Mucus plugs are a central, yet often underrecognized, hallmark of eosinophilic inflammation across asthma, chronic obstructive pulmonary disease, and related eosinophilic lung diseases. By obstructing the airway lumen, plugs not only impair airflow and worsen symptoms but are also associated with corticosteroid resistance and accelerated disease progression. Advances in high-resolution computed tomography have improved detection and quantification, linking plug burden to airflow limitation, loss of lung function, and even mortality. Eosinophils contribute to plug pathology through extracellular trap formation, release of cytotoxic proteins, and crystal deposition, which in turn drive airway structural changes and abnormal mucus composition and clearance. These interrelated processes promote the persistence of eosinophilic mucus plugs and reinforce airway dysfunction. Therapeutically, biologics targeting type 2 inflammatory pathways have demonstrated that they reduce mucus plugs in patients with asthma, with emerging evidence suggesting similar potential in eosinophilic chronic obstructive pulmonary disease. Innovative strategies designed to disrupt extracellular traps and reshape plug structure offer promising avenues for intervention. Recent advances in imaging, biology, and therapeutics have established mucus plugs as both a marker and a modifiable target across eosinophilic lung diseases. Future studies integrating imaging and biomarkers are essential to define persistence versus resolution, optimize patient stratification, and establish plugs as a transformative therapeutic target in eosinophilic lung diseases.
{"title":"Mucus Plugs and Eosinophilic Inflammation: Expanding the Paradigm to COPD","authors":"Shigeharu Ueki MD, PhD , Eleanor Dunican MD, PhD , Alejandro A. Diaz MD, MPH","doi":"10.1016/j.jaip.2025.11.028","DOIUrl":"10.1016/j.jaip.2025.11.028","url":null,"abstract":"<div><div>Mucus plugs are a central, yet often underrecognized, hallmark of eosinophilic inflammation across asthma, chronic obstructive pulmonary disease, and related eosinophilic lung diseases. By obstructing the airway lumen, plugs not only impair airflow and worsen symptoms but are also associated with corticosteroid resistance and accelerated disease progression. Advances in high-resolution computed tomography have improved detection and quantification, linking plug burden to airflow limitation, loss of lung function, and even mortality. Eosinophils contribute to plug pathology through extracellular trap formation, release of cytotoxic proteins, and crystal deposition, which in turn drive airway structural changes and abnormal mucus composition and clearance. These interrelated processes promote the persistence of eosinophilic mucus plugs and reinforce airway dysfunction. Therapeutically, biologics targeting type 2 inflammatory pathways have demonstrated that they reduce mucus plugs in patients with asthma, with emerging evidence suggesting similar potential in eosinophilic chronic obstructive pulmonary disease. Innovative strategies designed to disrupt extracellular traps and reshape plug structure offer promising avenues for intervention. Recent advances in imaging, biology, and therapeutics have established mucus plugs as both a marker and a modifiable target across eosinophilic lung diseases. Future studies integrating imaging and biomarkers are essential to define persistence versus resolution, optimize patient stratification, and establish plugs as a transformative therapeutic target in eosinophilic lung diseases.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 575-582"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.jaip.2026.02.001
{"title":"Differential Diagnosis of Eosinophilic Lung Diseases","authors":"","doi":"10.1016/j.jaip.2026.02.001","DOIUrl":"10.1016/j.jaip.2026.02.001","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 558-559"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-05DOI: 10.1016/j.jaip.2026.01.023
