Prospective Study to Investigate the Symptom Profile and Medication Consumption of Patients with Seasonal Allergic Rhinitis/Rhinoconjunctivitis who are Interested in Allergen-Specific Immunotherapy

Presenter: S. Allekotte

This multicentre epidemiologic study evaluated symptom severity among patients with grass pollen allergy who were interested in allergen immunotherapy (AIT). The study aimed to determine the proportion of patients with moderate-to-severe symptoms who may meet guideline-based criteria for AIT. A total of 479 patients with a history of grass pollen allergy and positive skin prick test results were assessed during the 2025 grass pollen season using electronic diaries. Symptom severity and medication use were measured using the Combined Symptom and Medication Score (CSMS) and visual analogue scale (VAS). Among evaluated participants, 63.3% had a CSMS ≥1.5, indicating moderate-to-severe allergy symptoms. The mean and median CSMS values were 2.14 and 1.88, respectively. The score was contributed equally by symptom severity and medication use components. Overall allergy symptom severity measured by VAS had a mean score of 41.8 and median score of 39.4. Asthma symptoms were also reported, with a mean VAS score of 49.2 and median score of 52.6. Among participants with asthma, asthma medication was used on average for 4.7 of the 30 documented days.

The findings suggest that approximately two-thirds of patients interested in grass pollen AIT had symptom severity levels consistent with potential benefit from treatment. The study also highlights the presence of asthma symptoms in a substantial proportion of patients with grass pollen allergy.

Severe Vernal Keratoconjunctivitis with Allergic Rhinitis Treated with House Dust Mite (HDM) Sublingual Immunotherapy (SLIT)

Presenter: M. Ahmed

This case report evaluated the effect of house dust mite (HDM) sublingual immunotherapy (SLIT) in a 15-year-old girl with severe vernal keratoconjunctivitis (VKC) and persistent allergic rhinitis (AR). VKC is a severe ocular allergic condition that can affect quality of life and may lead to eye complications if not adequately controlled. The patient had recurrent eye and nasal allergy symptoms since 2015, with worsening during monsoon and winter seasons. She had severe VKC with bilateral itching, redness, discharge, papillary changes, and limbal inflammation, along with moderate-to-severe persistent AR. Symptoms repeatedly worsened when ocular anti-inflammatory treatments were reduced, despite antihistamines and intranasal corticosteroids. Skin prick testing showed sensitization to house dust mites, including Dermatophagoides pteronyssinus (9 mm), Dermatophagoides farinae (7.6 mm), and Blomia (8 mm). Treatment with a standardized HDM SLIT tablet (12 SQ HDM once daily) was started. Improvement in eye and nasal symptoms was observed within 2 weeks of starting SLIT. By 6 weeks, symptoms were controlled, daily functioning and school activities improved, and intranasal corticosteroids were discontinued after 1 month. All other eye and oral allergy medications were stopped by 6 weeks. At 4.5 months of follow-up, the patient remained symptom-free on SLIT alone, with no relapse or treatment-related adverse events reported.

This case suggests that HDM SLIT may help achieve sustained symptom control and reduce the need for additional medications in HDM-sensitized patients with VKC and AR.

Effectiveness of Mepolizumab in Patients with Severe Asthma and Allergic Rhinitis: Real-World Evidence from the TYREX Study

Presenter: J. Dominguez-Ortega

The TYREX study evaluated whether the presence of allergic rhinitis (AR) affects response to mepolizumab treatment in patients with severe asthma. Mepolizumab is an anti–interleukin-5 (IL-5) monoclonal antibody used for severe type 2 (T2) asthma. This multicentre retrospective study included 446 patients with severe asthma who received mepolizumab for 12 months to more than 5 years. Among them, 87 patients had coexisting AR and 359 did not. Patients with AR had higher baseline serum immunoglobulin E (IgE) levels compared with those without AR. Treatment with mepolizumab resulted in significant and sustained reductions in blood eosinophil counts and fractional exhaled nitric oxide (FeNO) levels in both groups. Asthma exacerbations decreased significantly after 12 months and the improvement was maintained throughout follow-up, regardless of AR status.Lung function improved during treatment, with no clinically meaningful differences between patients with and without AR. Asthma control also improved, with 75–80% of patients achieving a clinically meaningful improvement in Asthma Control Test (ACT) scores (increase of ≥3 points). The proportion of patients achieving well-controlled asthma (ACT ≥20) increased significantly in both groups. Clinical remission rates were comparable between patients with and without AR, with improvements observed from 12 months through the end of follow-up. No significant differences were identified between the two groups for treatment outcomes.

Overall, mepolizumab demonstrated sustained effectiveness in severe asthma patients, irrespective of the presence of allergic rhinitis.

Building Expert Consensus on the Positioning of Allergen Immunotherapy (AIT) Within a Treatment Paradigm for Allergic Rhinitis/Rhinoconjunctivitis Led by Disease Remission: A Delphi Consensus

Presenter: GW. Canonica

This study used a Delphi consensus approach to evaluate current challenges in the management of allergic rhinitis/rhinoconjunctivitis (AR/ARC) and to establish practical recommendations for the use of allergen immunotherapy (AIT). A steering committee of 10 clinicians with expertise in AR/ARC management reviewed available evidence and developed consensus statements. These were evaluated through an online survey by an international panel of 156 specialists, including allergists (46%), pulmonologists (29%), and ear, nose, and throat (ENT) specialists (26%) from Europe, Asia, South America, and North America. All 47 proposed statements achieved the predefined consensus threshold of ≥75% agreement, with 32 statements (68%) reaching ≥90% agreement. Experts agreed that AIT plays an important role in AR/ARC management and is the only treatment option shown to provide sustained remission after stopping therapy. The panel also agreed on the long-term benefits of AIT and factors that help identify suitable candidates for treatment.

