The specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules. This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring of allergic diseases, asthma, allergic and nonallergic rhinitis, and new approaches to the diagnosis and treatment of drug hypersensitivity reactions are discussed in further detail. In the third section, unmet needs and future research areas for the treatment of allergic diseases are highlighted with topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen-specific immunotherapy for airway disease. Unknowns and future research needs are discussed at the end of each subsection.

Allergy Asthma and Clinical Immunology Service Alfred Health Melbourne Victoria Australia

Allergy Unit Regional University Hospital of Malaga IBIMA UMA ARADyAL Malaga Spain

Chair and Institute of Environmental Medicine UNIKA T Technical University of Munich and Helmholtz Zentrum München Augsburg Germany

Christine Kühne Center for Allergy Research and Education Davos Switzerland

Department of Immunology The University of Toronto Toronto Ontario Canada

Department of Otolaryngology Head and Neck Surgery and Department of Allergy Beijing Tongren Hospital Beijing China

Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore

Department of Otorhinolaryngology Amsterdam University Medical Centres Location AMC Amsterdam The Netherlands

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine Allergy and Clinical Immunology Central Clinical School Monash University Melbourne Victoria Australia

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland

Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Department of Pediatrics The Hospital for Sick Children Toronto Ontario Canada

Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria

Research Institute The Hospital for Sick Children Translational Medicine Program Toronto Ontario Canada

Sean N Parker Center for Allergy and Asthma Research Stanford University Stanford California

Swiss Institute of Allergy and Asthma Research University Zurich Davos Switzerland

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Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma