BACKGROUND:Existing trajectory studies have emphasised large-airway indices, but chronic obstructive pulmonary disease (COPD) might originate in smaller airways. This study aimed to investigate mid-to-small-airway function trajectories, their associated factors, and COPD risk. METHODS:In this prospective cohort study, probands (referred to throughout as offspring) were recruited to the Tasmanian Longitudinal Health Study from local schools across Tasmania, Australia at age 7 years. Pre-bronchodilator mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25-75%) of offspring was measured at age 7 years as a proxy measure of mid-to-small-airway function. Parents completed a comprehensive respiratory health survey on themselves and their offspring. Offspring were followed up at mean ages of 13, 18, 45, 50, and 53 years. Follow-up included pre-bronchodilator spirometry, demographic surveys, lifestyle factors, respiratory symptoms, and illnesses. Post-bronchodilator spirometry was measured at mean ages of 45 and 53 years. Parents were later approached to complete the 2010 Tasmanian Longitudinal Health Study Parents Postal Survey, which collected information on parental preconception factors, including exposures during their own childhood and adolescence. Group-based trajectory modelling was used to identify FEF25-75% trajectories. Regression models were used to assess associations of FEF25-75% trajectories with childhood and parental preconception factors, and with COPD risk by age 53 years. FINDINGS:Between Feb 23, 1968, and Nov 8, 2016, 2314 offspring from the Tasmanian Longitudinal Health Study were included. Six FEF25-75% trajectories were identified: persistently low (144 [6·2%]); early normal-reduced growth-rapid decline (168 [7·3%]); early below average-reduced growth (740 [32·0%]); early low-accelerated growth (80 [3·5%]); average (976 [42·2%]; reference); and persistently high (206 [8·9%]). Three impaired trajectories across the lifespan were associated with COPD: persistently low (adjusted odds ratio 112 [95%CI 42-304]), early normal-reduced growth-rapid decline (41 [15-112]), and early below average-reduced growth (3·1 [1·0-9·2]) trajectories. Factors associated with impaired trajectories included no breastfeeding, the presence of asthma or wheeze, allergic rhinitis, and pneumonia or pleurisy during childhood, maternal asthma or wheeze, and parental smoking before conception. The persistently high trajectory was associated with parental preconception microbial-related exposures (ie, fathers sharing a childhood bedroom with three or more siblings and maternal cat keeping before completing puberty). INTERPRETATION:FEF25-75% across the life course, particularly from early life, could be more relevant to COPD than previously recognised. Several childhood and novel parental preconception factors were associated with FEF25-75% trajectories, although causality cannot be inferred due to no clear temporality of these associations. Our findings on the relationship between FEF25-75% and COPD should be interpreted as life-course associations rather than as predictive. As COPD was rare in the average trajectory, the magnitude of effect estimates could be inflated. FUNDING:National Health and Medical Research Council of Australia; The University of Melbourne; Clifford Craig Medical Research Trust; the Victoria, Queensland, and Tasmania Asthma Foundations; The Royal Hobart Hospital Research Foundation; Helen MacPherson Smith Trust; GlaxoSmithKline; China Scholarship Council.

BACKGROUND:The role of exposure to cow's milk formula (CMF) in the first days of life, particularly transient exposure, in the development of cow's milk allergy is unclear. OBJECTIVE:To determine whether the timing of exposure to CMF influences the risk of cow's milk sensitization and allergy at ages 1 and 6 years. METHODS:Participants were 940 children recruited into the population-based, longitudinal HealthNuts study conducted in Melbourne, Australia with linked data available on formula use in hospital. Cow's milk formula use was parent-reported via retrospective questionnaire and supplemented with linked data from the Victorian Perinatal Data Collection. We categorized exposure to CMF in the first 3 months of life as no exposure, very early transient (exposure only in the first week of life), very early persistent (exposure both during and after the first week), and early exposure (after the first week). RESULTS:Overall, 46.9% of infants (n = 398 of 849) consumed CMF in the first 3 months of life; 20.2% of infants started in the first week and continued use, 12.7% had transient use only in the first week of life, and the remaining 14.0% started after the first week of life. At age 1 year, the prevalence of cow's milk sensitization and allergy was 2.1% (17 of 822) and 0.7% (6 of 818), respectively, reducing to 0.5% (4 of 744) and 0.1% (1 of 745 at age 6 years. We found no evidence of an association between very early transient use of CMF and any allergy outcomes at ages 1 or 6 years; however, CIs were wide. In infants who had very early transient exposure to CMF compared with no exposure, the adjusted odds ratio for cow's milk allergy and cow's milk sensitization at 1 year was 1.27 (95% CI, 0.16-10.00; P = .82) and 2.23 (95% CI, 0.76-6.54; P = .14), respectively. CONCLUSIONS:Very early transient use of CMF was not associated with the risk of cow's milk allergy.

