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Journal articleLu Y-T, John AE, Fernández-Yagüe MA, 2026,
Mechanoactive Biomaterials for Cell-Matrix Mechanotransduction.
, Adv MaterCells and extracellular matrices (ECMs) form mechanically coupled feedback loops in which cells generate forces, remodel their surroundings, and respond to mechanical information returned by the matrix. Conventional biomaterial models have established how passive matrix properties, including stiffness, viscoelasticity, architecture, and ligand presentation, regulate this feedback, but they provide limited control over the dynamic mechanical inputs transmitted through living tissues. Mechanoactive biomaterials address this limitation by converting external or encoded triggers into mechanical inputs with defined timing, magnitude, frequency, and spatial localization. Here, we compare mechanochemical hydrogels, light-responsive matrices, thermoresponsive systems, and optothermal mechanoactuators according to the material response, the mechanical input experienced by cells, spatial, and temporal control, reversibility, cytocompatibility, quantification, and translational constraints. We discuss how these platforms engage integrin-focal adhesion signaling, mechanosensitive ion channels, cytoskeletal and nuclear mechanotransduction, YAP/TAZ activity, and TGF-β activation. We conclude with design principles for selecting reversible or persistent actuation, matching mechanical parameters to receptor and tissue mechanics, and advancing mechanoactive platforms toward predictive in vitro models.
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Journal articleKarp T, Faiz A, Kerstjens HAM, et al., 2026,
Accounting for seasonal variation of nasal gene expression improves transcriptome analysis of asthma.
, J Allergy Clin ImmunolINTRODUCTION: Environmental seasonal changes, including allergen exposure, pollutants, and viral prevalence, impact gene expression across human tissues. Therefore, season of sample collection is critical to consider when analyzing disease-associated transcriptional programs. In this study we aimed to investigate the effect of season on identification of asthma-associated genes. METHODS: We analyzed RNA-seq data from nasal brushes of asthma patients (n=361) and healthy controls (n=57) included in the ATLANTIS study. Samples were compared across two time periods defined by a data-driven approach: winter-spring (Nov 15 -May 14) and summer-autumn (May 15 - Nov 14), correcting for age, sex, smoking, and asthma status. Gene Set Variation Analysis (GSVA) scores of the obtained seasonal gene signatures were compared using Mann-Whitney U test in the independent PIAMA cohort (n=325) for replication. RESULTS: We identified 1,731 genes differentially expressed between the two time periods (813 higher and 918 lower in winter-spring compared with summer-autumn; FDR < 0.05). This signature was replicated in the PIAMA cohort nasal gene expression data and was independent of asthma or allergy status. Samples collected in winter-spring showed a significantly lower predicted proportion of ciliated cells (p = 0.005) and a higher proportion of basal cells (p = 0.04) compared to those from summer-autumn. Crucially, including season as a covariate in models for asthma-associated gene expression nearly doubled the number of differentially expressed genes, from 126 to 271 (FDR < 0.05). We conclude that season of sampling strongly affects the nasal transcriptome, and we demonstrate that season-adjusted analyses significantly enhance sensitivity for detecting disease-associated changes.
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Journal articleHolaman J, Sills D, Saumtally H, et al., 2026,
Distinct gastrointestinal symptom phenotypes in adults with cystic fibrosis are linked to complications and medication use: the GRAMPUS-CF study.
