Abstracts of the 8th Congress of the Romanian Rhinologic Society

The correct diagnosis of allergic rhinitis (AR) and allergic asthma (AA) is paramount for implementing personalised management strategies such as measures to control environmental exposure, making informed life choices (e.g.hobbies, place of residence and pet keeping), and determining the indication for allergen immunotherapy (AIT) or biologicals.Until recently, the allergic phenotype has been largely synonymous with IgE-mediated pathways, under the umbrella of a type 2 (T2) immune response.However, substantial evidence demonstrates that allergens can trigger inflammation through several IgE-independent pathways, such as epithelial barrier dysfunction and activation, recruitment of innate lymphoid cells, and T1 and T3 immune responses.Thus, it is logical to describe AR and AA as extremely heterogeneous in terms of molecular phenotypes and acknowledge the inclusion of individuals without specific IgE (sIgE), or without predominant T2 inflammation.The recently published EAACI Nomenclature for Allergic Diseases provides a new mechanistic framework for the definition and conceptualization of AR and AA.Currently, the diagnosis of AR and AA relies largely on the demonstration of "IgE sensitisation" combined with a history that reflects the impact of aeroallergen exposure on disease symptoms and control."IgE sensitisation" is defined by a positive skin prick test and/or the detection of serum sIgE.However, these tests are not tailored to the immunobiology of the IgE isotype.Furthermore, the concept of "IgE sensitization" does not capture the complexity of the immune-inflammatory mechanisms elicited by allergens.Clinical history can also fail to capture the impact of allergen exposure on disease symptoms and control, especially in more severe cases where multiple triggers are involved.Thus, patients in whom the clinical history is doubtful regarding the relevance of allergen exposure, who remain insufficiently controlled, and/or who can be expected to obtain clinical benefit from specific interventions for AR and AA (both pharmacological or non-pharmacological) should be considered for allergen challenge testing.Allergen challenge tests are meant to reproduce the response of the airway mucosa to an allergen in a controlled manner.A nasal or ocular allergen challenge is recommended as the first step to investigate the clinical relevance of allergen exposure due to their excellent safety profile.These tests induce both early and late responses (up to 48 hours), thus being appro-