BACKGROUND:Allergic sensitization and respiratory infections are common in childhood. The "two-hit" hypothesis suggests these interact in early-life to increase risk of subsequent asthma. The "two-hit" effect on lung function, however, remains unknown. OBJECTIVE:We assessed for interactions between food allergic sensitization and respiratory infection in infancy and associations with lung function in childhood. METHODS:In a longitudinal community-based cohort, sensitization was assessed at age 1 year by skin prick testing to common food allergens. Respiratory infection was assessed via parental reports of doctor diagnosed bronchiolitis or antibiotics for lower respiratory infection in the first year of life. Regression models were fitted with interactions between these exposures to assess for associations with lung function at ages 6 and 10 years, controlling for potential confounders. RESULTS:No interaction was observed between food sensitization and lower respiratory infection in infancy on lung function at either age 6 or 10 years. Respiratory infection was associated with modest reductions in lung function at age 10 years for post-bronchodilator FEV1 in both sensitized (-0.25, 95% CI: -0.55 to 0.05 z-score units, p = .108, n = 285) and non-sensitized (-0.12, 95% CI: -0.26 to 0.02 z-score units, p = .081, n = 1179) children. Similar patterns were observed for FEV1/FVC, FVC, and FEF25-75. Associations were weaker and less consistent at age 6 years. CONCLUSION:A two-hit interaction between food sensitization and respiratory infection during infancy on subsequent lung function was not confirmed. Early-life lower respiratory infection was however associated with modest reductions in lung function at age 10 years, regardless of sensitization status.

Background and objective:Paternal passive smoke exposure before 15 years of age was associated with offspring childhood asthma, but its association with asthma beyond childhood had not been investigated. We aimed to investigate such long-term association. Methods:Data were from 1078 father-offspring and 1537 mother-offspring pairs from the Tasmanian Longitudinal Health Study. Offspring (probands of the original cohort) completed asthma surveys at age 7, 13, 18, 30, 43, 50 and 53 years. Life-course asthma trajectories were developed using group-based trajectory modelling. Parents self-reported their own passive smoke exposure before 15 years of age. Multinomial logistic regressions assessed associations between parental passive smoke exposure and offspring asthma trajectories. Active parental smoking, offspring sex, childhood respiratory illnesses and subsequent active smoking were evaluated for mediations and interactions. Results:Paternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory (adjusted multinomial odds ratio (aMOR) 2.53, 95% CI 1.09-5.85) in offspring, but not persistent asthma trajectories. Maternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory in offspring who were also exposed to childhood passive smoke (aMOR 4.30, 95% CI 1.01-18.40; p-interaction=0.044). The observed associations were partly mediated through active parental smoking or offspring childhood respiratory illnesses (each <10%). Conclusions:This study identified a novel association between parental passive smoke exposure before 15 years of age and an early-onset adult-remitting asthma trajectory in offspring, which is related to subsequent COPD. These findings suggest that in parents inevitably exposed to passive smoke during childhood/puberty, asthma risk in future generations associated with such exposure may be lower if parents avoid smoking around children.

