Background:To characterize patients with buckwheat allergy in China and to investigate the associations between clinical manifestations and different buckwheat IgE-binding proteins. Methods:Patients diagnosed with buckwheat allergy at the Department of Allergy, Peking Union Medical College Hospital, were followed up between 2023 and 2024 and retrospectively enrolled. Serum allergen-specific IgE (sIgE) levels were measured using the ImmunoCAP system, and buckwheat IgE-binding proteins were identified by immunoblotting. Results:A total of 46 patients with buckwheat allergy were included, with a mean age of 26 ± 11 years. 45 patients (97.8%) developed immediate allergic reactions after buckwheat ingestion. Anaphylaxis occurred in 33 patients (73.3%). Seventeen patients (37.0%) experienced respiratory allergic symptoms upon exposure to buckwheat husks. The median f11-sIgE level was 10.75 kUA/L (IQR, 3.01-20.38). Fifteen IgE-binding proteins with different molecular weights were identified, among which the 18-19 kDa protein showed the highest positivity rate (100%). The 14 kDa protein was detected more frequently in patients without anaphylaxis than in those with anaphylaxis induced by buckwheat consumption (25% vs 0%, P = 0.016). Sensitization to the 22-24 kDa protein was more common in patients with buckwheat husk allergy than in those with allergy limited to buckwheat ingestion (52.9% vs. 24.1%, P = 0.048). Patients positive for the 22-24 kDa protein had significantly higher f11-sIgE levels than those who were negative (21.85 [5.19-38.05] vs 7.53 [2.84-12.95] kUA/L, P = 0.009). Multivariate logistic regression analysis further showed that sensitization to the 22-24 kDa protein was independently associated with concomitant buckwheat husk allergy (P = 0.027, OR = 5.22, 95% CI: 1.21-22.60). Conclusion:Patients with buckwheat allergy may present with anaphylaxis, and respiratory symptoms upon exposure to buckwheat husks. Sensitization to the 22-24 kDa protein was associated with concomitant buckwheat husk allergy and higher f11-sIgE levels.

To investigate the clinical outcomes of patients with a history of iodinated contrast medium (ICM)-induced hypersensitivity reactions (HSR) undergoing re-exposure to ICM. Medical records of inpatients who received allergy consultations in Peking Union Medical College Hospital from January 1, 2019 to July 31, 2024 were retrospectively reviewed. Patients with prior ICM-related HSR who subsequently underwent ICM re-administration were enrolled. Of 997 patients referred for allergy consultation, 65 met inclusion criteria, including 47 males (72.3

Objective This study compares the efficacy of monthly subcutaneous injections of 150 mg versus 300 mg omalizumab in patients with seasonal allergic rhinitis (AR) caused by cypress pollen allergy and with total immunoglobulin E (IgE) levels below 100 IU/ml, aiming to provide a basis for individualized treatment in the population with low total IgE. Methods This single-center, randomized, double-blind, placebo-controlled trial enrolled 60 patients with seasonal allergic rhinitis induced by cypress pollen and total IgE levels below 100 IU/mL. Participants were randomly assigned (1:1) to receive a single subcutaneous injection of either 300 mg omalizumab or 150 mg omalizumab plus placebo within 5 days prior to the pollen season onset. The endpoints included daily symptom and medication scores (dSS, dMS, CSMS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Allergic Rhinitis Control Test (ARCT) score, and nasal resistance. Results Among the 54 patients ultimately included in the analysis (27 in each group), the 300 mg group demonstrated significantly better outcomes than the 150 mg group in the CSMS (1.1 ± 0.1 vs 1.6 ± 0.1, P = 0.007), dSS (0.6 ± 0.1 vs 0.8 ± 0.1, P = 0.016), and ocular symptom score (0.5 ± 0.1 vs 0.7 ± 0.1, P = 0.003). The total RQLQ score in the 300 mg group was significantly lower than that in the 150 mg group during both the peak and late phases of the pollen season (P < 0.05). Furthermore, the ARCT score during the peak phase was significantly better in the 300 mg group (P = 0.011), and nasal resistance was significantly reduced (P = 0.020). No drug-related adverse reactions occurred in either group. Conclusions In patients with seasonal AR and total IgE levels of less than 100 IU/ml, a monthly dose of 300 mg omalizumab provided greater improvement in symptoms, quality of life, and nasal ventilation function compared with the 150 mg dose. This suggests that a higher individualized dosing strategy should be considered for such patients. Trial registration National Medical Research Registration and Filing Information System (MR-11-25-016855), registered 27 February 2025.

Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease with an incompletely understood genetic basis. This study aimed to identify disease-causing genetic variants in a PBC family and to evaluate their functional relevance in vivo. A total of 27 family members were enrolled in the analysis, among whom three were affected. After filtering of the whole-exome sequencing results of the PBC family, 17 candidate variants were identified, among which a protein tyrosine kinase 2β (PTK2B) c.1679C > G variant exclusively co-segregated with PBC in affected family members and was absent in unaffected relatives, healthy controls, and public databases. Homozygous knock-in mice exhibited significantly elevated serum alkaline phosphatase (236 ± 55 vs. 142 ± 43 U/L, P = 0.01) and antimitochondrial antibody levels (3924 ± 769 vs. 1972 ± 632 U/mL, P = 0.001) compared with heterozygous mice, along with portal lymphocytic infiltration, intrahepatic bile duct proliferation, and liver fibrosis. Female homozygous knock-in mice showed increased hepatic infiltration of CD3+ T cells (50.8

A patient with systemic lupus erythematosus developed localized swelling with blistering after mosquito bites. A complete blood count showed eosinophils were 1.09 × 109/L (13.9%). Total IgE was more than 5,000 KU/L. Examination of the blister fluid showed very high levels of interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, tumor necrosis factor (TNF)-α, interferon (IFN)-α, and IFN-γ cytokines, while these serum cytokine levels were normal. After sterile extraction of the blister fluid, the inflammatory substances were removed, and the blister gradually disappeared. This might be a special manifestation after mosquito bites in a patient with a background of autoimmune diseases. Particular attention should be paid to patients with autoimmune diseases after insect bites.

Background: Allergic rhinitis (AR) is a significant global health issue, with pollen allergens being a major cause of seasonal AR and asthma. In northern China, the prevalence of pollen-related allergies is notably higher than in the south due to higher pollen levels. Over the past few decades, climate change and urbanization have considerably transformed pollen profile in northern China. Summary: Northern China experiences two annual pollen peaks: a spring peak (March to May) dominated by tree pollens (e.g., Cupressaceae, Ulmaceae) and a summer/autumn peak (August to September) dominated by weed pollens, particularly from Artemisia, Humulus, and Chenopodiaceae. Climate change has accelerated the onset of flowering periods, increased pollen production, and extended pollen seasons, with extreme weather events and air pollution further exacerbating pollen production and sensitization. Urbanization has increased tree pollens, resulting in spring peak pollen levels gradually exceeding those of summer/autumn in most northern regions. As ecological construction concepts have advanced, the selection of plant species for the shelterbelt and ornamental trees in cities has evolved, leads to changes in the dominant pollens in the north and northeast. Artemisia has been extensively planted in the Northwest for windbreak and sand fixation purposes, resulting in a significant rise in Artemisia pollen levels and sensitization rate with a widespread influence across northern China. Key Messages: Pollen allergens in northern China are a major driver of AR and asthma, with two distinct seasonal peaks. Changes in pollen profiles are influenced by natural factors such as geographical location and climate change, as well as social factors, including urbanization, national policies, and urban planning. In northern China, Spring pollen is predominantly composed of tree pollens, significantly influenced by urban planning across different regions. In contrast, summer and autumn pollen is primarily dominated by weed and grass pollens, with weed pollens exhibiting strong allergenic potential and widespread dispersal. The Northwest region is a major potential source for these weed pollens. .

