Search Results (197)

This study evaluated the immunomodulatory activity of live Lacticaseibacillus paracasei Yb in vitro and compared response patterns associated with practical L. paracasei Yb formulation formats in an ovalbumin (OVA)-induced allergic airway inflammation mouse model. In vitro, live L. paracasei Yb increased TNF-α production in RAW 264.7 macrophages at 2 × 10⁶ to 5 × 10⁷ CFU/mL, increased IL-1β only at 5 × 10⁷ CFU/mL, and increased IL-10 at 1 × 10⁷ and 5 × 10⁷ CFU/mL. In splenocytes, L. paracasei Yb increased TNF-α, IFN-γ, and IL-10 compared with untreated controls, although these responses did not show a simple concentration-dependent pattern. In vivo, BALB/c mice received fresh L. paracasei Yb yogurt (YG), freeze-dried yogurt (YG-FD), or bacterial powder (BP) for 53 days. Compared with the OVA-sensitized Negative control group, YG and BP did not significantly reduce serum total IgE or OVA-specific IgE, and airway responsiveness and BALF eosinophils showed limited or non-significant changes. In contrast, YG and BP significantly reduced lung inflammation scores (Negative control, 6.86 ± 1.57; YG, 5.13 ± 0.83; BP, 4.50 ± 0.55) and ConA-stimulated splenocyte IL-4 secretion (Negative control, 1168.43 ± 553.34 pg/mL; YG, 589.84 ± 233.54 pg/mL; BP, 472.28 ± 186.44 pg/mL). These findings suggest that practical formulation conditions may shape selected preclinical immunological and histopathological responses to L. paracasei Yb. Further studies incorporating CFU-matched dosing, probiotic-free yogurt controls, and mechanistic validation are required before clinical relevance in asthma can be inferred. Full article

Background: This study aimed to evaluate referral reasons, distribution of allergic diseases, atopic status, and comorbidity associations among patients aged 65 years and older presenting to a tertiary allergy clinic. Methods: This retrospective study included all geriatric patients (≥65 years) who attended the Immunology and Allergy outpatient clinic at Ankara Bilkent City Hospital between January 2024 and December 2025. Demographic characteristics, comorbidities, referral complaints, and allergic diagnoses were recorded. Allergen sensitization was assessed using skin tests and/or allergen-specific IgE measurements. Results: A total of 1302 geriatric patients were included (mean age 70.9 years; 59.8% female). At least one comorbidity was present in 62.6% of patients, with hypertension being the most common(39.4%). The leading referral complaints were rhinorrhoea/sneezing (22.8%), pruritus (19.1%), drug allergy/adverse drug reactions (14.8%), and chronic urticaria (10.9%). The most common diagnoses were rhinitis (63.2% non-allergic), non-allergic pruritus, drug allergy, and chronic urticaria. Among inhalant allergens, pollen sensitivity (42.2%) was most frequent, followed by house dust mite (32.5%). The most frequently implicated drug groups were antibiotics (42.4%) and analgesics (21.7%). Chronic urticaria and ACE inhibitor-associated angioedema showed significant gender differences: 68.6% female (p = 0.001) and 66.7% male (p = 0.008), respectively. Patients with asthma, rhinitis, or angioedema frequently had comorbid conditions (91.1%, 55.8%, and 83.7%, p = 0.001, p = 0.013, and p = 0.001, respectively). Conclusions: Allergy clinic presentations in elderly patients reflect a broad clinical spectrum, including non-allergic conditions, frequent drug-related reactions in elderly patients with multiple comorbidities, and age-related immunological changes alongside atopic diseases. A comprehensive, individualized diagnostic approach is essential when evaluating allergic complaints in the geriatric population. Full article

