This is despite recommendations by the UK and European medicines regulators that those at risk should have access to 2 AAIs at all times, since some reactions need more than one dose or to allow for incorrect use.

And with 1 in 10 episodes of anaphylaxis occurring in schools, providing all of them with ‘spare’ devices would be safer and save most local health funding bodies £millions, estimate the researchers.

On average, every UK school class will have one or two children at risk of anaphylaxis to a foodstuff, and many schools require these pupils to leave an AAI on the premises, in case they forget to bring one in.

Children with food allergies are not always prescribed AAI. The researchers analysed routinely collected primary care data from the nationally representative Clinical Practice Research Datalink (CPRD) Aurum for children and young people (5-18) diagnosed with a food allergy between 2008 and 2018.

They found that less than half (44%) of schoolchildren with a food allergy in the CPRD had been prescribed at least one AAI, and only a third (34%) had repeat AAIs prescribed. Among pupils who had already experienced anaphylaxis, rates were 59% and 44%, respectively.

To boost access and safety for all school children, UK legislation was changed in 2017 to allow schools to obtain, without a prescription, ‘spare’ AAI devices for use in emergencies—when the pupil’s own AAI is not readily available or they haven’t been prescribed one.

But only around half of schools have done this, possibly because of the prohibitive cost, which often exceeds £100 a device, when the subsidised NHS tariff is around £10 for two devices, suggest the researchers.

As a result, some local health funding bodies (Integrated Care Boards or ICBs) have piloted the provision of spare AAIs to local schools for use on any child. The researchers therefore wanted to compare the potential costs of this approach with that of prescribing AAIs for retention on school premises to pupils on a named-patient basis.

They looked at NHS data on AAI prescriptions issued to primary and secondary school age children with a food allergy during the 2023-4 and 2024-5 academic years—specifically, the number of pupils prescribed more than two AAIs.

The researchers then used these data to estimate the potential annual savings if ICBs were to provide every school in England with four spare AAIs on an annual basis during the 2023-24 academic year, rather than funding AAIs to each at-risk pupil over the same time period.

Nearly two thirds (63%) of pupils prescribed AAIs with a food allergy were dispensed more than two AAIs at an estimated cost of over £9 million in 2023-4. Most of these additional AAIs were most likely provided for retention on school premises, given the spike in prescriptions at the start of the school year, suggest the researchers.

The estimated cost of providing spare AAIs to every school was £4.5 million. And the researchers calculated that if spare AAIs were to replace the supply of named-patient AAIs exclusively for retention on school premises, this would potentially save at least £4.6 million—equivalent to 25% of the total national spend on AAIs.

The researchers acknowledge that the study data only included primary care NHS prescriptions, dispensed by community pharmacies and so excluded AAIs dispensed through hospitals and private healthcare.

But they conclude: “Irrespective, there can be little doubt that if ICBs were to limit dispensing to two unexpired AAIs per pupil at any one time (and so no longer provide additional AAIs on a named- patient basis just for school use), then providing spare AAIs to schools (at no cost to the school) would be a cost-neutral strategy for the vast majority of ICBs—and one that is likely to improve emergency access to AAIs and therefore safety.”

“The National Child Mortality Database shows that 76% of fatal allergic reactions in children involve modifiable factors, including delays in treating with adrenaline,” points out Helen Blythe of the Benedict Blythe Foundation, in a linked editorial.

“Prevention of Future Death reports issued by HM Coroners echo the same failures. Countries like Canada have had laws mandating allergy safety in schools for two decades. In the UK, we’re still shaking buckets to raise money for potentially life-saving medication in our schools,” she adds.

She calls for Benedict’s Law to enter the statute books. First presented to the Department for Education in 2023, this would require schools to hold spare AAIs funded by the government; training for all staff in allergy awareness and emergency response; and the implementation of a school-wide allergy policy.

“Across the country, regional pilots and local initiatives have shown that it’s possible, practical, and financially sound to equip schools with AAIs,” she emphasises. Such a strategy “would improve emergency access to adrenaline to all pupils, irrespective of whether they had been prescribed AAIs.”

Since 2017, national guidelines have encouraged pediatricians to recommend introducing peanut-containing foods around 4 to 6 months of age to reduce peanut allergies. Yet, surveys show that few pediatricians strictly follow these guidelines. Peanut allergy, the most common pediatric food allergy, is on the rise and affects more than 2% of children in the U.S.

