Janet M. Davies

Description:Component-resolved diagnostics (CRD) have revolutionized allergy diagnosis, offering enhanced accuracy and insights into allergen sensitization patterns. This review explores geographical variances in CRD for food and aeroallergens across the Asia-Pacific region. We examine the varying prevalence of allergic diseases and the utility of CRD in diagnosing common food allergies, including peanut, shellfish, fish, wheat, and fruits. Notable differences in serum-specific (sp)IgE sensitization patterns and the clinical relevance of particular allergen components are observed between populations in Asian countries and those in Europe and the United States. For food allergies, the literature reports significant differences in allergen components and their diagnostic utility across various countries. Peanut allergy diagnostics, particularly Ara h 2 spIgE, show varying sensitivity and specificity between Asian and Western populations. In shellfish allergy, emerging allergens beyond tropomyosin are gaining importance in the Asia-Pacific region. Fish and wheat allergies also demonstrate unique sensitization patterns, emphasizing the need for region-specific diagnostic approaches. Regarding aeroallergens, pollen sensitization profiles vary widely across the region, influenced by local flora and climate, to influence symptoms of pollen food allergy syndrome. House dust mite allergens remain a significant concern, with high sensitization rates to major components like Der p 1, Der p 2, and the emerging Der p 23. The cross-reactivity between house dust mite and shellfish allergens is particularly relevant in this region. These findings emphasize the need for region-specific CRD approaches, considering local allergen profiles and sensitization patterns. As the prevalence of allergic diseases continues to rise in the Asia-Pacific, further research into locally relevant allergens and their components is crucial for improving diagnosis, patient management, and targeted immunotherapy strategies in this diverse region.

Description:Isolated episodes and epidemic outbreaks of thunderstorm asthma have now been documented for over 40 years, with global geographical reach across Europe, North America, Middle East, Asia, Oceania, and Africa. This phenomenon encompasses specific environmental and meteorological factors, interacting with aeroallergen propagation and exposure in susceptible allergen-sensitized individuals and populations. There is a likely contribution from climate change with prolonged allergenic pollen seasons combined with increased pollen allergenicity, as well as heightened likelihood of extreme weather events. Differential population susceptibility to thunderstorm asthma presentations, hospitalizations, and deaths with increased vulnerability of certain ethnic groups suggests a gene-environment interaction. This clinical commentary reviews the characteristics and updates the epidemiology of thunderstorm asthma; examines the role of aerobiology and climate change; discusses risk factors for emergency presentations, hospital admissions, and deaths; considers latest research and predictors of thunderstorm asthma; and proposes strategies to manage and mitigate risk.

Description:This article addresses organisational governance, including perceived reputational concerns, by health data custodians as the principal barrier to timely and transparent research. Although existing literature primarily addresses ethics reviews and site-specific research approvals, our experience with a Local Hospital Network uncovered additional active barriers within this complex health system. We position these experiences in relation to literature that has documented inefficiencies in health research governance processes that lead to lost knowledge capital and opportunities for significant advancements in health systems research.

Description:Background: Globally, many pollen monitoring networks provide the community with daily pollen information, but there are limited data on health consumer uses and benefits. This research investigated why individuals in the community access pollen information, how they use it, and the perceived benefits. Methods: In- and post-pollen season surveys (2017-2018 and 2018-2019) enquired about symptoms, diagnoses, symptom management, access, benefits and usefulness of pollen information provided by the AusPollen Partnership. Open text responses were examined by thematic analysis. Theme frequency and quantitative data were compared across pollen seasons, within and after the season, and between respondents with and without access to AusPollen information. Results: Surveys were completed 4044 times by 3604 individuals who predominantly self-reported severe and frequent allergic rhinitis symptoms. Local AusPollen information was accessible to 84.6% of participants, and was reportedly used for preparation and planning (34.6%), guiding activities (32.9%), and medication decisions (28.2%). When asked how pollen information helped, similar themes were evident; but 16.1% also mentioned safety for themselves and others. However, secondary analysis of survey responses indicated that self-reported medication use did not differ between those with or without access to pollen information or between time points surveyed. Suggestions for improvement included extended duration (16.4%), wider geographic range (13.5%), and information on other taxa (17.2%). Conclusions: There was a perceived need for localised, detailed and timely pollen information by people with pollen allergy. Whilst responses suggested this helped inform behaviours linked to allergen avoidance, further education strategies on allergic rhinitis control are needed to support patients who self-manage their condition.

Description:Contemporary airborne pollen records underpin environmental health warnings, yet how pollen monitoring networks are sustained is poorly understood. This study investigated by whom and how pollen monitoring sites across the globe are managed and funded. Coordinators listed in the Worldwide Map of Pollen Monitoring Stations were invited to complete a digital questionnaire designed to survey the people and organisations involved, types, and duration of funding sources, as well as uses, purpose, and sharing of pollen information. Quantitative data were analysed by descriptive statistics and open text responses were examined by qualitative thematic analysis. Eighty-four of 241 (35%) coordinators from 37 countries responded. Universities (42%) and hospitals/health services (29%) were most commonly responsible for monitoring. Most sites involved employees (87%) in pollen monitoring, of whom many were part-time (41%) or casual (11%), as well as students (29%) and volunteers (6%). Pollen monitoring was additional to core duties for over one-third of sites (35%), and 25% reported pollen monitoring was an in-kind contribution. Whilst funding for pollen monitoring was often sourced from government agencies (33%), government research grants (24%), or non-government grants (8%), 92% reported more than 1 funding source, and 99% reported dependence on "partnerships or grants requiring co-contributions", indicating a complex resourcing structure, of short duration (median 3 years). Common reasons why airborne pollen was monitored included clinical allergy, population environmental health, aerobiology and forecasting. Climate change, research, and social duty were also referenced. Aerobiological monitoring is currently sustained by complex, insecure, and insufficient resourcing, as well as reliance on volunteerism. There are multiple direct, health-related, and other important uses of aerobiology data, that are aligned to multiple dimensions of sustainability. Evidence from this study can be used to inform the design of strategies to sustain the generation of aerobiology data.