Any role for respiratory allergens in IBS symptoms? From pathogenetic hypothesis to therapeutic implications.

Irritable bowel syndrome is a common disorder associated with substantial impairment in quality of life and remains challenging to manage due to its heterogeneous and incompletely understood pathophysiology leading to high rates of treatment failure. Recent evidence supports the existence of distinct IBS endotypes, including an emerging atopic variant characterised by allergic comorbidities, type 2 inflammation, and mast cell activation and possibly response to mast cell-directed therapies. Mast cells appear to play a central role in symptom generation by modulating intestinal permeability, motility, and visceral sensitivity, and through close interactions with enteric nerves. Beyond established triggers such as stress and diet and food-related factors, growing attention has been directed towards the role of aeroallergens in influencing symptom variability. Epidemiological, clinical and translational data suggest a link between respiratory allergy and gastrointestinal symptoms. Identifying this phenotype may have important diagnostic and therapeutic implications, supporting the development of targeted treatments and more precise management strategies.