Prize Winning Abstracts From the BSACI 2025 Meeting

The annual British Society of Allergy and Clinical Immunology (BSACI) conference was held at the International Convention Centre (ICC), Wales from 16 to 18 October 2025. This year, the Barry Kay Award, which recognises Professor Kay's national and international research contributions to the field of allergy and asthma that inspired so many young Allergists and Respiratory scientists, was awarded for the best abstracts in the Primary Care, Allied Health, Adult Clinical, Medical Student, Basic Science, Paediatric Allergy Services and Paediatric Clinical categories. Here, the award recipients summarise their research findings. Adrenaline Auto-Injector Prescribing in Primary Care in England: An Analysis of Non-Standard Dosing Adrenaline auto-injectors (AAIs) are the recommended first-line treatment for anaphylaxis in the community, with doses of 150 mcg or 300 mcg based on patient weight [1]. Currently, no standardised mechanisms exist in primary care to transition patients onto the higher 300 mcg dose when they reach the weight threshold of 25–30 kg. The NHS Business Services Authority Data Science team and collaborators analysed NHS community prescription data (December 2022–2024) dispensed in England to identify non-standard AAI prescribing, defined as patients likely over the weight threshold still receiving the 150 mcg dose. Weight was estimated using age-based models and compared to device-specific switching thresholds. We also examined prescribing patterns in relation to geographic deprivation. Of 46,999 patients identified as having been prescribed 150 mcg AAIs, 1747 (3.7%) to 9480 (20.2%) may have exceeded the recommended weight threshold depending on the growth centiles used. Using the Resuscitation Council UK guideline of switching doses at age 6, the rate of non-standard dosing rises to 23,059 patients (49.1%). Estimated rates of non-standard AAI prescribing were higher in areas of England with most deprivation. These findings suggest underdosing of AAIs is not uncommon. Healthcare professionals should review whether patients at risk of anaphylaxis are prescribed the appropriate dose based on weight. Dietary Outcomes Following Oral Immunotherapy for Cow's Milk Allergy: Results From the SOCMA Study Cow's milk oral immunotherapy (CM-OIT) is increasingly offered to treat cow's milk (CM) allergy, to increase the amount of CM protein that can be consumed and so reducing dietary restrictions [2]. There are limited data describing dietary behaviours following CM-OIT. We explored dosing and dietary behaviours of children in the second year of CM-OIT within the SOCMA study (improving the safety of oral immunotherapy for CM allergy NCT02216175). Structured telephone interviews at 15- and 24-month post-treatment assessed dairy intake, allergic reactions, and health-related quality of life (HRQL). Most participants maintained daily CM dosing and had tried yoghurt, cheese, baked milk and other milk-containing foods; however, variety and frequency of inclusion remained limited. Over 50% reported taste aversion, fear of allergic reactions and neophobia, which was reflected in participants perceptions of dairy. A trend towards a reduced range of dairy foods was observed over time. FAQLQ scores were significantly improved at both follow-up points compared with baseline. Although most participants continued maintenance intake and demonstrated improved HRQL, dietary expansion remained restricted when intake was self-directed. Ongoing, individualised dietetic support within a multidisciplinary team in maintenance phase of CM-OIT may support better long-term dietary and patient-reported outcomes. Desensitisation Therapy in Food Pollen Allergy Syndrome: A Literature Review and Evidence Appraisal Food pollen allergy syndrome (FPAS) is increasingly recognised as a cause of oral allergy symptoms triggered by cross-reactive pollen and food proteins, yet treatment options remain limited. This review critically evaluated the quality of evidence supporting desensitisation therapies for FPAS management. A systematic search identified eight eligible studies published between 2014 and 2024, comprising five randomised controlled trials and three systematic reviews. Oral immunotherapy with apple was the most studied intervention, with up to 63% of participants achieving tolerance to raw apple after 8 months, compared with none in placebo groups. Sublingual immunotherapy using recombinant Mal d 1 allergen significantly reduced oral symptoms, with overall moderate-certainty evidence for food-targeted desensitisation. In contrast, birch pollen allergen immunotherapy showed inconsistent efficacy and low-quality evidence. Food-specific desensitisation represents a promising, though still experimental, therapeutic strategy for FPAS. Further large-scale, high-quality trials are needed to confirm long-term benefits and establish its role in clinical practice. Diagnostic Accuracy of Independent Guidance for Detecting Cow's Milk Allergy in the FAIR Cohort Cow's milk allergy (CMA) affects ~1% of infants, but CMA overdiagnosis is common [3, 4]. We evaluated the performance of recent Delphi Consensus guidance, which aims to reduce CMA overdiagnosis. This guidance looks at the temporal relationship between symptoms and cow's milk