Background In patients with allergic rhinitis (AR), the dynamic longitudinal association between transition from normal body mass index (BMI) to overweight/obesity and metabolic inflammation remains unclear. Methods We conducted a retrospective longitudinal cohort study involving 1715 AR patients with normal baseline BMI between 2014 and 2025 at the Affiliated Hospital of Guangdong Medical University in Zhanjiang, Guangdong, China. Using targeted maximum likelihood estimation with time-window analysis, we estimated the average treatment effects of BMI increase on inflammatory and metabolic markers over 1–3 years and quantified risks of metabolic diseases. Results BMI transition was associated with progressively increased systemic inflammation and persistent metabolic dysregulation. Inflammatory markers showed a time-dependent increase, whereas metabolic abnormalities, characterized by elevated triglycerides and reduced high-density lipoprotein cholesterol, appeared earlier and remained stable. BMI gain was also associated with increased risks of several metabolic diseases, particularly fatty liver disease. Conclusion In AR patients, transitioning from normal BMI to overweight or obesity was associated with a gradual increase in systemic inflammation and persistent metabolic dysfunction that was associated with increased risks of various metabolic diseases. When implementing weight management for patients with AR, it is recommended to monitor changes in body weight over time and intervene early in the weight gain process.
Background The biological association between early-life antibiotic exposure and the risk of food allergy (FA) remains unclear. Given the widespread use of cephalosporins during the perinatal period and infancy, this relationship and potential mechanisms urgently require clarification. Methods This study employed a prospective birth cohort design, recruiting 1275 mother-infant pairs, followed until 6 months of age, recorded cephalosporins exposure timing, and collected fecal samples for multi-omics analysis. Results Nine hundred thirty-nine eligible mother-infant pairs completed the study, and 224 infants were diagnosed with IgE-FA. Multivariate analysis identified intrapartum cephalosporins exposure duration (OR = 1.04) and the first 2 months of life (0–1 months of age: OR = 4.03; 1–2 months of age: OR = 3.13) as critical risk windows for cephalosporins exposure-induced FA. Family allergic history was a synergistic risk factor. This effect exhibited an “all-or-none” pattern, independent of antibiotic dose or treatment course, suggesting it may act as a “switch” triggering allergic susceptibility. Gut microbiota and metabolomic analyses revealed that cephalosporins exposure led to dysbiosis, downregulation of tryptophan metabolism and nitric oxide (NO) production pathways, which were associated with impaired intestinal barrier function and T-helper 2 (Th2) immune imbalance. Conclusions This study is the first to precisely delineate the critical temporal windows of early-life cephalosporins exposure in the development of IgE-FA, propose the “switch hypothesis”, and preliminarily explore its underlying mechanisms. These findings provide a novel rationale for optimizing the precise use of antibiotics during the intrapartum period and infancy, and for FA interventions targeting the microbial metabolic axis. Trial registration number ChiCTR2300072832.
Background The management of house dust mite (HDM) allergies in children is evolving with new evidence for precision diagnosis and therapies. However, global disparities in resource availability and regional variations in sensitization profiles challenge the implementation of optimal care. Objective To synthesize the latest evidence (2014–2025) and propose a component-resolved diagnosis (CRD)-guided stepped-care framework for pediatric HDM allergies, addressing evidence gaps and global health disparities. Methods We conducted a systematic review following PRISMA guidelines and searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for randomized controlled trials, meta-analyses, cohort studies, and clinical guidelines. Two reviewers independently screened records, assessed eligibility, and extracted data. Of 3371 records identified, 92 studies met the inclusion criteria and were included in the qualitative synthesis. The outcomes included the efficacy and safety of environmental controls, immunotherapy (sublingual [SLIT] vs subcutaneous [SCIT]), biologics, and the role of CRD. A narrative synthesis was performed because of substantial clinical heterogeneity across studies, supplemented by recent meta-analyses in a quantitative context. Results Individual studies reported short-term Der p 1 reductions of 45–60% with physical interventions; however, a meta-analysis of 17 Randomized Clinical Trials (RCTs) revealed that these reductions were insufficient to improve clinical outcomes, and long-term adherence remained poor (<42%). Compared with SCIT, SLIT demonstrated a superior safety profile (local reactions <10%) and lower systemic reaction risk (OR 2.6, 95% CI 1.8–3.8), whereas SCIT was more effective in polysensitized children (symptom remission: 40% vs. 25%; RR 1.60, 95% CI 1.12–2.28). Omalizumab improved lung function (FEV1: +12.5%, p < 0.01) in patients with severe asthma, but its high cost (∼$30,000/year) limited patient access. CRD identified Der p 23 as a key biomarker for asthma severity (OR 2.5, 95% CI 1.3–4.8) and revealed distinct geographic sensitization patterns—such as Der p 1 predominance in Asia versus Der p 23 in Europe. These observations raise the hypothesis that regionally tailored immunotherapy formulations could improve outcomes, although this hypothesis requires prospective validation through multinational clinical trials. Conclusion Based on the synthesized evidence, this review outlines a preliminary CRD-guided, stepped-care framework that integrates molecular sensitization profiles with clinical phenotype and resource availability. This conceptual model seeks to move beyond conventional one-size-fits-all approaches by proposing resource-stratified pathways that prioritize cost-effective strategies in resource-limited settings while reserving intensive therapies for high-risk subgroups. However, the framework remains conceptual and requires prospective validation in diverse clinical and socioeconomic settings before its utility for addressing global health disparities can be assessed. Future priorities include gathering long-term biologic safety data, conducting real-world cost-effectiveness analyses, and developing globally harmonized, resource-sensitive guidelines.
Background Hypereosinophilic syndrome (HES) encompasses rare disorders characterized by persistent hypereosinophilia resulting in organ damage. This study assessed demographics, incidence, and prevalence of HES in the United States following the introduction of HES-specific International Classification of Diseases 10th revision, Clinical Modification (ICD-10-CM) codes in 2020. Methods This retrospective analysis used data from patients with HES and ≥12 months of continuous insurance coverage between October 1, 2020, and June 30, 2024, from Optum's de-identified Clinformatics® Data Mart Database. Incidence rates were calculated from the number of new HES cases divided by total person-time at risk, and prevalence from the proportion of HES cases in the population during the study. Results Overall, 695 and 1224 patients fulfilled the incident and prevalent HES case definition, respectively. The overall HES incidence rate (95% CI) was 2.01 (1.87–2.17) per 100,000 person-years, with fluctuations between 2021 and 2024. The overall HES prevalence (95% CI) was 5.32 (5.02–5.62) per 100,000 persons, with increases between 2020 and 2024. Incidence and prevalence increased with age, with an almost even female-to-male ratio (51:49). Conclusions HES had low incidence and prevalence, with increasing prevalence from 2020 to 2024, indicating an increased recording and growing awareness of HES with ICD-10-CM codes usage.