INTRODUCTION:Paternal prepubertal passive smoke exposure may increase the risk of childhood asthma. However, its association with impaired lung function trajectories at risk of chronic obstructive pulmonary disease in offspring was not investigated. We assessed the association between paternal prepubertal passive smoke exposure and lung function from childhood to middle age in their offspring. METHODS:Data were analysed from 890 father-offspring pairs from the Tasmanian Longitudinal Health Study. The offspring were probands in the original cohort who underwent spirometry at six time points from ages 7 to 53 years. Lung function (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC) trajectories were previously derived using group-based trajectory modelling. Fathers reported their own passive smoke exposure before age 15 years. Multinomial logistic regressions assessed associations between paternal prepubertal passive smoke exposure and lung function trajectories in offspring. Potential mediations and interactions were assessed for active paternal smoking, offspring passive smoke exposure and respiratory illnesses during childhood, and subsequent active smoking. RESULTS:Paternal prepubertal passive smoke exposure was associated with the below average FEV1 (adjusted multinomial OR (aMOR) 1.56; 95% CI 1.05 to 2.31) and early low-rapid decline FEV1/FVC trajectories (aMOR 2.30; 95% CI 1.07 to 4.94) in offspring. The association with the below average FEV1 trajectory was augmented for offspring exposed to childhood passive smoke (aMOR 2.36; 95% CI 1.34 to 4.13; p-interaction=0.053). Observed associations partly mediated through smoking and respiratory illnesses in fathers and offspring (each contributing <15%). CONCLUSIONS:Paternal prepubertal passive smoke exposure was associated with impaired lung function trajectories in offspring, which highlights the adverse impact of smoking on multiple generations.

Importance: Egg allergy is among the most common food allergies in infants. Allergy prevention guidelines have been updated globally based on evidence that earlier egg introduction reduces the risk of egg allergy, and these guidelines have been adopted widely. However, the association of this guideline change with the prevalence of egg allergy is unclear. Objective: To estimate the change in population prevalence of egg allergy after a guideline update recommending earlier introduction of egg into the infant diet. Design, Setting, and Participants: This cross-sectional study included infants aged 11 to 15 months in 2 population-based samples, recruited using identical methods when attending their 12-month immunization visit at immunization centers in Melbourne, Australia, before (2007-2011) and after (2018-2019) an update to allergy prevention guidelines. To isolate an association between a change in prevalence of egg allergy and the guideline change, direct regression standardization was used to estimate prevalence in the 2018-2019 sample had the distribution of known risk factors remained the same as in the 2007-2011 sample. Multiple imputation was used to address missing data. Prespecified subgroup analyses were conducted for infants with early eczema and stratified by parent country of birth. Data were analyzed between March 2025 and March 2026. Exposures: Data on demographics, food allergy risk factors, egg introduction, and reactions were collected via questionnaires. Main Outcome and Measures: Infants underwent skin prick tests to egg, and those with positive results underwent oral food challenges. Results: A total of 7209 of 9500 eligible infants were included from 2 cohorts: 5276 infants (median [IQR] age, 12.4 [12.2-12.9] months; 50.8% [2665 of 5244] males; response rate, 76% [5276 of 6957]) from the 2007-2011 cohort and 1933 infants (median [IQR] age, 12.5 [12.2-13.0] months; 51.8% [1001 of 1932] males; response rate, 76% [1933 of 2543]) from the 2018-2019 cohort. The median (IQR) age at egg introduction decreased from 8 (6-10) months in 2007-2011 to 6 (6-8) months in 2018-2019. After adjusting for known allergy risk factors, the prevalence of egg allergy decreased from 9.2% in 2007-2011 to 7.6% in 2018-2019 (adjusted absolute difference, -1.6 [95% CI, -3.3 to -0.005] percentage points). In infants with early eczema, egg allergy decreased from 34.6% to 21.9% (adjusted absolute difference, -12.7 [95% CI, -20.0 to -5.4] percentage points). Conclusions and Relevance: This study provides population-level evidence that updated infant feeding guidelines recommending earlier introduction of egg led to measurable reductions in the population prevalence of egg allergy. The findings suggest that guideline updates informed by randomized trial evidence may be associated with a reduction in food allergy prevalence when implemented effectively.