In the study, guideline adherence was 84% for low-risk infants (no eczema and no egg allergy) in practices that used the tools, compared with 35% in clinics that did not. Infants in the intervention group were nearly 15 times more likely to receive guidelines-based care.

“We found that supporting pediatricians with training, electronic health record prompts and educational materials for parents significantly improved their ability to counsel families on early peanut introduction,” said lead author Dr. Ruchi Gupta, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and pediatrician at Lurie Children’s.

“Because pediatric visits at 4 and 6 months are so busy, this support is critical to ensure families receive clear guidance,” Gupta added. “Our hope is that these conversations will help parents feel confident introducing peanut products early. We want to reverse the trend of increasing food allergies in the U.S. through prevention.”

The study will publish on Monday (Oct. 6) in the journal Pediatrics.

How the study was conducted

The randomized trial included 30 pediatric practices in the Chicago and Peoria, Illinois, regions, spanning federally qualified health centers, private clinics and academic practices. Intervention practices received a clinician training video, electronic health record prompts, visual aids for parents and a scorecard to identify severe eczema; control practices did not.

The primary outcome was clinician adherence to guidelines, documented in the electronic health record (EHR) data at the 4- or 6-month well-child visit. In total, 18,480 infants were seen by 290 clinicians. In total, 18,480 infants were seen by 290 clinicians.

Lucy Bilaver, lead statistician for the study and associate professor of pediatrics at Feinberg noted the importance of leveraging EHR data for this pragmatic trial. “We were able to measure the primary outcome by making use of the clinical notes and structured data that pediatric clinicians generate during these well-child visits,” she said.

The findings

Among low-risk infants, guideline adherence was 84% in the intervention group versus 35% in controls. For high-risk infants, adherence was 27% in the intervention group versus 10% in controls. In addition, 36% of high-risk infants in the intervention group were referred to an allergist or given an allergy test, compared with 10% in the control group.

“While more work is needed, the success of this intervention supports wider dissemination to prevent peanut allergy in children,” Gupta said.

Outcomes in the trial will be tracked until children are 2.5 years old to see if the intervention reduces actual peanut allergy prevalence.

What parents need to know

Since 2017, national guidelines have recommended introducing peanut-containing foods around 4 to 6 months of age — a major shift prompted by a landmark clinical trial that showed early introduction cuts peanut allergy risk by more than 80%. Before that, parents were often told to delay peanut feeding out of concern it might trigger allergies.

When your baby is developmentally ready to start solids, peanut products can be introduced, according to the study authors. (Instructions for how to do this are linked here.) Early introduction of egg and other common allergenic foods is also encouraged, based on family preference.

The study, titled “Pediatric Clinician Adherence to Peanut Allergy Prevention Guidelines: A Randomized Trial,” was funded by the National Institute of Allergy and Infectious Diseases (NIAID U01AI138907).

In the first randomised controlled trial to investigate the use of a 2-in-1 inhaler as the sole reliever therapy for children aged 5 to 15, an international team found the combined treatment to be more effective than salbutamol, the current standard for asthma symptom relief in children, with no additional safety concerns.

The results show that using a single 2-in-1 anti-inflammatory reliever inhaler – which combines the inhaled corticosteroid (ICS) budesonide and the fast-acting bronchodilator formoterol – reduced children’s asthma attacks by an average of 45%, compared to the widely-used salbutamol inhaler.

Asthma attacks in children may be life-threatening and reducing their frequency and severity is a public health priority.

The 2-in-1 budesonide-formoterol inhaler is widely recommended as the preferred reliever treatment for adults, but children are still usually prescribed salbutamol.

Researchers say the findings, published today in The Lancet, provide the evidence needed to bring children’s global asthma guidelines into line with adults’, which could benefit millions of children around the world with mild-to-moderate asthma.

The CARE study (Children’s Anti-inflammatory REliever) was designed and led by the Medical Research Institute of New Zealand (MRINZ), in collaboration with Imperial College London, University of Otago Wellington, Starship Children’s Hospital, and the University of Auckland. It recruited 360 children across New Zealand who were then randomly assigned to receive either budesonide-formoterol or salbutamol for on-demand symptom relief.

