Oscar Calderón Llosa

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common, disabling inflammatory airway disease marked by persistent sinonasal symptoms, impaired quality of life, and frequent comorbidities such as asthma and aspirin-exacerbated respiratory disease. Standard treatment relies on intranasal corticosteroids, systemic corticosteroids, and endoscopic sinus surgery; however, recurrence is common, and many patients develop corticosteroid dependence or require repeated surgery, raising concerns about long-term safety and disease control. Advances in understanding CRSwNP immunopathogenesis have identified type 2 (T2) inflammation as a central driver, characterized by eosinophilic infiltration and cytokine signaling mediated by interleukin (IL)-4, IL-5, IL-13, and epithelial alarmins such as thymic stromal lymphopoietin (TSLP), leading to targeted biologic therapies that modulate these pathways. This narrative review summarizes current evidence on biologic agents approved or in advanced clinical development for CRSwNP. Data from pivotal randomized controlled trials and real-world studies show that these biologics reduce nasal polyp size, improve sinonasal symptoms and olfactory function, enhance quality of life, and decrease the need for systemic corticosteroids and revision surgery, with benefits particularly pronounced in patients with coexisting asthma. Overall, biologic therapy represents a paradigm shift in managing severe CRSwNP, enabling personalized treatment while highlighting the need for long-term data, head-to-head comparisons, and cost-effectiveness analyses.

Background: Current international hereditary angioedema (HAE) guidelines and treat-to-target recommendations consistently emphasize accurate diagnosis, early on-demand treatment of attacks, appropriate short-term prophylaxis for procedures, individualized long-term prophylaxis (LTP), and routine assessment of disease control and quality of life. Published information on how these recommendations are implemented in Latin America remains limited. We therefore aimed to assess the extent to which a Latin American expert panel converges with recommendations across current international HAE guidelines and consensus documents and to identify the principal barriers affecting real-world implementation in the region. Methods: A scientific committee developed and externally validated a 74-item questionnaire (domains summarized in Supplementary Table S1) and conducted a 2-round Delphi process among Latin American HAE experts. Consensus items were rated on a 9-point agreement scale, with consensus defined a priori as at least two-thirds of panelists scoring within a 3-point band in the agreement (7-9) or disagreement (1-3) range. Descriptive items captured expert-reported diagnostic testing, acute and preventive treatment patterns, monitoring practices, and implementation determinants using 5-point Likert scales. Instrument validation (July-November 2024) demonstrated high inter-rater agreement (Kendall W = 0.84; p < 0.001) and excellent internal consistency (Cronbach alpha = 0.92). Results: Thirty experts from 10 countries completed the process (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, Peru, Uruguay, Venezuela). Panel consensus broadly converged with recommendations across current international HAE guidelines and consensus documents on core diagnostic work-up (C4 plus C1-INH antigen and function; 84% consensus), selective use of genetics (97% consensus), first-line targeted LTP (pdC1-INH, Lanadelumab, Berotralstat; 94% consensus), retention of on-demand therapy for breakthrough attacks and for patients without access to LTP, routine monitoring, and management in special populations. The principal novel finding was an implementation feasibility gap: frequent or constant interruptions in prophylaxis supply were reported by 19/30 experts (63%), including 13/23 (57%) practicing in settings where public or insurance coverage was reported. Across the panel, cost (19/30; 63%) and medicine availability (8/30; 27%) were the most commonly cited barriers, with additional constraints related to diagnostic testing access and administrative pathways. Conclusions: Latin American expert consensus largely converges with recommendations across current international HAE guidelines and consensus documents on diagnosis, acute management, prophylaxis selection, monitoring, and special-population care. The dominant divergence is not clinical disagreement but implementation feasibility—particularly access to diagnostic testing, financing mechanisms, medicine availability, and continuity of supply. These findings provide region-specific evidence to contextualize international recommendations and support implementation strategies tailored to Latin America.