, J Cyst FibrosBACKGROUND: Gastrointestinal symptoms remain common in adults with cystic fibrosis (CF) despite cystic fibrosis transmembrane conductance regulator modulator use, suggesting persistent and heterogeneous gut dysfunction. This prospective observational study tests the hypothesis that distinct gut symptom phenotypes in CF can be observed and linked to underlying mechanisms. METHODS: Adults from three UK CF centres completed the Gastrointestinal Symptom Rating Scale, Patient Assessment of Constipation Symptoms and a bowel-habit questionnaire. Latent class analysis using an ordinal logistic model was applied to 36 symptom indicators. Associations between phenotypes and demographic, clinical, and treatment variables were examined using generalised linear models. RESULTS: Three hundred participants completed questionnaires (54% male; median 31 years). We identified four symptom phenotypes: mild; moderate-constipation predominant; moderate-diarrhoea predominant and severe. The severe phenotype was associated with gastroesophageal reflux (RRR 2.86; 95%CI: 1.30-6.31; p = 0.009), distal intestinal obstruction syndrome (RRR 2.46; 95%CI: 1.04-5.81; p = 0.04), proton pump inhibitor (RRR 3.29; 95%CI 1.39-7.74; p = 0.007), and laxative use (RRR 6.13; 95%CI 2.54-14.84; p < 0.001). CF-related liver disease was associated with both moderate-constipation and diarrhoea phenotypes, respectively (RRR 2.08; 95%CI 1.13-3.81; p = 0.018; RRR 2.11; 95%CI 1.03-4.29; p = 0.04). There was a lower likelihood of long-term oral antibiotic use in the moderate-constipation phenotype (RRR 0.53; 95%CI 0.3-0.92; p = 0.025) and moderate-diarrhoea phenotype (RRR 0.46; 95%CI 0.24-0.91; p = 0.025). CONCLUSIONS: Four distinct symptom phenotypes were identified, independent of demographics and pancreatic status, but associated with specific complications and medication profiles. These phenotypes provide a framework for mechanistic studies within the GRAMPUS-CF cohort and precision management of CF-related g
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Journal articleAlferes de Lima Headley D, Richardson H, Hennayake C, et al., 2026,
Sputum and oral microbiota profiles are associated with long COVID severity and phenotype post-hospitalisation: a UK multicentre, prospective cohort study.
, Eur Respir JBACKGROUND: Acute COVID-19 alters the airway microbiota. Whether these changes persist post-COVID-19 and contribute to long COVID is unknown. We aimed to describe the microbiota by long COVID severity and subtype, and identify links with inflammation. METHODS: Adults were prospectively recruited to the longitudinal UK Post-hospitalisation COVID-19 study (PHOSP-COVID). Patients were grouped by previously described "severity clusters" (of ongoing health impairments) and symptom subgroups. Oral and sputum microbiota (at 6 months post-discharge) were characterised through 16S ribosomal RNA gene amplicon sequencing, and microbiota diversity was assessed. Co-occurrence network analysis identified keystone taxa. Associations between keystone taxa and plasma inflammatory proteins were assessed through Spearman's rank correlations. RESULTS: 771 participants had their microbiota assessed. Of participants with oral rinses and "severity cluster" assignment (mean age 57.5 years), 278 out of 722 (38.5%) were women. The "very severe" cluster, in which disease was predominantly pulmonary in nature, was associated with a distinct microbiota profile post-COVID-19. Reduced lung function was associated with a distinct oral microbiota profile. Persistent neurocognitive symptoms were associated with a distinct oral microbiota profile, while gastrointestinal symptoms were associated with a distinct sputum microbiota profile. Microbiota keystone taxa shifted to a higher prevalence of lactic acid bacteria associated with worse health outcomes. Lactic acid bacteria abundance was associated with elevated blood inflammatory proteins. CONCLUSION: Distinct oral and sputum microbiota profiles were associated with pulmonary function and with neurocognitive and gastrointestinal symptoms in long COVID. Shifts in keystone microbiota taxa linked with inflammation, based on worse health outcomes, suggest a potential role change for lactic acid bacteria, which may be a
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Journal articlePan Z, Du Z, Layhadi JA, et al., 2026,
A Novel Phenotype of Mugwort-Associated Delayed Gastrointestinal-Onset Anaphylaxis With Nasal-Ocular Involvement.
, Allergy -
Journal articleHine J, Bush A, De Simoni A, et al., 2026,
Experiences of financial incentives to improve medication adherence for children and young people with asthma: a qualitative study.
, Arch Dis Child -
Journal articleKlimek L, Torres MJ, Bousquet J, et al., 2026,
Natural Diversity of Grass Pollen in Europe-An EAACI Perspective.
, AllergyGrass 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.
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Journal articleHine J, Bush A, De Simoni A, et al., 2026,
Financial INcentives to improve Asthma (FINA): a pilot RCT to improve medication adherence for children and young people with asthma.
