This study quantifies the lagged association between grass pollen exposure and the onset of allergic rhinitis (AR) symptoms, including differences between asthmatic and non-asthmatic subgroups. Data included 114,834 self-reported AR symptoms collected from 25,194 uniquely identified users of a smartphone application. Reports were gathered prospectively for seven consecutive grass pollen seasons (2017-2023) in Melbourne. We adjusted for meteorological, air quality, and other time-varying covariates. A quasi-Poisson regression model combined with a distributed lag non-linear model (DLNM) was used, testing 0-7 days lagged effects. An association between grass exposure and daily AR incidence of any severity was observed on "low" exposure days (19 grains/m3), when exposure was modeled cumulatively across a 3-day lag period (RR 1.31, 95% CI 1.16-1.47). Higher grass concentrations were associated with increased risk at lag-1, with risk rising from RR 1.08 (95% CI 0.99-1.17) at 19 grains/m3 to RR 1.19 (95% CI 1.09-1.29) at 150 grains/m3. By lag-2, risk returned to a non-significant baseline. Asthmatics, users reporting medication use, and users reporting more severe symptoms exhibited elevated risk at later lags. The magnitude and duration of elevated risk varied across stratified models by age and sex. We provide new population-level evidence that grass pollen triggers allergic rhinitis symptoms predominately on the day of exposure, even at concentrations traditionally classified as "low", with symptom risk persisting longer in asthmatics and other sensitive groups. This study highlights the value of refining communication and early-warning systems to better support individuals who are sensitive to even low levels of exposure.

Broad evidence confirms that AR (ICD J30.3) is a chronic disease with high prevalence among children and adults worldwide. Its consequences, both from a public health perspective and at the level of the individual patient, are often underestimated, and the condition is inadequately treated. In addition, AR is often related to comorbidities with additional impact on diseases-severity. Allergen provocation of the easily accessible nasal (nasal allergen provocation test: NPT) or conjunctival mucosa (conjunctival allergen provocation test: CPT) reproduces the allergen-dependent, IgE-mediated allergic reaction under controlled and standardized conditions. These measures are regarded as the diagnostic gold standard, particularly in cases of unclear results in primary allergological tests, enabling clinically relevant identification of the causative allergen. Approved test allergens are critical for ensuring the methodological quality of the NPT. However, their availability is increasingly limited, although adequate quantities of allergen solutions remain indispensable for high-quality nasal allergen testing. Unilateral allergen provocation has been established in the clinical routine for decades in Germany. However, scientific evidence for unilateral application of the test allergen is pending. International position papers differ from this recommendation. The CPT is a simple, safe, and well-tolerated measure. It is primarily used in perennial and, in selected cases, seasonal allergic conjunctivitis. This method is less commonly applied for vernal keratoconjunctivitis and atopic keratoconjunctivitis. It is primarily used to confirm the underlying allergen, particularly when establishing the indication for allergen immunotherapy (AIT). It can also be employed to monitor treatment effects such as e.g., AIT or pharmacotherapy. Although highly sensitive, the procedure of nasal ASA provocation remains a time-consuming procedure. While challenging in children, NPT provides clinically relevant additional diagnostic information on the causes of the allergic symptoms. Allergological diagnostic work-up also includes pulmonary assessment, particularly in patients with established asthma or symptoms suggestive of asthma. Both AAR and PNIF are applied as standard procedures for assessing the outcome of NPT in Germany. In individual cases, other rhinometric methods may also be used.

Background/Objectives: Allergic rhinitis (AR) is a prevalent and chronic condition that is frequently underestimated in clinical practice, despite its substantial impact on quality of life (QoL). While epidemiological studies have quantified the prevalence, risk factors and symptom burden, limited research has explored the lived experiences of adults living with AR in Australia, and more specifically in Victoria. This study aimed to explore the lived experiences of adults with AR in urban Victoria, Australia. Methods: A qualitative study utilising online semi-structured in-depth interviews was conducted with thirty-eight adults residing in Melbourne and Geelong, Victoria, Australia. Data were analysed using reflexive thematic analysis as described by Braun and Clarke. Results: Of the 38 participants, 57.9% (n = 22) were self-diagnosed and 42.1% (n = 16) had received a professional diagnosis of AR. The following five themes were constructed: 1. AR is shaped by onset, family history and comorbidities; 2. Environmental exposures and seasonal changes strongly influence the experience of AR patients; 3. Coping with AR involves a mix of lifestyle adjustments, medication and personal adaptive strategies; 4. AR disrupts QoL through poor sleep, emotional strain, social limitations and reduced productivity; and 5. Limited awareness and barriers in healthcare access hinder effective management of AR. Conclusions: Participants described AR as extending beyond physical symptoms to emotional, social and economic impacts shaped by multiple factors. These complex lived experiences emphasise the need for more tailored management and improved clinical recognition of the psychosocial burden of AR.