Alexander Ruzic BSc , Merritt L. Fajt MD, FAAAAI , Mark M. Hammer MD , Manali Mukherjee MSc, PhD
Eosinophilic lung diseases (ELDs) represent a heterogeneous group of airway and parenchymal disorders unified by eosinophilic inflammation but distinguished by diverse clinical features, mechanisms of persistence, and variable therapeutic responses. Traditional diagnostic tools, including blood eosinophil counts, bronchoalveolar lavage, sputum cytology, and exhaled nitric oxide, predict the eosinophilic/T2 burden of the disease but often fail to distinguish IL-5–dependent from IL-5–independent pathways, overlook compartment-specific inflammation, and inadequately predict or monitor response to targeted biologics. The inconsistent efficacy of IL-5/IL-5R–directed monoclonal antibodies despite normalization of blood eosinophils across the ELD spectrum (robust clinical response in eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome, partial in asthma and largely absent in chronic obstructive pulmonary disease) underscores the limitations of current biomarkers and the need for refined precision endotyping. To address these gaps, emerging biomarker platforms move beyond eosinophil enumeration to define upstream drivers, activation states, tissue localization, and immune pathways sustaining persistent eosinophilia. These advances include noninvasive tools such as lateral-flow devices for assaying eosinophil peroxidase (eosinophil activity biomarker), breathomics and volatile organic compound profiling, cytokine-level inflammatory mapping, and composite biomarker models integrating airway, blood, and molecular signatures. In parallel, functional imaging modalities, including hyperpolarized gas magnetic resonance imaging, phase-resolved functional lung magnetic resonance imaging, and quantitative computed tomography, provide noninvasive, high-resolution visualization of regional ventilation, perfusion, and inflammation. This enables clinicians to look into the lungs and offer powerful stand-alone or complementary biomarker capability. Collectively, these innovations mark a shift toward mechanistically-informed, tissue-specific, multimodal biomarker strategies that refine diagnosis, improve therapeutic selection, and enhance monitoring across the ELD spectrum, advancing the promise of precision medicine.
嗜酸性粒细胞肺疾病（ELDs）是由嗜酸性粒细胞炎症引起的气道和实质疾病的异质组，但具有不同的临床特征、持续机制和不同的治疗反应。传统的诊断工具——包括血液嗜酸性粒细胞计数、支气管肺泡冲洗、痰细胞学和呼出的一氧化氮——预测疾病的嗜酸性粒细胞/T2负荷，但往往不能区分il -5依赖性途径和il -5非依赖性途径，忽略了室特异性炎症，并且不能充分预测/监测对靶向生物制剂的反应。IL-5/ il - 5r定向单克隆抗体的疗效不一致，尽管在整个ELD谱中血液嗜酸性粒细胞正常化，即在嗜酸性粒细胞肉芽肿合并多血管炎和嗜酸性粒细胞过多综合征，哮喘部分，copd大部分缺乏的临床反应中，强调了当前生物标志物的局限性和对精细精确内分型的需求。为了解决这些差距，新兴的生物标志物平台超越了嗜酸性粒细胞计数，以定义上游驱动因素、激活状态、组织定位和维持持续嗜酸性粒细胞的免疫途径。这些进步包括非侵入性工具，如用于分析嗜酸性粒细胞过氧化物酶（嗜酸性粒细胞活性生物标志物）的侧流装置、呼吸组学和挥发性有机化合物谱、细胞因子水平的炎症图谱，以及整合气道、血液和分子特征的复合生物标志物模型。与此同时，功能成像方式——包括超极化气体MRI、相位分辨功能肺MRI和定量计算机断层扫描（CT）——提供了非侵入性、高分辨率的局部通气、灌注和炎症可视化。这使临床医生能够“观察肺部”，并提供强大的独立或补充生物标志物能力。总的来说，这些创新标志着向机械信息、组织特异性、多模式生物标志物策略的转变，这些策略可以改进诊断、改善治疗选择，并加强整个ELD谱的监测，从而推进精准医学的发展。
{"title":"Novel Diagnostic Approaches for Eosinophilic Lung Diseases","authors":"Alexander Ruzic BSc , Merritt L. Fajt MD, FAAAAI , Mark M. Hammer MD , Manali Mukherjee MSc, PhD","doi":"10.1016/j.jaip.2026.01.023","DOIUrl":"10.1016/j.jaip.2026.01.023","url":null,"abstract":"<div><div>Eosinophilic lung diseases (ELDs) represent a heterogeneous group of airway and parenchymal disorders unified by eosinophilic inflammation but distinguished by diverse clinical features, mechanisms of persistence, and variable therapeutic responses. Traditional diagnostic tools, including blood eosinophil counts, bronchoalveolar lavage, sputum cytology, and exhaled nitric oxide, predict the eosinophilic/T2 burden of the disease but often fail to distinguish IL-5–dependent from IL-5–independent pathways, overlook compartment-specific inflammation, and inadequately predict or monitor response