Marta Vazquez-Ortiz

Introduction: Intranasal adrenaline has been approved in multiple countries for anaphylaxis treatment, based primarily on pharmacokinetic/pharmacodynamic comparisons to adrenaline autoinjectors (AAIs). Aim: To assess patient and caregiver perspectives regarding emerging non‐injectable adrenaline routes. Methods: Online survey of adults and caregivers of children with food allergy prescribed AAIs, with international dissemination supported by the European Academy of Allergy and Clinical Immunology (February–April 2025). Results: We analyzed 542 responses from caregivers and 224 from adults with food allergy. Effectiveness of adrenaline nasal spray (ANS) compared to AAI was rated “extremely important” by 78% of caregivers and 71% of adults. 48% of caregivers and 42% of adults were “extremely worried” that ANS may not work as well as AAI, and 50% and 44% (respectively) that it may not work well enough. Compared with AAI, respondents were less worried about ANS being painful or difficult to carry, and about fear/embarrassment around use, but more worried about side effects and knowing how to use it. Most anticipated being more comfortable using ANS than AAI, and over half anticipated earlier use during anaphylaxis. Only 17.2% of caregivers and 23.2% of adults preferred to be prescribed ANS only. There was interest in sublingual adrenaline due to portability and reduced needle‐related burden, but confidence depended on comparable speed/effectiveness and feasibility during reactions. Conclusions: Non‐injectable adrenaline is attractive to caregivers and adults, and may improve willingness to carry and use adrenaline. However, demand for evidence of effectiveness, safety, and real‐world feasibility is high, highlighting important information needs for shared decision‐making. image

Background: Adolescents and young adults (AYA) with asthma and allergies have unexpectedly high mortality and morbidity. A survey in 2019 amongst healthcare professionals (HCPs) in Europe highlighted significant gaps in transition care, which negatively impacts patients' outcomes. Since then, an evidence‐based guideline and practical toolbox for effective transition of AYA with asthma and allergies have been published.Aims: To assess HCPs' perspectives, practice and challenges on transition care for AYA with asthma and allergies, including the impact of the recent guideline, potential differences across countries and changes since 2019.Methods: Cross‐sectional online survey‐based study. European HCP managing AYA with allergies and/or asthma were invited to participate in May–June 2023.Results: 511 responses were collected. Amongst respondents, 60%–70% were familiar with the guideline and toolbox, and found them helpful. At least for selected patients, 50%–85% of respondents adhered to some guideline recommendations and initiatives/resources for transition care such as simplifying medication regimes, seeing AYA on their own or producing transition reports. We observed improvements compared to 2019 in areas such as prioritising transition, training, assessment of psychosocial issues and transition readiness, access to other HCP, transfer and post‐transfer feedback systems. However, 20% of respondents had no transition process and around 50% had no transition‐specific elements. Sixty percent found transition care ‘very’ or ‘moderately challenging’, with transition not being prioritised, time constraints and limited expertise on psychosocial issues as leading problems. Significant differences were observed in transition practice across countries.Conclusion: Despite improvement in training and approach towards transition care, challenges and limitations persist in effectively implementing evidence‐based guidelines. Raising greater awareness about the need for, and the positive impact of high‐quality transition care amongst policy‐makers, HCP, and patients/families remains a key priority to unlock resources for training and effective implementation at a national/international level.

Food allergy is a global public health problem that until recent years lacked any aetiological treatment supported by academy, industry and regulators. Food immunotherapy (AIT) is an evolving treatment option, supported by clinical practice and industry trial data. Recent AIT meta‐analyses have highlighted the difficulty in pooling safety and efficacy data from AIT trials, due to secondary heterogeneity in the study. An EAACI task force (CO‐FAITH) initiated by the Paediatric Section was created to focus on AIT efficacy outcomes for milk, egg and peanut allergy rather than in trial results. A systematic search and a narrative review of AIT controlled clinical trials and large case series was conducted. A total of 63 manuscripts met inclusion criteria, corresponding to 23, 21 and 22 studies of milk, egg and peanut AIT, respectively. The most common AIT efficacy outcome was desensitization, mostly defined as tolerating a maintenance phase dose, or reaching a particular dose upon successful exit oral food challenge (OFC). However, a large degree of heterogeneity was identified regarding the dose quantity defining this outcome. Sustained unresponsiveness and patient‐reported outcomes (e.g. quality of life) were explored less frequently, and to date have been most rigorously described for peanut AIT versus other allergens. Change in allergen threshold assessed by OFC remains the most common efficacy measure, but OFC methods suffer from heterogeneity and methodological disparity. This review has identified multiple heterogeneous outcomes related to measuring the efficacy of AIT. Efforts to better standardize and harmonize which outcomes, and how to measure them must be carried out to help in the clinical development of safe and efficacious food allergy treatments.

Introduction: Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self‐manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence‐based guideline on effective transition for AYA with asthma and allergies was published by EAACI.Aim: We herein summarize practical resources to support this guideline's implementation in clinical practice.Methods: For this purpose, multi‐stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence‐basis and user friendliness.Results: Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web‐based and had limited evidence‐basis.Conclusions: This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient‐centred tools to further assist evidence‐based transition care.

Acute food protein‐induced enterocolitis syndrome (‘FPIES’) is a potentially severe type of non IgE‐mediated food allergy affecting mainly infants usually when foods are introduced [1]. Acute FPIES triggered by multiple unrelated foods (‘multiple food FPIES’) has been reported in up to two thirds of patients, particularly in the USA [2,3]. FPIES reactions are often traumatic experiences for parents and weaning leads to significant anxiety, as there is no test to identify safe new foods. This has led to complex weaning recommendations in children with FPIES in an attempt to support parents [4]. However, evidence suggests that multiple food FPIES is rare in other regions, such as Southern Europe [5,6], which questions the applicability of such weaning advice in this population. Studies including a detailed dietary history in children with FPIES are lacking.