The trial lasted a year and the budesonide-formoterol reliever resulted in a lower rate of asthma attacks than salbutamol reliever, with rates of 0.23 versus 0.41 per participant per year. This means that for every 100 children with mild asthma who are switched from salbutamol to a 2-in-1 budesonide-formoterol inhaler, there would be 18 fewer asthma attacks per year. Importantly, the study also confirmed the safety of the combined-inhaler approach, with no significant differences in children’s growth, lung function, or asthma control between the two groups.

Dr Lee Hatter, lead author of the study and Senior Clinical Research Fellow at the MRINZ, said: “This is a key step in addressing the evidence gap that exists between asthma management in adults and children. For the first time, we have demonstrated that the budesonide-formoterol 2-in-1 inhaler, used as needed for symptom relief, can significantly reduce asthma attacks in children with mild asthma. This evidence-based treatment could lead to improved asthma outcomes for children worldwide.”

Professor Richard Beasley, Director of MRINZ and senior author of the study, said: “Implementing these findings could be transformative for asthma management on a global scale. The evidence that budesonide-formoterol is more effective than salbutamol in preventing asthma attacks in children with mild asthma has the potential to redefine the global standard of asthma management.”

The burden of asthma in the estimated 113 million children and adolescents with asthma worldwide is substantial. The latest study builds on previous studies in adults led by MRINZ researchers (see detail in Notes, below) which shaped international asthma treatment guidelines. These findings contributed to the recommended use of the 2-in-1 ICS–formoterol reliever inhaler as the preferred reliever treatment for adults with asthma around the world.

The incorporation of findings from the CARE study into global asthma treatment strategies could help reduce disparities in care and ensure that more children access effective, evidence-based treatments.

The researchers say that global health organisations have long advocated for child-targeted asthma interventions, and their findings provide crucial evidence to support those efforts.

However, the authors acknowledge some limitations of the clinical trial. It was undertaken during the COVID-19 pandemic, during which stringent public health measures and fewer circulating respiratory viruses contributed to the lower than predicted rate of severe asthma attacks. The authors also acknowledge the challenges with the identification of asthma attacks in children, and the potential bias with the lack of blinding of the randomised treatments. They say though that the study’s findings are generalisable to clinical practice due to its pragmatic, real-world design.

Professor Andrew Bush, from Imperial College London, senior respiratory paediatrician and co-author of the CARE study, said: “Having an asthma attack can be very scary for children and their parents. I’m so pleased that we’ve been able to prove that an inhaler that significantly reduces attacks – already a game-changer for adults – is safe for children with mild asthma too. We believe this will transform asthma care worldwide and are excited to be building on this work with the CARE UK study.”

Professor Helen Reddel, Chair of the Science Committee of the Global Initiative for Asthma (GINA), commented on the global significance of the study, saying that it fills a critically important gap for asthma management globally. Professor Reddel said: “Asthma attacks have a profound impact on children’s physical, social and emotional development and their prevention is a high priority for asthma care. It is in childhood, too, that lifelong habits are established, particularly reliance on traditional medications like salbutamol that only relieve symptoms and don’t prevent asthma attacks.”

Professor Bob Hancox, Medical Director of the New Zealand Asthma and Respiratory Foundation, said: “This is a very important study for children with mild asthma. We have known for some time that 2-in-1 budesonide/formoterol inhalers are better than the traditional reliever treatment in adults, but this had not been tested in children. This research shows that this 2-in-1 inhaler is effective and safe for children as young as 5. This information will help to reduce the burden of asthma for many children, and both they and their families will breathe easier because of it.”

The study was made possible by the generous support of the Health Research Council of New Zealand, Cure Kids (New Zealand), and the Barbara Basham Medical Charitable Trust managed by Perpetual Guardian. Symbicort Rapihalers for the trial were provided by AstraZeneca.