to targeted biologics. The inconsistent efficacy of IL-5/IL-5R–directed monoclonal antibodies despite normalization of blood eosinophils across the ELD spectrum (robust clinical response in eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome, partial in asthma and largely absent in chronic obstructive pulmonary disease) underscores the limitations of current biomarkers and the need for refined precision endotyping. To address these gaps, emerging biomarker platforms move beyond eosinophil enumeration to define upstream drivers, activation states, tissue localization, and immune pathways sustaining persistent eosinophilia. These advances include noninvasive tools such as lateral-flow devices for assaying eosinophil peroxidase (eosinophil activity biomarker), breathomics and volatile organic compound profiling, cytokine-level inflammatory mapping, and composite biomarker models integrating airway, blood, and molecular signatures. In parallel, functional imaging modalities, including hyperpolarized gas magnetic resonance imaging, phase-resolved functional lung magnetic resonance imaging, and quantitative computed tomography, provide noninvasive, high-resolution visualization of regional ventilation, perfusion, and inflammation. This enables clinicians to look into the lungs and offer powerful stand-alone or complementary biomarker capability. Collectively, these innovations mark a shift toward mechanistically-informed, tissue-specific, multimodal biomarker strategies that refine diagnosis, improve therapeutic selection, and enhance monitoring across the ELD spectrum, advancing the promise of precision medicine.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 560-574"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/S2213-2198(26)00102-9
{"title":"Continuing Medical Education Calendar","authors":"","doi":"10.1016/S2213-2198(26)00102-9","DOIUrl":"10.1016/S2213-2198(26)00102-9","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages A21-A22"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-30DOI: 10.1016/j.jaip.2025.10.030
Christian Carrier MD , Barbara Polivka RN, PhD , Luz Huntington-Moskos RN, PhD , Kamal Eldeirawi RN, PhD , Emily Cramer PhD , Sharmilee M. Nyenhuis MD
Background
A significant portion of patients with asthma do not adhere to their medication regimen, and the influence of their neighborhood characteristics on their adherence is unclear.
Objective
To examine how certain neighborhood factors are associated with asthma medication adherence in adults.
Methods
Between 2020 and 2022, adults with asthma were recruited into the Global COVID-19 Asthma Study and completed an online questionnaire. A secondary post hoc analysis was performed. Perceived neighborhood and adherence responses were dichotomized, and a backward elimination change-in-estimate method was performed to choose variables for logistic regression analysis. A cumulative problem score was constructed from these perceptions, and a bivariate analysis was performed comparing adherent and nonadherent groups for each perception.
Results
A total of 988 participants provided complete data, and almost half (44%) were medication nonadherent. Participants who reported a perceived problem with the presence of litter, homes not being well maintained, vacant homes, and vandalism in their neighborhood were more likely to be nonadherent, as well as those who felt unsafe walking alone at night and that their neighborhood was not a good place to live. Those who felt their neighborhood was not a good place to live were 1.79 times more likely to have reported nonadherence (95% confidence interval, 1.07-2.09) compared with those who did not have this feeling. Those with higher cumulative problem scores were also more likely to be nonadherent.
Conclusion
Neighborhood factors are associated with asthma medication adherence and provide valuable insights for providers when evaluating patient adherence.