Background/Objectives: Allergen immunotherapy (AIT) is the only disease-modifying treatment for grass pollen allergy. However, the proportion of patients interested in AIT who meet guideline-defined eligibility criteria remains unclear. This study aimed to characterise symptom burden, medication use, and AIT eligibility in adult patients with grass pollen allergy during the peak pollen season. Methods: In this multicentre, prospective, non-interventional epidemiological study, 479 adults with confirmed grass pollen allergy recorded daily nasal, ocular, and systemic symptoms, as well as anti-allergic medication use, via a validated electronic diary (CCC STUDY Diary) over a 30-day period in June/July 2025. A combined symptom–medication score (CSMS) was calculated daily, with a predefined threshold of ≥1.5 indicating clinically relevant symptom severity and potential eligibility for AIT. Both additive and weighted calculation approaches for the CSMS and the daily medication score (dMS) were evaluated to assess methodological robustness and reproducibility. Results: The mean additive CSMS was 2.14, indicating moderate symptom burden. Overall, 63.3% of participants exceeded the CSMS threshold of 1.5 and were considered eligible for AIT. Sensitivity analyses demonstrated excellent concordance between additive and weighted CSMS/dMS calculations (Spearman’s ρ >0.98; p < 0.001), and Bland–Altman analysis confirmed minimal bias (0.157) and narrow limits of agreement. Asthma was reported as a comorbidity in 36% of patients, generally associated with mild to moderate daily respiratory symptoms. Limitations included the self-reported nature of the data and a slightly reduced sample size; however, the results are representative of adult patients seeking care in specialised allergy centres in Germany. Conclusions: The CSMS also in its additive and therefore modernised form is a reliable, reproducible, and clinically meaningful tool for quantifying symptom severity and identifying patients suitable for AIT. Approximately two-thirds of adults interested in grass pollen AIT exhibited moderate to severe symptoms and were eligible for treatment according to current guideline recommendations. Full article

Background: The relationship between allergic status, SARS-CoV-2 infection, Long COVID, and post-restriction respiratory outcomes in children remains incompletely understood. This study aimed to explore the associations between allergic status and Long COVID, as well as between SARS-CoV-2 vaccination and post-restriction changes in allergic rhinitis (AR), asthma, and upper respiratory infections, in a pediatric tertiary-care cohort. Methods: We conducted a single-center, questionnaire-based observational study involving children aged 0–16 years, who were followed at the Pediatric Allergy Clinic of Umberto I Hospital in Rome. Parents completed an email-based questionnaire addressing SARS-CoV-2 infection, vaccination, persistent post-infectious symptoms, allergic diseases, and respiratory infections following restrictions. Analyses of Long COVID were limited to children with confirmed SARS-CoV-2 infection. Results: A total of 214 questionnaires were analyzed. Allergic status was not significantly associated with SARS-CoV-2 infection in the overall cohort. Among infected children, allergic status was independently associated with higher odds of Long COVID (adjusted OR 3.12, 95% CI 1.20–8.09; p = 0.019). Severe acute infection was also strongly associated with Long COVID (adjusted OR 6.84, 95% CI 2.72–17.21; p < 0.001). Complete vaccination was associated with lower odds of SARS-CoV-2 infection in the overall sample (adjusted OR 0.20, 95% CI 0.09–0.46; p < 0.001) but was not independently associated with Long COVID among infected children. After the removal of COVID-19 restrictions, 90.1% of allergic children reported worsening AR and 52.0% reported worsening asthma, with no significant association with SARS-CoV-2 infection or Long COVID. Group A Streptocossus (GAS) pharyngitis was reported in 50.0% and viral pharyngitis in 10.7% of the cohort, with no significant differences between allergic and non-allergic children. Conclusions: In this single-center, questionnaire-based pediatric cohort, allergic status was correlated with increased likelihood of Long COVID among children with confirmed SARS-CoV-2 infection; however, it was not associated with a higher risk of infection itself. Complete vaccination was linked to a reduced risk of infection, whereas no independent correlation with Long COVID was identified. Post-restriction exacerbation of allergic respiratory symptoms was prevalent, while the incidence of bacterial and viral pharyngitis did not vary significantly according to allergic status. Full article