Allergic cross-reactivity among different fungal species appears to be widely existing. Fungus-related foods, such as edible mushrooms, mycoprotein, and fermented foods by fungi, can often induce to fungus food allergy syndrome (FFAS) by allergic cross-reactivity with airborne fungi. This article presents a case study of an individual with mold allergy who experienced anaphylaxis after consuming seafood mushrooms. This study indicated that Alt a 1 mediating cross-allergy between Alternaria alternata and Hypsizygus marmoreus, which has not been documented in the literature concerning the FFAS. Mushrooms tend to induce anaphylaxis in patients with mold-allergy and warrants clinicians' attention.

Eosinophil-induced adverse events (Eo-irAEs) have been observed in patients treated with programmed cell death 1/ligand 1 (PD-1/PD-L1) inhibitors. Surprisingly, the clinical features and outcomes of Eo-irAEs induced by PD-1/PD-L1 inhibitors have not yet been elucidated. This study investigated the characteristics of and risk factors for Eo-irAEs induced by PD-1/PD-L1 inhibitors. We extracted data on Eo-irAEs related to PD-1/PD-L1 inhibitors from the FDA Adverse Event Reporting System (FAERS) from 2015 to 2023. Disproportionality and Bayesian analyses were applied for data mining and analysis. A total of 430 Eo-irAEs induced by PD-1/PD-L1 inhibitors were included in this study. Older male patients were found to be at a high risk of developing Eo-irAEs. Cemiplimab (ROR 2.66 [1.38, 5.13]), nivolumab (ROR 1.82 [1.61, 2.05]), and pembrolizumab (ROR 1.35 [1.13, 1.62]) showed stronger signals than the other drugs. Cemiplimab showed higher signals for Eo-irAEs than other PD-1/PD-L1 inhibitors, with an information component (IC) of 1.41 (IC 0.25:0.73). Patients experienced Eo-irAEs within the first 100 days, with a median onset time of 56 (interquartile range: 17.0-169.0) days. Eo-irAEs were more likely to occur in patients with lung (n = 147, 34.83%) and skin tumors (n = 145, 34.36%). Eosinophilia (n = 193, 44.88%), drug reactions with eosinophilia and systemic symptoms (DRESS) (n = 98, 22.79%), and eosinophilic fasciitis (n = 69, 16.05%) were the most common adverse events. Eo-irAEs that were life-threatening or resulted in death comprised 5.15% (n = 21) and 5.39% (n = 22) of the patients. PD-1/PD-L1 inhibitors used across a broad spectrum of cancers are associated with an increased risk of Eo-irAEs, which tend to occur early. Although these complications are rare, clinicians using PD-1/PD-L1 inhibitors should be aware of and monitor these potentially serious adverse events related to Eo-irAEs.

Extrahepatic manifestations in patients with primary biliary cholangitis (PBC) are frequently observed recently. We aimed in this study to explore the clinicopathological characteristics and prognosis of glomerulonephritis in patients with PBC. Consecutive PBC patients admitted to Peking Union Medical College Hospital from January 2002 to May 2019 were retrospectively enrolled. PBC patients with other autoimmune diseases which may have nephritis were excluded. Structured interview, systemic rheumatologic examination, and laboratory tests were conducted for each patient. Literature about patients with PBC and glomerulonephritis was reviewed and summarized. Among the 330 PBC patients enrolled, glomerulonephritis were identified in 10 patients (3.0

Background and Aims Elevated total IgE levels are traditionally associated with allergic conditions; however, their potential role as biomarker for mortality risk beyond allergic diseases has not been extensively explored. Recent studies have suggested that IgE is associated with cardiovascular (CV) disease. We aimed to investigate the association between total IgE levels and the risk of all-cause and cause-specific mortality, as well as to explore the potential mediating role of vitamin status in these associations. Methods and Results The association between IgE and mortality risk was examined in the National Health and Examination Survey 2005-2006. Weighted multivariable Cox proportional hazards model was employed. We further performed restricted cubic spline analysis to assess dose-response relationships and conducted mediation analysis to explore the influence of vitamins on IgE-related mortality risk. Individuals in the highest total IgE quantile (>107.0 kU/L) exhibited a 32% increased risk of all-cause mortality (95% CI: 1.07-1.64) and a 98% elevated risk of CV mortality (95% CI: 1.28-3.07) compared to the lowest quantile (<14.5 kU/L). Heterogeneity exists in the dose-response relationship and threshold effects among individuals with and without allergic diseases. Vitamin deficiency is associated with elevated total IgE levels, and vitamins mediated the relationship of the IgE-related all-cause mortality with the proportion of mediation ranging from 4.68 to 12.71%. Conclusions Our findings introduce a novel dimension to the understanding of IgE as a biomarker for mortality beyond its traditional role in allergic diseases, challenging the current paradigm that elevated IgE levels without overt allergic symptoms are benign.

