Molecular Patterns of Fungal Sensitization in Patients with Asthma and Allergic Rhinitis: Evidence from Real-Life Clinical Practice

Presenter: O. Mirzaev

This retrospective study evaluated fungal sensitization patterns in patients with respiratory allergic diseases using component-resolved diagnostics. The study included 79 patients with physician-diagnosed asthma and/or allergic rhinitis who underwent testing for specific immunoglobulin E (IgE) against 12 fungal molecular components. Asthma was present in 68.4% (54/79) of patients, allergic rhinitis in 67.1% (53/79), and both conditions occurred together in 36.7% (29/79). A significant association was observed between asthma and allergic rhinitis (Chi-Square Test [χ²]=6.41; p=0.011), supporting the concept of shared airway disease. Sensitization to at least one fungal allergen component was detected in 46.8% (37/79) of patients. The most common sensitization was to Alt a 1 from Alternaria alternata allergen, identified in 24.1% (19/79) of the overall cohort and in 51.4% (19/37) of fungal-sensitized patients. Most sensitized individuals showed isolated Alt a 1 sensitization, while co-sensitization was less frequent and mainly involved Malassezia sympodialis allergen (Mala s 6) and Cladosporium herbarum allergen (Cla h) components. Other fungal components were detected less frequently and were not significantly associated with having both asthma and allergic rhinitis.

Overall, fungal sensitization was common among patients with respiratory allergies, with Alternaria alternata and Alt a 1 representing the predominant sensitization pattern. Molecular testing may help better define fungal allergy profiles and support individualized clinical management.

Prospective Study to Investigate the Symptom Profile and Medication Consumption of Patients with Seasonal Allergic Rhinitis/Rhinoconjunctivitis who are Interested in Allergen-Specific Immunotherapy

Presenter: S. Allekotte

This multicentre epidemiologic study evaluated symptom severity among patients with grass pollen allergy who were interested in allergen immunotherapy (AIT). The study aimed to determine the proportion of patients with moderate-to-severe symptoms who may meet guideline-based criteria for AIT. A total of 479 patients with a history of grass pollen allergy and positive skin prick test results were assessed during the 2025 grass pollen season using electronic diaries. Symptom severity and medication use were measured using the Combined Symptom and Medication Score (CSMS) and visual analogue scale (VAS). Among evaluated participants, 63.3% had a CSMS ≥1.5, indicating moderate-to-severe allergy symptoms. The mean and median CSMS values were 2.14 and 1.88, respectively. The score was contributed equally by symptom severity and medication use components. Overall allergy symptom severity measured by VAS had a mean score of 41.8 and median score of 39.4. Asthma symptoms were also reported, with a mean VAS score of 49.2 and median score of 52.6. Among participants with asthma, asthma medication was used on average for 4.7 of the 30 documented days.

The findings suggest that approximately two-thirds of patients interested in grass pollen AIT had symptom severity levels consistent with potential benefit from treatment. The study also highlights the presence of asthma symptoms in a substantial proportion of patients with grass pollen allergy.

Efficacy and Safety of a Combined Nasal Spray with a Fixed Dose of Mometasone and Olopatadine for the Treatment of Allergic Rhinitis in Pets under Save Ongoing Exposure to Epidermal Allergens

Presenter: K. Pavlova

This study evaluated the effectiveness and safety of a fixed-dose combination nasal spray containing mometasone and olopatadine in adults with allergic rhinitis (AR) caused by epidermal allergens, while they continued daily exposure to the allergenic pet. The study included 30 adults with confirmed pet-related allergic rhinitis who had ongoing contact with the allergen source for at least 8 hours daily. Participants received mometasone plus olopatadine nasal spray twice daily for 90 days. Treatment response was assessed using the Total Nasal Symptom Score (TNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), visual analogue scale (VAS), and adverse event monitoring. The combination therapy improved nasal symptoms, including congestion, runny nose, sneezing, and itching, despite continued allergen exposure. TNSS scores significantly decreased after 30 days of treatment compared with baseline (0.56 vs 2.5; p<0.05). VAS scores also improved, decreasing from 70.76 at baseline to 20.5 after 1 month and further to 10.8 after 90 days. No serious adverse events were reported. The most frequently reported side effects were nasal bleeding in 15 patients (50%) and nasal discomfort in 7 patients (21%), which were considered non-serious and did not require additional treatment.