, Arch Dis ChildOBJECTIVE: To assess effectiveness and feasibility of financial incentives to improve medication adherence for children and young people (CYP) with asthma. DESIGN: Pilot randomised controlled trial measuring adherence in CYP using an electronic monitoring device (EMD) with twice-daily reminders; design supported by patient and public involvement. SETTING: CYP were recruited between 2 and 12 weeks after attendance at an emergency department (ED) following a severe asthma exacerbation. PATIENTS: CYP aged 11-17 years old with asthma, who were prescribed inhaled corticosteroids for at least 6 months prior to their exacerbation, owned their own smartphone and understood verbal and written English. INTERVENTIONS: Intervention CYP received £1 per complete morning/£1 per complete evening inhaler dose(s) for 12 weeks (max £168). Controls received usual care (with EMD and reminder use) with no financial incentives. MAIN OUTCOME MEASURES: adherence, asthma control and psychological outcomes. Feasibility assessed by recruitment, randomisation and intervention delivery indicators. RESULTS: 32 CYP (mean age: 13.4 years (±1.64, SD); 65.6% male) were enrolled; 16 randomised to intervention. After 12 weeks, those who received financial incentives had higher median adherence (73.0%, range: 23.0-89.0%), compared with control (56.0%, range: 7.0-87.0%); this did not reach significance (p=0.077). During follow-up, intervention and control adherence significantly decreased (to 39.0%, range: 0.0-72.0%, p=0.012 and 31.5%, range: 3.0-62.0%, p=0.002, respectively). Study implementation was challenging due to slow recruitment and technological issues. CONCLUSIONS: In this small pilot study, financial incentives were not effective in sustaining adherence. Improved technology is necessary for a definitive study. Future work could explore individual characteristics that contribute to successful financial incentive use in CYP. TRIAL REGISTRATION
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Journal articleHatziagorou E, Bush A, 2026,
Home spirometry in bronchiectasis: when does a measurement become medicine?
, Thorax -
Journal articleSilva AE, Ferrante G, Silveyra P, et al., 2026,
Peripubertal changes in asthma.
, Am J Respir Crit Care Med, Vol: 212, Pages: 2592-2606Asthma is a heterogeneous disease affecting nearly 300 million people around the world. It is the most common chronic respiratory disease of childhood. There are significant sex differences in asthma incidence, severity, and morbidity around the time of puberty. The reasons for these peripubertal changes are still not fully understood, but they are likely multifactorial. In this review, we will discuss several proposed contributing mechanisms, including sex differences in anatomy and development, the effects of sex hormones on airway inflammation and reactivity, the immunomodulatory effects of sex hormones, differences in mucociliary function, and sex differences in genetic and epigenetic factors.
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Journal articleBush A, Ramsey B, 2026,
Cystic fibrosis in 2026: game over, or game on? Introduction to an AJRCCM special section on cystic fibrosis.
, Am J Respir Crit Care Med, Vol: 212, Pages: 2518-2519 -
Journal articleKhor YH, Luppi F, Adegunsoye A, et al., 2026,
Acute exacerbation in fibrotic interstitial lung disease: an international working group report.
, Am J Respir Crit Care Med, Vol: 212, Pages: 2358-2385Acute exacerbations (AEs) occur both in patients with idiopathic pulmonary fibrosis (IPF) and those with non-IPF fibrotic interstitial lung disease (fILD). These events confer high morbidity and mortality, with a lack of proven effective therapeutic interventions. The objective of this state-of-the-art document is to summarize latest evidence since the 2016 International Working Group Report on AE-IPF, expanding it across the spectrum of all fILDs. A comprehensive literature review on the epidemiology, associated and risk factors, prognosis, and management of AE-fILD is summarized. In addition to revising the AE definition and diagnostic criteria for broad application across different fILDs, a conceptual framework for acute respiratory worsening (ARW) has been proposed to encompass a variety of acute respiratory deteriorations, both related and unrelated to AEs. This allows structured evaluation in both clinical and research settings. The proposed revised definition for AE-fILD is an acute respiratory event characterized by increased respiratory symptoms or signs and associated with radiologic or histologic features consistent with diffuse alveolar damage (with or without superimposed organizing pneumonia) in a patient with known or newly diagnosed fILD. On the other hand, ARW refers to a heterogeneous group of clinical events with acute symptom worsening not attributable to diffuse alveolar damage in patients with fILD, such as pulmonary edema, bronchitis, and pneumonia, although severe pneumonia can trigger AE-fILD. Additionally, we discuss considerations for inclusion of AE as a clinical trial endpoint, as well as research priorities for advancing knowledge on the pathogenic mechanisms, event prediction, risk stratification, and development of drugs and supportive treatments.