Budesonide-formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial is published in The Lancet; https://doi.org/10.1016/S0140-6736(25)00861-X

Post-embargo link here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00861-X/fulltext

Study key points:

1. The CARE study is the first randomised controlled trial comparing ICS–formoterol anti-inflammatory reliever inhaler treatment with salbutamol reliever inhaler treatment, in children aged five to 15 years with asthma.
2. Budesonide-formoterol demonstrated a significant reduction in asthma attacks, with a 45% decrease in the rate of attacks compared to salbutamol (0.23 vs 0.41 attacks per participant per year; relative rate 0.55, 95% CI 0.35–0.86, p=0.01).
3. These findings are consistent with established benefits seen in adults, where ICS–formoterol has become the preferred reliever treatment for asthma management.
4. The study found no safety concerns regarding the use of a combined inhaled steroid treatment in children, with no adverse effects on growth or lung function.
5. This study provides compelling evidence that switching from a salbutamol reliever inhaler to a budesonide-formoterol reliever inhaler can help prevent asthma attacks in children with mild asthma as young as five, which could lead to a potential shift in asthma treatment globally.

Previous evidence from MRINZ Adult Clinical Trials of anti-inflammatory reliever therapy:

1. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(13)70007-9/abstract
2. https://www.nejm.org/doi/full/10.1056/NEJMoa1901963

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31948-8/abstract

The research was based on an analysis of food-induced anaphylaxis cases reported to the Allergy Vigilance Network from 2002–2023. Allergenic foods involved in ≥1% of cases and not included in the European Regulation list included goat’s and sheep’s milk (2.8% of cases), buckwheat (2.4%), peas and lentil (1.8%), alpha-gal (1.7%), pine nut (1.6%), kiwi (1.5%), beehive products (1.0%), and apple (1.0%).

Due to their frequency, severity, recurrence, and potential for hidden exposure, the study’s investigators propose that four of these—goat’s and sheep’s milk, buckwheat, peas-lentil, and pine nut—be considered for inclusion on the European mandatory labelling of foods list. The recurrence rate (the same allergen causing several anaphylactic accidents in the same patient) for these foods ranged from 7.3% for peas–lentil to 56% for goat’s and sheep’s milk.

“In our series of nearly 3,000 food anaphylaxis cases, 413 were caused by one of these eight ‘emerging food allergens’ without mandatory labelling, with 2 deaths,” said corresponding author Dominique Sabouraud-Leclerc, MD, of CHU Reims, in France. “We therefore believe it is time to review the list of the 14 foods with mandatory labelling to include at least the most severe of these emerging food allergens.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/cea.70130

The international research team used an electronic health database in the United States, TriNetX, to investigate the link between COVID-19 and so-called type-2 inflammatory diseases, a group of chronic conditions in which the immune system overreacts to allergens or infections.

The researchers compared 973,794 people who had had COVID-19 with 691,270 people who had been vaccinated against the SARS-CoV-2 virus and 4,388,409 healthy controls with no documented infection or vaccination.

Inflammation in the airways

The results are presented in The Journal of Allergy and Clinical Immunology. People who had had COVID-19 had a 66 per cent higher risk of developing asthma, a 74 per cent higher risk of chronic sinusitis and a 27 per cent higher risk of hay fever compared with healthy controls. However, no increased risk was seen for the skin disease atopic eczema or for eosinophilic oesophagitis, an inflammation of the oesophagus.

“Our results suggest that COVID-19 can trigger type-2 inflammation in the airways, but not in other organs,” says Philip Curman, a physician and researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, Sweden, who led the research.

Vaccination against the virus had the opposite effect. The risk of asthma was 32 per cent lower among vaccinated individuals compared with healthy unvaccinated individuals. The risk of sinusitis and hay fever was also slightly lower.

More than twice the risk

When people who had had COVID-19 were compared with vaccinated individuals, an even clearer effect was seen. Infected individuals had more than twice the risk of developing asthma or chronic sinusitis and a 40 per cent higher risk of developing hay fever compared with those who had been vaccinated.

“It is interesting to see that vaccination not only protects against the infection itself, but also appears to provide good protection against certain respiratory complications,” says Philip Curman.

The study is retrospective, i.e. based on data that has already been collected. This means that the researchers cannot draw any firm conclusions about causal links. Another limitation is that some infections may have gone undiagnosed, especially if they were detected through self-testing.

The research was conducted in close collaboration with the University of Lübeck and the Lübeck Institute of Experimental Dermatology in Germany, the Technical University of Madrid in Spain and Bar-Ilan University in Israel. It was mainly funded by the German Research Foundation (Deutsche Forschungsgemeinschaft), Region Stockholm and Karolinska Institutet. Two researchers received travel grants from TriNetX, which provides the database used in the study, and one of the authors is employed by the company.