Overall, mometasone plus olopatadine nasal spray provided effective symptom control and improved quality of life in patients with pet-allergen-induced allergic rhinitis despite continued exposure.

Severe Vernal Keratoconjunctivitis with Allergic Rhinitis Treated with House Dust Mite (HDM) Sublingual Immunotherapy (SLIT)

Presenter: M. Ahmed

This case report evaluated the effect of house dust mite (HDM) sublingual immunotherapy (SLIT) in a 15-year-old girl with severe vernal keratoconjunctivitis (VKC) and persistent allergic rhinitis (AR). VKC is a severe ocular allergic condition that can affect quality of life and may lead to eye complications if not adequately controlled. The patient had recurrent eye and nasal allergy symptoms since 2015, with worsening during monsoon and winter seasons. She had severe VKC with bilateral itching, redness, discharge, papillary changes, and limbal inflammation, along with moderate-to-severe persistent AR. Symptoms repeatedly worsened when ocular anti-inflammatory treatments were reduced, despite antihistamines and intranasal corticosteroids. Skin prick testing showed sensitization to house dust mites, including Dermatophagoides pteronyssinus (9 mm), Dermatophagoides farinae (7.6 mm), and Blomia (8 mm). Treatment with a standardized HDM SLIT tablet (12 SQ HDM once daily) was started. Improvement in eye and nasal symptoms was observed within 2 weeks of starting SLIT. By 6 weeks, symptoms were controlled, daily functioning and school activities improved, and intranasal corticosteroids were discontinued after 1 month. All other eye and oral allergy medications were stopped by 6 weeks. At 4.5 months of follow-up, the patient remained symptom-free on SLIT alone, with no relapse or treatment-related adverse events reported.

This case suggests that HDM SLIT may help achieve sustained symptom control and reduce the need for additional medications in HDM-sensitized patients with VKC and AR.

Comparison of Non-Asthmatic Allergic Rhinitis Patients with Normal and Low FEF25–75 Levels

Presenter: E. Gülşen

This retrospective study evaluated whether small airway changes could be detected in adults with allergic rhinitis (AR) who did not have asthma symptoms, and whether these changes were associated with specific allergy profiles or risk factors for future asthma. The study included adults with AR symptoms, positive allergy testing, and no asthma symptoms between January 2023 and September 2025. Clinical characteristics, allergy sensitization patterns, blood markers, and pulmonary function parameters were assessed. Small airway function was evaluated using Forced Expiratory Flow between 25% and 75% of vital capacity (FEF25–75). Patients were grouped based on FEF25–75 levels below or above 70%. Significant differences between groups were observed for sex (p<0.001), presence of pets at home (p=0.01), tree pollen sensitization (p=0.002), age, and forced expiratory volume in 1 second (FEV₁). Patients with lower FEF25–75 values were more likely to be older, female, have pets at home, lower FEV₁ values, and sensitization to tree pollen. These findings suggest that some patients with AR may have early lower airway involvement even without asthma symptoms.

The study indicates that including FEF25–75 assessment during routine lung function testing may help identify AR patients who require closer monitoring for possible asthma development. However, prospective follow-up studies are needed to confirm whether patients with reduced FEF25–75 eventually develop asthma.

