Belard N, Blin T, De Luca A
… +4 more, Adam SM, Plantier L, Flament T, Mankikian J
Rev Mal Respir
· 2026 Jun · PMID 42248741
·
Publisher ↗
INTRODUCTION: Triple therapy with Elexacaftor, Tezacaftor and Ivacaftor (ETI) has transformed the management of cystic fibrosis. The aim of this study was to describe the patients under treatment who do not show improvem...INTRODUCTION: Triple therapy with Elexacaftor, Tezacaftor and Ivacaftor (ETI) has transformed the management of cystic fibrosis. The aim of this study was to describe the patients under treatment who do not show improvement in FEV1. METHODS: In a single-center retrospective study of 63 adults, data were collected over the 12 months before and after initiation of ETI. Patients were classified as "improved FEV1" (FEV1 gain≥5% at 12 months of ETI) and "stable FEV1" (FEV1 gain<5%). RESULTS: The patients in our study were at least 18 years old, suffered from cystic fibrosis, and had initiated a course of treatment by elexacaftor/tezacaftor/ivacaftor (ETI) between December 2019 and December 2021. They presented with either homozygosity or heterozygosity for the Phe508del mutation, with minimal function of the CFTR gene. At 12 months of ETI, an improvement in sweat chloride (-56 [-34; -69] mmol/L), FEV1 +17 [9; 24] % pred), RV/TLC ratio (-6 [-10; -3] %), walking distance +28 [14; 82] m and BMI (+1.5 [0.7; 2.6] kg/m) was observed. Aside from the RV/TLC ratio, the improvement was similar between the "stable FEV1" (7 patients) and "improved FEV1" (56 patients) groups. CONCLUSION: A benefit in terms of sweat chlorine, BMI, walking distance and exacerbations was observed in patients whose FEV1 remained stable on ETI. This observation underlines the importance of multiparametric evaluation of patients treated with CFTR modulators.
Le Gac C, Hamane S, Costantini A
… +2 more, Leprieur EG, Wang P
Rev Mal Respir
· 2026 May · PMID 42173732
·
Publisher ↗
INTRODUCTION: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona. Rare in Europe, it can lead to diagnostic delays insofar as its clinical and radiological features m...INTRODUCTION: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona. Rare in Europe, it can lead to diagnostic delays insofar as its clinical and radiological features may mimic lung cancer, mycobacterial and/or bacterial diseases. OBSERVATION: We report a case of pulmonary and mediastinal coccidioidomycosis diagnosed in France following travel to an endemic area by a 68-year-old immunocompetent woman, a former smoker, who presented with a persistent cough and constitutional symptoms (fatigue, weight loss and anorexia). Chest computed tomography revealed a paramediastinal mass in the middle lobe as well as ipsilateral mediastinal lymphadenopathy. Given the patient's age, clinical deterioration, and heavy smoking history, lung cancer was initially suspected but rapidly ruled out after direct examination, reverse transcription quantitative real-time polymerase reaction (RT-qPCR), and serology had confirmed the presence of coccidioidomycosis. Due to several risk severity factors, treatment with fluconazole was promptly initiated, leading to clinical and radiological improvement. CONCLUSION: Rarely reported in France, pulmonary and mediastinal coccidioidomycosis can mimic the clinico-radiological presentation of bronchopulmonary cancer. Diagnosis relies on thorough travel history, careful assessment of symptoms, and mycological confirmation - often requiring repeated serological sampling.
Tran A, Dury S, Deslee G
… +4 more, Estellat C, Taille C, Perotin JM, et le Ramses study group
Rev Mal Respir
· 2026 May · PMID 42173731
·
Publisher ↗
INTRODUCTION: The Asthma Control Test (ACT) is an easy-to-use tool assessing the level of asthma control. However, interpretation in a population of severe asthma patients with obesity may be partially biased due to symp...INTRODUCTION: The Asthma Control Test (ACT) is an easy-to-use tool assessing the level of asthma control. However, interpretation in a population of severe asthma patients with obesity may be partially biased due to symptoms directly associated with obesity. METHODS: The RAMSES study is a nationwide cohort of severe asthma patients. In this pilot study, we considered a subgroup of patients recruited in our center, compared the ACT scores of obese and non-obese severe asthma patients, and analysed associations between ACT scores and phenotypic features. RESULTS: Forty non-obese and 25 obese severe asthmatics were included in the study. The ACT score did not differ between the two groups, nor was it correlated with body mass index. Unlike the non-obese group, the ACT score in the obese group was not associated with number of exacerbations (P=0.158), number of hospitalizations (P=0.840), or the HADS anxiety (P=0.105) and depression (P=0.056) scores. CONCLUSION: Our results suggest that the ACT score may not fully reflect asthma control in the obese severe asthma population. They rather tend to indicate a distinct severe asthma and obesity phenotype, in which a low ACT score would not be associated with number of exacerbations or psychological burden, thereby highlighting the primordiality of comprehensive assessment and multidisciplinary management.
