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Sastre, JoaquinAuthor

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March 20, 2023
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EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities

Publicated to:Allergy. 77 (6): 1667-1684 - 2022-06-01 77(6), DOI: 10.1111/all.15203

Authors: Agache, Ioana; Antolin-Amerigo, Dario; de Blay, Frederic; Boccabella, Cristina; Caruso, Cristiano; Chanez, Pascal; Couto, Mariana; Covar, Ronina; Doan, Serge; Fauquert, Jean-Luc; Gauvreau, Gail; Gherasim, Alina; Klimek, Ludger; Lemiere, Catherine; Nair, Parameswaran; Ojanguren, Inigo; Peden, David; Perez-de-Llano, Luis; Pfaar, Oliver; Rondon, Carmen; Rukhazde, Maia; Sastre, Joaquin; Schulze, Johannes; Silva, Diana; Tarlo, Susan; Toppila-Salmi, Sanna; Walusiak-Skorupa, Jolanta; Zielen, Stefan; Eguiluz-Gracia, Ibon;

Affiliations

Aix Marseille Univ, Dept Resp CIC Nord INSERMINRAE C2VN, Marseille, France - Author
ALYATEC Environm Exposure Chamber, Strasbourg, France - Author
Ctr Integre Univ Sante & Serv Sociaux Nord Lile M, Res Ctr, Montreal, PQ, Canada - Author
Ctr Rhinol & Allergol, Wiesbaden, Germany - Author
Dalla Lana Dept Publ Hlth, Toronto, ON, Canada - Author
EPE, Serv Imunoalergol, Ctr Hosp Sao Joao, Porto, Portugal - Author
Fdn Adolphe De Rothschild, Paris, France - Author
Goethe Univ Hosp, Dept Children & Adolescents, Div Allergol Pulmonol & Cyst Fibrosis, Frankfurt, Germany - Author
Helsinki Univ Hosp, Hosp Dist Helsinki & Uusimaa, Skin & Allergy Hosp, Haartman Inst,Med, Helsinki, Finland - Author
Hosp CUF Descobertas, Ctr Alergia, Lisbon, Portugal - Author
Hosp Univ Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria, Serv Alergia, Madrid, Spain - Author
Inst Salud Carlos III, Ctr Biomed Network Resp Dis CIBERES, Allergy Unit, Hosp Univ Fdn Jimenez Diaz, Madrid, Spain - Author
IRCCS, Allergy Unit, Fdn Policlin A Gemelli, Rome, Italy - Author
McMaster Univ, Dept Med, Div Respirol, Hamilton, ON, Canada - Author
McMaster Univ, Dept Med, Firestone Inst Resp Hlth, St Josephs Healthcare, Hamilton, ON, Canada - Author
Natl Jewish Hlth, Pediat, Denver, CO USA - Author
Nofer Inst Occupat Med, Dept Occupat Dis & Environm Hlth, Lodz, Poland - Author
Philipps Univ Marburg, Univ Hosp Marburg, Dept Otorhinolaryngol Head & Neck Surg, Sect Rhinol & Allergy, Marburg, Germany - Author
Teaching Univ Geomedi LLC, Ctr Allergy & Immunol, Tbilisi, Georgia - Author
Transylvania Univ, Fac Med, Brasov, Romania - Author
Univ Autonoma Barcelona UAB, Dept Med, Serv Pneumol,CIBER Enfermedades Respiratorlas CIB, Hosp Univ Vall dHebron,Inst Recerca VHIR, Barcelona, Spain - Author
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Cardiovasc & Thorac Sci, Rome, Italy - Author
Univ Helsinki, Helsinki, Finland - Author
Univ Hosp Lucus Augusti, Dept Resp Med, Lugo, Spain - Author
Univ Hosp, Clermont Ferrand, France - Author
Univ Malaga, Inst Invest Biomed Malaga IBIMA, Hosp Reg, Allergy Unit, Malaga, Spain - Author
Univ Montreal, Fac Med, Montreal, PQ, Canada - Author
Univ N Carolina, Div Pediat Allergy & Immunol, Ctr Environm Med Asthma & Lung Biol, Sch Med, Chapel Hill, NC USA - Author
Univ Porto, Fac Med, Dept Pathol, Basic & Clin Immunol Unit, Porto, Portugal - Author
Univ Strasbourg, Strasbourg Univ Hosp, Chest Dis Dept, ALYATEC Environm Exposure Chamber, Strasbourg, France - Author
Univ Toronto, Dept Med, Toronto Western Hosp, Univ Hlth Network,Resp Div, Toronto, ON, Canada - Author
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Abstract

Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE-sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate-to-severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite-driven AA and with FEV1 >= 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long-term and costly management pathways.

Keywords

allergic asthmaallergy diagnosisbronchial allergen challengeActivating protein inhibitorAllergic asthmaAllergy diagnosisBronchial allergen challengeCrth2 antagonistExhaled nitric-oxideHouse dust mitesInduced airway responsesInhaled allergenLate asthmatic responsesLeukotriene biosynthesisPeak expiratory flowProvocationReproducibility

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Allergy due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 2/28, thus managing to position itself as a Q1 (Primer Cuartil), in the category Allergy. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.01. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 6.01 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-18, the following number of citations:

  • WoS: 9

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-18:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 26.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 26 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 25.8.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 30 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Canada; Finland; France; Georgia; Germany; Italy; Oman; Poland; Portugal; United States of America.