An Observational Study of Techniques of Intranasal Spray in Allergic Rhinitis

Presenter: M. Ahmed

This study evaluated whether healthcare workers were familiar with the correct administration technique for intranasal corticosteroid sprays (INCS), as incorrect use may reduce treatment effectiveness in patients with allergic rhinitis (AR). The study assessed 200 cases of AR using a detailed checklist covering essential spray-use steps, including medication preparation, nose preparation, nozzle positioning, breathing technique, and storage practices. All respondents correctly understood the purpose of the medication and removed the dust cap before use (100%). However, knowledge of several important technique steps was variable. Correct responses were reported for shaking the bottle (81%), holding the spray device correctly (77%), directing the nozzle away from the nasal septum (59%), priming the spray before use (59%), clearing nasal blockage before spraying (61%), maintaining an upright head position (65%), and using the opposite hand for each nostril (57%). Before educational intervention, only 24 pharmacists demonstrated all essential steps and were classified as competent. Following training, pharmacist competence significantly improved from 29% to 48% (p=0.0057).

The findings highlight gaps in INCS administration knowledge among healthcare workers and suggest that targeted education may improve correct spray technique and potentially enhance treatment outcomes in AR.

A Prospective Long-Term Cohort Study with Seasonal Allergic Rhinitis (TAPAS) with MATAs in Tree- and Grass-Allergic Patients

Presenter: R. Mösges

The 5-year TAPAS (Tyrosine Allergoid Paediatric and Adult Study) cohort study evaluated the long-term effectiveness and safety of perennial subcutaneous allergen immunotherapy (SCIT) using glutaraldehyde-modified, microcrystalline tyrosine-associated allergoids (MATAs) in patients with allergic rhinitis (AR) caused by grass or tree pollen. The study included 320 patients aged 5–75 years (129 children/adolescents and 191 adults) who received 3 years of SCIT. Treatment adherence after the third year was 71%. Symptom severity, medication use, asthma symptoms, and quality of life were assessed during pollen seasons. After 3 years of treatment, the combined symptom and medication score (CSMS) significantly improved compared with the first pollen season (p=0.021). Rhinitis symptoms decreased by 50% across all patients, including both grass pollen and tree pollen allergy groups (p<0.0001). Conjunctivitis symptoms also improved, with reductions of 60% in all patients, 60% in grass pollen allergy, and 80% in tree pollen allergy groups (p<0.0001). Asthma symptom scores improved by 100% in all evaluated groups after 3 years of SCIT (p<0.0001). Quality of life also improved, with lower Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores during the third pollen season compared with baseline. The treatment showed an acceptable safety profile. Non-serious adverse drug reactions (ADRs) occurred in 16.3% of patients, serious ADRs in 2 patients, systemic reactions in 9.1%, and local reactions in 12.8% of patients. ADR frequency decreased over the course of treatment.

Overall, 3 years of MATA-based SCIT provided sustained symptom improvement and was well tolerated in patients with grass and tree pollen allergic rhinitis.

Effectiveness of Mepolizumab in Patients with Severe Asthma and Allergic Rhinitis: Real-World Evidence from the TYREX Study

Presenter: J. Dominguez-Ortega

The TYREX study evaluated whether the presence of allergic rhinitis (AR) affects response to mepolizumab treatment in patients with severe asthma. Mepolizumab is an anti–interleukin-5 (IL-5) monoclonal antibody used for severe type 2 (T2) asthma. This multicentre retrospective study included 446 patients with severe asthma who received mepolizumab for 12 months to more than 5 years. Among them, 87 patients had coexisting AR and 359 did not. Patients with AR had higher baseline serum immunoglobulin E (IgE) levels compared with those without AR. Treatment with mepolizumab resulted in significant and sustained reductions in blood eosinophil counts and fractional exhaled nitric oxide (FeNO) levels in both groups. Asthma exacerbations decreased significantly after 12 months and the improvement was maintained throughout follow-up, regardless of AR status.Lung function improved during treatment, with no clinically meaningful differences between patients with and without AR. Asthma control also improved, with 75–80% of patients achieving a clinically meaningful improvement in Asthma Control Test (ACT) scores (increase of ≥3 points). The proportion of patients achieving well-controlled asthma (ACT ≥20) increased significantly in both groups. Clinical remission rates were comparable between patients with and without AR, with improvements observed from 12 months through the end of follow-up. No significant differences were identified between the two groups for treatment outcomes.

Overall, mepolizumab demonstrated sustained effectiveness in severe asthma patients, irrespective of the presence of allergic rhinitis.

Symptom Burden and Sensitization Patterns in Allergic Rhinitis: Real-World Data

Presenter: AV. Gorbatovschi

This retrospective study evaluated symptom severity, allergen sensitization patterns, treatment approaches, and associated allergic conditions among patients with allergic rhinitis (AR) in a real-world outpatient allergy setting. The study included 32 patients with AR, with a median age of 38 years (range 4–69 years); 59.4% were female. Perennial AR was present in 65.6% of patients, while 34.4% had seasonal AR. Symptom severity was assessed using the visual analogue scale (VAS), with uncontrolled disease defined as VAS >5. The median VAS score was 5 (range 3–9), and 43.8% of patients had uncontrolled symptoms at presentation. Pharmacological treatment was most commonly prescribed as a combination of antihistamines and intranasal corticosteroids (37.5%), followed by intranasal corticosteroids alone (28.1%) and antihistamines alone (28.1%). Skin prick testing (SPT) showed that 62.5% of patients were polysensitized, while 37.5% were monosensitized. Sensitization to pollens and house dust mites was identified in 62.5% of patients each, while sensitization to animal epithelia and moulds was less frequent (12.5% and 9.4%, respectively). Associated allergic conditions were present in 34.4% of patients, most commonly urticaria and asthma.

The findings highlight the usefulness of combining VAS assessment and SPT to evaluate disease burden and guide individualized management in patients with AR.

Real-world Practices in the Diagnosis and Evaluation of Allergic Rhinitis among Korean Specialists

Presenter: SC. Park

This survey-based study evaluated real-world diagnostic and assessment practices for allergic rhinitis (AR) among different medical specialties in Korea. The study explored the use of diagnostic tools, symptom assessment methods, and evaluation of associated conditions. A total of 77 specialists participated, including 31 internists, 24 otorhinolaryngologists, and 22 pediatricians. Specific immunoglobulin E (IgE) testing was used more commonly than skin prick testing (SPT) for identifying allergen sensitization across all specialties. Assessment practices differed between specialties. Rhinoscopy was routinely performed by all otorhinolaryngologists, but was less frequently used by pediatricians (47.7%) and internists (12.9%). Use of ostiomeatal unit computed tomography (CT) in more than half of patients was reported by 20.8% of otorhinolaryngologists, 3.2% of internists, and none of the pediatricians. Symptom assessment tools, including visual analogue scale (VAS), total nasal symptom score (TNSS), and quality of life questionnaires, were used infrequently. Time limitations and reliance on clinical history were reported as major barriers. Assessment of comorbidities also varied, with pediatricians more frequently evaluating mouth breathing and obstructive sleep apnea. Screening for pollen-food allergy syndrome was performed in more than half of seasonal AR patients by 47.7% of pediatricians and 35.5% of internists, compared with 8.3% of otorhinolaryngologists.

Overall, the study highlights variability in AR evaluation across specialties and suggests the need for standardized, multidisciplinary approaches to improve consistent diagnosis and management.