Rev Mal Respir
· 2026 May · PMID 42168007
·
Publisher ↗
INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition, particularly among at-risk populations such as patients with obesity, diabetes, or chronic respiratory disease. There is a growing ne...INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition, particularly among at-risk populations such as patients with obesity, diabetes, or chronic respiratory disease. There is a growing need for simplified, automated diagnostic approaches that can be implemented outside specialized sleep laboratories. METHODS: We conducted a prospective, interventional study in two hospital centers in Alsace (France), comparing an automated mandibular movement analysis device (Sunrise®) with standard ventilatory polygraphy (VP). Agreement between the two methods for determining the apnea-hypopnea index (AHI) was assessed using Bland-Altman analysis. RESULTS: Thirty-seven patients were enrolled, from whom 29 pairs of recordings (78%) were suitable for analysis. Seven Sunrise® failures and one ventilatory polygraphy failure, were due mainly to sensor malfunctions or connectivity issues. In comparison with VP, Sunrise® tended to overestimate AHI, with a mean difference of +4.76 events/h. The limits of agreement ranged from -15.4 to +24.9 events/h, indicating moderate variability between the methods. CONCLUSIONS: The Sunrise® device demonstrates feasibility for use in non-expert clinical settings and shows reasonable agreement with ventilatory polygraphy, supporting its potential as a simplified screening tool for OSAS. However, these results should be interpreted cautiously, especially for high AHI, and technical limitations must be addressed in future "real world" studies.
Gherzi L, Di Giovannantonio C, Prieto M
… +1 more, Alifano M
Rev Mal Respir
· 2026 May · PMID 42168006
·
Publisher ↗
INTRODUCTION: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related death. In addition to tumor stage, host-related factors play a critical role in determining outcomes. STATE OF KNOWLEDGE: Data fr...INTRODUCTION: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related death. In addition to tumor stage, host-related factors play a critical role in determining outcomes. STATE OF KNOWLEDGE: Data from the French Epithor database and institutional cohorts have consistently highlighted a "lung cancer paradox": while underweight is associated with increased mortality, overweight and obesity seem to confer a survival advantage. Morphometric studies have confirmed that skeletal muscle mass, which is assessed in terms of psoas or total muscle area, is an independent predictor of prognosis. On a parallel track, simple biomarkers such as preoperative C-reactive protein (CRP) and prealbumin have demonstrated strong prognostic value, as they are closely linked to systemic inflammation and intratumoral immune infiltration. More recently, patient height and height-normalized weight (sH and sHNW) have emerged as novel independent prognostic factors, once again underscoring the relevance of morphomic measures other than BMI. PERSPECTIVES: Integration of simple and reproducible anthropometric indices (BMI, height, sHNW), body composition, and biological markers (CRP, prealbumin) provides a more comprehensive framework for risk stratification. This enriched approach may help to optimize perioperative management, identify high-risk patients, and refine indications for adjuvant or immune-based therapies in cases of resectable NSCLC. CONCLUSIONS: Although BMI alone is only a crude measure, when interpreted within an integrative model it retains prognostic significance. The combining of nutritional, inflammatory, and morphometric parameters yields a robust overall representation of patient status, paving the way toward personalized prognostic assessment and improved therapeutic decision-making.
