002/0008 Funding for open access charge: Universidad de Málaga/CBU