EPOS2020/EUFOREA expert opinion on defining disease states and therapeutic goals in CRSwNP.

Severe chronic rhinosinusitis with nasal polyps (CRSwNP), a form of diffuse bilateral (usually type 2) CRS, is a debilitating disease with a significant impact on quality of life (QoL). With novel knowledge and treatment options becoming available, there is a growing need to update or revise key definitions to enable communication across different specialties dealing with CRS, and to agree on novel goals of care in CRSwNP. The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) and EPOS expert members discussed how to measure treatment responses and set new treatment goals for CRSwNP. In this paper a consensus on a list of definitions related to CRSwNP is provided: control, remission, cure, recurrence/exacerbation, treatable traits, remodeling, progression, and disease modification. By providing these definitions, the involved experts hope to improve communication between all stakeholders involved in CRSwNP treatment for use in routine care, basic and clinical research and international guidelines aimed to harmonize and optimize standard of care of patients with CRSwNP in the future.

Pre-asthma: a useful concept? A EUFOREA paper. Part 2-late onset eosinophilic asthma.

The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.

Farm Environment During Pregnancy and Childhood and Polysensitization at the Age of 31: Prospective Birth Cohort Study in Finland

BACKGROUND: The farm environment, especially contact with farm animals in early childhood, may prevent allergic sensitization during adulthood. However, prospective associations between exposure to the farm environment and polysensitization have not been studied. Polysensitization is a risk factor for asthma and asthma-related morbidity. OBJECTIVE: To investigate whether exposure to a farming environment in early childhood, especially exposure to animals, is associated with sensitization to specific allergens and polysensitization at the age of 31. METHODS: In a prospective birth cohort study, 5509 individuals born in northern Finland in 1966 underwent skin prick testing against birch, timothy, cat, and house dust mite at the age of 31. Prenatal exposure to the farming environment was documented at birth, whereas information on childhood exposure to pets was only collected retrospectively at the age of 31. Data were analyzed using logistic regression. RESULTS: Being born to a family with farm animals was associated with a reduced risk of sensitization to birch, timothy, and cat (adjusted odds ratio [aOR], 0.55 [95%CI, 0.43-0.70]; aOR, 0.62 [95%CI, 0.48-0.79]; aOR, 0.60 [95%CI, 0.47-0.75]) and polysensitization at the age of 31 (aOR, 0.62 [95%CI, 0.48-0.80]). The number of animal species present during childhood was dose-dependently associated with a reduced risk of sensitization to birch, timothy, and cat, as well as of polysensitization. No association was found with sensitization to house dust mite. CONCLUSIONS: Growing up on a farm and contact with higher numbers of animal species in childhood are associated with less frequent sensitization to birch, timothy, and cat allergens and polysensitization in adulthood, but not with sensitization to house dust mite

ANTECEDENTES: El ambiente de granja, especialmente el contacto con animales de granja en la primera infancia, puede prevenir la sensibilización alérgica durante la edad adulta. Sin embargo, no se han estudiado las posibles asociaciones entre la exposición al entorno agrícola y la polisensibilización. La polisensibilización es un factor de riesgo para el asma y su morbilidad. OBJETIVO: Investigar si el entorno agrícola en la primera infancia, especialmente la exposición a animales, está asociado con la sensibilización a alérgenos específicos y la polisensibilización a la edad de 31 años. MÉTODOS: En un estudio prospectivo de cohorte de nacimiento, 5.509 sujetos nacidos en el norte de Finlandia en 1966 se sometieron a pruebas cutáneas a la edad de 31 años con abedul, hierba timotea, gato y ácaros del polvo doméstico. La exposición prenatal al ambiente agrícola se documentó al nacer, mientras que la información sobre la exposición infantil a las mascotas solo se recopiló retrospectivamente a la edad de 31 años. Se utilizó La regresión logística en los análisis estadísticos. RESULTADOS: Nacer en una familia con animales de granja se asoció con un menor riesgo de sensibilización frente a abedul, hierba timotea o gato (odds ratio ajustado, aOR = 0,55 [intervalo de confianza del 95% 0,43-0,70]; aOR = 0,62 [0,48-0,79] ; aOR = 0,60 [0,47-0,75]) y polisensibilización a la edad de 31 años (aOR = 0,62 [0,48-0,80]). La sensibilización frente a abedul, hierba timotea y gato, así como la polisensibilización, se asociaron de forma dependiente e inversa a la dosis con el número de especies animales presentes durante la infancia. No se encontró asociación con la sensibilización frente a los ácaros del polvo doméstico. CONCLUSIONES: Crecer en una granja y el contacto con un mayor número de especies animales en la infancia se asocia con una menor sensibilización frente al abedul, la hierba timotea, alérgenos de gato y polisensibilización en la edad adulta, pero no con sensibilización frente a los ácaros del polvo doméstico