Jouneau S, Debec T, Chauvin P
… +2 more, Balusson F, Bajeux E
Rev Mal Respir
· 2026 May · PMID 42120265
·
Publisher ↗
INTRODUCTION: French guidelines on the management of primary spontaneous pneumothorax (PSP) were first communicated in 2022 and subsequently published in 2023. They emphatically promoted outpatient management. We aimed t...INTRODUCTION: French guidelines on the management of primary spontaneous pneumothorax (PSP) were first communicated in 2022 and subsequently published in 2023. They emphatically promoted outpatient management. We aimed to assess current therapeutic management of PSP following the release of these guidelines. METHODS: A nationwide online survey was conducted to evaluate therapeutic management strategies for large PSP without signs of severity. A standardized questionnaire was sent via the French Society of Respiratory Diseases (SPLF) and the French Federation of Pulmonology (FFP). One response per center was requested. RESULTS: All in all, 98 responses were collected from physicians (91 pulmonologists) representing 81 healthcare facilities, including 33 (40.7 %) general hospitals and 29 university hospitals (35.8 %). The majority of centers managed PSP through hospitalization (71.6 %), primarily via chest tube drainage (64.2 %), most often using small-bore chest tubes (≤14 French, in 76 % of cases). Outpatient management was practiced in 27.2 % of facilities, mainly using chest drainage with a one-way mini-valve (21 %). Analgesic prescriptions and sick leave duration significantly varied. CONCLUSION: Following publication of the French guidelines, PSP management has remained predominantly hospital-based, although small-bore chest tubes are commonly used. Outpatient care remains underdeveloped and should be encouraged. Any future update of these guidelines would need to provide more detailed recommendations on analgesia and sick leave.
Rev Mal Respir
· 2026 May · PMID 42120264
·
Publisher ↗
INTRODUCTION: As a rare bacterial infection caused by Tropheryma whipplei, Whipple's disease often manifests systemically, most commonly with rheumatological and/or digestive symptoms. An unusual pulmonary pathology, it...INTRODUCTION: As a rare bacterial infection caused by Tropheryma whipplei, Whipple's disease often manifests systemically, most commonly with rheumatological and/or digestive symptoms. An unusual pulmonary pathology, it may be considered as non-specific granulomatosis. CASE REPORT: We report on the case of a 57-year-old man presenting with mediastinal lymphadenopathy, which was discovered incidentally during an episode of pulmonary embolism. Notwithstanding negative bacterial cultures, adenomegaly PCR testing confirmed the hypothesis of T. whipplei infection. Following antibiotic therapy, significant clinical and radiological improvements were observed. CONCLUSION: Although uncommon, Whipple's disease should be considered as a possibility when unexplained granulomatous pulmonary involvement occurs. An early diagnosis, followed by appropriate antibiotic therapy, generally leads to a favorable outcome.
Roy V, Bironneau V, Guerin L
… +8 more, Dufay P, Charron M, Luque-Paz D, Jouneau S, Jayle C, Caron F, Meurice JC, Jutant EM
Rev Mal Respir
· 2026 May · PMID 42115115
·
Publisher ↗
INTRODUCTION: Intrapleural fibrinolysis has proved effective in reducing the length of hospital stay and the need for surgery in pleural infection. However, it carries risks, and its use in France remains unsystematic. T...INTRODUCTION: Intrapleural fibrinolysis has proved effective in reducing the length of hospital stay and the need for surgery in pleural infection. However, it carries risks, and its use in France remains unsystematic. The aim of this study was to assess the efficacy and safety of pleural infection drainage with or without intrapleural fibrinolysis. METHOD: A single-center retrospective non-interventional study at Poitiers University Hospital (2012-2022) including patients drained for complicated pleural infection or at risk of complication and divided into two groups according to whether intrapleural fibrinolysis was or was not performed. RESULTS: Out of 85 patients drained for pleural infection, 23 (27 %) received fibrinolysis. The two groups (with or without fibrinolysis) were similar in terms of initial characteristics. The duration of oxygen therapy and fever did not differ. However, the fibrinolysis group had more iatrogenic bleeding (26 % versus 5 %, P=0.01) and a longer hospital stay (18days versus 14days, P=0.03). Survival at one month and one year was comparable, but residual effusion was more frequent in the group without fibrinolysis. CONCLUSION: Intrapleural fibrinolysis remains a therapeutic option requiring regular reassessment due to difficult-to-prove benefits and marked risks in real-world practice.