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Journal articlePugashetti JV, Jee AS, Yu AR, et al., 2026,
Mycophenolate and azathioprine in fibrotic interstitial lung disease
, American Journal of Respiratory and Critical Care Medicine, Vol: 212, Pages: 2493-2503, ISSN: 1073-449XRationaleImmunosuppression is routinely used for non–idiopathic pulmonary fibrosis (IPF) interstitial lung diseases (ILDs), despite limited trial evidence and unclear impact on long-term outcomes.ObjectivesTo evaluate whether mycophenolate or azathioprine improves 3-year transplant-free survival and lung function trajectory in fibrotic ILD, including non-IPF idiopathic interstitial pneumonia (IIP), fibrotic hypersensitivity pneumonitis (fHP), and connective tissue disease (CTD)–associated ILD.MethodsWe employed a clone-censor-weighting framework to emulate a randomized controlled trial in this multicenter retrospective study. Each patient was cloned and assigned to immunosuppression initiation within 6 months of enrollment or no initiation strategies and censored when the assigned strategy deviated from observed treatment. Stabilized inverse probability treatment and censoring weights were used.MeasurementsThe primary endpoint was 3-year transplant-free survival assessed with weighted Cox models across treatment strategies. Weighted generalized estimating equations were used to model lung function trajectory.Main resultsAmong 2270 included patients, 18% (186/1022) with non-IPF IIP, 30% (162/544) with fHP, and 31% (221/704) with CTD-ILD were initiated on immunosuppression within 6 months. Immunosuppression was not associated with improved survival within any ILD subtype but was associated with worse survival in non-IPF IIP (hazard ratio [HR] = 1.38; 95% CI, 1.04-1.84) and fHP (HR = 1.62; 95% CI, 1.09-2.40). Immunosuppression was not associated with differential lung function trajectory within any ILD subtype.ConclusionsIn this study, immunosuppression initiation showed no evidence of benefit for 3-year transplant-free survival or lung function and was associated with higher mortality in select fibrotic ILD subtypes. Prospective randomized controlled trials are needed to inform patient care.
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Journal articleBush A, 2026,
Update in childhood asthma.
, Allergol Int, Vol: 75, Pages: 511-520The areas covered represent a personal selection in the field. Asthma is defined in this manuscript as a clinical syndrome of wheeze, breathlessness and chest tightness, sometimes with excess cough. No assumptions are made about underlying pathology, and asthma thus becomes a clinical description, not a diagnosis. The areas covered include the need never to forget the importance of getting the basics right, including correct diagnosis and appropriate management; most children with asthma do not need biologics. Recent advances in preschool wheeze are covered next, especially the beginnings of phenotype-driven treatment, and the difficult issue of understanding non-eosinophilic wheezing. It is becoming clearer that infection likely plays a big role, but management is very difficult with no evidence base. We are now coming to realize the importance of phenotyping acute asthma attacks; one size does not fit all, but whereas many are eosinophilic, some are infection driven and are non-eosinophilic, especially in the preschool years. A phenotypic approach may allow us to reduce the burden of repeated oral corticosteroid bursts. Furthermore, we need to move beyond mere cell counting to assessing functional status. We are increasingly appreciating the importance of replacing short-acting β-2 agonist reliever therapy with combined inhaled corticosteroid and a fast acting short- and especially long-acting β-2 agonists. Finally, the use of biologicals in severe asthma is discussed. The possibility that early use of biologics may induce remission or even cure asthma.
