Background – Available epidemiology data on mustard allergy have not been updated in the last 20 years, while such food remains considered as an important source of severe reaction and is required to be notified on food labels in the European Union. The present study aimed to evaluate the real epidemiology of mustard allergy, proven by oral food challenge (OFC), and the severity of recorded reactions. Methods – We conducted a retrospective observational study at the Allergy Department of Montpellier University Hospital, including children and adults undergoing an OFC for suspected IgE-mediated mustard allergy between 2000 and 2024. The primary objective was to assess the prevalence of proven mustard allergy; secondary objectives included evaluating the diagnostic performance of clinical history and associations between specific IgE levels and clinical variables. Results – 86 patients (mean age 7.7 years, 77.9% males) were included in the present cohort. Twenty-five reported a prior mustard allergy clinical history, mostly mild grade 1 cutaneous reactions; 8 reported a history of non-severe anaphylaxis. The rest of them were sensitized to mustard but did not experience any previous reaction. In the whole cohort, only one patient (1.2%) reacted during OFC, with generalized urticaria. Conclusion – Mustard has long been considered a major food allergen, but our findings, as well as those available in the literature, suggest that proven IgE-mediated mustard allergy is rare and severe reactions are exceptional. These updated data encourage to perform a complete allergy work-up to avoid overdiagnosis and question the relevance of maintaining mustard as a mandatory allergen in food labeling.

Background – While the definition of anaphylaxis is clear, its grade of severity remains a subject of debate, especially since different published classifications provide different grading score, and the same reaction may not receive the same score from different classifications. The objective of this study was to evaluate the possible discrepancies in severity scoring system for anaphylaxis in patients with a positive food challenge (OFC), using the WHO for the 11 th version of the International Classification of Diseases (ICD-11) as the main reference. Methods – We conducted a retrospective observational study at the University Hospital of Montpellier, France, including patients with a positive OFC, between 2018 and 2022. We classified the severity of each reaction, as per the ICD-11 classification, but also as per four other widely used and validated classifications for grading anaphylaxis severity. Results – 235 patients presented a positive OFC between January 2018 and December 2022: 143 suffered from anaphylaxis, according to the ICD-11 classification. 76.2% of them were classified as grade 2 according to the ICD-11 classification, and 23.8% as grade 3. When comparing the different classifications, a complete concordance was recorded in 8 patients (5.6%) only. All classifications showed a good sensitivity (ranging from 99.3 to 100%), but different specificity (from 67.4 to 93.5%), and discrepancies between them were shown in most patients. Conclusion – Our work highlights the need to refine the different scoring systems, to accurately capture anaphylactic reactions and ensure appropriate management, and, in the end, to adopt a universal, intuitive, and easy-to-use classification, such as the ICD-11 one.

Background: Artificial Intelligence (AI) technologies could potentially change many aspects of clinical practice. While Allergen Immunotherapy (AIT) can change the course of allergic diseases providing relief of symptoms that extend for many years after treatment completion, it can also bring uncertainty to patients, who turn to readily available resources such as ChatGPT-4 to address these doubts. The aim of this study was to use validated tools to evaluate the information provided by ChatGPT-4 regarding AIT in terms of quality, reliability and readability. Methods: In accordance with AIT clinical guidelines, 24 questions were selected and introduced in ChatGPT-4. Answers were evaluated by a panel of allergists, using validated tools DISCERN, JAMA Benchmark and Flesch Reading Ease Score and Grade Level. Results: Questions were sorted into 6 categories. ChatGPT provided bad quality information according to DISCERN medians scores in the “Definition”, “Standardization and Efficacy”, and “Safety and Adverse Reactions” categories. It provided insufficient information according to JAMA Benchmark across all categories. Finally, ChatGPT-4 answers required a “college graduate” level of education to be understood as they were very difficult to read. Conclusions: ChatGPT-4 exhibits potential as a valuable complement to healthcare; however, it requires further refinement. The information it provides should be approached with caution regarding its quality, as significant details may be omitted or may not be fully comprehensible. Artificial intelligence models continue to evolve, and medical professionals should participate in this process, given that AI impacts various aspects of life, including health, to ensure the availability of optimal information.

Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization and natural history review. Numerous factors that may affect disease activity and patient wellbeing need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even ‘real-time’, monitoring between visits. Following an approach that included needs assessment, evidence appraisal and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.

Background: Allergic rhinitis (AR) is a major non-communicable disease that affects the health-related quality of life (HRQoL) of patients. AR is significantly related to asthma also affecting HRQoL. However, data on HRQoL and symptom control in AR patients with comorbid asthma are lacking. Objective: To assess the differences of symptom control and HRQoL in AR patients with and without comorbid asthma. Methods: In this multicentre, cross-sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT). Results: Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate-severe intermittent AR, followed by moderate-severe persistent AR (34%). Patients with both AR and asthma had significantly higher RHINASTHMA scores than the patients with AR alone (e.g., median RHINASTHMA-total score 84 vs. 48.5, respectively). Conversely, CARAT scores were significantly lower in AR with comorbid asthma than in the patients with AR alone (median CARAT-total score 16.5 vs. 23, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than AR patients with mild persistent asthma. Conclusions: Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.

Should cashew and pistachio be clinically considered as one allergen?Authors (Last Name and First Name): Manca Enrica1,2, Touati Nidhal1, De Filippo Maria1,3, Carboni Elena1,4, Diaferio Lucia1,5, Demoly Pascal1,6, Caimmi Davide1,6Affiliations :1. Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, France.2. Pediatric Unit, University Hospital of Foggia, Italy.3. Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.4. Pediatric Unit, Ospedale Maggiore, ASST Cremona, Italy.5. Department of Pediatrics, Giovanni XXIII Hospital, Aldo Moro University of Bari, Bari, Italy.6. UMR-S 1136 INSERM-Sorbonne Université, Equipe EPAR – IPLESP, Paris, France.Running title: Allergy to cashew and pistachio

Background: Allergy is witnessing major advances, in particular with the advent of biological therapies for treating allergic diseases. Given the novelty of these therapeutics, we aimed to explore by a worldwide survey, the prescription and the management of hypersensitivity reactions (HR) of biological agents (BA) in Allergy. Method: We built up an anonymous online questionnaire, sent out by mail and social media and circulated for 40 days. Results: 348 responses were from 59 countries, with a majority from Europe (62.6%). 97% of responders practiced allergy and 48.5%, exclusively so. Allergy was mentioned as a full specialty in 69.5 % of cases. 71% of responders confirmed the right of prescription of BA for allergists in their country and 78.4 % prescribed BA in their clinical practice. Europe included almost all the allergists who did not have the right of prescribing BA (95.5%), specifically France (91%). The most prescribed BA were Anti IgE (78.1%) and anti IL5 (43.9%). The most declared HR to BA were local reactions (74.1%) followed by anaphylaxis like symptoms (6.8%) and delayed exanthemas (5.1%). Desensitization was considered in 18.9% of cases. These HR were reported in 48.8% of cases. Conclusion: Although BA are now a pillar in the treatment of allergic diseases and allergists are familiar with management of HR associated with BA, their prescription is not authorized for allergists in all countries. BA showed to be generally safe but HR, which may be severe, could occur with a lack of consensus on the management.