Claudia Traidl-Hoffmann

Background: A critical lesson from the public health crisis caused by the COVID-19 pandemic is that pandemic preparedness requires rapid identification of early biomarkers to predict need of hospitalization. Furthermore, while therapy for COVID-19 is available, it must be administered early after infection and targeted specifically to patients in need. Currently, patient demographics and pre-existing clinical conditions are used to determine treatment eligibility. However, these factors do not provide accurate predictions, and previous research on COVID-19 severity biomarkers has focused on hospitalized patients. Here, we identify point-of-care biomarkers capable of accurately predicting COVID-19-related hospitalization risk and disease progression shortly after a positive diagnosis.Methods: Previously uninfected and non-vaccinated individuals (N=201) were recruited at, or shortly after, SARS-CoV-2 diagnosis. Biochemistry and serum cytokine levels were longitudinally measured. Biomarker combinations were tested by multi-dimensional clustering followed by dimension reduction.Findings: The combination of high levels of LDH or serum IL-6 showed the most accurate prediction (sensitivity=100%, specificity=94.5%) for hospitalization risk. The combination of four cytokines (IFN-a, IFN-g, IL-6, IL-8) was the most accurate predictor for moderate versus mild disease. Age and BMI showed significantly lower predictive values for hospitalization risk and were not predictive of mild versus moderate symptoms.Interpretation: Early accurate prediction of COVID-19 hospitalization and severity is possible using biomarkers feasibly measurable at point-of-care, thus allowing optimizing personalized treatment and public health management. The methodology used here sets out a paradigm for severity prediction in the framework of pandemic preparedness.

Developed using the GRADE methodology, these EAACI guidelines provide evidence‐based recommendations on the effectiveness of pollen reduction/avoidance strategies for allergic rhinitis (AR) and asthma, the utility of biomarkers for monitoring pollen‐induced asthma and the efficiency of mitigation measures and of public health strategies. Systematic and narrative reviews and health economic analysis support the recommendations. According to GRADE, the certainty of evidence was moderate to very low, therefore conditional recommendations are provided to guide healthcare professionals, patients, and policymakers in developing personalized, preventive, and scalable interventions. Reducing/avoiding exposure to pollen should be recommended to reduce the risk of severe asthma exacerbations. Lung function decrease and exhaled nitric oxide increase may be predictive for pollen‐induced asthma exacerbations. Real‐time pollen monitoring and pollen concentration‐based forecast may be recommended for managing pollen‐induced AR and/or asthma. Pollutant information should be included in pollen information systems. Combined forecast (weather, pollen, pollutants) and warning systems might reduce the impact of thunderstorm asthma (TA). Emergency department/asthma‐related services should be strengthened during pollen season and in TA. Personalized frameworks covering the types and allergenic potential of pollen, the coaggressors and the vulnerability of each patient are needed in daily practice. The fundamental role of prevention should be further prioritized.

Allergic diseases are heterogeneous conditions shaped by immune pathways and environmental influences, including the gut microbiome. Using cross-sectional data from 508 adults in the KORA FF4 cohort (275 with IgE sensitization, 233 without), we provide a multimodal statistical analysis of deep IgE profiles and concomitant gut microbial amplicon sequencing variant (ASV) data. We identified three latent allergy components in the cohort’s IgE profiles that reflects food, pollen, and house dust mite markers and enables interpretable stratification of the cohort. Contrary to prior studies, microbial diversity did not differ between sensitized and non-sensitized individuals across all cohort strata. Differential abundance analysis identified 61 ASVs, with enrichment in Bacteroidaceae , Oscillospiraceae , and Veillonellaceae families, and depletion in the Lachnospiraceae family. Microbial network analysis further identified altered family-level associations in pollen- and food-sensitized individuals. Taxon set enrichment highlighted folic acid- and vitamin A-producing taxa, with consistent signals from Prevotella copri (depleted) and Bacteroides massiliensis (enriched). Together, our analysis points toward specific microbial families and metabolic groups as correlates of IgE sensitization in an adult population. HIGHLIGHTS: IgE sensitization clusters reflect allergen sources and cross-reactive proteins Three latent allergy components capture the IgE profile structure of the entire cohort Distinct IgE patterns are linked to changes in taxa compositions and associations Folic acid– and vitamin A–producing taxa are enriched in IgE-sensitized individuals GRAPHICAL

Background: Atopic diseases—including atopic dermatitis (AD), food allergy (FA), allergic rhinitis (AR), and asthma—are the most common chronic conditions in childhood and adolescence, affecting up to 30% of the global population. In Germany alone, more than 2.1 million children and adolescents are affected. These conditions frequently coexist and share common genetic, environmental, dietary, and microbial risk factors. Methods: A comprehensive literature review was conducted, and a multidisciplinary Task Force of the German Society for Pediatric Allergology and Environmental Medicine (GPA) and the German Society for Allergology and Clinical Immunology (DGAKI) developed consensus‐based algorithms for early risk assessment and recognition of allergies in children in already existing preventive medical check‐ups. The approach emphasizes stepwise risk assessment, including family history, environmental exposures, and early clinical signs such as recurrent wheezing. Results: For children identified as at risk for or with early clinical signs of atopy, targeted diagnostic steps are recommended that follow the national/international guidelines for the management of the suspected atopic disease. This may include general and specific recommendations for nutrition, measurement of specific sensitization and selected biomarkers, if indicated and recommended by the guidelines. Routine allergy testing in asymptomatic children is not recommended. The algorithms are designed to be embedded into routine pediatric check‐ups, enabling systematic and early identification of children at increased risk or with early clinical signs of atopic diseases. Early recognition and management can reduce disease severity, improve quality of life, and decrease healthcare costs. Conclusion: Structured programs for early risk assessment and recognition of allergies in children are currently lacking but can provide substantial clinical and economic benefits. Integration into routine pediatric preventive examinations, supported by standardization, interdisciplinary collaboration, and sustainable funding, offers a promising strategy to improve long‐term outcomes for affected children and their families.

The allergy and asthma epidemic in urban societies following World War II is mostly caused by changes in the environment, diet and lifestyle. Disconnection of urban populations from the wider environment has reduced the protective factors building up immunological resilience. The European Academy of Allergy and Clinical Immunology (EAACI) guidelines on greenness impact on allergy and asthma follow the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and provide eight recommendations encouraging greenness exposure to support immune health. Controlled follow‐up studies are still scarce, and the strength of evidence is generally low or moderate at best. For primary prevention of allergy and asthma, most of the evidence indicates beneficial effects. Exposure is also useful for secondary prevention. Asthma patients may feel better and need less medication by combining green space exposure with physical activity. During the high‐pollen season, effective seasonal medication is necessary for patients with pollen allergy. In urban planning, implementing appropriate green infrastructure and easy access to green space promotes immune health and reduces risks of air pollution and heatwaves. These EAACI guidelines are the first recommendations highlighting the importance of urban green spaces on immune health and call for prioritising innovative research in this field.