Ancel J, Dewolf M, Nawrocki-Raby B
… +7 more, Durlach A, Dalstein V, Cortot A, Dormoy V, Gilles C, Polette M, Deslée G
Rev Mal Respir
· 2026 May · PMID 42106230
·
Publisher ↗
INTRODUCTION: Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality worldwide. Immunotherapy has significantly reshaped its treatment, leading to improved survival in a subset o...INTRODUCTION: Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality worldwide. Immunotherapy has significantly reshaped its treatment, leading to improved survival in a subset of patients. However, failed initial response or acquired resistance may limit the long-term benefits of immunotherapy. STATE OF THE ART: Resistance to immunotherapy arises from complex and multifactorial mechanisms. They include intrinsic tumor cell alterations - such as STK11 and KEAP1 mutations, antigen presentation defects, and impaired IFNγ signaling - as well as extrinsic factors related to the tumor microenvironment, including hypoxia, immunosuppressive cell infiltration, and T-cell exclusion. In response, several combination strategies have been explored: immunotherapy with chemotherapy, anti-angiogenic agents, alternative immune checkpoint inhibitors (e.g., CTLA-4, TIGIT, LAG-3), or innate immune modulators (e.g., STING, RIG-I), with encouraging early results. PERSPECTIVES: Despite recent progress, current approaches remain primarily focused on the tumor and its microenvironment, often overlooking host-related factors - such as age, comorbidities, dysbiosis, and chronic inflammation - that can significantly impact immune responsiveness. More refined patient stratification, incorporating tumor, immune, and host-derived immune and non-immune biomarkers, is essential to better tailor treatments and improve outcomes. CONCLUSIONS: The future of immunotherapy in NSCLC will likely be premised on a holistic understanding of tumor biology, immune dynamics, and host characteristics. Such an integrated approach is key to overcoming current limitations, enabling personalized strategies, and broadening the clinical benefit of immunotherapy to a wider patient population.
Benazzouz RS, Benyagoub M, Benazzouz MS
… +1 more, Ould Setti M
Rev Mal Respir
· 2026 May · PMID 42097971
·
Publisher ↗
OBJECTIVE: To estimate the frequency of initial refusal of inhaled treatment in Algerian pneumology outpatients and to describe the characteristics of patients presenting this refusal. METHODS: Multicenter cross-sectiona...OBJECTIVE: To estimate the frequency of initial refusal of inhaled treatment in Algerian pneumology outpatients and to describe the characteristics of patients presenting this refusal. METHODS: Multicenter cross-sectional study (September 2022 to January 2023) conducted in seven clinics. Attitudes were classified as immediate acceptance, difficult acceptance, or persistent refusal. Initial refusal combined the last two. RESULTS: Three hundred eighty-five (385) patients were included (mean age 40.1±25.0 years; 49.9% male). Initial refusal occurred in 127/385 (33.0%), including 32/385 (8.3%) with persistent refusal; 95/127 (74.8%) accepted after discussion. Patients with initial refusal were younger, more often in a new initiation setting, and more likely to show poor disease acceptance. Immediate acceptance was more frequent when prescriptions included a long-acting beta-2 agonist or a fixed inhaled corticosteroid plus long-acting beta-2 agonist combination, and when the device was a capsule inhaler. It was also more frequent in patients previously exposed to inhaled therapy or with a close relative using an inhaler. Fears (adverse effects, dependence, stigma) and social influences were mainly reported by refusers; 54/127 (42.5%) cited close relatives as the main influence. Time devoted to information and advice was longer in the initial refusal group (6.39±3.33 vs. 4.00±2.00minutes). CONCLUSION: One in three patients initially refuses inhaled therapy. Structured counselling at the time of prescribing, with attention to patients' beliefs and family influence, may help reduce these early refusals.
INTRODUCTION: The OPALE program has been designed to bolster observance of antifibrotic treatments in patients with diffuse interstitial lung disease (ILD). The effectiveness of these treatments depends largely on therap...INTRODUCTION: The OPALE program has been designed to bolster observance of antifibrotic treatments in patients with diffuse interstitial lung disease (ILD). The effectiveness of these treatments depends largely on therapeutic adherence, which is often vitiated by side effects. The objective of this study was to describe the evolution and maintenance of treatment observance among participants in the OPALE program. METHODS: A retrospective analysis was carried out regarding patients in the OPALE program over the course of nine months. Observance was measured using the Girerd self-administered questionnaire, and side effects were collected based on the participants' declarations. RESULTS: Among the 976 participants in the program, 319 definitively withdrew, including 187 due to treatment discontinuation; satisfactory treatment observance was noted in 67.4%. Notwithstanding distinct side effects, no difference regarding observance was noted among patients on nintedanib as opposed to pirfenidone. No single factor was associated with treatment observance. CONCLUSION: The OPALE program assessed observance of antifibrotic treatments among patients with ILD. Additional studies ensuring prospective assessment with more adapted tools are called for, the objectives being to confirm these results and to identify factors potentially impacting observance.
Rev Mal Respir
· 2026 May · PMID 41991384
·
Publisher ↗
Sarcoidosis is a systemic inflammatory disease characterized by heterogeneous organ involvement and an unpredictable clinical course. Although clinical assessment often focuses on objective measures of disease activity,...Sarcoidosis is a systemic inflammatory disease characterized by heterogeneous organ involvement and an unpredictable clinical course. Although clinical assessment often focuses on objective measures of disease activity, many patients experience persistent symptoms that substantially impair their quality of life. Fatigue, cognitive disorders, dyspnea and pain are common and often markedly underestimated, particularly when objective disease activity appears limited. These symptoms may significantly interfere with daily life activities and work commitment, even in patients with clinically stable disease. Relying solely on organ involvement or traditional clinical parameters may therefore lead to an incomplete assessment of work ability. A holistic approach, integrating clinical findings with patient-reported outcomes and psychosocial factors, is essential. Explicit attention to quality of life and limitations in daily activities is conducive to an accurate evaluation of functional capacity, improved patient-physician communication, and individualized support aimed at achieving sustainable participation in work and society.
Rev Mal Respir
· 2026 May · PMID 41896093
·
Publisher ↗
INTRODUCTION: Frailty is a complex and multidimensional clinical syndrome characterized by decreased physiological reserves. It, results in increased susceptibility to adverse health outcomes. In 2001, Fried et al. estab...INTRODUCTION: Frailty is a complex and multidimensional clinical syndrome characterized by decreased physiological reserves. It, results in increased susceptibility to adverse health outcomes. In 2001, Fried et al. established the phenotypic diagnostic criteria for frailty. Owing to the frequency, prognostic implications, and potential reversibility of frailty, systematic screening is recommended for all individuals over the age of 65. Several tools are currently available for the purposes of screening, assessment, and diagnosis. STATE OF THE ART: Fibrotic interstitial lung diseases (ILDs) occur predominantly in elderly patients. The reported prevalence of frailty in this population varies depending on the diagnostic criteria employed. In a prospective cohort of more than 1,500 patients, Guler et al. demonstrated that frailty was associated with a heightened risk of mortality and functional decline. In a related study, the same team reported that frailty was associated with a higher risk of antifibrotic dose reduction and deteriorated quality of life. PERSPECTIVES: These findings suggest that enhanced recognition and management of frailty could help optimize therapeutic care and improve the quality of life of patients with fibrotic ILDs.
Rev Mal Respir
· 2026 May · PMID 41881764
·
Publisher ↗
Inhaled treatments represent a pillar in pneumology management, especially insofar as they allow for optimal local delivery of therapeutic agents. In addition to bronchodilators and corticosteroids, numerous inhalation-b...Inhaled treatments represent a pillar in pneumology management, especially insofar as they allow for optimal local delivery of therapeutic agents. In addition to bronchodilators and corticosteroids, numerous inhalation-based treatments exist. Some of them are little known by clinicians, such as mucolytic drugs, antibiotics, saline solutions, morphine derivatives, prophylactic agents such as pentamidine, etc. Each of these treatments has specific indications and requires specific means of administration according to the nature of the medicine, the type of nebulizer being used, and a given patient's clinical characteristics. The present narrative review of the literature describes and synthesizes the indications and modalities of these different treatments, to the exclusion of asthma, COPD, cystic fibrosis, and ventilated intensive care patients.
