Radosław Gawlik

Allergic diseases are among the most prevalent chronic conditions in Europe, yet undergraduate medical curricula lack structured Allergy and Clinical Immunology (ACI) teaching. Moreover, desite advances in specialist education, postgraduate university training varies due to differences in specialty recognition, regulatory frameworks, and the implementation of the European Training Requirements. These disparities contribute to inconsistent physician competencies, limited academic visibility of the specialty, and unequal access to high‐quality allergy care. This Position Paper, developed within the framework of the Declaration of Salamanca, analyses the current educational landscape, identifies the main barriers to integrating ACI into medical education, and proposes a strategic roadmap for future development. Evidence from an EAACI‐led European survey, published studies, and expert consensus demonstrates substantial variability in undergraduate curricula, limited academic representation of allergists, fragmented integration of basic immunology and clinical allergy, and challenges in educational innovation, including digital learning and artificial intelligence. The Declaration of Salamanca advocates a coordinated European strategy focused on strengthening undergraduate curricula, increasing ACI's academic presence, promoting closer integration between basic immunology and clinical practice, fostering educational innovation, and enhancing collaboration among universities, scientific societies, accreditation bodies, policymakers, and patient organizations. While responsibility for university curricula and specialty recognition remains with national authorities, the EAACI and National Allergy and Immunology Societies, in partnership with patient organizations, can provide scientific leadership, develop educational standards, and advocate for harmonised approaches. The Declaration of Salamanca offers a practical framework to improve the quality, consistency, and sustainability of ACI education across Europe.

Background and Objectives: Hymenoptera venom allergy (HVA) represents one of the most frequent causes of anaphylaxis in adults. Venom immunotherapy (VIT) remains the only causal intervention that effectively reduces the risk of systemic reactions following subsequent stings. Accelerated-induction protocols enable rapid attainment of the maintenance dose; however, data on their safety with depot preparations are still limited. To evaluate the safety of accelerated-induction VIT using a depot preparation in a real-world clinical setting. Materials and Methods: A retrospective, single-center study was conducted between 2022 and 2024; accelerated-induction VIT with a depot preparation was initiated in 54 consecutive patients at a tertiary referral center. All patients had a documented history of systemic allergic reactions after Hymenoptera stings. A three-day accelerated-induction protocol was applied. Safety outcomes and adverse events occurring during the induction phase were systematically recorded and analyzed. Results: All 54 patients successfully achieved the maintenance dose. Adverse reactions were observed only in five patients (9.3%) and were restricted to mild local reactions at the injection site, including erythema and localized swelling. No systemic reactions or cases of anaphylaxis were reported. None of the patients required permanent discontinuation of VIT. Conclusions: Accelerated-induction VIT using a depot preparation demonstrated a favorable safety profile. When performed in an experienced tertiary care setting, this approach allows for rapid attainment of the maintenance dose while maintaining excellent tolerability.

Chronic rhinitis is induced by endotype-diverse inflammatory processes, which complicates effective therapeutic management. According to the current principles of personalized medicine, which also apply to the management of rhinological disorders, the best therapeutic results can be achieved after targeted treatment preceded by analysis of the patient’s endotype. Analysis of immune and cellular mechanisms allows for the use of biological treatment, and its effects provide new information on inflammatory processes in the nasal mucosa. The effects of biological treatment may be particularly interesting in the case of mixed endotypes, which pose a difficult therapeutic challenge. In eosinophilic asthma co-occurring with allergic rhinitis, as well as in eosinophilic asthma associated with non-allergic rhinitis, eosinophils represent a key effector cell population driving the underlying type 2-mediated inflammatory response. The aim of this study is to analyze the efficacy of anti-IL5 or anti-ILR5 therapy in patients with severe eosinophilic asthma and persistent allergic or non-allergic rhinitis. Methods: In this single-center real-life study, the authors analyzed the effects of biological treatment on rhinological symptoms in patients over the age of 18 with severe uncontrolled eosinophilic bronchial asthma with coexisting persistent allergic or non-allergic rhinitis treated with mepolizumab or benralizumab. In all patients, the otolaryngologist performed anterior rhinoscopy. Evaluation of rhinological symptoms and quality of life in patients treated with anti-IL5 or anti-IL5 therapy before and six months after biological treatment was performed using the TNSS and SNOT-22 scales. Results: In total, 67 patients with eosinophilic severe bronchial asthma were included in the study; among them 39 (58.2%) suffered from persistent allergic rhinitis and 28 (41.8%) suffered from chronic non-allergic rhinitis. After six months of treatment, higher absolute differences for SNOT and TNSS were observed in the persistent allergic rhinitis group. Conclusions: Biological treatment with mepolizumab and benralizumab may reduce the severity of rhinological symptoms in both endotypes of inflammation. However, higher therapeutic benefits were observed in patients with co-existing persistent allergic rhinitis. It was demonstrated that, in addition to IgE-mediated responses, the eosinophil represented an important component of the inflammatory reaction in allergic rhinitis.