BACKGROUND:This study aimed to analyze the risk signals of iodinated and gadolinium-based contrast media associated with anaphylaxis. RESEARCH DESIGN AND METHODS:Data from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) were retrospectively reviewed from January 2004 to September 2022. Disproportionality and Bayesian analyses were used in data mining to screen for suspected anaphylaxis using contrast media. RESULTS:A total of 1240 reports of anaphylaxis associated with contrast media were identified (464 men, 37.4%). The average age of anaphylaxis associated with iodinated contrast media (ICM) and gadolinium-based contrast media (GBCM) was 56.8 ± 17.2 and 50.9 ± 18.0 years old, respectively (p < .001). Among ICM, iopamidol showed the highest reporting odds ratio (ROR) (29.0), and amidotrizoate showed the lowest ROR (7.4). Among low-osmolality ICM, iopamidol had the highest ROR (29.0), and iopromide had the lowest ROR (8.8). Among the macrocyclic agents, gadoteridol had the highest ROR (37.3), while gadoterate meglumine had the lowest (10.4). Among the linear agents, gadobenate dimeglumine had the highest ROR (28.8), and gadodiamide had the lowest (1.4). The mortality rate in ICM was significantly higher than that in GBCM (p < 0.001). CONCLUSIONS:This study provides clinicians and pharmacists evidence for risk signals of anaphylactic reactions among contrast agents.

OBJECTIVE:This study aimed to analyze the sensitization rate of different aeroallergens in children of different age, sex, and disease groups, describe the changing trend of different aeroallergens in different ages, and analyze the sensitization risk factors for asthma. METHODS:Children (<18 years old) with suspected atopic diseases who visited the Department of Allergy of Children's Hospital Affiliated to Capital Institute of Pediatrics and underwent a skin prick test (SPT) were retrospectively enrolled from January 2019 to November 2021. RESULTS:A total of 5465 patients (3514 boys, 1951 girls; mean age, 7 ± 3 years) were enrolled. Of them, 3703 patients (67.8%) were sensitized to at least one aeroallergen. Before 4 years of age, mold was the most prevalent aeroallergen (103/380 [27.1%]), whereas after 4 years of age, weed pollen was the most prevalent aeroallergen. After 6 years of age, tree pollen became the second most prevalent aeroallergen. After 12 years of age, the sensitization rate of indoor aeroallergens was lower than that of outdoor aeroallergens. Logistic regression showed that sensitization to mold (odds ratio [OR]:1.4, 95% confidence interval (CI): 1.2-1.7, p < 0.001), animal dander (OR: 1.6, 95% CI: 1.4-1.9, p < 0.001), and polysensitization (OR: 1.4, 95% CI: 1.0-1.8, p = 0.038) were potential sensitization risk factors for asthma. CONCLUSIONS:Mold is an important allergen in early life. Different kinds of allergens affect different age groups. Patients who are sensitized to mold or animal dander or experience polysensitization should be carefully monitored for asthma risk.