The findings support the development of a standardized treatment pathway to improve the appropriate and timely use of AIT in patients with AR/ARC.

Effectiveness and Predictors of House Dust Mite Subcutaneous Immunotherapy in Polysensitized Patients with Allergic Rhinitis: A Multicenter Retrospective Study

Presenter: Z. Pan

This multicentre retrospective study evaluated the effectiveness of house dust mite (HDM) allergen immunotherapy (AIT) in patients with polysensitized allergic rhinitis (AR) and assessed factors that may influence treatment response. The study included 81 patients with AR who were sensitized to HDM and at least one additional inhalant allergen such as pollen, mould, or animal dander. All patients received HDM subcutaneous immunotherapy (SCIT) for 12–36 months. Treatment response was defined as a ≥30% reduction in visual analogue scale (VAS) symptom scores. After treatment, 68.8% of patients showed improvement in perennial AR symptoms. Response rates also varied based on coexisting allergen sensitization, with improvement observed in patients sensitized to moulds (72.7%), animal dander (70.0%), tree pollen (65.5%), and weed pollen (70.2%). Allergen-specific symptom improvement differed across allergens: 68.2% for mould-related symptoms, 30.0% for animal dander-related symptoms, 56.7% for tree pollen-related symptoms, and 74.5% for weed pollen-related symptoms. Higher serum allergen-specific immunoglobulin E (sIgE) levels against HDM and mould were associated with lower treatment response among patients sensitized to both allergens. A prediction model combining HDM and mould sIgE levels showed good ability to identify patients less likely to respond.

Overall, single-allergen HDM SCIT provided symptom improvement in many polysensitized AR patients; however, response varied depending on coexisting allergens and sensitization levels, highlighting the need for individualized AIT strategies.

Efficacy and Safety of TQC2938 Injection in Patients with Moderate-to-severe Seasonal Allergic Rhinitis: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase II Study

Presenter: Y. Zhang

This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of TQC2938, a monoclonal antibody targeting suppression of tumorigenicity 2 (ST2), in adults with moderate-to-severe seasonal allergic rhinitis (SAR). The study included 136 adults aged 18–75 years with inadequate symptom control despite standard treatments during previous pollen seasons. Participants were randomly assigned to receive subcutaneous TQC2938 at 210 mg, 420 mg, 630 mg, or placebo every 4 weeks. The primary outcome was change in reflective total nasal symptom score (rTNSS) over 2 weeks. Compared with placebo, the 420 mg dose showed a numerical improvement in rTNSS over 2 weeks (least-squares mean difference: -0.97; 95% confidence interval [CI]: -2.177 to 0.244; p=0.1166), although the difference was not statistically significant. The 210 mg and 630 mg groups also did not show significant improvement compared with placebo. In patients with baseline blood eosinophil counts <0.3×10⁹/L, the 420 mg dose significantly improved rTNSS compared with placebo (least-squares mean difference: -1.46; 95% CI: -2.865 to -0.057; p=0.0416). The 420 mg group also showed significant improvement over a 4-week treatment period (least-squares mean difference: -1.37; 95% CI: -2.638 to -0.103; p=0.0342). No serious adverse events, severe treatment-emergent adverse events, deaths, or treatment discontinuations due to adverse events were reported.

Overall, subcutaneous TQC2938 at 420 mg improved nasal symptoms in selected patients with SAR, particularly those with lower eosinophil levels, and showed a favorable safety profile.

Safety and Immunologic Evaluation of a Biodegradable Transdermal Microneedle Array Patch Immunotherapy (DF19001) in House Dust Mite-Sensitized Allergic Rhinitis: A Phase I Double-Blind, Placebo-Controlled Study

Presenter: KH. Park

This phase I randomized study evaluated DF19001, a biodegradable transdermal microneedle patch designed to deliver Dermatophagoides farinae (Df) allergen for allergen immunotherapy (AIT) in adults with house dust mite (HDM)-sensitized allergic rhinitis (AR).nThe study included adults with moderate-to-severe persistent HDM-related AR who received DF19001 or placebo five times weekly for 16 weeks. Three dose levels were assessed: 200, 400, and 800 protein allergen units (PAU). Safety, tolerability, nasal symptoms, quality of life (QoL), and immune responses were evaluated.nAmong 54 participants who received treatment, 43 completed the study. No serious adverse events were reported, and no participants stopped treatment due to adverse events. Most treatment-related events were mild to moderate and included local skin reactions and temporary upper respiratory symptoms. No clinically important changes in laboratory or cardiovascular parameters were observed.nDF19001 did not show statistically significant differences compared with placebo in total nasal symptom score (TNSS) or QoL, although the medium-dose group showed a trend toward symptom improvement. Immune analyses showed a dose-related effect, with the high-dose group demonstrating a 3.2-fold greater increase in Df-specific immunoglobulin G4 (sIgG4) compared with placebo (p=0.004). A 2.3-fold increase in Df-specific immunoglobulin E (sIgE) was also observed (p=0.037).

Overall, DF19001 was well tolerated and produced dose-dependent immune changes, supporting further evaluation in larger and longer clinical studies.

EAACI 2026, June 12-15, Istanbul, Türkiye