{"title":"The Associations Between Neighborhood Factors on Asthma Medication Adherence in Adults","authors":"Christian Carrier MD , Barbara Polivka RN, PhD , Luz Huntington-Moskos RN, PhD , Kamal Eldeirawi RN, PhD , Emily Cramer PhD , Sharmilee M. Nyenhuis MD","doi":"10.1016/j.jaip.2025.10.030","DOIUrl":"10.1016/j.jaip.2025.10.030","url":null,"abstract":"<div><h3>Background</h3><div>A significant portion of patients with asthma do not adhere to their medication regimen, and the influence of their neighborhood characteristics on their adherence is unclear.</div></div><div><h3>Objective</h3><div>To examine how certain neighborhood factors are associated with asthma medication adherence in adults.</div></div><div><h3>Methods</h3><div>Between 2020 and 2022, adults with asthma were recruited into the Global COVID-19 Asthma Study and completed an online questionnaire. A secondary <em>post hoc</em> analysis was performed. Perceived neighborhood and adherence responses were dichotomized, and a backward elimination change-in-estimate method was performed to choose variables for logistic regression analysis. A cumulative problem score was constructed from these perceptions, and a bivariate analysis was performed comparing adherent and nonadherent groups for each perception.</div></div><div><h3>Results</h3><div>A total of 988 participants provided complete data, and almost half (44%) were medication nonadherent. Participants who reported a perceived problem with the presence of litter, homes not being well maintained, vacant homes, and vandalism in their neighborhood were more likely to be nonadherent, as well as those who felt unsafe walking alone at night and that their neighborhood was not a good place to live. Those who felt their neighborhood was not a good place to live were 1.79 times more likely to have reported nonadherence (95% confidence interval, 1.07-2.09) compared with those who did not have this feeling. Those with higher cumulative problem scores were also more likely to be nonadherent.</div></div><div><h3>Conclusion</h3><div>Neighborhood factors are associated with asthma medication adherence and provide valuable insights for providers when evaluating patient adherence.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 630-636.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-07DOI: 10.1016/j.jaip.2025.10.041
Daniel G. Rayner MSc , Shelly-Anne Li PhD , Dario M. Ferri MD, MSc , Isabella Silang BSc , Athena Fernandes , Alexandro W.L. Chu MD , Solomon Tse , Kaharu Sumino MD , Sharmilee M. Nyenhuis MD , John Oppenheimer MD , Tamara T. Perry MD , Flavia Hoyte MD , Bradley Chipps MD , Katherine Rivera-Spoljaric MD, MSCI , Elliot Israel MD , Lindsay E. Shade MHS, PA-C , Susana Rangel MSN, FNP-C , Ellen McCabe PhD , Paul M. O’Byrne MBChB , Valerie G. Press MD, MPH , Derek K. Chu MD, PhD
Background
Understanding patient values and preferences can inform optimal care of moderate-to-severe asthma.
Objective
To systematically synthesize studies addressing the values and preferences of patients with moderate-to-severe asthma and their caregivers toward the management of asthma.
Methods
As part of updating the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma, and Immunology (AAAAI/ACAAI) Joint Task Force on Practice Parameters severe asthma guidelines, we searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to June 1, 2025, for studies addressing the values and preferences of patients with moderate-to-severe asthma or their caregivers. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. We used iterative thematic content analysis to qualitatively synthesize findings and the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Quantitative Research (GRADE-CERQual) approach to rate the confidence of the evidence. We prospectively registered our review in PROSPERO (CRD42024572812).
Results
Synthesizing 88 studies enrolling 9,593 patients and 274 caregivers, we identified 5 key themes: (1) Patients and their caregivers place high value on avoiding potential adverse effects of asthma treatment (high confidence). Patients probably place high value toward (2) avoiding severe asthma exacerbations, (3) having autonomy in the administration of advanced therapies, such as biologics, and (4) are probably more willing to accept treatment if provided counselling by clinicians knowledgeable in asthma (moderate confidence). (5) Patients may place a high value on asthma treatments that are practical and logistically simple to implement (low confidence).
Conclusions
We identified 5 key themes on the values and preferences of patients with moderate-to-severe asthma and their caregivers to inform optimal clinical care, practice guidelines, and future research.