Publication: “COVID-19 infection raises respiratory type-2 inflammatory disease risk, whereas vaccination is protective”, Henning Olbrich, Sophie L Preuß, Khalaf Kridin, Gema Hernandez, Diamant Thaçi, Ralf J Ludwig, Philip Curman, The Journal of Allergy and Clinical Immunology, online 12 August 2025, doi: 10.1016/j.jaci.2025.07.030.

Led by Darlene Bhavnani, Ph.D., MPH, an infectious disease epidemiologist in Dell Med’s Department of Population Health, the study — published in The Journal of Allergy and Clinical Immunology — found that children in under-resourced communities face sharply higher rates of asthma flare-ups tied to viral infections during the first weeks of school.

“Every parent knows the start of the school year can bring colds and sniffles,” Bhavnani said. “But for kids with asthma, those viral infections can quickly turn dangerous — and our research shows the risk isn’t equal. Children in more disadvantaged neighborhoods are bearing an uneven share of this burden.”

Using health data from Texas’ four largest cities between 2016 and 2019, Bhavnani and her team analyzed emergency department visit rates across 3,000 neighborhoods before and after children went back to school. As expected, asthma-related ER visits surged when children went back to school each year — but the increase was significantly greater in neighborhoods with higher levels of poverty and social vulnerability. This suggests that living in a disadvantaged area may raise a child’s risk of viral infections that often trigger asthma emergencies, Bhavnani said.

The study also points to why these flare-ups are worse in some neighborhoods: factors such as crowded classrooms, environmental stress, and limited access to sick leave among caregivers can make it easier for viruses to spread — and harder for kids with asthma to recover.

“Back-to-school season shouldn’t mean a trip to the ER,” Bhavnani said. “We need to focus not just on managing asthma, but on the environments kids are returning to and their risk of viral infections — in homes, schools and neighborhoods.”

For parents of children with asthma, Bhavnani encourages proactive planning as the school year begins:

• Talk to your child’s doctor about updating their asthma action plan.

• Make sure teachers and school nurses know your child’s triggers and medications.

• Advocate for cleaner air and healthier school environments in your neighborhood.

“This study reinforces what many families already feel,” Bhavnani said. “Health risks don’t stop at the clinic door — they start at home, at school and across our neighborhoods. By understanding those risks, we can start to fix them.”

Eosinophilic asthma is characterized by high levels of eosinophils, a type of white blood cell involved in the body’s immune response. While eosinophils typically help fight infections, in eosinophilic asthma, they accumulate in the lungs and airways, causing chronic inflammation, swelling and damage to the respiratory system.

Eosinophilic asthma is driven by type 2 (T2) inflammation, an immune response involving cytokines that promote the production and activation of eosinophils. Because of this, therapies targeting T2 inflammation are used to reduce eosinophil levels and prevent asthma flare-ups.

But even with targeted therapies against T2 inflammation, some children still experience asthma attacks. This suggests that other inflammatory pathways also play a role in exacerbations, said Rajesh Kumar, MD, Interim Division Head of Allergy and Immunology at Ann & Robert H. Lurie Children’s Hospital of Chicago, who was a co-author of the paper.

In the study, scientists analyzed data from a previous clinical trial studying respiratory illnesses in children with eosinophilic asthma living in low-income urban areas across nine U.S. cities. Investigators compared the effects of mepolizumab—a biologic therapy that targets T2 inflammation—with a placebo over a 52-week period.

While mepolizumab significantly reduced the expression of eosinophil-associated T2 inflammation during asthma flare-ups, exacerbations still occurred.

“The previous trial raised questions about what happens when you take away some of the allergic inflammation using a biologic drug, and why is it that some children experience exacerbations and some don’t?” Dr. Kumar said. “Different types of inflammation–allergic and different types of nonallergic inflammation–interact with exacerbations, both viral and non-viral. We wanted a more precise way of understanding what’s driving some of the exacerbations in kids.”