protein (CMP) ingestion. Key criteria are symptom reproducibility, that is, symptoms occurring every time CMP is ingested, and symptom specificity, meaning that symptoms do not occur when cow's milk is avoided. We conducted secondary analysis of the Isle of Wight Food Allergy and Intolerance Research prospective birth cohort of 918 infants followed for a year. We mapped the Delphi guidance to the symptom diaries at 3, 6, 9 and 12 months to classify whether CMA was suspected by the Delphi. We were then unblinded to the true CMA status (21 IgE or non-IgE CMA, 889 no CMA) and the diagnostic accuracy of the Delphi guidance was calculated. The Delphi guidance classified 78 (19 CMA) infants as having possible CMA. This compared with 212 (13 CMA) using CoMiSS and 874 (21 CMA) using iMAP. These findings suggest CMA detection in infants should focus on identifying reproducible, specific symptoms related to direct cow's milk exposure. RGS12 as a Molecular Brake on Airway Smooth-Muscle Remodelling in Asthma Airway smooth muscle (ASM) hypercontractility and structural remodelling are central features of asthma and major contributors to steroid-resistant disease. This study, carried out by Dr. Palavilayil, Dr. Shaikh and colleagues under the guidance of Dr. Fernandes, investigated the role of regulator of G-protein signalling 12 (RGS12) in maintaining ASM homeostasis. Using ASM-specific RGS12 knockout models and in vitro assays, loss of RGS12 was linked to disrupted intracellular calcium oscillations, reduced cAMP regulation and increased ASM proliferation, producing a phenotype consistent with airway hyperresponsiveness. RGS12 expression decreased following IL-13 stimulation, with only partial recovery after dexamethasone treatment, suggesting a link to steroid resistance. Increased expression of α-SMA and versican, both markers of airway wall thickening and extracellular-matrix deposition, indicated enhanced structural remodelling in RGS12-deficient tissue. Overall, RGS12 appears to act as a protective regulator that integrates calcium and G-protein signalling to stabilise ASM function. These findings highlight RGS12 as a potential molecular target to limit airway remodelling and improve outcomes in severe asthma. Allergy Care for All? Mapping Social Gradients in Paediatric Allergy Services Despite the NHS commitment to equitable care, allergy pathways are not evenly accessed across socioeconomic groups. Additionally, most allergy research focuses on biomedical or environmental topics while socioeconomic patterns only account for approximately 5% of published research. This study examined whether patients attending a tertiary paediatric allergy centre accurately represented the broader populations socioeconomic distribution, by mapping patient postcodes to the Index of Multiple Deprivation across several domains. Overall deprivation patterns revealed underrepresentation of the most deprived families, as well as those in the highest deciles (6% instead 12% in IMD decile 1; and 27% vs. 65% in deciles 7–10). Analysis of specific domains revealed complex gradients: while income showed relatively normal distribution (52% in deciles 1–4), education was markedly skewed towards higher deciles (73% in deciles 6–10), and housing showed concentration in lower deciles (71% in deciles 1–3). Peak attendance occurred in ages 5–9 years among families with poor housing. These findings suggest housing emerges as a key disadvantage marker in London, while educational attainment may enable better navigation of referral systems. The study highlights the need for proactive outreach to deprived communities, improved primary care referral equity and environmental health collaboration with local authorities. Are Milk Ladders Created Equal? A Biochemical Analysis of Milk Ladder Foods Milk ladders are widely used to support the (re)introduction of milk in the diets of milk-allergic children, progressing from extensively heated to unheated forms [5-7]. These ladders have been devised based on theoretical estimates of milk protein content and the assumed impact of heat-treatment and matrix effects on allergenicity. However, the ‘ladder steps’ lack quantification and standardisation, especially regarding the amount of specific milk proteins at each step; this is important to maximise safety. This study provides a biochemical analysis of foods used in milk ladders, examining the presence of total and specific milk proteins, including β-lactoglobulin, β-casein and total caseins. Caseins are of particular importance, as IgE to casein has been identified as a marker for persistent milk allergy and baked milk reactivity. Our findings revealed discrepancies between the assumed order of some foods and their actual protein content per portion, highlighting potential mismatches between estimated and actual allergen exposure. Based on these findings, we proposed a modified milk ladder that sequentially increases exposure to clinically relevant milk proteins for pre-defined portion sizes. Using biochemical data to inform clinical practice, this work aims to improve safety and effectiveness of milk ladders to reduce dietary restrictions in children with milk allergy. M.H.S. and R.J.B. conceived the manuscript. R.J.B. reviewed and edited the final draft. The authors declare no conflicts of interest.