{"title":"Values and Preferences of Patients and Caregivers Regarding the Management of Moderate-to-Severe Asthma: A Systematic Review and Qualitative Evidence Synthesis","authors":"Daniel G. Rayner MSc , Shelly-Anne Li PhD , Dario M. Ferri MD, MSc , Isabella Silang BSc , Athena Fernandes , Alexandro W.L. Chu MD , Solomon Tse , Kaharu Sumino MD , Sharmilee M. Nyenhuis MD , John Oppenheimer MD , Tamara T. Perry MD , Flavia Hoyte MD , Bradley Chipps MD , Katherine Rivera-Spoljaric MD, MSCI , Elliot Israel MD , Lindsay E. Shade MHS, PA-C , Susana Rangel MSN, FNP-C , Ellen McCabe PhD , Paul M. O’Byrne MBChB , Valerie G. Press MD, MPH , Derek K. Chu MD, PhD","doi":"10.1016/j.jaip.2025.10.041","DOIUrl":"10.1016/j.jaip.2025.10.041","url":null,"abstract":"<div><h3>Background</h3><div>Understanding patient values and preferences can inform optimal care of moderate-to-severe asthma.</div></div><div><h3>Objective</h3><div>To systematically synthesize studies addressing the values and preferences of patients with moderate-to-severe asthma and their caregivers toward the management of asthma.</div></div><div><h3>Methods</h3><div>As part of updating the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma, and Immunology (AAAAI/ACAAI) Joint Task Force on Practice Parameters severe asthma guidelines, we searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to June 1, 2025, for studies addressing the values and preferences of patients with moderate-to-severe asthma or their caregivers. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. We used iterative thematic content analysis to qualitatively synthesize findings and the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Quantitative Research (GRADE-CERQual) approach to rate the confidence of the evidence. We prospectively registered our review in PROSPERO (CRD42024572812).</div></div><div><h3>Results</h3><div>Synthesizing 88 studies enrolling 9,593 patients and 274 caregivers, we identified 5 key themes: (1) Patients and their caregivers place high value on avoiding potential adverse effects of asthma treatment (high confidence). Patients probably place high value toward (2) avoiding severe asthma exacerbations, (3) having autonomy in the administration of advanced therapies, such as biologics, and (4) are probably more willing to accept treatment if provided counselling by clinicians knowledgeable in asthma (moderate confidence). (5) Patients may place a high value on asthma treatments that are practical and logistically simple to implement (low confidence).</div></div><div><h3>Conclusions</h3><div>We identified 5 key themes on the values and preferences of patients with moderate-to-severe asthma and their caregivers to inform optimal clinical care, practice guidelines, and future research.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 644-655"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.
Objective
To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality of life (QoL) outcomes in PAR and NAR.
Methods
This cross-sectional study prospectively included adults with moderate to severe PAR and NAR, all of whom had experienced symptoms for more than 6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. We assessed VAS validity via Spearman’s correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.
Results
Among 445 patients (298 PAR and 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. The VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI, 0.40-0.57) but weakly in NAR (Spearman correlation = 0.35; 95% CI, 0.20-0.49). Patients with a VAS result of 70 mm or greater (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.
Conclusions
The VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.
{"title":"Validation of the Visual Analog Scale in Perennial Allergic and Non-Allergic Rhinitis: Association With Symptom Severity and Quality of Life","authors":"Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Mongkhon Sompornrattanaphan MD , Kawita Atipas MD , Navarat Kasemsuk MD , Dichapong Kanjanawasee MD, PhD , Triphoom Suwanwech MD , Pongsakorn Tantilipikorn MD, PhD , Wannada Laisuan MD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD","doi":"10.1016/j.jaip.2025.11.041","DOIUrl":"10.1016/j.jaip.2025.11.041","url":null,"abstract":"<div><h3>Background</h3><div>Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.</div></div><div><h3>Objective</h3><div>To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality of life (QoL) outcomes in PAR and NAR.</div></div><div><h3>Methods</h3><div>This cross-sectional study prospectively included adults with moderate to severe PAR and NAR, all of whom had experienced symptoms for more than 6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. We assessed VAS validity via Spearman’s correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.</div></div><div><h3>Results</h3><div>Among 445 patients (298 PAR and 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. The VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI, 0.40-0.57) but weakly in NAR (Spearman correlation = 0.35; 95% CI, 0.20-0.49). Patients with a VAS result of 70 mm or greater (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.</div></div><div><h3>Conclusions</h3><div>The VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 693-703.e4"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/S2213-2198(26)00100-5
{"title":"Information for Readers","authors":"","doi":"10.1016/S2213-2198(26)00100-5","DOIUrl":"10.1016/S2213-2198(26)00100-5","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Page A14"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rhinitis and asthma often co-occur; however, studies on their associations with air pollution have always considered them separately.