Background/Objectives: Comparative effects of oral second-generation H1-antihistamines vary by rhinitis category, outcome, and treatment period. We assessed evidence structure, estimability, and differentiation among regimens. Methods: PubMed, Embase, Web of Science Core Collection, CENTRAL, WHO ICTRP, ClinicalTrials.gov, and the EU Clinical Trials Register were searched on 1-3 July 2026 for records through 30 June 2026. Eligible studies were natural-exposure randomized trials. Continuous outcomes were analyzed using covariance-aware generalized least squares, and binary harms were analyzed using Bayesian arm-level models. RoB 2, CINeMA, and ROB-MEN were applied in duplicate. Registration was retrospective. Results: Sixty-one reports generated 66 report-randomization entries from 64 cohorts (34,831 participants); 35 model-ready randomizations informed nine structures. In seasonal allergic rhinitis, six of seven TNSS estimates, two of three ocular estimates, and four RQLQ estimates favored active treatment. Any-adverse-event estimates were imprecise. Under the primary prior, cetirizine yielded a WDAE OR of 0.25 (95% CrI 0.08-0.66), but predictive classification was prior-sensitive. Of 34 continuous active-active comparisons, seven were directly informed and 27 indirect-only. All 147 estimable binary active-active contrasts were reported as secondary derivations: 141 CrIs included one and six excluded one, all indirect-only and not formally appraised with CINeMA. Six of 14 regimen-level nodes contributed only to tolerability structures, precluding balanced regimen-specific benefit-harm assessment. All 89 estimable comparisons within the defined CINeMA appraisal scope were rated very low; two non-estimable effects were not evaluable. Conclusions: Predominantly placebo-anchored and sparse evidence established neither a reliable regimen hierarchy nor therapeutic equivalence. Findings were hypothesis-generating, and somnolence remained an evidence gap. No external funding supported conduct; NEXUS PEOPLE, S.L. funded the APC. OSF registration was retrospective: doi:10.17605/OSF.IO/DPT5N.

Thunderstorm asthma is defined as acute asthma exacerbations occurring during or shortly after thunderstorms, characterized by sudden onset, wide geographic impact, and clustering of cases. Climate change is driving more frequent extreme weather and higher aeroallergen concentrations, making future thunderstorm asthma episodes more frequent and less predictable. In China, the geographic range of pediatric thunderstorm asthma is expanding and its disease burden is underestimated. This paper reviews the literature on thunderstorm asthma in Chinese children, integrates global advances in mechanisms and management, and provides a comprehensive analysis of the epidemiology, pathogenesis, and clinical management of pediatric thunderstorm asthma in China. Regional variation is evident, with historical predominance in northern regions and recent reports from southern cities. Children with seasonal allergic rhinitis constitute a hidden high-risk population; even without an asthma diagnosis, enhanced surveillance and preventive management are warranted. Core components of comprehensive management include graded acute-phase care, pollen concentration monitoring with early warning, and pre-thunderstorm prophylactic medication.

Pollen-induced allergic rhinitis is a common respiratory allergic disease that significantly impairs patients' quality of life. Available evidence indicates that preventive treatment initiated before the pollen season can effectively alleviate in-season symptoms and delay disease onset; however, standardized and unified preventive treatment strategies are still lacking in China. This consensus was developed by a multidisciplinary panel of experts using the Delphi method. The evidence on preseasonal preventive treatment for pollen-induced allergic rhinitis was systematically reviewed, and through multiple rounds of expert discussions and anonymous voting, core recommendations were formulated. This consensus recommends that oral second-generation antihistamines be initiated 1-2 weeks before the pollen season and intranasal corticosteroids 2-4 weeks before the pollen season, with both continued until the end of the pollen season; the latter is particularly indicated for patients with moderate-to-severe allergic rhinitis. Biologics targeting type 2 inflammation have demonstrated efficacy during the pollen season, but additional evidence is required to support their use as preventive medications. Leukotriene receptor antagonists are not recommended as monotherapy for preventive treatment. In China, allergen immunotherapy is mainly administered as a continuous, year-round regimen, and short-term intermittent preseasonal use is currently not recommended. Systemic corticosteroids and decongestants are not recommended for preventive use. This consensus aims to provide a scientific and standardized basis for clinical decision-making, thereby improving symptom control and enhancing patients' quality of life.

Allergic conjunctivitis is a common, under-appreciated, and largely benign process. It is rarely vision-threatening but can significantly decrease the quality of life for patients. There are three subtypes of simple allergic conjunctivitis: acute, seasonal, and perennial. There is considerable overlap with atopic conjunctivitis (vernal and atopic keratoconjunctivitis) and giant papillary conjunctivitis in both treatment and certain aspects of pathophysiology. As such, these are all considered to be ocular allergies. Initial treatment strategies can be similar, although outcomes and rates of complications vary.

