Clinical studies of biologics in severe asthma exclude smokers or ex-smokers (ExS) with over 10 pack-years (py). Thus, the effectiveness of this therapy in ex-smokers with severe asthma is not well understood.

Antimicrobial stewardship (AMS) is crucial for optimising antimicrobial use and restraining emergence of antimicrobial resistance. The overall increase in reported antibiotic allergies in children can pose a significant barrier to AMS, but its impact on clinical AMS care in children has not been addressed.

Digital health is an umbrella term for components of healthcare utilizing computer platforms, software, connectivity and sensors to augment the recording, documentation and communication of clinical information. The functions of digital health may be viewed in three domains: 1) the repository for patient information, 2) monitoring devices and 3) communication tools. Monitoring devices have provided robust information as diagnostic and prognostic tools in office and hospital settings. In this review, as a case study, we will discuss the research and our direct clinical experience of electronic medication monitoring technology and the potential benefits to patient care, and the opportunities and perils encountered in utilizing this approach for patients with moderate to severe asthma, including issues related to patient uptake and concerns for bias, impacts on the provider/patient relationship, and discussions regarding monitoring of rescue medication use in exacerbations. Additionally, despite the fact that there is evidence for improvements in various aspects of patient care afforded by electronic medication monitoring, these devices have not yet seen widespread uptake in clinical settings, and we will discuss the steps needed to address these barriers and keep these important devices available for patient use in the future.

Otitis media with effusion (OME) is associated with comorbidities such as allergic rhinitis, gastroesophageal reflux disease, asthma, and more. Many of these comorbidities can be caused by type 2 inflammation (T2I). This study aims to determine the risk of undergoing OME surgery in patients with and without T2I disease.

Reintroduction of offending food in pediatric patients affected by Food Protein-Induced Enterocolitis Syndrome (FPIES) is carried out in hospitals with Oral Food Challenge (OFC), which leads to long waiting time and increases the societal burden of medical cost and human resources.

Evidence on the role of IgE sensitisation in acute Food Protein-Induced Enterocolitis Syndrome ('atypical FPIES') is limited. Initial reports claimed association with persistent disease, however recent studies have not replicated this.

As the number of monoclonal antibodies available for severe asthma is growing, specialists currently choose without clear guidelines. Despite increasing knowledge on treatment response to these monoclonal antibodies, making the optimal choice for each individual patient remains a challenge. However, evidence of this daily challenge is lacking.

Data on oral immunotherapy (OIT) for hazelnut allergy is limited and its potential to cross-desensitize for other nuts is unknown.

Following a negative oral food challenge (OFC), it is recommended the individual continues to consume the historical allergen regularly. However, the proportion of families achieving sustained reintroduction, and enablers and barriers for reintroduction, are currently unclear.

The prevalence and clinical implications of chronic cough (CC) in patients with severe asthma receiving asthma treatment remain relatively unknown.

Mucus plugging has been identified as an important feature of severe asthma contributing to airway obstruction and disease severity. Recently, improvement of mucus plugging has been found upon treatment with several biologic therapies.

Evaluating penicillin allergy labels and expanding access to preferred treatment options safely is of critical public health importance. Most patients with penicillin allergy labels are not allergic, and even in those with verified allergy, sensitization wanes over time. However, sensitization is complex and while a patient may have a negative penicillin allergy evaluation (including a drug challenge), resensitization can occur, raising a risk of a subsequent reaction upon exposure. In this pro/con debate we deliberate on whether patients who have had negative penicillin allergy evaluations should undergo retesting for sensitization prior to subsequent administrations. The pro position is presented by Drs. Inmaculada Doña, María Salas, and María Torres, while the con position is described by Drs. Ami Belmont and Roland Solensky.

The management of food allergy has evolved over the past several years with regulatory approval of food allergy therapeutics as well as the common practice of oral immunotherapy. Whether a patient or family chooses one of these therapies or avoidance, they are still considered at risk of reaction, and thus clinicians still need to stay up to date with the latest advancements in the management of anaphylaxis in patients with food allergy. This review will highlight some of these updates, starting with the definition, diagnosis, and classifications of anaphylaxis. It will then review the latest updates in management of food anaphylaxis in the community. Finally, the review will discuss the latest in epinephrine including recommendations on epinephrine dosing and novel routes of epinephrine administration.