Objective: To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy (SCIT) in patients undergoing SCIT injections in Peking Union Medical College Hospital (PUMCH). Methods: This is a single center retrospective cohort study. Using the outpatient information system of PUMCH, the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT. Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis, and multiple logistic regression was used for multiple-factor analysis. Results: A total of 2 897 patients received 18 070 SCIT injections in Allergy Department during the four years, and 40 systemic allergic reactions occurred, with the overall incidence rate of 0.22%. The incidence of systemic allergic reaction was 0.37% when using imported dust mite preparation and 0.15% when using domestic multi-component allergen preparation. The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old (OR=3.186,95%CI: 1.255-8.085), highest injection concentration (OR value could not be calculated because all patients with systemic reactions were injected with highest concentration), and large local reaction in previous injection (OR=22.264,95%CI: 8.205-60.411). The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens (OR=3.455,95%CI: 1.147-10.402), highest injection concentration (OR=3.794,95%CI: 1.226-11.740) and large local reaction in previous injection (OR=63.577,95%CI: 22.248-181.683). However, SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction. Conclusion: The incidence of SCIT-induced systemic allergic reactions was low in the Chinese patient population of this study. Patients with one or more risk factors, such as multiple allergen injection, highest injection concentration, large local reaction in previous injection, should be given high attention and vigilance against systemic allergic reactions.

IgG4-related disease (IgG4-RD) is a chronic inflammation with fibrosis. About 30% to 40% of patients with IgG4-RD are complicated with atopic manifestations as allergic rhinitis and asthma, usually with elevated serum total immunoglobulin E and peripheral blood eosinophils, which are also of some value for predicting disease activity and relapse. Similar to allergic diseases, activation of type 2 inflammation is also observed in the pathogenesis of IgG4-RD, and eosinophils, basophils, mast cells, thymic stromal lymphopoietin, IL-33, IL-4, IL-5, and IL-13 all participate in the pathogenesis of IgG4-RD. Studies of susceptible genes showed that IgG4-RD and allergic disease shared the same susceptible genes. Monoclonal antibodies targeting type 2 inflammation pathway may become a novel choice for IgG4-RD treatment.

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

Background Data on allergic reactions after the administration of coronavirus disease (COVID-19) vaccines are limited. Our aim is to analyze reports of allergic reactions after COVID-19 vaccine administration. Methods The Vaccine Adverse Event Reporting System database was searched for reported allergic reactions after the administration of any of the COVID-19 vaccines from December 2020 to June 2021. After data mapping, the demographic and clinical characteristics of the reported cases were analyzed. Potential factors associated with anaphylaxis were evaluated using multivariable logistic regression models. Results In total, 14,611 cases were reported. Most cases of allergic reactions comprised women (84.6%) and occurred after the first dose of the vaccine (63.6%). Patients who experienced anaphylaxis were younger (mean age 45.11 ± 5.6 vs. 47.01 ± 6.3 years, P < 0.001) and had a higher prevalence of a history of allergies, allergic rhinitis, asthma, and anaphylaxis than those who did not (P < 0.05). A history of allergies (odds ratio (OR) 1.632, 95% confidence interval (CI) 1.467–1.816, P < 0.001), asthma (OR 1.908, 95%CI 1.677–2.172, P < 0.001), and anaphylaxis (OR 7.164, 95%CI 3.504–14.646, P < 0.001) were potential risk factors for anaphylaxis. Among the 8,232 patients with reported outcomes, 16 died. Conclusions Female predominance in allergic reaction cases after the receipt of COVID-19 vaccines was observed. Previous histories of allergies, asthma, or anaphylaxis were risk factors for anaphylaxis post-vaccination. People with these risk factors should be monitored more strictly after COVID-19 vaccination.

目的 评价猫皮屑、屋尘螨2种常年性变应原制剂集群免疫治疗剂量递增期的安全性.方法 对确诊为猫皮屑(10例)和屋尘螨(21例)过敏的变应性鼻炎伴或不伴哮喘患者进行集群免疫治疗.观察并记录剂量递增期不良反应发生率,并分析可能的危险因素.结果 在5周剂量递增期中,猫皮屑和屋尘螨集群免疫治疗分别注射共计126剂次和248剂次.其速发型局部反应发生率分别为11.1％和3.6％,迟发型局部反应发生率分别为1.6％和4.0％.特异性IgE/总IgE占比在速发型局部反应发生组[14.54％(4.81％,24.17％)]显著高于未发生组[4.65％(0.76％,10.86％)](P=0.043).结论 猫皮屑、屋尘螨集群免疫治疗方案可显著缩短剂量递增期时间,不良反应发生率低.特异性IgE/总IgE占比较高的患者需警惕速发型局部反应发生.