Annesi-Maesano I, Bonniaud P, Bouchaud G
… +18 more, Boyer L, Gosset P, Gras D, Guignabert C, Ladjemi MZ, Matecki S, Morélot C, Pilette C, Planes C, Plantier L, Polette M, Si-Tahar M, Taillé C, Vachier I, Zaragosi LE, Mari B, Guibert C, membres du groupe RESPIRenT
Rev Mal Respir
· 2026 May · PMID 41856819
·
Publisher ↗
Gephine S, Le Guillou F, Tieghem P
… +10 more, Pochulu C, Daffourd V, Nguyen L, Antone E, Scanu P, Robic M, Joubert H, Sauvaget O, Grosset C, Grosbois JM
Rev Mal Respir
· 2026 May · PMID 41832101
·
Publisher ↗
Strentz P, Rinaldo F, Jacquet-Pierroulet C
… +7 more, Baumann E, Fonne S, Bizot C, Hammas K, Palpacuer C, Debieuvre D, Decanphar Study Group
Rev Mal Respir
· 2026 May · PMID 41826137
·
Publisher ↗
INTRODUCTION: In 2022, the French National Health Authority launched a task force for experimentation of low-dose chest CT screening in patients at high risk of lung cancer. In 2023, a study was conducted in the Haut-Rhi...INTRODUCTION: In 2022, the French National Health Authority launched a task force for experimentation of low-dose chest CT screening in patients at high risk of lung cancer. In 2023, a study was conducted in the Haut-Rhin region (France) to assess the feasibility of a program involving ten general practitioners. METHODS: The patients included were prescribed a low-dose chest CT (<100mGy.cm). If the result was negative, follow-up CT was scheduled after one year and then every other year in the absence of risk factors other than smoking. Indeterminate results necessitated a repeat CT at three months, while positive results led to referral to a pulmonologist. The primary endpoint was the proportion of patients having undergone the first screening CT. RESULTS: One hundred and twenty-six patients were included (median age 58.5 years, 54.8% women) and 117 patients (92.9%) underwent the first CT. The median time between prescription and CT completion was 14 days, and the median radiation dose was 78.6 mGy.cm. One hundred and eight scans were negative (92.3%), and nine indeterminate (7.6%), all of which were subsequently reclassified as negative after follow-up. CONCLUSIONS: The high completion rate demonstrates good adherence to the program. These encouraging results need confirmation through the analysis of follow-up CTs.
Saliby N, Maury F, Barakat L
… +7 more, Le Brun M, Garinat M, Huth E, Laborier F, Roland Nicaise P, Taille C, Neukirch C
Rev Mal Respir
· 2026 May · PMID 41826136
·
Publisher ↗
INTRODUCTION: Alternaria alternata is a mold commonly found in both indoor and outdoor environments. It can induce IgE-mediated sensitization, leading to symptoms such as rhinitis and, in some cases, severe asthma. Howev...INTRODUCTION: Alternaria alternata is a mold commonly found in both indoor and outdoor environments. It can induce IgE-mediated sensitization, leading to symptoms such as rhinitis and, in some cases, severe asthma. However, allergic reactions resulting from the accidental ingestion of food contaminated with Alternaria have only rarely been reported. OBSERVATIONS: We report two cases of patients with respiratory allergies who were sensitized to Alternariaalternata, with asthma exacerbations in humid environments and during summer thunderstorms. Following the ingestion of mold-contaminated food, both patients experienced anaphylaxis. (1) Male, 33 years old: skin prick-tests (SPT) and sIgE were positive only for Alternariaalternata (sIgE rAlt a1 at 10.5kU/L). Multiplex IgE (ISAC®) revealed strong sensitization to Alt a1 and less sensitization to Thaumatin-Like Protein (TLP) from kiwi. (2) Male, 58 years old: SPTs were are positive for pollen and Alternaria; sIgE was positive only for Alternaria alternaria (sIgE rAlt a1 at 1.59kU/L). CONCLUSION: The ingestion of food contaminated with aeroallergens can trigger severe allergic reactions in sensitized patients, as described in "pancake syndrome" associated with dust mite contamination. In the present cases, reactions were related neither to true food allergy nor to cross-reactivity between aeroallergens and food allergens, but rather to food contamination with Alternariaalternata. These findings highlight the importance of comprehensive allergy evaluation in asthmatic patients, including systematic assessment for food-related allergic reactions.