Multiple interacting risk factors can influence the origin of asthma. Asthma is characterized by different clinical phenotypes, each of which includes different endotypes. There are four main clinical asthma phenotypes: (1) early-onset mild allergic asthma; (2) early-onset allergic moderate-to-severe remodeled asthma; (3) late-onset non-allergic eosinophilic asthma; and (4) late-onset non-eosinophilic non-allergic asthma. The main endotypes of asthma are T-helper (Th)-2 low and Th-2 high. The identification of asthma endotypes might help precision-based care move toward the personalized management of airway inflammation. In this scenario, it is important to know how the risk factors affect the pathophysiology of asthma. Accordingly, we focus our attention on the impact of obesity and air pollutants and how these risk factors together with epigenetic alterations influence the asthma phenotype/endotype and the pathogenesis of airway diseases. Our aim is to disseminate the progress of studies in this area by reporting recent observations on the topic. Finally, we believe that data/observations enclosed in this review suggest the need of further epidemiological studies to be useful to examine simultaneously the effect of more than one risk factor on clinical and biologic parameters of asthma. Full article

Background: Diets composed of various components have been shown to influence inflammatory diseases such as asthma. While most studies have focused on fiber-rich diets to investigate their effects on the immune system and, consequently, on asthma, little is known about the impact of sugar-rich diets, particularly when such diets are consumed over short periods of time. Methods: To investigate the short-term effects of a sugar-rich diet on allergic airway inflammation, A/J mice were fed either a standard diet or a sugar-enriched diet and subsequently sensitized and challenged with ovalbumin or PBS. Airway inflammation was assessed by bronchoalveolar lavage (BAL) cell analysis, including eosinophil counts and cytokine levels (IL-4, TNF-α, IL-33), and by lung histology (H&E for inflammatory infiltrate and PAS for mucus). Serum IgE levels were also measured. In addition, glucose tolerance, visceral and subcutaneous adipose tissue mass, and inflammatory markers in visceral adipose tissue were evaluated. Results: Short-term consumption of a sugar-rich diet induced glucose intolerance and expansion of adipose tissue, particularly visceral fat, independent of ovalbumin sensitization. Gonadal adipose tissue analysis revealed a shift toward M1 macrophage polarization, characterized by elevated TNF-α, IL-6, and IL-1β, increased leptin levels, and reduced adiponectin. In OVA-sensitized mice, the sugar-rich diet significantly exacerbated eosinophil infiltration in BAL, increased IL-4, TNF-α, and IL-33, and enhanced PAS-positive mucus accumulation and inflammatory infiltrates in the lung. Moreover, total serum IgE was significantly higher in allergic mice fed the sugar-rich diet compared with allergic mice on the standard diet. Importantly, in non-sensitized mice fed the sugar-rich diet, no pulmonary inflammation was detected by BAL, demonstrating that HSD alone does not induce asthma but amplifies allergic responses when sensitization is present. Conclusions: Our findings demonstrate that short-term consumption of a sugar-rich diet is sufficient to exacerbate, but not initiate, allergic pulmonary inflammation. From a translational perspective, reducing dietary sugar intake may represent a valuable adjuvant strategy in the management of allergic asthma. Full article

