Neutrophilic asthma (NA) is an inflammatory phenotype of asthma, characterized by predominantly neutrophilic infiltrations in bronchial mucosa. It is usually diagnosed on the basis of high neutrophil count in induced sputum (from >40% to >76%) with low eosinophils (<2%). The prevalence of NA ranges from 16% to 28% of the adult asthma population depending on the definitions and study methods applied. A clinical picture of NA is characterized by late onset of symptoms, higher exacerbation rate, lower level of symptoms control, and poorer response to steroids compared to eosinophilic phenotype. Comorbidities such as obesity and GERD as well as the influence of environmental factors (air pollution, smoking, bacterial infections) contribute to the development and severe course of the disease. NA is T2-low disease with predominantly Th1/Th17-type inflammation. Neutrophils are key cells responsible for initiating and sustaining inflammation. In addition to their primary functions like phagocytosis, degranulation, and NETosis, neutrophils release several pro-inflammatory cytokines (IL-1α, IL-1β, IL-6, TNF) and chemokines (CXCL-1, -2, -8, -9, -10) responsible for the recruitment of other neutrophils or T cells. Increasing knowledge about the biology of neutrophiles and their role in asthma results in new potential therapies that could improve control of NA, particularly new biologicals targeting Th1/Th17-related cytokines. In this review, we discuss the prevalence, mechanisms, and clinical features of neutrophilic asthma. Furthermore, current therapeutic options and some promising perspectives for the near future are presented.

Background: Several strategies such as premedication or allergologic work-up have been used to facilitate safe iodinated contrast media (ICM) application. The aim of this study was to assess the negative predictive value of skin tests and complete allergologic work-up with iodinated contrast media in real-life settings. Methods: We retrospectively enrolled 210 patients with a history of immediate hypersensitivity reactions to ICMs. The stepwise protocol of selecting safe ICMs included skin prick tests (SPTs), intracutaneous tests (ICTs), and intravenous drug provocation tests (DPTs). The tests were performed with one or more of the following medications: iohexol, iodixanol, iomeprol, iopromide, and ioversol. At least 6 months after selecting safe ICMs, a telephone follow-up was scheduled. Based on this data, negative predictive values of skin tests and the whole work-up were calculated. Results: Overall, we obtained the following rates of positive tests: SPT—12% (55/441); ICT—10% (40/383); and DPT—5% (10/195). The highest rates of positive work-ups were found in patients tested within 1 year after the reaction and patients with a history of urticaria/angioedema after ICMs. The skin tests and DPTs determined a safe ICM in 184/210 (87%) patients. The negative predictive value of skin tests in reference to DPTs in hospital settings was 95%. Finally, a telephone follow-up demonstrated that 75/184 participants (41%) had been given the recommended ICM, including 68 cases (37%) with no subsequent hypersensitivity reaction and 7 (4%) with a reaction. The negative predictive value of allergologic work-up consisting of SPTs, ICTs and DPTs in real-life settings was 90%. Conclusions: Skin tests and intravenous drug provocation tests with ICMs are characterised by high negative predictive value, and enable the determination of safe ICMs for most patients.

Background: Beta-lactam antibiotic allergy is one of the most frequently reported drug hypersensitivities. True allergy is rarely confirmed. Inaccurate labeling leads to unnecessary avoidance of beta-lactams, antimicrobial resistance, and increased healthcare costs. Delabeling is mainly evaluated using electronic databases, whereas patient perceptions, quality of life, and real-world barriers remain uncertain. Methods: This cross-sectional, questionnaire-based study included 96 adults with a reported history of beta-lactam hypersensitivity: 46 after successful specialist delabeling and 50 before specialist evaluation. Structured telephone interviews assessed diagnostic pathways, perceived correctness of diagnosis or exclusion, confidence in beta-lactam safety, antibiotic use, and symptom recurrence. Quality of life was assessed using the WHOQOL-BREF questionnaire. Results: Perceived safety of beta-lactam antibiotics was significantly higher in the delabeled group than in the non-delabeled group (7.37 vs. 2.40; p < 0.001). WHOQOL-BREF scores were similar between groups, except for a small difference in the Environment domain, favoring delabeled (p = 0.029) patients. Among delabeled patients, 57% required antibiotics during follow-up; of these, 65% received beta-lactams. In 35% of cases with an indication, physicians withheld beta-lactams despite documented delabeling. Self-reported mild cutaneous symptoms occurred in 18% of patients re-exposed to beta-lactam antibiotics despite delabeling; the significance of this finding needs to be assessed in the future. Conclusions: Patients who underwent beta-lactam allergy delabeling reported greater perceived safety regarding the use of beta-lactam antibiotics, while no significant differences in quality of life were observed. Persistent reluctance among patients and physicians may, however, limit the real-world benefits of delabeling.