Aeropalynology, the monitoring and interpretation of airborne pollen, has become increasingly relevant in Latin America as allergic rhinitis and asthma rise alongside rapid urbanization, land-use change, and climate variability. Yet the region’s capacity remains heterogeneous: long-standing traditions in the Southern Cone coexist with emerging programs in tropical and Andean settings, and many series are not translated into standardized products useful for clinical care or public health. We conducted a structured literature review guided by PRISMA 2020 to synthesize the historical evolution, current monitoring infrastructure, dominant pollen taxa, and translational outputs reported across Latin American countries. Evidence indicates that Mexico currently represents the most mature aeropalynological ecosystem in the region, supported by multi-site monitoring, open weekly reporting (REMA), multiple city-level pollen calendars, and emerging computational approaches for pollen identification. Across countries, recurrent high-impact taxa include Cupressaceae, Fraxinus, Platanus, Olea, Poaceae, Urticaceae, Amaranthaceae, Rumex, Ambrosia, and Parietaria, with local dominance shaped by biogeography and urban vegetation. Key gaps include limited long-term continuity outside a few cities, variable methodology (sampler type, taxonomic resolution, units, thresholds), and scarce linkage of pollen exposure metrics with clinical outcomes. Future priorities include harmonized volumetric monitoring, interoperable data standards, routine publication of pollen calendars and thresholds, integration with meteorology for forecasting, and expansion of digital decision-support tools to improve prevention and management of allergic respiratory diseases in Latin America.

Aeropalynology the monitoring and interpretation of airborne pollen has become increasingly relevant in Latin America as allergic rhinitis and asthma rise alongside rapid urbanization, land‑use change, and climate variability. Yet the region’s capacity remains heterogeneous: long‑standing traditions in the Southern Cone coexist with emerging programs in tropical and Andean settings, and many series are not translated into standardized products useful for clinical care or public health. We conducted a structured literature review guided by PRISMA 2020 to synthesize the historical evolution, current monitoring infrastructure, dominant pollen taxa, and translational outputs reported across Latin American countries. Evidence indicates that Mexico currently represents the most mature aeropalynological ecosystem in the region, supported by multi‑site monitoring, open weekly reporting (REMA), multiple city‑level pollen calendars, and emerging computational approaches for pollen identification. Across countries, recurrent high‑impact taxa include Cupressaceae/Juniperus, Fraxinus, Platanus, Olea, Poaceae, Urticaceae, Chenopodiaceae–Amaranthaceae, Rumex, Ambrosia, and Parietaria, with local dominance shaped by biogeography and urban vegetation. Key gaps include limited long‑term continuity outside a few cities, variable methodology (sampler type, taxonomic resolution, units, thresholds), and scarce linkage of pollen exposure metrics with clinical outcomes. Future priorities include harmonized volumetric monitoring, interoperable data standards, routine publication of pollen calendars and thresholds, integration with meteorology for forecasting, and expansion of digital decision‑support tools to improve prevention and management of allergic respiratory diseases in Latin America.

Fungal spore calendars help illustrate the abundance and distribution of spores throughout the year, enabling clinicians and patients to predict and treat allergic symptoms based on spore presence and concentration. This three-year study (2021–2024) established the first fungal spore calendar for the most clinically important spore types in Lima, Perú: Alternaria, Cladosporium, Nigrospora, Curvularia, Drechslera, Fusarium, and Stemphylium. Air sampling was performed using a Burkard volumetric spore trap placed on the rooftop of SANNA Clínica el Golf in San Isidro, Lima. Cladosporium was the most abundant (37,945 spores/m³), followed by Nigrospora (11,558), Curvularia (3946), Fusarium (2454), Alternaria (2138), Drechslera (1850), and Stemphylium (201). The highest concentrations of Alternaria, Nigrospora, Curvularia, and Drechslera were recorded in 2023–2024, with seasonal peaks mainly during spring/summer. Meteorological correlations showed that Alternaria, Cladosporium, Nigrospora, and Curvularia were positively correlated with temperature while Drechslera had a negative correlation. Cladosporium, Curvularia, Fusarium, and Stemphylium were negatively correlated with relative humidity, while other types showed a mix of both positive and negative responses or inverse responses. These two meteorological parameters are likely the main influences on spore concentrations; however, other factors may include other meteorological parameters. Cladosporium correlated positively with southwesterly winds, and negatively with northwesterly, winds, and Curvularia was positively correlated with northeasterly winds.