Globally, the prevalence of food allergy in children is estimated to be approximately 4% to 10%.[1] Food allergy usually begins early in the allergic march, and cow's milk allergy (CMA) is one of the most common food allergens in infants and children. In Europe, the overall incidence of challenge-proven CMA is 0.54%, and in the United States, the overall prevalence is 0.4% and pediatric prevalence is 1.9%.[2–4] In China, the prevalence of oral food challenge (OFC)-confirmed CMA is 0.83% to 3.5% in various cities.[5] Double-blind placebo-controlled food challenge is not applied widely in clinical practice because of its complex process and the risk of anaphylaxis for patients that receive the test. Allergen-specific IgE (sIgE) is usually used as a critical assessment method for food allergy. In China, studies of CMA on the basis of medical history, serum cow's milk sIgE, component sIgEs, and long-term follow-up of remission of CMA are limited. In this study, patients with allergic diseases were enrolled and serum cow's milk sIgE and cow's milk component sIgEs were analyzed. Patients referred to the Tertiary Allergic Clinical Center of Peking Union Medical College Hospital in 2011, who were aged 0 to 70 years old, met the diagnosis of allergic disease, which included allergic rhinitis (AR), allergic asthma, food allergy, atopic dermatitis (AD), drug allergy and anaphylaxis, made by experienced allergists, and successfully answered and completed the follow-up questionnaire [Supplementary material, https://links.lww.com/CM9/B56] in 2021 were enrolled in this study. Information on demographics, diagnosis, sIgE, and milk component sIgEs was collected. CMA was defined as a convincing reaction (defined by symptoms within 2 h of isolated ingestion, which included at least urticaria and/or angioedema, difficulty breathing, wheezing, throat tightness, and/or vomiting, shock) or a flare of AD associated with cow's milk ingestion and sensitization to milk (milk sIgE level ≥0.35 kUA/L).[1,6] CMA resolution was defined by the successful home introduction of uncooked milk products (milk, yogurt, or ice cream).[6] This study was approved by the Institutional Review Board of Peking Union Medical College Hospital (CTN10SP049.01, S-K1674). All patients or guardians of patients had signed informed consent. All patients had detectable serum sIgEs, which included cow's milk (f2), f76 nBos d 4α-lactalbumin, f77 nBos d 5β-mlactoglobulin, f78 nBos d 8Casein, and e204 nBos d 6bovine serum albumin (BSA), Cow, at their first visit in 2011. sIgE levels were detected by enzyme-linked immunosorbent assays (ImmunoCAP system). Patients with cow's milk sIgE values ≥0.1 kUA/L were considered to have suspected milk sensitization and were enrolled for follow-up.[7] We considered this cutoff to enroll as many patients as possible to reduce missed diagnoses. Continuous and categorical variables were compared by the independent samples t-test and Pearson's χ2 test or Fisher's exact probability test, respectively. Potential factors associated with milk allergy were further evaluated with multivariable logistic regression models. All statistical analysis was performed using SPSS 22.0 (SPSS Inc, Chicago, IL, USA). Among the 709 patients with allergic diseases, which included AR, asthma, food allergy, AD, drug allergy, and anaphylaxis, 50 patients (7.1%) had cow's milk sIgE of >0.35 kUA/L and 158 patients (22.3%) had cow's milk sIgE of ≥0.1 kUA/L. Allergists followed up these 158 patients 10 years later in 2021 and 109 patients completed the follow-up questionnaire. Among the 109 patients, the median age was 14.0 (Q1–Q3: 8.5–29.0) years and 64 were male (58.7%). Five patients had CMA (4.6%) among the 109 milk-sensitized patients, four patients had a history of an acute reaction to milk (including one patient with anaphylaxis), and one patient had a diagnosis of CMA on the basis of AD criteria [Supplementary Figure 1, https://links.lww.com/CM9/B56]. Detailed description of cases with CMA is shown in Supplementary Table 1, https://links.lww.com/CM9/B56. The first time that symptoms had occurred after ingestion of milk was 6 to 10 months of age. A total of 96 milk-sensitized patients (88.1%) had combined AR, 62 patients (56.9%) had asthma, 21 patients (19.3%) had AD, 12 patients (11.0%) had a drug allergy, and 33 patients (30.3%) had another food allergy. Compared with milk-sensitized patients without symptoms, patients with CMA were younger (median ages of 3.0 [Q1–Q3: 2.5–8.0] and 16.0 [Q1–Q3: 9.0–29.8] years, P = 0.003) and more were combined with AD (80.0% vs. 16.3%, P = 0.005) [Supplementary Table 2, https://links.lww.com/CM9/B56]. Cow's milk (f2) sIgE and milk component sIgEs, which included f76 nBos d 4α-lactalbumin, f77 nBos d 5β-lactoglobulin, and f78 nBos d 8Casein, e204 nBos d 6BSA, Cow, were compared in milk-sensitized patients with or without symptoms. The f2 sIgE level in patients with CMA was significantly higher