Background/Objectives: Radon exposure has recently been associated with asthma morbidity, including increased airway inflammation and school absenteeism in children, though limited data on underlying biological mechanisms exist. Interleukin-6 (IL-6), a pleiotropic cytokine implicated in both Type 2-low airway inflammation and radon-related lung carcinogenesis, may represent a key mechanistic link between radon exposure and asthma morbidity. We aimed to evaluate the association between indoor radon exposure and plasma IL-6 levels in children with asthma and whether this relationship differs by allergic sensitization status. Methods: We analyzed baseline data from the School Inner-City Asthma Study, a prospective cohort of children aged 4–13 years with persistent asthma. Monthly indoor radon concentrations at each participant’s residential ZIP Code Tabulation Area were estimated using a validated spatiotemporal prediction model. Plasma IL-6 was measured from baseline blood samples. Multivariable linear mixed-effects models with random intercepts for school were used to assess the association between radon exposure and IL-6, adjusting for demographic, clinical, and socioeconomic covariates. Effect modification by allergic sensitization was evaluated using an interaction term. Results: Among 144 participants, 62.5% were allergen-sensitized. The median home radon concentration was 46.6 Bq/m³ (range 30.7–99.9), and the mean plasma IL-6 was 0.22 pg/mL (SD 0.41). A significant interaction was observed between radon exposure and allergic sensitization status (β-interaction = −0.012; p = 0.014), indicating differential effects by phenotype. Among non-sensitized children, higher radon exposure was associated with increased IL-6 levels (β = 0.0088; p = 0.044), corresponding to a 0.32 pg/mL rise in IL-6 per 37 Bq/m³ increase in radon. No significant association was observed among sensitized children. Conclusions: Indoor radon exposure is associated with higher plasma IL-6 levels in non-sensitized children with asthma, suggesting a potential IL-6–mediated pathway linking radon exposure to asthma morbidity in the Type 2-low phenotype. These findings highlight heterogeneity in environmental asthma responses and support further investigation into radon mitigation as a modifiable factor to improve asthma outcomes. IL-6 may serve as a biomarker to identify children most susceptible to radon-related airway inflammation, guiding personalized mitigation strategies and targeted interventions to improve asthma outcomes. Future studies should incorporate direct home radon measurements, comprehensive endotyping panels, and longitudinal biomarker sampling to validate these findings and elucidate whether IL-6 trans-signaling pathways mediate radon-induced airway injury in non-allergic asthma. Full article

Background: Prenatal vitamin D exposure has been proposed as a potential determinant of immune development and subsequent allergic disease risk in offspring; however, long-term cohort data remain inconsistent. Methods: We analyzed data from the KLOTHO birth cohort, including 98 adolescents with available allergic outcome assessment. A maternal–neonatal sub-cohort of mother–child pairs with available maternal and neonatal serum total 25-hydroxyvitamin D₃ [25(OH)D] measurements at delivery was used for vitamin D analyses. Allergic outcomes included asthma, allergic rhinitis, and eczema in offspring. Associations were evaluated using descriptive statistics, Spearman correlation analyses, and logistic regression models. Results: Maternal 25(OH)D concentrations were not significantly associated with asthma (ρ = 0.075, p = 0.652), allergic rhinitis (ρ = 0.100, p = 0.556), or eczema (ρ = 0.131, p = 0.426). In crude logistic regression models, vitamin D concentrations were not associated with asthma (odds ratio (OR) per 10 nmol/L: 1.07, 95% confidence interval (CI): 0.78–1.48, p = 0.67), allergic rhinitis (OR: 1.05, 95% CI: 0.76–1.45, p = 0.77), or eczema (OR: 1.17, 95% CI: 0.86–1.60, p = 0.31). Adjusted models including maternal age, pre-pregnancy body mass index (BMI), season of delivery, and ultraviolet exposure yielded similar non-significant findings, although analyses were limited by a reduced complete-case sample size. Conclusions: In this prospective cohort with follow-up into early adolescence, vitamin D status at delivery was not associated with asthma, allergic rhinitis, or eczema in offspring. These findings support a lack of statistically significant association; however, potential non-linear relationships should be interpreted cautiously, given the modest sample size. Full article

