Ludger Klimek

Background: The aim of this study was to compare the onset of action (primary), and overall efficacy (secondary) of azelastine nasal spray 0.15% (AZE 0.15%) with mometasone/olopatadine combination therapy (OloMom) in subjects with allergen‐induced rhinitis under controlled allergen exposure conditions in an Environmental Exposure Unit (EEU). Method: This was a randomized, double‐blind, placebo‐controlled, three‐period Williams cross‐over study. Participants were randomized to receive AZE 0.15%, OloMom, or placebo. Efficacy was assessed during two pollen challenge sections in an EEC, after a single dose and after 3.5 days of treatment. Following a minimum 14‐day washout period, subjects received alternate treatment and repeated study procedures until all three interventions were evaluated. The primary endpoint was time to onset of action based on change from baseline in Total Nasal Symptom Score (TNSS). Secondary assessments included total and individual nasal and ocular symptoms and overall efficacy after 3.5 days of treatment. Results: Eighty‐four subjects completed the study (mean age 41.5 years; balanced sex distribution), all with confirmed ragweed sensitivity. All treatments reduced TNSS post‐dose, with most effective and fastest relief from AZE 0.15%, onset at 15 minutes, sensitivity analyses supported onset at 10 minutes, and greater early nasal, ocular, and total symptom relief compared to OloMom and placebo. Conclusion: AZE 0.15% delivered rapid and clinically significant relief of AR, demonstrating greater early symptoms improvement compared with OloMom. Overall efficacy was comparable between treatments, supporting AZE 0.15% as an effective, steroid‐free alternative for rapid symptom control in patients with pollen allergies.

Human exposure to fungi and parasites (helminths, protozoa and ticks) can lead to the development and/or exacerbation of allergic/atopic diseases due to the production of IgE antibodies to components from these organisms. However, some of these IgE‐binding components are not currently listed in the official Allergen Nomenclature Database of the World Health Organization/International Union of Immunological Societies (WHO/IUIS) Allergen Nomenclature Sub‐Committee. The aim of the Task Force (TF) BACALL (including members from this Sub‐Committee and four additional groups/committees) was to identify in the literature (PubMed up to October 2025) potential allergens from fungi and parasites and their reported clinical relevance, for possible future inclusion in the WHO/IUIS Allergen Nomenclature Database according to Sub‐Committee criteria. Forty‐nine IgE‐binding proteins from fungi and parasites were identified as potential allergen candidates. The IgE‐binding oligosaccharide α‐Gal was excluded because it is not proteinic, although it is associated with allergic reactions and anaphylaxis. Exposure to helminths outside the context of infection, such as ingestion of Anisakis ‐infected fish or vaccination against hookworms, can also elicit allergic reactions. The TF recommends that non‐conventional routes of exposure be considered in the identification of new allergens, and that future studies assess the clinical relevance of new allergens identified by the TF in larger populations.

Grass pollen, the most clinically relevant outdoor aeroallergen in Europe and worldwide, presents a complex challenge due to the diverse nature of its subspecies. This diversity complicates the interpretation of their contribution to the overall pollen burden during the grass pollen season and the selection of the appropriate allergen immunotherapy. Almost all species of the Pooideae subfamily share important major allergens, namely the allergens of Group 1 and 5, leading to a high level of cross‐reactivity at the IgE level. However, the presence of a multitude of additional minor allergens and species‐specific epitopes adds to the complexity. Timothy ( Phleum pratense ), previously considered the most relevant allergen source among grass species, is found during the late‐blooming grass pollen season, while symptom severity and pollen concentrations already show several peaks during the early‐blooming grass and main grass pollen seasons. Current data suggest a limited regional relevance of timothy grass during the natural grass pollen season in southern Europe from both the aerobiology and allergy perspectives. This review aims to discuss the latest evidence supporting a broad‐spectrum approach to best reflect natural grass pollen exposure in allergen immunotherapy, presenting a complex but crucial aspect of allergology.