By employing RNA sequencing of nasal samples collected during 176 episodes of acute respiratory illness, investigators identified three distinct inflammatory drivers of asthma exacerbations. The first were epithelial inflammatory pathways, which were increased in children receiving mepolizumab, regardless of viral infection. The second was macrophage-driven inflammation, which was specifically linked to viral respiratory illnesses, and the third involved mucus hypersecretion and cellular stress responses, which were elevated in both treatment and placebo groups during flare-ups.

“We found that children who still exacerbated on the drug had less of this allergic type of inflammation, but they had other residual epithelial pathways which were driving some of that inflammatory response that was involved in exacerbation,” Dr. Kumar said.

The study highlights the complexity of asthma in children and underscores the need for more personalized treatment strategies, Dr. Kumar said.

“There are multiple different types of inflammatory responses that are involved in exacerbations, and they’re driving exacerbations differentially based on whether patients have a virus or are taking drugs to block different parts of the inflammatory response,” Dr. Kumar said.

As asthma continues to affect children in urban communities disproportionately, the insights from the study could pave the way for precision interventions for children based on the type of inflammation driving their asthma, and lead to improved quality of life for young patients, Dr. Kumar said.

“This study gives us a better understanding of what results in persistent exacerbations and opens up the potential for new therapies or combinations of therapies based upon that.”

The study was supported by a National Institutes of Health grant (UM1AI11427).

Ann & Robert H. Lurie Children’s Hospital of Chicago is a nonprofit organization committed to providing access to exceptional care for every child. It is the only independent, research-driven children’s hospital in Illinois and one of less than 35 nationally. This is where the top doctors go to train, practice pediatric medicine, teach, advocate, research and stay up to date on the latest treatments. Exclusively focused on children, all Lurie Children’s resources are devoted to serving their needs. Research at Lurie Children’s is conducted through Stanley Manne Children’s Research Institute, which is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is the pediatric training ground for Northwestern University Feinberg School of Medicine. It is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report.

The study was published in the journal Health Expectations (Wiley) and conducted by full Professor Francesco Pagnini of the Department of Psychology at the Università Cattolica and colleagues.

Professor Pagnini explains: “this study was developed in response to the difficulties reported by patients in managing asthma. Patients helped identify key areas of concern, and their perspectives influenced the choice of outcomes and tools”. Although direct involvement in recruitment and dissemination was limited due to the pandemic, the design and focus of the study were guided by patient priorities, with potential applications in clinical consultations and future co-designed interventions.

BACKGROUND

After receiving a diagnosis, people often develop expectations about how their condition will evolve, Professor Pagnini explains. This cognitive framework, known as “illness expectations” (IE), comprises future-oriented beliefs about the course of the disease and its symptoms. In chronic conditions such as asthma, IEs can play a crucial role in determining patient-reported outcomes and also variations in clinical markers indicative of disease progression. “In this study, we empirically assessed the impact of IEs on asthma symptoms and respiratory function in patients,” Pagnini affirms.

THE STUDY

‘We involved a group of 310 people diagnosed with asthma who were followed for a period of 6 months, with three assessment points, measuring the level of asthma control with the Asthma Control Test (ACT), while respiratory function was assessed through forced expiratory volume in 1 second (FEV1) using spirometry,’ he explains. At the beginning of the study, we assessed each person’s IE using the validated Illness Expectation Test (IET), which captures both explicit (conscious) and implicit (unconscious) expectations.

It emerged that people with more negative explicit IE about their asthma reported worse symptoms over time. Explicit IE about symptom progression was also associated with changes in lung function, with more negative expectations predicting greater decline in respiratory performance, the professor adds.

These findings suggest that IE may be significantly associated with asthma outcomes, highlighting their potential relevance in understanding patient experiences and symptom perception. “In experiments with patients affected by other diseases, such as multiple sclerosis, we obtained similar results”, the expert continues.

The hypothesis suggested to explain these results is that, as with the placebo effect, what happens is that if I have an idea about the world and the future that awaits me, that idea will prevail, largely influencing behaviour and thus, for example, modifying adherence to therapies and clinical recommendations, he concludes.

There was no increase in asthma attacks for women taking the combined oestrogen and progesterone contraceptive pill.

The researchers say their finding could be an important step towards understanding why women are more likely to have severe asthma than men.