Background: Tezepelumab has demonstrated efficacy in severe uncontrolled asthma (SUA), although real-world evidence remains limited. Methods: We included patients with SUA who completed at least 6 months of treatment. Lung function, eosinophil counts, IgE, FeNO, comorbidities, and changes in asthma control were assessed using ACT, ACQ, the VAS, and quality of life (AQLQ), as well as severe exacerbations (hospital admissions and emergency visits), oral corticosteroid (OCS) courses, OCS withdrawal/dose reduction, and reductions in maintenance and reliever medication. Response was evaluated using the FEOS and EXACTO scales. Baseline (T0) and 6-month (T6) outcomes were compared in the overall cohort and according to T2-high (eosinophilic/allergic) vs. T2-low phenotype. Results: A total of 33 patients were analyzed (58 ± 12 years; 94% women), with a high burden of comorbidities (88%), mainly rhinosinusitis (79%), obesity (41%), and smoking (37%). Of these, 45.5% had received prior biologic therapy. All patients were on high-dose ICS + LABA, frequently with LAMA and other controllers; 30% were on maintenance OCS. In the previous year, 49% had been hospitalized, 97% had attended the emergency department, and 100% required OCS courses. After 10 ± 3 months, the overall group showed significant improvement in VAS, ACT, ACQ, and AQLQ (p < 0.001), with a reduction in eosinophils, but no significant change in FEV1%. Severe exacerbations, emergency visits, hospitalizations, and OCS courses decreased markedly (p < 0.001). Among 10 patients on maintenance OCS, OCS were discontinued in 7 and reduced in 3; maintenance/reliever medication was also reduced. The T2-high phenotype showed a higher likelihood of “complete response” (52% vs. 17% in non-T2), although “good response” predominated in non-T2; this difference was significant (p = 0.04). Conclusions: Tezepelumab improved asthma control and reduced healthcare utilization and corticosteroid use in both T2 and non-T2 patients, achieving clinical remission in 40%, with better outcomes in T2. Full article

Background and Objectives: Professional voice users (PVUs) are individuals for whom the voice is the primary tool of work, and whose professional success and income largely depend on its quality. This paper’s study population predominantly consisted of occupational voice users with moderate vocal demands and the study aimed to identify risk factors and causes of voice quality and production disorders, as well as the socio-epidemiological characteristics of affected patients. Materials and Methods: A retrospective study was conducted in Serbia, including 145 occupational voice users aged 20–70 years who were treated for dysphonia between August 2019 and July 2024. Data collected included demographics, symptom duration, tobacco exposure, throat and nasal swab results, gastroenterological and endocrinological evaluations and information on treatment for allergic rhinitis, asthma, and dysphonia. Patients were stratified by age, profession, and cause of dysphonia into the appropriate groups. Results: Dysphonia is significantly more common among female occupational users. There is a significant association between the cause of dysphonia and both age and hyperthyroidism. Smoking was highly prevalent in the study population and showed associations with selected videolaryngostroboscopic parameters; however, causal inferences could not be made due to the lack of a non-smoking comparison group. No statistically significant association was observed between positive nasal or throat swabs and dysphonia, nor between allergic rhinitis or asthma and the onset of dysphonia in occupational voice users. Treatment modality varies by gender, with male occupational voice users more likely to undergo surgery and female occupational voice users more often receiving conservative therapy. Symmetric vocal fold vibrations were observed in 85.5% of participants, while regular vibrations were present in 53.1%, and insufficient glottal closure in 10.3%. Regular vocal fold vibration was significantly less frequent in patients with structural disorders and more common in individuals aged 30–39 years. Male sex showed a borderline association with reduced likelihood of symmetric vocal fold vibrations. No independent predictors of insufficient glottal closure were identified. Conclusions: These results support the implementation of systematic otolaryngologic examinations, combined with mandatory education on proper voice use, vocal hygiene, and the harmful effects of tobacco smoke, as measures to prevent voice disorders in occupational voice users. Full article