Background: The mannan‐conjugated birch pollen polymerised allergoid EP‐088_T502 has previously been shown to reduce allergic symptoms and anti‐allergic medication use during the birch pollen season. This confirmatory phase III trial aimed to evaluate the efficacy, safety, tolerability, and immunologic effects of EP‐088_T502 administered as eight subcutaneous injections over six pre‐seasonal treatment visits. Methods: In this double‐blind, placebo‐controlled (DBPC) trial, 278 participants with birch pollen–induced allergic rhinoconjunctivitis (ARC) received either placebo or a cumulative dose of 28,000 mannan therapeutic units (mTU) of EP‐088_T502. The primary efficacy endpoint was the combined symptom and medication score (CSMS) during the peak birch pollen season. Safety, tolerability, health‐related quality of life (QoL), and immunologic parameters were also assessed. Results: In the full analysis set (FAS), EP‐088_T502 significantly reduced the CSMS during the peak birch pollen season compared with placebo (mean absolute difference [MAD] −0.31; 95% confidence interval [CI], −0.56 to −0.05; p = 0.0169). In the per‐protocol (PP) and complete‐case sets, the corresponding MADs were −0.36 ( p = 0.012) and −0.51 ( p = 0.013), respectively. Health‐related QoL improved by 20% in the EP‐088_T502 group compared with placebo during the peak season ( p < 0.005). EP‐088_T502 increased Bet v 1‐specific immunoglobulin G4 (IgG4) levels after treatment compared with placebo (6.4‐fold; p < 0.0001). The Bet v 1‐specific immunoglobulin E (IgE)/IgG4 ratio was reduced by 73% from baseline and by 69% compared with placebo (both p < 0.0001). Thirteen systemic allergic reactions occurred, including one grade III systemic reaction considered related to EP‐088_T502. Conclusions: EP‐088_T502 significantly improved symptom and medication scores in participants with birch pollen–induced ARC and induced a substantial Bet v 1‐specific IgG4 response. The 28,000 mTU regimen induced a substantial immunological response and showed an acceptable safety and tolerability profile.

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.

Among bacteria that are associated with the development and/or exacerbation of allergic/atopic diseases, several have been described to produce IgE‐binding components. However, only one bacterial protein, Bac s 1, is currently listed in the official database of the World Health Organization/International Union of Immunological Societies (WHO/IUIS) Allergen Nomenclature Sub‐Committee. The aim of this position paper was to identify potential bacterial allergens and their reported clinical relevance in the published literature and consider candidates for the Allergen Nomenclature database. PubMed and the WHO/IUIS Allergen Nomenclature database were searched up to October 2025. Consensus was obtained during task force meetings and by a written commentary process. Sixty‐six IgE‐binding components in 20 different species of bacteria were found, most associated with clinical symptoms. Allergen candidates include staphylococcal superantigens, bacterial enzymes, and components from two Chlamydia species, some of which are potential marker allergens for disease severity. The results point to long‐neglected evidence of “bacterial allergy” that in certain cases may be induced by unconventional mechanisms. Diseases that are currently considered non‐allergic might be re‐classified as allergic if these IgE‐binding components are recognized as allergens and used for diagnosis in the future.

Background: Patients with allergic rhinitis often use as‐needed medication instead of regular treatment. Using data from the MASK‐air mHealth app, we compared weeks with use of as‐needed versus regular medication on treatment satisfaction and symptom control. Methods: We assessed data from the MASK‐air app. We compared weeks in the pollen season in which patients reported the use of one same medication during all the days in the week (“regular treatment”) versus those in which patients reported the use of the same single medication (and no other treatments) in at most 4 days per week (“as‐needed treatment”). We built mixed‐effects linear regression models, evaluating the differences between regular and as‐needed treatments on visual analogue scales for symptom control and treatment satisfaction. We performed sensitivity analyses (i) considering a different definition of as‐needed treatment (use of medication ≤ 2 days per week), and (ii) evaluating treatment days preceded by non‐treatment days. Results: We assessed 2690 weeks (18,830 days, 1042 MASK‐air users). For intranasal corticosteroids (INCS) and fixed combinations of intranasal antihistamines (INAH) + INCS, there were no significant differences between as‐needed versus regular treatments for treatment satisfaction. For oral antihistamines (OAH) and INCS + OAH, results tended to favour as‐needed approaches. For symptom control, we observed either no significant differences between the two approaches or significant differences favouring as‐needed medication use. Similar results were found in the sensitivity analyses. Conclusion: Some patients use medication regularly and others use it on‐demand. This study shows that both approaches can satisfy patients and result in good disease control.