Allergic rhinitis imposes a substantial clinical and socioeconomic burden globally. While symptomatic pharmacotherapy such as oral antihistamines and intranasal corticosteroids offers temporary relief, allergen immunotherapy provides disease-modifying benefits but requires higher upfront costs. This systematic review synthesises cost-effectiveness evaluations of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) compared to symptomatic pharmacotherapy (SP). A systematic search of electronic databases was undertaken, identifying 35 eligible economic evaluations. Due to methodological heterogeneity, a narrative synthesis was performed. Thirty-two evaluations (91%) concluded that allergen immunotherapy represents a cost-effective intervention, with incremental cost-effectiveness ratios predominantly falling below jurisdictional willingness-to-pay thresholds. Both SCIT and SLIT demonstrated economic value, particularly in patients with co-morbid asthma and when models incorporated sustained post-treatment benefits. Future clinical research should prioritise endpoints that facilitate direct estimation of health utility. Despite diverse healthcare settings and modelling approaches, the evidence supports allergen immunotherapy (AIT) as an economically rational investment. Policymakers should utilise these findings to inform reimbursement decisions. Trial Registration: PROSPERO registration number: CRD42024530911.

BACKGROUND:Atopic dermatitis (AD) significantly impacts quality of life, with well-documented physical and psychological consequences. While disease burden is well characterised, the influence of psychosocial determinants on AD outcomes remains underexplored. This study examines these factors in an Australian paediatric population. OBJECTIVES:To investigate whether children from populations at risk of health inequities-such as those from rural areas, culturally diverse backgrounds, First Nations communities, socioeconomically disadvantaged postcodes, those with neuropsychiatric conditions and 'Vulnerable' children (defined as those under state or relative care or with a history of familial abuse or neglect)-experience more severe disease. METHODS:This retrospective cross-sectional study included children ≤ 16 years with confirmed AD attending a tertiary paediatric referral centre in Melbourne (Aug 2022-Aug 2023). Risk factors were defined by social determinants of health, including economic, cultural and geographic influences. Disease outcomes (severity, hospitalisations, emergency department visits treatment patterns) were analysed using univariate and multivariate methods. A total of 454 at-risk children were compared to 454 controls. RESULTS:Children from at-risk groups were more likely to have severe AD (43.8% vs. 28.3%, p < 0.001), higher annual rates of hospital admissions, increased antibiotic use, and greater prednisolone use for flares (p < 0.001). Multivariate analysis revealed significantly higher odds of severe AD (aMOR 4.72, p < 0.001) and hospitalisation (aIRR 2.73, p < 0.001) in the at-risk cohort. CONCLUSION:Psychosocial determinants of health are associated with increased AD severity and healthcare use in children. These findings highlight the need for targeted, equity-focused interventions to reduce disparities in AD care in Australia.

BACKGROUND:Food allergy affects families' quality of life, can be lifelong and life-threatening, urging the identification of early modifiable risk factors. Formula feeding in the first days of life may increase the risk of cow's milk allergy, a risk often attributed to cow's milk allergens exposure. Early formula feeding also reduces the colostrum intake, the first 3 days' milk, which is rich in bioactive compounds critical for immune and gut health. This study investigates whether partial colostrum feeding increases the risk of food allergy beyond cow's milk. METHODS:Data from 666 mother-infant pairs in the Australian ORIGINS cohort categorised neonates as exclusive colostrum-fed (ECF, only breastmilk) or partial colostrum-fed (PCF, formula plus breastmilk) within the first 3 days. IgE-mediated food allergy (egg, peanut, cow's milk, cashew) at 12-18 months was determined by skin prick tests and maternal-reported immediate reactions to allergens. RESULTS:PCF prevalence was 46%. PCF infants showed an increased risk of peanut allergy [aOR (95% CI) 4.47 (1.04-19.12)] and multiple food allergies [aOR 11.44 (1.48-88.55)] compared to ECF infants. Risk was greater in PCF infants with later (> 7 M) peanut introduction [aOR 5.45 (1.18-25.11)], while ECF infants maintained a low risk regardless of timing. To disentangle the effect of reduced colostrum intake from formula feeding in PCF infants, we analysed the association between the number of colostrum feeds and allergic outcomes. No peanut allergy cases occurred in infants receiving nine or more colostrum feeds per day within their first 72 h, regardless of formula feeding. CONCLUSION:Partial colostrum feeding may be an overlooked risk factor for peanut and multiple food allergies. With over a third of neonates globally partially colostrum-fed, findings highlight the importance of promoting colostrum feeding and exploring colostrum-based therapies for high-risk infants.