Background: Mucous stools in infancy are commonly attributed to non–IgE-mediated gastrointestinal food allergies and are generally considered transient and benign. However, whether mucous stools may indicate an atopy-prone clinical phenotype and relate to later respiratory atopy remains insufficiently explored. Objective: To evaluate the long-term risk of respiratory atopy (asthma and/or allergic rhinitis) in infants presenting with mucous stools during the first year of life and to identify early clinical predictors of this risk. Methods: This retrospective cohort study included infants who presented with mucous stools within the first 12 months of life and were followed for four years. Baseline demographic, clinical, dietary, and laboratory data were extracted from standardized medical records. Mucus severity was graded using a pragmatic 0–3 clinical mucus score. The primary outcome was physician-diagnosed asthma and/or allergic rhinitis at four years. Multivariable logistic regression was used to identify independent predictors, with model discrimination assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 142 infants with complete follow-up data were analyzed. At four years, respiratory atopy was observed in 45 infants (31.7%). In multivariable analysis, family history of atopy (adjusted odds ratio [aOR] 2.68, 95% CI 1.20–5.98, p = 0.016) and wheezing at presentation (aOR 3.74, 95% CI 1.56–8.94, p = 0.003) were independent predictors of respiratory atopy. The mucus score was associated with respiratory atopy in univariable analysis but did not remain an independent predictor in multivariable modeling. The model showed good discrimination (AUC = 0.769). Conclusions: In this cohort of infants presenting with mucous stools in the first year of life, respiratory atopy was observed in nearly one-third by age 4. While mucous stool burden was associated with the outcome in univariable analyses, it did not remain an independent predictor after adjustment. Early wheezing and a family history of atopy were the strongest clinical predictors and may help identify infants who warrant closer follow-up. These findings should be interpreted as associative and hypothesis-generating in the absence of a mucous-stool–free comparison group. Full article

Background: Vasicine (Vas) is a quinazoline alkaloid derived from Adhatoda vasica Nees, which has good anti-allergic asthma and anti-inflammatory effects. However, its specific functional mechanism on allergic asthma is unclear. This study aims to investigate the protective effect of Vas on allergic asthma and its underlying mechanisms. Methods: Initially, the therapeutic effects of Vas were assessed in ovalbumin-sensitized BALB/c mice using airway hyperresponsiveness (AHR), histopathological examinations, immunohistochemistry, and enzyme-linked immunosorbent assays (ELISA). Subsequently, a non-targeted metabolomic analysis was performed to examine the influence of Vas on lung metabolites, while molecular docking was utilized to clarify the mechanisms by which Vas intervenes in allergic asthma. Lastly, RBL-2H3 cells were employed in vitro to validate the metabolomic findings by measuring intracellular Ca²⁺ concentrations, in addition to conducting ELISA and Western blot analyses. Results: In vivo, Vas alleviates AHR in mice with allergic asthma, enhances histopathological conditions, and reduces inflammatory factors. Non-targeted metabolomics analyses indicate that the primary pathway implicated in its intervention in allergic asthma may be the FcεRI pathway. Furthermore, molecular docking techniques were utilized to evaluate the binding affinity between Vas and proteins associated with this pathway. In vitro, Vas effectively inhibits degranulation in RBL-2H3 cells and diminishes the release of inflammatory factors by modulating the FcεRI/Lyn + Syk/MAPK pathway. Conclusions: These findings indicate that Vas may effectively alleviate allergic asthma by reducing inflammatory responses, decreasing AHR, and improving histopathological features. Furthermore, Vas seems to inhibit mast cell degranulation and modulate the FcεRI/Lyn + Syk/MAPK pathway. Full article

Background: T2 low asthma in children is an emerging yet underexplored endotype that challenges traditional views of type 2 inflammation. Recent data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and strong associations with modifiable comorbidities such as obesity, passive smoke exposure, and recurrent respiratory infections. This phenotype often shows a poor response to standard inhaled corticosteroid therapy and T2-targeted biologics, underscoring the urgent need for improved diagnostic and therapeutic approaches. Methods: This narrative review conducted a literature search from PubMed and WoS databases (2020–2025), focusing on T2-low asthma defined by low blood eosinophils (<150–300/µL), FeNO (<20–25 ppb), and absent atopy in children under 18. Results: This review highlights the heterogeneity of T2-low asthma, including subtypes from neutrophilic/Th 17-high to paucigranulocytic airway remodeling and metabolic driven forms, as well as diagnostic challenges from biomarker supresssion by high-dose therapies. Pragmatic phenotyping algorithms using routine tests enable identification, directing comorbidity management over ineffective biologics. Conclusions: Systematic T2-low phenotyping in pediatric practice, alongside prospective studies and non-T2 therapy trials, promises precision medicine to enhance outcomes for these children, moving beyond eosinophil-centric care. Full article