Objective
We investigated the association between long-term air pollution exposure and rhinitis and asthma multimorbidity in adults.
Methods
We used data at inclusion from Constances, a large French population-based adult cohort. Current rhinitis (CR) and current asthma (CA) were defined by questionnaire. Annual exposure to nitrogen dioxide (NO2), particulate matter 2.5 μm or less (PM2.5), and black carbon were estimated by linking participants' residential address to land-use regression models. We performed cross-sectional multinomial logistic regressions between each air pollutant and CR alone, CA alone, and CR+CA (no-CR/no-CA being the reference) adjusted for age, sex, smoking, education level, and French deprivation index.
Results
Among the 177,968 participants included in the analyses (mean age 47 years; 54% female), 111,108 were classified as no-CR/no-CA (62%), 49,971 CR alone (28%), 6,435 CA alone (4%), and 10,454 CR+CA (6%). One interquartile range (IQR) increase of black carbon and NO2 was significantly associated with the three phenotypes, with adjusted odds ratios from 1.04 to 1.13 for BC (IQR = 0.55-10–5·m–1), and from 1.06 to 1.14 for NO2 (IQR = 13.7 μg·m–3). For PM2.5, one IQR increase (4.09 μg·m–3) was significantly associated with CR alone and CR+CA. In all our analysis, the highest associations were observed for CR alone.
Conclusion
Our results show that long-term air pollution is more associated with rhinitis alone or with asthma multimorbidity than with asthma alone.
{"title":"PM2.5, Black Carbon, and NO2 Associations With Rhinitis and Asthma Multimorbidity in Adults: The Constances Cohort","authors":"Marine Savouré PhD , Émeline Lequy PhD , Jean Bousquet PhD , Marcel Goldberg PhD , Kees de Hoogh PhD , Danielle Vienneau PhD , Céline Ribet PhD , Marie Zins PhD , Rachel Nadif PhD , Bénédicte Jacquemin PhD","doi":"10.1016/j.jaip.2025.12.031","DOIUrl":"10.1016/j.jaip.2025.12.031","url":null,"abstract":"<div><h3>Background</h3><div>Rhinitis and asthma often co-occur; however, studies on their associations with air pollution have always considered them separately.</div></div><div><h3>Objective</h3><div>We investigated the association between long-term air pollution exposure and rhinitis and asthma multimorbidity in adults.</div></div><div><h3>Methods</h3><div>We used data at inclusion from Constances, a large French population-based adult cohort. Current rhinitis (CR) and current asthma (CA) were defined by questionnaire. Annual exposure to nitrogen dioxide (NO<sub>2</sub>), particulate matter 2.5 μm or less (PM<sub>2.5</sub>), and black carbon were estimated by linking participants' residential address to land-use regression models. We performed cross-sectional multinomial logistic regressions between each air pollutant and CR alone, CA alone, and CR+CA (no-CR/no-CA being the reference) adjusted for age, sex, smoking, education level, and French deprivation index.</div></div><div><h3>Results</h3><div>Among the 177,968 participants included in the analyses (mean age 47 years; 54% female), 111,108 were classified as no-CR/no-CA (62%), 49,971 CR alone (28%), 6,435 CA alone (4%), and 10,454 CR+CA (6%). One interquartile range (IQR) increase of black carbon and NO<sub>2</sub> was significantly associated with the three phenotypes, with adjusted odds ratios from 1.04 to 1.13 for BC (IQR = 0.55-10<sup>–5</sup>·m<sup>–1</sup>), and from 1.06 to 1.14 for NO<sub>2</sub> (IQR = 13.7 μg·m<sup>–3</sup>). For PM<sub>2.5</sub>, one IQR increase (4.09 μg·m<sup>–3</sup>) was significantly associated with CR alone and CR+CA. In all our analysis, the highest associations were observed for CR alone.</div></div><div><h3>Conclusion</h3><div>Our results show that long-term air pollution is more associated with rhinitis alone or with asthma multimorbidity than with asthma alone.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 621-629.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号