Building Expert Consensus on the Positioning of Allergen Immunotherapy (AIT) Within a Treatment Paradigm for Allergic Rhinitis/Rhinoconjunctivitis Led by Disease Remission: A Delphi Consensus

Presenter: GW. Canonica

This study used a Delphi consensus approach to evaluate current challenges in the management of allergic rhinitis/rhinoconjunctivitis (AR/ARC) and to establish practical recommendations for the use of allergen immunotherapy (AIT). A steering committee of 10 clinicians with expertise in AR/ARC management reviewed available evidence and developed consensus statements. These were evaluated through an online survey by an international panel of 156 specialists, including allergists (46%), pulmonologists (29%), and ear, nose, and throat (ENT) specialists (26%) from Europe, Asia, South America, and North America. All 47 proposed statements achieved the predefined consensus threshold of ≥75% agreement, with 32 statements (68%) reaching ≥90% agreement. Experts agreed that AIT plays an important role in AR/ARC management and is the only treatment option shown to provide sustained remission after stopping therapy. The panel also agreed on the long-term benefits of AIT and factors that help identify suitable candidates for treatment.

The findings support the development of a standardized treatment pathway to improve the appropriate and timely use of AIT in patients with AR/ARC.

Management of Severe Occupational Allergic Rhinitis and Asthma in a Veterinary Student: A Molecular-Guided Approach

Presenter: B. Çelik Eroğlu

This case report describes the role of component-resolved diagnostics in identifying clinically relevant animal allergen sensitization in a veterinary medicine student with severe occupational allergy. A 21-year-old male veterinary student developed severe rhinoconjunctivitis, contact urticaria, and uncontrolled asthma, with symptoms worsening during exposure to animals at the veterinary clinic. A severe asthma exacerbation with oxygen saturation (SpO₂) of 85% required hospitalization, oxygen therapy, and systemic corticosteroids. Despite treatment with budesonide/formoterol and intranasal corticosteroids, the patient continued to experience sneezing, breathlessness, and angioedema after cat and dog exposure at the workplace. Symptoms were milder at home despite having two cats. Serum total immunoglobulin E (IgE) was 461 IU/mL and eosinophil count was 0.42×10³/µL. Skin prick testing showed sensitization to cat, dog, horse, grass pollen, and birch. Molecular allergen testing identified high levels of major cat and dog allergens, including secretoglobin Felis domesticus 1 [Fel d 1] as 33.54 Kiloallergen Units per Liter [kUA/L] and Canis familiaris 1 [Can f 1] (29.95 kUA/L), indicating that these allergens were likely the main drivers of clinical symptoms. Sensitization to additional allergen families, including lipocalins and serum albumins, suggested cross-reactivity with multiple animal species. Due to severe uncontrolled asthma and ongoing occupational exposure, anti-IgE therapy with omalizumab was initiated. Cat allergen immunotherapy was planned as a longer-term disease-modifying approach.

The case highlights how molecular allergen profiling can help differentiate primary sensitization from cross-reactivity and support individualized management strategies in occupational animal allergy.

Effectiveness and Predictors of House Dust Mite Subcutaneous Immunotherapy in Polysensitized Patients with Allergic Rhinitis: A Multicenter Retrospective Study

Presenter: Z. Pan

This multicentre retrospective study evaluated the effectiveness of house dust mite (HDM) allergen immunotherapy (AIT) in patients with polysensitized allergic rhinitis (AR) and assessed factors that may influence treatment response. The study included 81 patients with AR who were sensitized to HDM and at least one additional inhalant allergen such as pollen, mould, or animal dander. All patients received HDM subcutaneous immunotherapy (SCIT) for 12–36 months. Treatment response was defined as a ≥30% reduction in visual analogue scale (VAS) symptom scores. After treatment, 68.8% of patients showed improvement in perennial AR symptoms. Response rates also varied based on coexisting allergen sensitization, with improvement observed in patients sensitized to moulds (72.7%), animal dander (70.0%), tree pollen (65.5%), and weed pollen (70.2%). Allergen-specific symptom improvement differed across allergens: 68.2% for mould-related symptoms, 30.0% for animal dander-related symptoms, 56.7% for tree pollen-related symptoms, and 74.5% for weed pollen-related symptoms. Higher serum allergen-specific immunoglobulin E (sIgE) levels against HDM and mould were associated with lower treatment response among patients sensitized to both allergens. A prediction model combining HDM and mould sIgE levels showed good ability to identify patients less likely to respond.