Micro-RNAs (miRNAs) are short, non-coding RNA molecules regulating genes’ expression. Studies published over last years demonstrated that they play an important role in allergic diseases by regulating humoral and cellular immunity, cytokine secretion and epithelium function. Some of them seem potential non-invasive biomarkers facilitating diagnosis of the most common allergic diseases, such as allergic rhinitis (miR-21, miR-126, miR-142-3p, miR-181a, miR-221), asthma (miR-16, miR-21, miR-126, miR-146a, miR-148a, miR-221, miR-223) and atopic dermatitis (miR-24, miR-124, miR-155, miR-191, miR-223, miR-483-5p), or objectively assessing severity of inflammation and endotype of the disease. In spite of the large body of literature available, its scientific value is limited due to the small numbers of study participants, heterogeneity of populations enrolled, and diverse methodology. Some studies have revealed significant changes in miRNAs’ profile in the course of allergen immunotherapy. Tolerance induction is associated with processes controlled by miRNAs: enhanced activity of Treg cells and increased production of tolerogenic IL-10 and TGF-β. Thus, miRNAs may be candidates as biomarkers of successful immunotherapy. Finally, they are also possible therapeutic agents or targets of therapies based on antagomirs blocking their activity. However, so far no studies are available that demonstrate efficacy in overcoming delivery barriers, tissue targeting or drugs’ safety. As a consequence, despite promising results of in vitro and animal model studies, translation into human therapeutic agents is uncertain. Full article

Chronic rhinitis is induced by endotype-diverse inflammatory processes, which complicates effective therapeutic management. According to the current principles of personalized medicine, which also apply to the management of rhinological disorders, the best therapeutic results can be achieved after targeted treatment preceded by analysis of the patient’s endotype. Analysis of immune and cellular mechanisms allows for the use of biological treatment, and its effects provide new information on inflammatory processes in the nasal mucosa. The effects of biological treatment may be particularly interesting in the case of mixed endotypes, which pose a difficult therapeutic challenge. In eosinophilic asthma co-occurring with allergic rhinitis, as well as in eosinophilic asthma associated with non-allergic rhinitis, eosinophils represent a key effector cell population driving the underlying type 2-mediated inflammatory response. The aim of this study is to analyze the efficacy of anti-IL5 or anti-ILR5 therapy in patients with severe eosinophilic asthma and persistent allergic or non-allergic rhinitis. Methods: In this single-center real-life study, the authors analyzed the effects of biological treatment on rhinological symptoms in patients over the age of 18 with severe uncontrolled eosinophilic bronchial asthma with coexisting persistent allergic or non-allergic rhinitis treated with mepolizumab or benralizumab. In all patients, the otolaryngologist performed anterior rhinoscopy. Evaluation of rhinological symptoms and quality of life in patients treated with anti-IL5 or anti-IL5 therapy before and six months after biological treatment was performed using the TNSS and SNOT-22 scales. Results: In total, 67 patients with eosinophilic severe bronchial asthma were included in the study; among them 39 (58.2%) suffered from persistent allergic rhinitis and 28 (41.8%) suffered from chronic non-allergic rhinitis. After six months of treatment, higher absolute differences for SNOT and TNSS were observed in the persistent allergic rhinitis group. Conclusions: Biological treatment with mepolizumab and benralizumab may reduce the severity of rhinological symptoms in both endotypes of inflammation. However, higher therapeutic benefits were observed in patients with co-existing persistent allergic rhinitis. It was demonstrated that, in addition to IgE-mediated responses, the eosinophil represented an important component of the inflammatory reaction in allergic rhinitis. Full article