Background: Several biologics are now available as add-on treatment for severe asthma but, currently there are no universally accepted criteria to measure the response to these therapies. This survey aims to establish consensus criteria to use in practice for the initial evaluation of response to biologics after four months of treatment. Method: Using Delphi methodology, a questionnaire including ten items was developed and validated by a 13-member panel of international experts in asthma. The electronic survey circulated within the INterasma Scientific Network platform, Global Asthma Association membership, contact list of the co-authors, national associations for specialists, and social media. For each item, five answers were proposed graduated from “no importance” to “very high importance” and by a score (A=2 points; B=4 points; C=6 points; D=8 points; E=10 points). The final criteria were selected if the median score for the item was ≥7 and >60% of responses accorded “high importance” and “very high importance”. All selected criteria were validated by the thirteen experts. Results: Four criteria were identified to evaluate the efficacy of biologics in asthma: to reduce daily systemic corticosteroids dose by ≥50% (ideally complete withdrawal); to decrease the number of asthma exacerbations requiring systemic corticosteroids by ≥50%, (ideally no asthma exacerbation); to have no/minimal side-effects and to obtain asthma control according validated questionnaires. The consensual decision was that ≥3 criteria are needed to conclude a good response to biologics. Conclusions: Specific criteria were defined by an international panel of experts and could be used as tool in clinical practice.

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.

The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented. The change in hierarchy in ICD-11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD-11 was presented and adopted by the 72nd World Health Assembly in May 2019 and the implementation is ongoing worldwide. We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD-11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the sub-sections of the new A/H section of the ICD-11 had been considered with good accuracy by the majority of respondents. We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients.

Since the first description of anaphylaxis in 1902, its clinical importance as an emergency condition has been recognized worldwide. Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life through respiratory or circulatory compromise. It is usually, although not always, associated with skin and mucosal changes. Although the academic/scientific communities have advocated to promote greater awareness and protocols for management of anaphylaxis based on best evidence, there are few efforts documenting feedback as to the success of these efforts. In this document, we review the key unmet needs related to the diagnosis and management of anaphylaxis, propose a public health initiative for prevention measures and a timetable action plan which intends to strengthen the collaboration among health professionals and especially primary care physicians dealing with anaphylaxis that can encourage enhanced quality of care of patients with anaphylaxis. More than calling for harmonized action for best management of anaphylaxis to prevent undue morbidity and mortality, the Montpellier World Health Organization Collaborating Centre here proposes an action plan as a baseline for a global initiative against anaphylaxis. We strongly believe these collaborative efforts are a strong public health and societal priority that is consistent with the overarching goals of providing optimal care of allergic patients and best practices of allergology.

Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (COVID-19), although recent reports from the United States of America and the United Kingdom suggest that asthma is much more common in children and adults with mild to severe COVID-19 than it was previously reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. Different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. But, for the moment, it’s crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without self-making any dose adjustments or stopping medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.