Allergic diseases, particularly respiratory allergies like asthma and allergic rhinitis, are a growing public health concern influenced by environmental factors such as climate change and air pollution. The exposome framework enables a comprehensive assessment of how lifelong environmental exposures shape immune responses and allergic sensitization. Peru’s diverse ecosystems and climates provide a unique setting to investigate regional variations in allergic sensitization. This study characterized these patterns in five Peruvian regions with distinct climatic, urbanization, and socioeconomic characteristics. A total of 268 individuals from Lima, Piura, Tarapoto, Arequipa, and Tacna were analysed for allergen-specific IgE responses using a multiplex IgE detection system. The results revealed significant geographical differences in sensitization frequencies and serodominance profiles, based on descriptive statistics and supported by Chi-square comparative analysis. House dust mites were predominant in humid regions, while Arequipa exhibited higher sensitization to cat allergens. In Tacna, olive pollen showed notable prevalence alongside house dust mites. Tarapoto’s high humidity correlated with increased fungal and cockroach allergen sensitization. Notably, some allergens traditionally considered minor, such as Der p 5 and Der p 21, reached sensitization prevalences close to or exceeding 50% in certain regions. These findings provide the most detailed molecular characterization of allergic sensitization in Peru to date, highlighting the importance of region-specific allergy management strategies. Understanding environmental influences on allergic diseases can support more effective diagnostic, therapeutic, and preventive approaches tailored to diverse geographical contexts.

Climate change is significantly altering the dynamics of airborne allergens, affecting their seasonality, allergenicity, and geographic distribution, which correlates with increasing rates of allergic diseases. This study investigates aeroallergen sensitization among populations from Tenerife, Spain, and Lima, Peru—two regions with similar climates but distinct socio-economic conditions. Our findings reveal that Spanish individuals, particularly those with asthma, demonstrate higher sensitization levels to a broader range of allergens, especially mites, with 85% of participants reacting to at least one mite allergen. In contrast, Peruvian patients exhibit a narrower spectrum of sensitization. These results highlight the influence of environmental factors, such as pollution and socioeconomic disparities, on allergen exposure and immune responses. Moreover, the study underscores the necessity for region-specific diagnostic and therapeutic strategies to effectively address these variations. By elucidating the intricate relationship between climate change, environmental factors, and allergen sensitization, this research offers insights into respiratory allergic conditions, advocating for tailored interventions to mitigate their impact across diverse populations.

Climate change is significantly altering the dynamics of airborne allergens, affecting their seasonality, allergenicity, and geographic distribution, which correlates with increasing rates of allergic diseases. This study investigates aeroallergen sensitization among populations from Tenerife, Spain, and Lima, Peru—two regions with similar climates but distinct socio-economic conditions. Our findings reveal that Spanish individuals, particularly those with asthma, demonstrate higher sensitization levels to a broader range of allergens, especially mites, with 85% of participants reacting to at least one mite allergen. In contrast, Peruvian patients exhibit a narrower spectrum of sensitization. These results highlight the influence of environmental factors, such as pollution and socio-economic disparities, on allergen exposure and immune responses. Moreover, this study underscores the necessity for region-specific diagnostic and therapeutic strategies to effectively address these variations. By elucidating the intricate relationship between climate change, environmental factors, and allergen sensitization, this research offers insights into respiratory allergic conditions, advocating for tailored interventions to mitigate their impact across diverse populations.