ABSTRACTBackground and ObjectiveThe impact of lifetime body mass index (BMI) trajectories on adult lung function abnormalities has not been investigated previously. We investigated associations of BMI trajectories from childhood to mid‐adulthood with lung function deficits and COPD in mid‐adulthood.MethodsFive BMI trajectories (n = 4194) from age 5 to 43 were identified in the Tasmanian Longitudinal Health Study. Lung function outcomes were defined using spirometry at 45 and 53 years. Associations between these BMI trajectories and lung function outcomes were investigated using multivariable regression.ResultsCompared to the average BMI trajectory, the child's average‐increasing BMI trajectory was associated with greater FVC decline from 45 to 53 years (β = −178 mL; 95% CI −300.6, −55.4), lower FRC, ERV and higher TLco at 45 years, lower FVC (−227 mL; −345.3, −109.1) and higher TLco at 53 years. The High BMI trajectory was also associated with lower FRC, ERV and higher TLco at 45 years, while spirometric restriction (OR = 6.9; 2.3, 21.1) and higher TLco at 53 years. The low BMI trajectory was associated with an obstructive picture: lower FEV1 (−124 mL; −196.4, −51.4) and FVC (−91 mL; −173.4, −7.7), and FEV1/FVC (−1.2%; −2.2, −0.1) and higher ERV and lower TLco at 45 and 53 years. A similar pattern was found at 53 years. No associations were observed with spirometrically defined COPD.ConclusionOur findings revealed contrasting lung function abnormalities were associated with high, subsequently increasing, and low BMI trajectories. These results emphasise the importance of tracking changes in BMI over time and the need to maintain an average BMI trajectory (BMI‐Z‐score 0 at each time point) throughout life.

Background: Skin lipids are crucial components of the skin barrier. Individuals with atopic dermatitis (AD or eczema) have a different skin lipid profile from those without. However, whether altered skin lipids precede and predict the subsequent risk of AD remained unclear, especially for different AD phenotypes. Objective: We sought to examine the relationship between skin lipids and subsequent AD and AD phenotypes in infants. Methods: Skin lipids from the forearms of 133 infants with family history of allergic disease were sampled using tape strips at age 6 weeks. Lipids were quantified using liquid chromatography-tandem mass spectrometry. AD by age 1 year was diagnosed using modified UK Working Party Criteria. Allergic sensitization was assessed using skin prick tests. Associations and predictive discrimination were estimated using univariable logistic regression. Potential causation was explored using multivariable logistic regression. Results: Reduced levels of 6 protein-bound v-hydroxyl sphingosine (POS) ceramides with C30 and C32 fatty acids at 6 weeks were associated with increased risk of AD by age 1 year. In univariate models, a number of POS ceramides predicted subsequent AD, such as PO30:0-C20S (area under the curve, 0.65; 95% CI, 0.55-0.75). After confounderswere adjusted, only PO30:0-C20S was associated with AD (adjusted odds ratio, 0.62; 95% CI, 0.39-0.96 per 1-SD increase), and a trend for AD without sensitization (adjusted odds ratio, 0.57; 95% CI, 0.31-1.05) but not ADwithsensitization (adjustedodds ratio, 0.76; 95% CI, 0.39-1.47). Conclusions: Reduced levels of POS ceramides are associated with the development of nonatopic AD, suggesting that these lipids may play a role in the pathogenesis of AD and may be useful predictive biomarkers. Interventions that increase POS ceramides may reduce the incidence of AD.