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Journal articleDribin TE, Sobolewski B, Campbell RL, et al., 2026,
Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline).
, J Allergy Clin Immunol Pract, Vol: 14, Pages: 2254-2261Health care providers across settings must be trained to manage anaphylaxis by (1) removing the offending allergen if still present; (2) positioning the patient with legs elevated, and if respiratory distress is present, allow the patient to sit upright with legs extended and elevated; (3) immediately administering epinephrine (adrenaline) intramuscularly (IM) or intranasally (IN) every 5 to 15 minutes for persistent anaphylaxis; and (4) optimizing airway, breathing, and cardiovascular (ABC) resuscitation. This may include supplemental oxygen, noninvasive or invasive positive-pressure ventilation, and intravenous fluid resuscitation. For life-threatening or refractory presentations, (5) IM/IN epinephrine should be administered every 5 minutes while addressing ABC derangements; this includes aggressive intravenous fluid resuscitation for patients in anaphylactic shock. Providers may continue IM or IN epinephrine or switch to the other, as both routes are considered equally efficacious based on pharmacokinetic data. An intravenous epinephrine infusion should be prepared for patients with persistent anaphylaxis after 2 doses of IM/IN epinephrine and initiated after the third dose, or earlier at the provider's discretion. In settings without epinephrine infusions, repeat IM/IN epinephrine should be administered every 5 minutes, along with other ABC interventions, and the patient should be transferred quickly to a setting equipped to provide advanced resuscitative care.
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Journal articleLele S, Pillai A, Quayum M, et al., 2026,
Combined Large and Small Airway Obstruction Is Associated With Increased Exacerbation Frequency and Poorer Symptom Control in Persistent Asthma.
, J Allergy Clin Immunol Pract, Vol: 14, Pages: 2348-2355.e3BACKGROUND: Spirometry remains central to the assessment of asthma but may fail to detect small airways dysfunction (SAD), which contributes to considerable symptoms and exacerbation risk. OBJECTIVE: We investigated whether integrating oscillometry with spirometry improves physiological phenotyping and risk stratification in asthma. METHODS: In this retrospective, multicenter study, data from 1497 adults with asthma were analyzed from the Oscillometry Asthma Registry. SAD was defined using the ratio of resistance heterogeneity between 5 and 20 Hz to resistance at 5 Hz ≥19% and airflow obstruction as forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <70%. Participants were categorized into 4 mutually exclusive groups: (1) group 1-normal oscillometry and normal spirometry, (2) group 2-abnormal oscillometry with normal spirometry, (3) group 3-normal oscillometry with abnormal spirometry, and (4) group 4-abnormal oscillometry and abnormal spirometry. Associations with symptom control, exacerbations, and type 2 inflammatory biomarkers were assessed using multivariable logistic regression. RESULTS: For ≥1 exacerbation, the adjusted odds ratios (aORs) (95% confidence intervals) for group 4 were as follows: versus group 1, 3.19 (2.31, 4.42); versus group 2, 1.99 (1.46, 2.74); and versus group 3, 1.59 (1.07, 2.37). Corresponding aOR values for group 3 were as follows: versus group 2, 1.26 (0.85, 1.86), and versus group 1, 2.01 (1.37, 2.94). The aOR for ≥1 exacerbation for group 2 versus group 1 was 1.60 (1.18, 2.16). Results were similar when using FEV1/FVC <lower limit of normal instead of traditional predicted values. CONCLUSIONS: The combined use of oscillometry and spirometry identifies distinct physiological phenotypes of asthma with clinically meaningful differences in symptom burden and exacerbation risk.
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Journal articleWu Z, Yazbeck L, Smith DJF, et al., 2026,
Characterizing Cough and Its Response to Therapy in Hypersensitivity Pneumonitis.
