Peng Zhang,1,2 Yiyin Zhang,1,2 Yiyang Hu,1,2 Ilaria Baiardini,3 Fulvio Braido,4 Jiajia Wang,1,2,5 Tao Chen,2,6 Yang Xie1,2,5 1Lung Disease Diagnosis and Treatment Center, National Medical Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China; 2Henan International Joint Laboratory of Evidence-Based Evaluation for Respiratory Diseases, Henan Province Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China; 3Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova – Azienda Policlinico IRCCS San Martino, Genova, Italy; 4Department of Biomedical Sciences, Humanitas University, Milan, Italy; 5Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China; 6Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UKCorrespondence: Yang Xie, Lung Disease Diagnosis and Treatment Center, National Medical Center, The First Affiliated Hospital of Henan University of Chinese Medicine, No. 19 Renmin Road, Zhengzhou, Henan, 450000, People’s Republic of China, Email xieyanghn@163.comBackground: Combined allergic rhinitis and asthma syndrome (CARAS) impairs health-related quality of life (HRQoL). The 8-item RhinAsthma Patient Perspective (RAPP) measures their combined impact. We translated and culturally adapted the RAPP for China and evaluated its psychometric properties.Methods: Following International Society for Pharmacoeconomics and Outcomes Research principles, the RAPP was translated from Italian into simplified Chinese and cognitively debriefed. Psychometric evaluation included 164 adults with comorbid allergic rhinitis and asthma; 80 with isolated allergic rhinitis and 80 with isolated asthma served as exploratory comparators. Internal consistency, 2-week test-retest reliability, structural, convergent, and discriminant validity, 4-week responsiveness, sex-related differential item functioning (DIF), item response theory (IRT) characteristics, and feasibility were evaluated. In participants with both conditions, responsiveness was assessed after 4 weeks of individualized, consensus-guided traditional Chinese medicine treatment based on syndrome differentiation.Results: Internal consistency (Cronbach α = 0.876) and test‑retest reliability (intraclass correlation coefficient = 0.835) were good. Confirmatory factor analysis supported a single-factor structure (comparative fit index = 0.983; root mean square error of approximation = 0.053). RAPP scores correlated with RQLQ (r = 0.613), AQLQ (r = − 0.659), and ACT (r = − 0.772; all P < 0.001) and differed across clinical phases and asthma-control levels. Distribution-based indices indicated sensitivity to change (effect size = 0.41; standardized response mean = 0.79). IRT parameters were acceptable overall, although item 7, which assesses the burden of having to take medication, provided less information. No sex-related DIF was detected. Mean completion time was 1.89 minutes.Conclusion: The simplified Chinese RAPP demonstrated acceptable reliability, validity, and feasibility, with preliminary evidence of responsiveness, in adults with CARAS. Its brief format supports routine clinical assessment, follow-up monitoring, and outcome evaluation in research.Plain Language Summary: Why was the study done? People who have both allergic rhinitis and asthma can experience connected upper- and lower-airway symptoms that interfere with sleep, concentration, work, exercise, and other daily activities. The brief RhinAsthma Patient Perspective questionnaire measures this combined burden, but a validated Chinese version was not available.What did the researchers do and find? We translated the 8-item questionnaire into simplified Chinese, checked that patients understood it, and tested it in 164 adults with both conditions. We also included 80 adults with allergic rhinitis alone and 80 with asthma alone for exploratory comparisons. The Chinese questionnaire produced consistent scores, remained stable over 2 weeks in clinically controlled participants, agreed with established quality-of-life and asthma-control questionnaires, detected improvement over 4 weeks, and usually took less than 2 minutes to complete.What do the results mean? The Chinese questionnaire offers clinicians and researchers a short way to understand how combined allergic rhinitis and asthma affect daily life. It is intended to measure patient-perceived burden and change over time, not to diagnose disease. Larger studies in different regions are needed to confirm how well it performs over longer periods and to define the smallest change that matters to patients.Keywords: combined allergic rhinitis and asthma syndrome, allergic rhinitis, asthma, health-related quality of life, patient-reported outcome measures, psychometric validation