than that in milk-sensitized patients without symptoms (median 1.04 [Q1–Q3: 0.70–5.88] and 0.20 [Q1–Q3: 0.13–0.45] kUA/L, P = 0.002). The f77 nBos d 5β-lactoglobulin level was also significantly higher in patients with CMA than in milk-sensitized patients without symptoms (median 0.48 [Q1–Q3: 0.25–1.99] and 0.09 [Q1–Q3: 0.05–0.20] kUA/L, P = 0.014). Other components were comparable in the two groups. Specific information is shown in Supplementary Table 3, https://links.lww.com/CM9/B56. We further compared the positive rates of cow's milk and component sIgEs. When sIgE ≥0.1 kUA/L was considered positive, the positive rate of cow's milk and components was comparable in the two groups [Supplementary Table 4, https://links.lww.com/CM9/B56]. When sIgE ≥0.35 kUA/L was considered positive, the positive rate of f2 sIgE was the highest (100.0%), followed by f77 nBos d 5β-lactoglobulin (80.0%) with e204 nBos d 6BSA, Cow as the lowest (40.0%) in CMA patients. The positive rate of f2 sIgE was significantly higher in the CMA group than in the milk-sensitized group (100.0% vs. 29.8%, P = 0.001). The positive rates of f77 nBos d 5β-lactoglobulin (80.0% vs. 11.5%, P < 0.001) and e204 nBos d 6BSA, Cow (40.0% vs. 8.7%, P = 0.024) were also significantly different in the two groups [Figure 1A].Figure 1: (A) Positive rate of cow's milk sIgE and its component sIgEs in patients with CMA and cow's milk-sensitized patients without symptoms (sIgE≥0.35 kUA/L); (B) Risk factors of CMA in cow's milk-sensitized patients. (C) Natural resolution rate of CMA. ∗ P< 0.05,† P< 0.01. AD: Atopic dermatitis; BSA: Bovine serum albumin; CI: Confidence interval; CMA: Cow's milk allergy; OR: Odds ratio; sIGE: Allergen-specific IgE.Factors that were different between the two groups, which included age, combination with AD, f2 sIgE, f77 nBos d 5β-lactoglobulin sIgE, and e204 nBos d 6BSA, Cow sIgE, were applied to logistic regression analysis. We found that the combination with AD was a potential risk factor of CMA (odds ratio = 46.146, 95% confidence interval: 1.939–1098, P = 0.018) [Figure 1B]. The patients had completed a follow-up questionnaire 10 years later. All five patients (100%) with milk allergy had a natural resolution. The mean age of resolution was 7.0 ± 3.5 years. At 4 years of age, one patient had resolution (20%), at 6 years of age, four patients had resolution (80%), and at 13 years of age, all five patients had resolution (100%). They drink milk in daily life at present and do not have any symptoms [Figure 1C]. In this study, patients with CMA were younger than those with milk sensitization and had a higher proportion of combination with AD. Logistic regression also showed that combination with AD was a potential risk factor of CMA. Previous studies have also concluded that young children have a high prevalence of food allergy. For example, the HealthNuts study on the basis of a population in Australia found that the prevalence of OFC-confirmed food allergy was 11% in children at 1-year-old, while the prevalence was 3.8% when these children were followed up at 4 years old.[8] A Greek study of newborns and their follow-ups suggested that AD was an independent factor for food allergy.[9] Among patients with CMA, the positive rate of β-lactoglobulin was the highest compared with other components in our study, followed by α-lactalbumin, casein, and BSA. Another study of children with CMA showed that the positive rates of β-lactoglobulin and casein were the highest, followed by a-lactalbumin.[10] Therefore, β-lactoglobulin might be a more sensitive indicator of CMA. After 10 years of follow-up, all five patients with CMA had a natural resolution and most patients (80%) had a resolution at approximately 6 years of age. An observational study of the natural history of milk allergy reviewed data of children in Korea and the results showed that half of the children had a natural resolution of CMA at a median age of 8.7 years.[6] This study also had some limitations. This was a single-center study. The sample size of CMA in this study was relatively small. Therefore, the results of this study might have limitations and biases and not representative for patients in other areas. In conclusion, among patients who visited the Tertiary Allergic Clinical Center of Peking Union Medical College Hospital with milk sensitization, 4.6% of patients had milk allergy. Patients with milk allergy were young and more likely to also have AD. Milk and β-lactoglobulin sIgE levels were higher in the CMA group than in the milk-sensitized group. When the cutoff value of sIgE was 0.35 kUA/L, milk, β-lactoglobulin, and e204 nBos d 6BSA, Cow sIgEs had a preferred diagnostic value. After a long-term follow-up of 10 years, children with milk allergy had a natural resolution rate of 80% at 6 years of age. Funding This work was supported by a grant from the National Natural Science Foundation of China (No. 31972189). Conflicts of interest None.