Objetivo: Identificar y registrar las esporas de hongos más importantes captadas en nuestra estación de aerobiología, además reportar la prevalencia de sensibilización cutánea a estos alérgenos. Métodos: La identificación y los conteos de esporas de hongos se realizaron según la técnica estandarizada con un equipo colector Burkard Spore Trap For Seven Days, siguiendo las recomendaciones de la National Allergy Bureau (NAB), de la American Academy Allergy Asthma and Immunology (AAAAI). El equipo se instaló a 20 m de altura desde el nivel del suelo, en la azotea de la Clínica SANNA El Golf, distrito de San Isidro, (12°5'54"S 77°3'6"O), en la zona sur-oeste del área urbana de Lima. El periodo de captación se llevó a cabo entre septiembre de 2020 y octubre de 2021. Se realizaron estudios de pruebas cutáneas (skin prick-test), según recomendaciones de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC), en 200 pacientes (entre 18 y 60 años), con sintomatología de rinoconjuntivitis y/o asma. Fueron evaluados en el servicio de Alergología de la Clínica SANNA El Golf. Se aplicaron extractos alergénicos de ácaros del polvo (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), epitelios de gato y perro, Periplaneta americana, mezclas de seis gramíneas, mezclas de malezas, hongos ambientales (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum, Nigrospora spp.), extractos del laboratorio INMUNOTEK-España. Además, testeamos otros alérgenos fúngicos de Fusarium spp, Stemphylium spp, Curvularia spp, una mezcla de Helmintosporum/Dreschlera spp. del laboratorio DIATER-Argentina. Resultados: Identificamos esporas de Alternaria alternata, Cladosporium spp., Nigrospora spp., Stemphylium spp., Fusarium spp., Curvularia spp., Dreschlera/Helmintosporum spp. Los pacientes mostraron sensibilización a Cladosporium herbarum (14%), Fusarium spp. (13,5%), Nigrospora spp. (8%), Alternaria Alternata (7%), Stemphylium (6%), Dreschlera/Helmintosporium spp. (5,5%), Curvularia spp. (3%) y Aspergillus fumigatus (2,5%). Conclusiones: Los habitantes de la zona sur-oeste de la ciudad urbana de Lima están expuestos a distintas esporas de hongos con potencial alergénico, identificándose mayor concentración durante los meses de verano y otoño. Se demuestra sensibilización cutánea en porcentajes variables a las esporas fúngicas identificadas en este muestreo aerobiológico. Los resultados de este estudio deberían ampliarse y ser comparados con data en los años siguientes, identificar fluctuaciones estacionales y anuales y extender los captadores a otras locaciones en Lima.

Objetivo: Identificar y registrar los aeroalérgenos más importantes captados en la estación de aerobiología en la ciudad de Samborondón, Ecuador. Métodos: Los conteos de granos de polen y esporas de hongos se realizaron según la técnica estandarizada, con un equipo colector tipo Hirst, Burkard spore trap for seven days, siguiendo las recomendaciones de la National Allergy Bureau (NAB) de la American Academy Allergy Asthma and Immunology (AAAAI). El equipo se instaló en la azotea de la Universidad Espíritu Santo (UEES), en la ciudad de Samborondón, a 25 m de altura desde el nivel del suelo, 2°07´57´´S 79°52´06´´O. El periodo de captación se llevó a cabo entre noviembre de 2022 y abril de 2023. Resultados: Identificamos las siguientes familias polínicas: Poaceae (258 granos/m3), Apocynaceae (Plumeria rubra pc) (214 granos/m3), Lamiaceae (180 granos/m3), Asteraceae - Ambrosía spp.- (60 granos/m3), Chenopodiacea (27 granos/m3), Myrtaceae (17 granos/m3), Pinaceae (11 granos/ m3), Betulaceae (7 granos/m3). Además esporas fúngicas: Fuzariella spp./Leptosphaeria spp. (1899/m3), Cladosporium spp. (1407/m3), Nigrospora spp. (1183/m3), Dreschlera/ Helmintosporum spp. (329/m3), Alternaria spp. (98/m3), Pithomyces spp. (79/m3), Curvularia spp. (48/m3), Stemphylium spp. (46/m3). Conclusiones: Se reporta el primer estudio de aerobiología (captación e identificación de pólenes y hongos ambientales), en la ciudad de Samborondón. Los habitantes de esta zona están expuestos a diferentes aeroalérgenos con predominancia al polen de Poaceaes y esporas de Fuzzariella spp./ Leptosphaeria spp. Los alérgenos identificados deberían formar parte de los estudios alergológicos habituales. Los resultados de este primer estudio preliminar deberían ser comparados con información de los siguientes años para ayudar a identificar las variaciones de concentración de aeroalérgenos estacionales, las fluctuaciones anuales, y extender los captadores a otros puntos de la ciudad.