ObjectiveThis study aimed to evaluate the clinical efficacy and safety of Artemisia annua pollen allergen sublingual immunotherapy combined with symptomatic medication in patients with seasonal allergic rhinoconjunctivitis or seasonal allergic rhinoconjunctivitis with asthma.MethodsThis open-label, observational cohort study was conducted from November 2024 to May 2025 and included a total of 500 patients diagnosed with A. annua pollen-induced seasonal allergic rhinoconjunctivitis; after accounting for dropouts, 354 patients remained eligible for analyses, including 228 patients with isolated seasonal allergic rhinoconjunctivitis and 126 patients with seasonal allergic rhinoconjunctivitis and asthma. Participants received A. annua pollen sublingual immunotherapy plus standard symptomatic treatment and were followed up during the 2025 pollen season. Primary outcomes included changes in the total rhinoconjunctivitis symptom, total medication, combined symptom-medication, and visual analog scale scores from that at baseline (2024 pollen season). For patients with concomitant asthma, asthma daytime symptom and asthma nighttime symptom scores were also recorded. Efficacy was assessed by comparing scores between the two pollen seasons, and safety was evaluated based on occurrence of adverse events. This study was retrospectively registered via the National Medical Research Registration System (PID: 332836, syncing to ChiCTR); the formal registration number is pending administrative review.ResultsMean pollen concentrations during the 2024 and 2025 pollen seasons were 15.07 grains/m[3] (duration: 64 days) and 15.48 grains/m[3] (duration: 61 days), respectively, indicating comparable exposure levels. Compared with baseline, total rhinoconjunctivitis symptom, total medication, combined symptom-medication, and visual analog scale scores decreased significantly in both groups (isolated seasonal allergic rhinoconjunctivitis and seasonal allergic rhinoconjunctivitis with asthma groups, all p < 0.001). Among patients with comorbid asthma, asthma daytime symptom and asthma nighttime symptom scores also improved significantly (p < 0.001). Adverse events occurred in 64 patients with isolated seasonal allergic rhinoconjunctivitis and 11 patients with seasonal allergic rhinoconjunctivitis and asthma; all adverse events resolved spontaneously or with minimal intervention, and no serious adverse events were reported.ConclusionThese findings suggest that A. annua pollen sublingual immunotherapy significantly improves seasonal symptoms in seasonal allergic rhinoconjunctivitis patients, maintains lung function stability in those with concomitant controlled asthma, and demonstrates a favorable safety profile.

Background: Grass pollen represents one of the most common and clinically important groups of aeroallergens. Objective: This study evaluated the correlation between grass panel (GP) specific immunoglobulin E (sIgE) levels measured using the IMMULITE system and skin-prick test (SPT) reactivity in children with asthma or seasonal allergic rhinitis (SAR) and aimed to determine a clinically meaningful optimal cutoff value. Methods: In this single-center retrospective study, children with SAR and/or asthma who had positive GP sIgE results and underwent grass pollen SPT were included. Demographic, clinical, and laboratory data were extracted from medical records, and diagnoses were established according to the GINA and ARIA guidelines. Serum sIgE levels were measured using the IMMULITE 2000 system. The GP sIgE assay includes orchard grass, meadow fescue, perennial ryegrass, timothy grass, and June grass. SPT was performed using Phleum pratense and/or Graminaceae mix-5 extracts, the latter containing orchard grass, meadow fescue, Italian ryegrass, timothy grass, and Kentucky bluegrass. SPT results were classified as reactive or nonreactive, and the optimal cutoff value for GP sIgE was determined. Results: A total of 888 children with positive GP sIgE results who underwent grass pollen SPT were included; 89.3% (n = 793) were SPT-reactive. Of all patients, 649 (73.1%) had SAR alone, whereas 239 (26.9%) had concomitant SAR and asthma. GP sIgE levels were significantly correlated with eosinophil parameters, total IgE levels, and SPT wheal diameters for both extracts. Receiver operating characteristic analysis identified optimal GP sIgE cutoff values of 15.05 kUA/L for overall grass pollen SPT reactivity, 28.2 kUA/L for Phleum pratense, and 20.5 kUA/L for Graminaceae mix-5, each demonstrating clinically useful discriminatory performance. Conclusion: IMMULITE-measured GP sIgE levels were significantly associated with grass pollen SPT reactivity and provided clinically useful information for the assessment of sensitization. Although Graminaceae mix-5 demonstrated greater discriminatory performance than Phleum pratense, both extracts were informative. Mixed extracts may better reflect cross-reactivity, whereas single extracts may complement species-specific assessment and immunotherapy planning. These cutoff values may aid interpretation when SPT cannot be performed.