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Asthma is a chronic respiratory disease characterized by bronchial hyperreactivity. There are several endotypes of which allergic asthma is the most common. Severe eosinophilic asthma is prevalent in approximately 5% of asthmatics and its phenotype overlaps with allergic asthma and type 2 inflammation. Patients with refractiveness to corticosteroids underline the difficulty in controlling persistent inflammation in severe eosinophilic asthma. The focus of biological therapies is geared towards the understanding of the intricate interplay of the cytokines that drive the eosinophil’s ability to induce chronic inflammation with airway obstruction. This chapter takes the reader down a historical journey of initial studies that were performed using mouse helper T cell clones for reconstitution experiments to unravel the mechanism of the role T helper 2 cytokines play in allergic asthma. We then reviewed the classic in vivo experiments that demonstrated how antibodies to IL5 can down regulate eosinophils in the blood and their progenitors in the bone marrow of mice. We also delve into the complex interaction of the alarmins on the cytokines triggers of allergic inflammation with elevated eosinophils. Finally, we review the clinical literature on the beneficial effects of humanized monoclonal antibodies in use for treatment of patients suffering from severe eosinophilic asthma. 

Rationale: Ambrosia (ragweed), a member of the Asteraceae family, is very allergenic and its pollen is clinically important because its immunogenic components can exacerbate airway allergic diseases. Investigators have demonstrated that ragweed flourishes more in urban than rural areas because of the increase levels of atmospheric CO2. From the recent weather reports of unusually high temperatures in Florida, we hypothesized that anemophilous ragweed pollen will increase significantly in 2023. Methods: A 7-day Burkard volumetric sampler on the roof of a 5-story dormitory at Edward Waters University in Jacksonville Florida collected daily pollen from December 2020 to August 2023. However, the spore trap was inoperable during the late spring of 2022 through the summer of 2022. Pollen samples were analyzed as specified by the NAB of the AAAAI. Results: Previously, we observed only moderate (>10<50 grains /m3) levels of Ambrosia pollen during the late Spring and Summer of 2021. In 2023, high levels were observed as the difference between the median Ambrosia pollen concentrations from the 2021 and 2023 seasons was statistically significant (p<0.001) and estimated to be 4.32 (95% CI 2.16 to 6.48). Conclusions: The significant increase in concentration of Ambrosia pollen grains from moderate in 2021 to high in 2023 are important aerobiological data to assist the allergists for the treatment of patients with pollinosis especially from the vulnerable urban communities. The unusually high temperatures in 2023 may be partially responsible for the observed significant increase in pollen concentration levels in Jacksonville Florida. 

Allergic asthma and the legacy of structural racism on the African American urban communities Asthma is a chronic inflammatory disease that is characterized by bronchial hyperreactivity (wheezing due to narrowing of the airways) and it disproportionately affects African Americans. Allergic asthma is a chronic inflammatory disease that is characterized by bronchial hyperreactivity and elevation of allergic antibodies. In the United States approximately 25 million people are affected by this disease with a death toll of about 3,500 per year. African American children are at least 10 times more likely to die from asthma than their white counterparts. Collectively, the mortality rate in the African American population is double the rate in Caucasians (21.8 vs 9.5 death rate per million). The 2005 Agency for Healthcare Research and Quality's report on the Disparity in Health Care among African Americans and Ethnic minority reported allergic asthma as the second largest disparity in the quality of health care for them versus Caucasians. Today, health disparity in asthma persists and several hypotheses for this disparity have been proposed.