The study was led by Dr Chloe Bloom, a clinical senior lecturer in respiratory epidemiology at the National Heart and Lung Institute, Imperial College London, UK, and funded by Asthma + Lung UK. She said: “Asthma is common in women, and unfortunately, women are twice as likely to die from asthma as men. To help prevent these deaths, we need a better understanding of why women are at greater risk.

“One theory is that sex hormones play a major role. But studying their effects can be tricky. For example, it’s often hard to know exactly when someone has reached puberty or menopause. Instead, we can study women who take sex hormone medications like the contraceptive pill, because we know exactly when they started and stopped using them.”

The researchers used the UK’s Clinical Practice Research Datalink to study a group of 261,827 women aged between 18 and 50 who had been diagnosed with asthma. They compared women who had never used the contraceptive pill with women who started taking either the combined or progesterone-only pill. They gathered data on whether the women experienced any asthma attacks – meaning they were either prescribed oral steroids for asthma, they visited the hospital emergency department for asthma or they died of asthma – between 2004 and 2020.

“We found that the combined pill did not affect whether women had asthma attacks. But some women who took the progesterone-only pill had more asthma attacks. These included women under 35 years old, those who used fewer asthma medications, like inhaled or oral steroids, and those with higher levels of inflammation linked to asthma in their blood,” Dr Bloom explained.

The risk of asthma attacks in women under 35 was around 39% higher in those taking the progesterone-only pill; in women taking fewer asthma treatments, the risk was around 20% higher; and in women with eosinophilic asthma (where sufferers have high levels of blood cells called eosinophils that cause inflammation) the risk was around 24% higher.

Dr Bloom said: “Our study is the first to look at a large group of women over time with such detailed data on both their contraceptive pill use and their medical history. We also used a special type of study design that mimics the methods of a clinical trial, but applied to real-world health data. This approach helped us identify which groups of women might be more at risk of asthma attacks while using the pill.

“Asthma is common in women of reproductive age, many of whom are taking the pill. This study helps women and healthcare professionals make more informed decisions about which contraceptive pill might be best for them. The findings also add another piece to the puzzle of why women may be more likely to have severe asthma than men.

“This is an area that hasn’t been studied much. Most research has focused on oestrogen and testosterone, not progesterone. Our study is one of the first to show that progesterone may play an important role. We’re now calling for more research into how progesterone affects asthma, including how it might interact with asthma medications like steroids.”

The researchers are continuing to study the effects of sex hormones on asthma by looking at the possible effects of hormone replacement therapy and at the impact of pregnancy.

Professor Apostolos Bossios is head of the European Respiratory Society’s group on airway diseases, asthma, COPD, and chronic cough, based at Karolinska University Hospital, Stockholm, Sweden, and was not involved in the research. He said: “We know that women are more likely to have asthma and to suffer more severe asthma. We need much more research to understand why asthma is worse for women than men so we can begin to reduce the risk. This major study in an important step towards that aim.

“Women with asthma who are taking the combined pill, or considering it, should speak to their doctor about their contraception options and their asthma symptoms. Whichever contraception they use, it’s vital that women with asthma use their preventer inhalers and any other prescribed treatments regularly.”

When investigators assessed research published between 2000 and 2023, they identified 30 studies that reported on the current epidemiological state of allergic rhinitis, described factors related to climate change, and observed how global warming is affecting pollen seasons and allergy symptoms.

Sixteen studies reported longer pollen seasons and/or higher pollen concentrations related to climate change. As an example, total pollen emissions in the U.S. are projected to increase by 16–40% by the end of the century and pollen season length to increase by 19 days. Four studies reported an increase in allergic rhinitis–related health care usage, particularly among low-income residents. Two studies reported that health care professionals want more education on climate change.

“Physicians are uniquely positioned to witness the impact of allergic rhinitis on patient outcomes and can adapt their practice as climate change intensifies,” said corresponding author Alisha R. Pershad, BS, a third-year medical student at the George Washington University School of Medicine and Health Sciences. “As trusted voices in the community, they should leverage their frontline experience to advocate for meaningful change in addressing the climate crisis.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/lary.32124

Approximately 10% of inpatients are labelled as ‘allergic to penicillin’ but the vast majority have not experienced a true allergic reaction. Having a penicillin allergy label can results in patients receiving sub-optimal alternative antibiotics and this may lead to poorer outcomes and increased costs. Moreover, patients with a history of low-risk allergy can safely be offered a supervised oral challenge to determine their true penicillin allergy status.