Overall, single-allergen HDM SCIT provided symptom improvement in many polysensitized AR patients; however, response varied depending on coexisting allergens and sensitization levels, highlighting the need for individualized AIT strategies.

Efficacy and Safety of TQC2938 Injection in Patients with Moderate-to-severe Seasonal Allergic Rhinitis: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase II Study

Presenter: Y. Zhang

This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of TQC2938, a monoclonal antibody targeting suppression of tumorigenicity 2 (ST2), in adults with moderate-to-severe seasonal allergic rhinitis (SAR). The study included 136 adults aged 18–75 years with inadequate symptom control despite standard treatments during previous pollen seasons. Participants were randomly assigned to receive subcutaneous TQC2938 at 210 mg, 420 mg, 630 mg, or placebo every 4 weeks. The primary outcome was change in reflective total nasal symptom score (rTNSS) over 2 weeks. Compared with placebo, the 420 mg dose showed a numerical improvement in rTNSS over 2 weeks (least-squares mean difference: -0.97; 95% confidence interval [CI]: -2.177 to 0.244; p=0.1166), although the difference was not statistically significant. The 210 mg and 630 mg groups also did not show significant improvement compared with placebo. In patients with baseline blood eosinophil counts <0.3×10⁹/L, the 420 mg dose significantly improved rTNSS compared with placebo (least-squares mean difference: -1.46; 95% CI: -2.865 to -0.057; p=0.0416). The 420 mg group also showed significant improvement over a 4-week treatment period (least-squares mean difference: -1.37; 95% CI: -2.638 to -0.103; p=0.0342). No serious adverse events, severe treatment-emergent adverse events, deaths, or treatment discontinuations due to adverse events were reported.

Overall, subcutaneous TQC2938 at 420 mg improved nasal symptoms in selected patients with SAR, particularly those with lower eosinophil levels, and showed a favorable safety profile.

Safety and Immunologic Evaluation of a Biodegradable Transdermal Microneedle Array Patch Immunotherapy (DF19001) in House Dust Mite-Sensitized Allergic Rhinitis: A Phase I Double-Blind, Placebo-Controlled Study

Presenter: KH. Park

This phase I randomized study evaluated DF19001, a biodegradable transdermal microneedle patch designed to deliver Dermatophagoides farinae (Df) allergen for allergen immunotherapy (AIT) in adults with house dust mite (HDM)-sensitized allergic rhinitis (AR).nThe study included adults with moderate-to-severe persistent HDM-related AR who received DF19001 or placebo five times weekly for 16 weeks. Three dose levels were assessed: 200, 400, and 800 protein allergen units (PAU). Safety, tolerability, nasal symptoms, quality of life (QoL), and immune responses were evaluated.nAmong 54 participants who received treatment, 43 completed the study. No serious adverse events were reported, and no participants stopped treatment due to adverse events. Most treatment-related events were mild to moderate and included local skin reactions and temporary upper respiratory symptoms. No clinically important changes in laboratory or cardiovascular parameters were observed.nDF19001 did not show statistically significant differences compared with placebo in total nasal symptom score (TNSS) or QoL, although the medium-dose group showed a trend toward symptom improvement. Immune analyses showed a dose-related effect, with the high-dose group demonstrating a 3.2-fold greater increase in Df-specific immunoglobulin G4 (sIgG4) compared with placebo (p=0.004). A 2.3-fold increase in Df-specific immunoglobulin E (sIgE) was also observed (p=0.037).

Overall, DF19001 was well tolerated and produced dose-dependent immune changes, supporting further evaluation in larger and longer clinical studies.

EAACI 2026, June 12-15, Istanbul, Türkiye