Yadong Li,1,* Bin Wang,1,* Qianyun Wang,2,* Gang Xu,3 Shuying Chen31Department of Clinical Laboratory, Fujian Children’s Hospital, Fujian Branch of Shanghai Children’s Medical Center, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, 350000, People’s Republic of China; 2Department of Clinical Laboratory, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, People’s Republic of China; 3Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shuying Chen; Gang Xu, Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Lane, Lucheng District, Wenzhou, Zhejiang, 325000, People’s Republic of China, Email wyyycsy@163.com; xugang217@163.comRationale: Regional allergen exposure varies with climate, lifestyle, and developmental stage. Evidence from coastal southeastern China remains limited, particularly across the full age range and across multiple allergic phenotypes. This study described age-related patterns of allergen sensitization in patients with allergic disease in Wenzhou, China, and evaluated associations with sex, season, clinical phenotype, polysensitization, and allergen co-occurrence.Methods: This retrospective study analyzed electronic medical records and routine laboratory data from 20,019 patients who underwent allergen testing at the First Affiliated Hospital of Wenzhou Medical University between March 2023 and February 2026. Serum total immunoglobulin E (IgE) and allergen-specific IgE (sIgE) to 22 allergens (11 inhalant and 11 food allergens) were measured. sIgE positivity was defined as ≥ 0.35 IU/mL. Clinical phenotypes included allergic rhinitis (AR), asthma (AS), and skin allergy (SA). Positivity rates were compared using chi-square or Fisher’s exact tests. Age- and sex-adjusted logistic regression, allergen co-occurrence networks, and an age-season clustering heatmap were used to examine sensitization patterns.Results: Total IgE positivity was 43.5% (8,700/20,019). Dermatophagoides farinae (38.5%) and Dermatophagoides pteronyssinus (36.6%) had the highest sIgE positivity rates, followed by cockroach (14.4%) and house dust (12.9%). Among food allergens, egg (9.5%), crab (7.0%), and milk (4.4%) predominated. Food sensitization peaked in infants and toddlers and declined with age, whereas inhalant sensitization rose during childhood and remained elevated through school age and adolescence. Total IgE positivity was higher in males than in females (50.0% vs 38.1%; odds ratio [OR] for females versus males, 0.62; 95% confidence interval [CI], 0.58– 0.65; P < 0.001). Mite, house dust, and Alternaria sensitization peaked in summer, whereas cockroach sensitization peaked in autumn. After adjustment for age and sex, inhalant sensitization was associated with increased odds of AR (OR, 2.21; 95% CI, 2.05– 2.38; P < 0.001) and AS (OR, 1.18; 95% CI, 1.03– 1.35; P < 0.05), whereas food sensitization was more closely associated with SA (OR, 1.43; 95% CI, 1.32– 1.56; P < 0.001).Conclusion: Allergen sensitization in Wenzhou exhibits distinct age-, season-, and phenotype-specific patterns. Testing and management should consider developmental stage, seasonal exposures, and clinical phenotype, with emphasis on mite control, indoor environmental measures, and comprehensive evaluation in patients with comorbid allergies.Keywords: allergen sensitization, allergen-specific IgE, allergic rhinitis, asthma, skin allergy
Jing Xie,1,* Xiaopei Yan,1,* Ye Song,2 Hui Wang,1 Guopeng Xu,1 Li Xu11Department of Respiratory and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China; 2Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li Xu, Department of Respiratory and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China, Tel +86-0512-62362042, Fax +86-0512-62362043, Email xuli198008@njmu.edu.cn Guopeng Xu, Department of Respiratory and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China, Tel +86-0512-62362042, Fax +86-0512-62362043, Email xuguopeng@njmu.edu.cnPurpose: Early identification of asthma in pregnancy is challenging due to limited feasibility of pulmonary function testing. We aimed to characterize serum CCL23 expression in pregnant women with asthma and to assess its potential as an auxiliary clinical marker.Methods: Transcriptomic sequencing first identified differentially expressed genes (DEGs) in peripheral blood between pregnant women with asthma and healthy pregnant controls. A validation cohort of 37 pregnant women with asthma and 36 healthy pregnant controls was then enrolled. Clinical data (EOS, pregnancy outcomes) were collected, and serum CCL23, IL-4, and IL-5 levels were measured. The expression characteristics and potential adjunctive identification value of CCL23 were evaluated using the Mann–Whitney U-test, Spearman correlation analysis, and binary logistic regression.Results: Transcriptomic sequencing revealed CCL23 upregulation in asthma (P < 0.01). ELISA showed higher serum CCL23 in pregnant women with asthma than in healthy pregnant controls (adjusted means 775.0 ± 91.42 vs 512.92 ± 92.95 pg/mL; adjusted P = 0.07). CCL23 correlated positively with EOS (ρ=0.74, P< 0.01) and FeNO (ρ=0.35, P = 0.03) in the asthma group. Elevated CCL23 was independently associated with an increased risk of asthma in pregnancy (overall P < 0.01). ROC analysis showed an AUC of 0.74 (95% CI 0.63– 0.86) for CCL23, 0.88 (0.80– 0.95) for EOS, 0.87 (0.79– 0.95) for CCL23 + EOS; combined model sensitivity 94.60% and specificity 66.70% at optimal cut-off. The combination did not improve discrimination over EOS alone (DeLong P = 0.13).Conclusion: Serum CCL23 is elevated in pregnant women with asthma and positively correlates with peripheral blood EOS and FeNO, implicating a role in systemic type 2 inflammation. CCL23 was independently associated with asthma after adjustment for gestational age and maternal age, but adding it to EOS did not improve discrimination over EOS alone. These exploratory findings require validation in large-scale, multicenter cohorts before any clinical use.Keywords: asthma in pregnancy, CCL23, eosinophils, biomarkers