, Chest, Vol: 170, Pages: 1105-1113BACKGROUND: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease driven by repeated antigen exposure in susceptible individuals. Cough is a prominent but poorly characterized symptom, especially in relationship to objective measures and treatment response. RESEARCH QUESTION: What are the clinical predictors of cough severity in HP, and how does cough respond to corticosteroid therapy based on subjective and objective assessments? STUDY DESIGN AND METHODS: A prospective cohort of patients with fibrotic HP diagnosed per American Thoracic Society/Japanese Respiratory Society/Asociación Latinoamericana del Tórax guidelines was recruited. Baseline assessments included cough visual analog scale (VAS) and Leicester Cough Questionnaire (LCQ) score. Cough frequency was assessed using the VitaloJAK (Vitalograph) cough monitor in a subset of patients. Multivariable models evaluated predictors of cough severity, and in incident cases, changes in cough outcomes were evaluated after 3 months of corticosteroid therapy. RESULTS: A total of 101 patients were recruited (41 male patients; mean age, 65 years). The median cough VAS was 35 mm (interquartile range [IQR], 14-50 mm) and the median LCQ score was 15.2 (IQR, 13.2-17.4). The median cough count was 8.7/h (range, 0.2-32.1/h; n = 28). Subjective cough scores correlated with objective cough frequency (cough VAS, ρ = 0.69 [P < .001] and LCQ score, ρ = -0.555 [P = .002]). Female sex, reduced FVC, and higher bronchoalveloar lavage lymphocyte fractions were independent predictors of worse cough severity, as measured by cough VAS. Corticosteroids significantly improved cough subjectively (cough VAS, -13.7 mm [P = .002] and LCQ score, +1.9 [P < .001]; n = 44), but did not significantly reduce objective cough frequency (n = 16). Lung function remained unchanged at 3 months. INTERPRETATION: Our results show that cough is a major symptom for patients with HP. Although corticosteroids
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Journal articleVassileva SM, Khamas SS, Dyhre-Petersen N, et al., 2026,
The impact of benralizumab and dupilumab on exhaled volatile organic compound profiles of severe asthma patients - a preliminary analysis.
, Respir Med, Vol: 262Volatile organic compounds (VOCs) in exhaled breath reflect biological processes in the lungs. Exploring VOC profiles in severe asthma patients starting biologics may reveal treatment-related biological changes over time. This study aimed to assess the performance and feasibility of applying a sparse partial least squares-discriminant analysis (sPLS-DA) analytical approach in detecting longitudinal changes in exhaled VOCs of patients with severe asthma initiating biologic treatment. Exhaled breath was collected in the 3 TR-ABC study, a multicenter observational prospective cohort study, at baseline and 4 months after starting biologics (benralizumab or dupilumab). VOCs were trapped on thermal desorption tubes and analyzed by gas chromatography-mass spectrometry. Paired sPLS-DA was used to distinguish baseline from post-treatment VOC profiles, and Kendall rank correlation assessed associations with clinical parameters at baseline. Data from two sites (Amsterdam and Copenhagen) were available of 25 severe asthma patients. The sPLS-DA resulted in a model containing five VOCs (methyl isobutyl ketone, 2-ethyl-1-hexanol, 5-methyl octadecane, 2-methylundecane and 1,1'-oxybis(decane)) with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval: 0.79-0.99) for distinguishing baseline and 4 months post treatment. At baseline, a positive correlation was observed between 2-ethyl-1-hexanol and asthma control (Asthma Control Questionnaire); τ = 0.40, p < 0.01. A negative correlation was found between 1,1'- oxybis(decane) and blood eosinophil counts (τ = -0.30, p = 0.04). Based on our results, the proposed analytical approach appears feasible for analyzing longitudinal data in patients with severe asthma initiating biologics. Further validation in larger cohorts is warranted to confirm robustness and generalizability.
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Journal articleTorres MJ, Atanaskovic Marković M, Gelincik A, et al., 2026,
EAACI Spring Meeting 2026: Prevention as Treatment-A New Paradigm.
, Allergy, Vol: 81, Pages: 3407-3410 -
Journal articleGonzalez-Matamala MF, Patel N, Kahn-Santoro D, et al., 2026,
International survey of parental and patient perspectives on emerging adrenaline devices for community-based management of anaphylaxis: An EAACI task force report.
, Pediatr Allergy Immunol, Vol: 37INTRODUCTION: 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.
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