目的 分析腺样体肥大合并鼻炎患儿随访3年后的变应原谱变化特征.方法 纳入2017年7月～2017年10月就诊于首都儿科研究所附属儿童医院耳鼻咽喉头颈外科,诊断腺样体肥大伴鼻炎的患儿,观察随访至2021年3月.记录基线及随访时血清变应原特异性IgE(sIgE)结果,以及腺样体大小、改良Lund-Kennedy(MLK)鼻内镜评分结果.结果 共纳入36例诊断腺样体肥大合并鼻炎的患儿,9例(25％)为女性,27例(75％)为男性,平均年龄(7.8±2.5)岁,27例(75％)患儿合并变应性鼻炎.基线及随访3年后霉菌均为最主要的变应原,3年后合并尘螨过敏的患儿比例较入组时有下降趋势(37％vs 24％,P=0.28),蒿sIgE水平有上升趋势[4.2(1.7-23.2)vs 9.3(2.8-88.5)KU/L,P=0.35].分层分析发现在6岁以上患儿中屋尘螨sIgE水平较前明显下降[1.8(1.2-2.6)KU/L vs 0.1(0.0-0.7)KU/L,P<0.05].患儿经药物或手术治疗后,腺样体较前明显缩小,MLK鼻内镜评分较前显著下降(6.6±0.9 vs 4.3±1.6,P<0.05).结论 腺样体肥大合并鼻炎患儿中霉菌为最主要的变应原,3年后随访尘螨过敏比例呈下降趋势.药物或手术治疗后患儿腺样体大小及MLK评分均有显著下降.

由中国医师协会、中国医师协会变态反应医师分会(以下简称分会)主办的"中国医师协会第五届变态反应医师分会年会(CCAA2021)"于2021年12月17日至19日以线上线下相结合形式召开.目前疫情虽尚未结束,但分会推广变态反应专科建设、过敏专科医生培训体系建设的脚步没有停下,在尹佳会长的领导下,分会为全国同道精心准备了一场学术盛宴,同时创造了安全而高效的学习、交流渠道.