Hegarty and colleagues described the introduction of a penicillin allergy de-labelling service in Cavan and Monaghan Hospital, Ireland.¹ In addition to penicillin allergy de-labelling, the project set out to improve documentation of all medication allergies in patient records.

The Antimicrobial Stewardship (AMS) pharmacists adapted the Scottish Antimicrobial Prescribing Group (SAPG) penicillin allergy toolkit, complying with local governance requirements. This toolkit is designed to be used by non-allergy specialists and supports the identification and removal of penicillin allergy labels in patients who do not have a history of Type 1 or Type 4 hypersensitivity reactions. They also undertook a wide-ranging education campaign on the toolkit and on penicillin allergy awareness.  This included using grand rounds, medical, surgical and ED journal clubs, pharmacy meetings, clinical nurse manager meetings and ward safety pauses.

The results showed that during the period October 2022 – July 2023 61 patients were screened. 37 were deemed eligible for de-labelling and 34 were successfully de-labelled. Of these, 20 were de-labelled in accordance with the protocol (oral challenge); 12 did not require oral challenge “as they were deemed no more likely to have a penicillin allergy than another member of the population”. Two were not de-labelled in accordance with the approved protocol (both were receiving penicillin when reviewed).

Completion of the drug allergy section on the medical records increased from 80% to 100%.  Documentation of the nature of the adverse drug reaction increased from 14% to 27% for patients with a documented penicillin allergy. Both succeeded in the aim of achieving a 10% improvement.

The authors concluded that progress had been made but further improvements were possible as there were still considerable variations in staff engagement.

Reference

1. Hegarty M, Martin D, McKenna A, Caceda B, Trautt E, Daly R. Penicillin allergy awareness and de-labelling. (Poster) EAHP Congress 2025

The findings were published on Nov. 27, 2024 in The Lancet Respiratory Medicine.

Lead investigator Professor Mona Bafadhel, Director of the King’s Centre for Lung Health, and the Chair of Respiratory Medicine at King’s College in London. UK said: “This could be a game-changer for people with asthma and COPD. Treatment for asthma and COPD exacerbations have not changed in fifty years despite causing 3.8 million deaths worldwide a year combined.

She continued, “Benralizumab is a safe and effective drug already used to manage severe asthma. We’ve used the drug in a different way — at the point of an exacerbation — to show that it’s more effective than steroid tablets which is the only treatment currently available. The big advance in the ABRA study is the finding that targeted therapy works in asthma and COPD attacks. Instead of giving everyone the same treatment, we found targeting the highest risk patients with very targeted treatment, with the right level of inflammation was much better than guessing what treatment they needed.”

Benralizamab is a monoclonal antibody that reduces inflammation by targeting specific white blood cells called eosinophils.  It is currently used for the treatment of severe asthma.

Between May 13, 2021, and Feb 5, 2024, the investigators screened 287 patients for enrollment in the study. They excluded 129, leaving 158 eligible subjects. They were randomized at the time of acute eosinophilic exacerbation of asthma or COPD.

Eighty-six (54%) of the subjects were female and 72 (46%) were male, with a mean age of 57 years.

The investigators randomized 53 subjects to the PRED (prednisolone tablets plus dummy injection) treatment group, 53 to the BENRA (benralizumab plus dummy tablets) treatment group and 52 to the BENRA plus PRED treatment group.

After 28 days, respiratory symptoms of cough, wheeze, breathlessness and sputum were significantly improved in favor of the of the pooled-BENRA group (P=0.0065).

At 90 days, treatment failures occurred in 39 (74%) of 53 in the PRED group, and 47 (45%) of 105 in the pooled-BENRA group (P=0·0005), a significant difference.

There were no fatal adverse events, Benralizumab was well tolerated.

The authors concluded, “In patients with an eosinophilic exacerbation of asthma or COPD, a single subcutaneous injection of benralizumab, with or without a short course of systemic glucocorticoids (oral prednisolone) reduced treatment failures, prolonged time to first event, and improved respiratory symptoms and disease-specific health quality compared with standard care with oral corticosteroids following an exacerbation.”