Background: The symptoms of chronic spontaneous urticaria can be exacerbated or even induced by psychological stress. Assessing the severity of symptoms using the recommended Urticaria Control Test is an important diagnostic step before deciding on the type of pharmacological treatment to be used. Due to the possibility of urticaria symptoms affecting patient’s emotional condition, the authors attempted to analyze if the way of coping with stress has an impact on urticaria symptom control as assessed with this questionnaire. Methods: The study included 61 (37 female; 60,6%;) patients with symptoms of chronic spontaneous urticaria without other coexisting diseases. All patients were treated with antihistamines. In the analyzed group of patients, the Urticaria Control Test and the Polish version of Endler and Parker’s Coping Inventory for Stressful Situations questionnaire were conducted. Results: The average score on the Urticaria Control Test in the analyzed group was 8.5 (±3.9) points. In our group, the most common coping style was a mixed style based on emotions and avoidance—32 (53%) respondents. Next, 11 (18%) patients reported an emotion-based style. A task-oriented style of coping with stress was observed in 8 (13%) respondents. In the study group, we found no statistical significance in the correlation between the UCT results and the patient’s coping style. Conclusions: Emotions play a significant role as a stress-coping style in chronic spontaneous urticaria patients. The lack of relation found between the Urticaria Control Test result and the Coping Inventory for Stressful Situations questionnaire confirms the objective usefulness of the Urticaria Control Test in assessing the control of spontaneous urticaria.

In recent years, biological therapy based on endotyping has become a therapeutic option for patients with type 2 inflammatory process with chronic rhinosinusitis with nasal polyps with or without bronchial asthma. It is also used in the course of a particularly aggressive chronic rhinosinusitis with nasal polyps in patients with bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drug (NSAID-exacerbated respiratory disease, N-ERD). Identification of the patient’s inflammatory endotype enables targeted biological treatment and optimal results from biological therapy. The search for biomarkers that identify patients who will benefit from biological treatment remains a current topic of investigation. A particularly difficult therapeutic decision concerns patients with a mixed endotype (eosinophilic/allergic), which affects patients with N-ERD. The authors present a case of multidimensional beneficial results in a 39-year-old female patient with N-ERD syndrome during biological treatment with omalizumab. The parameters of inflammation, the results of computed tomography, and the results of questionnaires assessing the patient’s quality of life before, after 4 months and 9 years of biological treatment are presented. Excellent results were found in all criteria of efficacy of biological treatment: reduced nasal polyp size (complete remission of polyps in the paranasal sinuses), reduced need for systemic corticosteroids (no systemic steroids have been used since the start of therapy), improved sense of smell, reduced impact of comorbidities (complete control of bronchial asthma) and in the patient’s opinion, an extremely significant improvement in quality of life. Thus, the patient can be considered as a super-responder. Analysis of the parameters of patients who achieved optimal therapeutic results may also be helpful in selecting type of biological treatment for future patients.

Background: Severe asthma is a chronic, difficult-to-treat disorder that significantly affects quality of life, and oral glucocorticosteroids are usually required. Many patients suffering from severe asthma exhibit T2 inflammation and may benefit from biological treatment. This study aims to evaluate changes in cytokine concentrations during therapy with benralizumab, dupilumab, and mepolizumab in severe eosinophilic asthma. Materials and Methods: In this prospective, single-center study, 39 patients with severe eosinophilic asthma received treatment with one of the above-mentioned biologics. Parameters, such as the cytokine profile (Human Th9/Th17/Th22 Luminex, Performance Assay 18-plex Fixed Panel, R&D Systems, Minneapolis, MN, USA) and additionally the Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), spirometry (FEV1, FEV/FVC), FeNO, and functional status, were assessed at baseline and after 3–4 months of therapy. Results: The biologic therapies demonstrated diverse effects on inflammatory biomarkers. Dupilumab showed the most pronounced decreases in CD40L, IL-6, and FeNO in comparison to other drugs. In turn, the greatest decrease in TNF-α concentration was observed in the group treated with mepolizumab. Conclusion: Changes in cytokine concentrations highlight the heterogenous immunomodulatory mechanisms of biologics and support personalized strategies based on inflammatory profiles. However, the results should be interpreted with prudence, as the concentrations of cytokines in blood serum fluctuate and the study sample size is small.

Alpha-gal syndrome (AGS) is an IgE-mediated allergy, triggered by a carbohydrate—galactose-α-1,3-galactose (α-Gal). AGS is marked by a delayed onset of symptoms, typically occurring 3–8 h after the ingestion of red meat or other mammalian-derived products. The primary risk factor is believed to be tick bites, which sensitize individuals through the introduction of α-Gal via tick saliva. Diagnosis of AGS is based on a combination of anamnesis and detection of α-Gal-specific IgE antibodies. We evaluated 28 patients with a history of unexplained anaphylaxis, angioedema, and/or urticaria, in whom the diagnostic work-up included the assessment of serum IgE specific to alpha-gal. Elevated alpha-gal-specific IgE levels were detected in five patients. Among them, four reported anaphylactic episodes following meat consumption. In three cases, symptoms developed during the evening or nighttime, typically 3 to 6 h after the last meal. One patient experienced anaphylaxis within one hour after a meal. Another patient presented angioedema up to 24 h after meat consumption and was also tested positive for specific IgE against beef and pork allergens. The AGS case series showed variability in clinical picture and time to reaction. In patients presenting idiopathic anaphylaxis and nonspecific symptoms after red meat consumption, AGS should be considered as a differential diagnosis.