Xudong Xu,1 Cuiying Ye,1 Dong Chen,1 Xiangyang Xiao,2 Zhichang Wang,1 Xinfeng Zhao11Department of Laboratory Medicine, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310014, People’s Republic of China; 2Department of Laboratory Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310021, People’s Republic of ChinaCorrespondence: Xinfeng Zhao, Department of Laboratory Medicine, Hangzhou Children’s Hospital, 195 Wenyan Road, Hangzhou, Zhejiang, 310014, People’s Republic of China, Email zhaoxinfeng8516@163.comBackground: House dust mite (HDM) is the predominant indoor allergen in children with allergic rhinitis (AR), but conventional binary reporting obscures both sensitization intensity and component-specific profiles.Methods: This two-stage retrospective cross-sectional study enrolled 2036 children (1– 15 years) with AR. Serum sIgE against 19 allergens was measured by immunoblot (≥ 0.35 kU/L positive). D. pteronyssinus-positive samples were stratified into six sensitization grades. In Stage 2, 110 HDM-positive children underwent component-resolved diagnostics for Der p 1, Der p 2, Der f 1, Der f 2, Der p 23, and Der p 10.Results: D. pteronyssinus was the most prevalent allergen (43.91%, 894/2036; 95% CI 41.77– 46.07%). Boys had higher positivity than girls (46.34% vs 39.50%; OR 1.32, 95% CI 1.10– 1.59), but among sensitized children, high-grade sensitization (≥grade 4) was similar between sexes (69.08% vs 66.43%, P=0.427). In cross-sectional analyses, the proportion of grade 6 sensitization (> 100 kU/L) increased with age, from 15.00% at age 3 to 25.51% at age 5 and 34.58% at age 6. Component positivity rates were: Der f 1 72.73% (80/110), Der p 1 70.91% (78/110), Der f 2 64.55% (71/110), Der p 2 62.73% (69/110), Der p 23 41.82% (46/110), and Der p 10 11.82% (13/110). Co-sensitization between Der p 1 and Der p 23 occurred in only 53.85% of Der p 1-positive children. Exclusive sensitization to D. farinae (0.91%; 95% CI 0.16– 4.97%) or Der p 23 (0.91%; 95% CI 0.16– 4.97%) was rare.Conclusion: HDM is the leading allergen in pediatric AR in East China. Cross-sectional analyses identified an age-associated increase in the proportion of high-grade sensitization that was most evident around 5– 6 years of age. CRD revealed Der p 23 as a major sensitizing component whose sensitization frequently occurred independently of group 1 allergens. Because clinical allergy phenotypes and AIT outcomes were not assessed, the utility of component-resolved profiles for guiding AIT selection requires prospective validation.Keywords: allergic rhinitis, children, house dust mite, component-resolved diagnosis, sensitization grade, Der p 23
Ragıp Fatih Kural,1,2 Ceyda Tunakan Dalgıç,1 Sinem İnan,3 Melih Özışık,3 Serpil Akten,1 Kasım Okan,1 Reyhan Gumusburun,1 Emine Nihal Mete Gökmen,1 Aytül Zerrin Sin11Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, İzmir, Turkey; 2Division of Allergy and Clinical Immunology, İzmir Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey; 3Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, TurkeyCorrespondence: Ragıp Fatih Kural, Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, İzmir, Turkey, Tel +90 553 825 44 55, Email ragipfatihkural@gmail.comPurpose: Drug provocation testing (DPT) is the gold standard for diagnosing drug hypersensitivity reactions (DHRs). We assessed the change in anxiety from baseline to one week after DPT and identified which patients remain anxious despite a negative (reassuring) test, alongside correlates of the nocebo response.Patients and Methods: In this ambispective (retro-prospective) two-center study, 155 adults with suspected immediate-type DHR underwent single-blind, placebo-controlled DPT. Anxiety was measured with the Beck Anxiety Inventory (BAI) before and one week after testing. Factors associated with baseline anxiety, residual (post-test) anxiety and the nocebo response were examined in the full cohort. For residual anxiety, the post-test BAI score was the primary outcome, and a sensitivity analysis was restricted to DPT-negative patients.Results: DPT was negative in 147 patients (94.8%); among 57 tested with the culprit drug, 53 (93.0%) were de-labeled. BAI fell from 15.7± 15.0 to 4.8± 7.8 (p< 0.001; r=0.75). The proportion with at least moderate anxiety (BAI ≥ 16) decreased from 41.9% to 5.2%. Residual anxiety (BAI ≥ 8) persisted in 36 patients (23.2%) and was associated with baseline anxiety. Baseline anxiety was associated mainly with a severe index reaction, psychiatric history and low income. Atopy showed an exploratory, baseline-adjusted association with residual anxiety (+3.2 points; p=0.004). A nocebo response occurred in 20.0% of patients. In exploratory multivariable analysis, recurrent prior reactions remained independently associated with this response (low income less consistently), whereas baseline anxiety did not.Conclusion: In this single-arm study, anxiety fell substantially after DPT and most patients tested with the culprit drug were de-labeled, but a negative result did not reassure everyone. Residual anxiety was associated with elevated baseline anxiety and, less robustly, with atopy; nocebo responses related mainly to recurrent prior reactions. Brief pre-test screening could thus direct targeted psychological support to those least reassured by testing alone.Keywords: drug provocation test, drug hypersensitivity, nocebo effect, anxiety, Beck anxiety inventory