Background: Life-course lung function trajectories leading to airflow obstruction, as measured by impaired FEV1/FVC (forced vital capacity), precede the onset of chronic obstructive pulmonary disease (COPD). We aimed to investigate whether individuals on impaired FEV1/FVC trajectories have an increased burden of respiratory symptoms, including those who do not meet the spirometric criteria for COPD. Methods: We analysed serial life-course data from two population-based cohort studies separately, which included respiratory symptoms and spirometry: the Tasmanian Longitudinal Health Study (TAHS, Australia) cohort was recruited at age 6-7 years and followed up until middle age (mean age 53 years; range 51-55); and the Coronary Artery Risk Development in Young Adults (CARDIA, USA) cohort was recruited at a mean age of 25 years (range 18-30) and followed up to a mean age of 55 years (range 47-64). Participants' symptom profiles at ages 53 and 55 years were derived by latent class analysis. Symptom profiles were compared across pre-bronchodilator FEV1/FVC trajectories derived by group-based modelling, then restricted to those without COPD defined by post-bronchodilator airflow obstruction (FEV1/FVC <5th percentile) at ages 51-55 years and 47-64 years. Findings: Six FEV1/FVC trajectories previously derived for TAHS were replicated in CARDIA. Optimal models identified five symptom profiles in TAHS (n=2421) and six in CARDIA (n=3153). For both cohorts, the most impaired FEV1/FVC trajectory (early low, rapid decline in TAHS; low peak, rapid decline in CARDIA) was associated with predominant wheeze (multinomial odds ratio [mOR] 671 [95% CI 410-1090] in TAHS and 990 [452-2170] in CARDIA) and nearly all respiratory symptoms (495 [252-974] and 1480 [597-3660]) at age 51-55 years in TAHS and age 47-64 years in CARDIA, compared with the average trajectory. Among individuals belonging to the three most impaired trajectories, the associations with predominant wheeze increased with worsening FEV1/FVC impairment and persisted when considering only those without spirometry-defined COPD. Additionally, for those belonging to the two rapid decline trajectories, both wheezing and usual phlegm or bronchitis were reported by 54 (20%) of 265 participants younger than 14 years in TAHS and by 31 (25%) of 123 participants aged 30 years or younger in CARDIA. Interpretation: In two independent cohorts that collected similar data, people on impaired FEV1/FVC trajectories often had a longstanding history of both wheeze and phlegm or bronchitis, and wheeze was the predominant symptom in individuals aged 47-64 years among those who had not already progressed to COPD.

Background and objectives While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. Methods Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. Results The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. Conclusions Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

BACKGROUND AND AIMS:Multiple myeloma (MM) is responsible for significant morbidity and mortality, yet our knowledge regarding MM aetiology remains limited. We investigated whether a history of allergic conditions is associated with MM risk. METHODS:Incident cases (n = 782) of MM were recruited via cancer registries in Victoria and NSW. Controls (n = 733) were siblings (n = 436) or spouses (n = 297) of cases. Unconditional logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for associations between self-reported allergic conditions (asthma, eczema, food allergy, hay fever) and MM risk. RESULTS:Eczema was inversely associated with MM risk (OR = 0.54, 95 %CI = 0.42-0.70), as was a combined history of food allergy and eczema (OR = 0.52, 95 %CI = 0.29-0.93). There was an inverse association between a history of any allergic condition (compared with none) and risk of MM (OR = 0.68, 95 %CI = 0.55-0.84). In the mean-centred dose-risk analysis the OR was 0.87 (95 %CI = 0.73-1.04) per additional allergic condition of interest. No notable associations were identified for food allergy, asthma, or hay fever alone. CONCLUSIONS AND FUTURE DIRECTIONS:We found that a history of allergic disease, particularly eczema, was associated with reduced MM risk. Further research is recommended to confirm findings and investigate potential mechanisms.

Background: Allergic rhinitis (AR) is a highly prevalent condition associated with significant morbidity globally. Few recent studies have detailed the experiences of sufferers and explored their perspectives of treatment options. Allergen immunotherapy (AIT) is an effective treatment option that remains underused in eligible patient populations. Objective: We sought to describe patient perspectives of AR and treatment options including AIT. Methods: Twenty-five semistructured interviews were conducted with adult participants at a tertiary hospital center in Sydney, Australia. Authors used an inductive thematic analysis methodology to code and interpret the data. Results: Three major themes emerged from the qualitative thematic analysis: (1) a prolonged journey with symptoms, (2) multiple trials of therapy with incomplete symptom control, and (3) diverse experiences with AIT. Several subthemes were identified: (1) delays to diagnosis and management, (2) underestimating the impact of symptoms, (3) substantially impaired quality of life, (4) limited efficacy of symptomatic pharmacotherapy, (5) perceptions of tolerance and dependence, (6) motivations to access AIT, (7) diverse expectations of AIT, and (8) barriers to AIT access. Conclusions: Sufferers of AR experience an impactful symptom journey, with many achieving inadequate disease control despite symptomatic pharmacotherapy. The uptake of AIT is constrained by direct medication costs, insufficient public awareness, and limited prescriber availability. The findings of this study offer insights for health care professionals and policymakers to formulate strategies to enhance AR management and improve AIT access for eligible patients.