Abstract Background Blood testing aids pneumonia diagnosis, but its effectiveness varies. Given the invasiveness of bronchoalveolar lavage fluid (BALF) sampling versus blood testing’s simplicity, this study investigates when blood can reliably substitute for BALF in detecting microbial presence, especially for pathogens. Results Metagenomic sequencing was performed on paired BALF-blood samples from 21 post-HSCT immunocompromised (ICP) and 21 immunocompetent (ICT) patients. The ICP cohort was expanded to 62 for biomarker validation. Host responses were profiled via metatranscriptomics (30 BALF samples). Microbial alpha and beta diversity differed significantly between blood and BALF in ICP, but not ICT, patients. ICP patients’ BALF contained a greater diversity and abundance of microbes. A higher proportion of microbial DNA sequences in ICP patients’ blood was also present in their BALF, suggesting a potentially more permeable alveolar-capillary barrier. Related genes (e.g., NABA CORE MATRISOME, extracellular matrix organization, cell-cell adhesion) were downregulated. Upregulated pathways like VEGFA-VEGFR2 signaling and Rho GTPases suggested increased vascular permeability. In ICP patients, 419 microbial sequences in blood indicated their presence in the lower respiratory tract with > 70% certainty. Conclusion Host immune status significantly influences blood-BALF microbial diversity differences. Shared blood-BALF microbial DNA sequences show potential for aiding pneumonia pathogen diagnosis, offering a novel biomarker identification approach.

Inotuzumab ozogamicin (InO) is effective for relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) but is associated with hepatotoxicity, particularly sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), which leads to portal hypertension (PH). We report a case of a 50-year-old woman who, after receiving InO, developed SOS/VOD and subsequent chronic PH, manifesting as recurrent variceal bleeding approximately 18 months post-treatment. A literature review highlights diagnostic advances using non-invasive tools like transient elastography, the central role of calicheamicin-induced endothelial injury and complement activation in pathogenesis, and risk mitigation through ursodiol prophylaxis and avoidance of dual-alkylator conditioning regimens. The case further illustrates that PH can present with atypical hemodynamics, such as preserved portal flow and absence of cirrhosis, and may emerge as a chronic sequela long after acute SOS/VOD resolution. Quantitative risk assessment using a validated model (CIBMTR) revealed a very low pre-treatment SOS/VOD risk (2.64%), highlighting that InO-induced injury can override a favorable baseline risk profile. This underscores the importance of long-term monitoring for PH, even after resolution of acute SOS/VOD and achievement of leukemia remission, to optimize outcomes in InO-treated patients.

Ambient ozone (O₃) links to childhood allergic rhinitis (AR), but the nasal microbiome's role remains unclear. We did a case-control study in Shanghai (176 AR children, 114 controls). AR children had higher 12-month O₃ (OR=1.21, 95 %CI:1.11-1.29 per 10 μg/m³) and reduced nasal microbial α-diversity (P < 0.05). Co-occurrence network analysis showed the nasal microbial community in AR children had reduced connectivity and lost keystone taxa compared to controls. O₃ was negatively correlated with α-diversity (P < 0.05) which indices mediated annual (9.15 %, 95 %CI:3.17-18.45 %) and warm-season (14.21 %, 95 %CI:5.27-27.84 %) O₃-AR links; predicted microbial functional pathways in particular steroid hormone biosynthesis (8.77 % for annual O₃, 18.49 % for warm-season O₃) and limonene/pinene degradation (7.46 % for warm-season O₃) (P < 0.05) mediated the O₃-AR link too. Our findings highlighted the nasal microbiome's potential role in mediating the link between O3 exposure and childhood AR. This fills gaps in the mechanism on ambient O3 and childhood AR in perspective of the mediation by nasal microbiome and its functional pathways and offers actionable insights for O3 - targeted environmental management and precise pediatric health protection.

Background:Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is a common alternative for patients with hematological malignancies. Epstein-Barr virus (EBV) reactivation is a common complication post-transplantation, but its impact on immune reconstitution and survival remains unclear. Objective:To compare immune reconstitution and survival between patients with and without EBV reactivation after haplo-HSCT. Design:A retrospective study was conducted involving 322 patients aged 18-60 years, diagnosed with hematological malignancies, who underwent haplo-HSCT at our center from January 2018 to December 2021. Methods:Data analysis was performed using SPSS (version 24.0) and R4.3.0 software. Statistical methods included Chi-square tests for qualitative variables, independent t tests for continuous variables, Kaplan-Meier method for survival analysis, and logistic regression for risk factor analysis. Results:After a median of 58 days posttransplant, 176 patients (54.6%) had EBV reactivation, but only 5 patients developed posttransplant lymphoproliferative disorder. Logistics multivariate analysis showed EBV IgA-negative donor, cytomegalovirus (CMV) reactivation, and graft-versus-host disease (GVHD) prophylaxis with anti-thymocyte globulin (ATG) were independent risk factors of EBV reactivation. Then a risk factor prediction model for EBV reactivation after transplantation was established based on the multivariate regression. The analysis based on the generalized linear mixed model showed dramatic improvements in the reconstitution of CD8+CD45RO+ memory T-cells and CD16+CD56+ NK cells of the EBV-reactivated group. There was no statistical difference in overall survival (p = 0.26), relapse-free survival (p = 0.72), GVHD-relapse free survival (p = 0.44), cumulative incidence of relapse (Gray's test p = 0.72), and transplant-related mortality (Gray's test p = 0.066) between patients with and without EBV reactivation. Conclusion:Our study showed EBV IgA-negative donor, CMV reactivation, and GVHD prophylaxis with ATG were independent risk factors of EBV reactivation. Posttransplant EBV reactivation had no significant influence on the outcomes of patients, but its impact on immune reconstitution might be complicated. The predictive model based on the study could direct our attention toward patients at high risk of EBV reactivation.

OBJECTIVE:To evaluate the effects of treatment with nebulized budesonide inhalation suspension (BIS) at dosages of 500 µg/day and 250 µg/day on mild to moderate asthma in young children. METHODS:This was a randomized, parallel group, open-label study at 19 Chinese clinical sites. A total of 340 patients (4-7 years) with mild to moderate persistent pediatric asthma were randomly and evenly divided into the 500-µg group (BIS 500 µg/day) and the 250-µg group (BIS 250 µg/day); 323 patients completed the study. The Children-Asthma Control Test (C-ACT), asthma control, Pediatric Asthma Quality of Life Questionnaire (PAQLQ), pulmonary function tests (PFT), additional asthma-related therapy, and adverse effects (AEs) were compared after 1, 3, and 6 months of treatment between groups. RESULTS:There were no statistically significant differences in C-ACT scores, level of asthma control, PAQLQ scores, PFT parameters, additional medications and AE occurrences from baseline to 6 months post-treatment between the two groups (all p > 0.05). Compared with baseline values, both groups showed improvements in C-ACT and PAQLQ scores, the rate of well-controlled asthma, and PFT parameters (all p < 0.05). The cumulative number of unplanned outpatient visits (50 vs. 49) and hospitalizations (3 vs. 0) in the 250-µg group was higher than that in the 500-µg group (p < 0.05). CONCLUSIONS:The lower dosage of 250 µg/day BIS was found to be as effective as 500 µg/day BIS. For young children with mild to moderate persistent asthma who have well-controlled, a lower dose of BIS treatment can be chosen.

BackgroundA reduction in biodiversity and alterations in the microbiota composition are relevant to allergic diseases. However, combined analyses of the skin, nasal and gut microbiotas are lacking in the literature. In addition, in previous studies, microbiota were detected mainly by V3–V4 sequencing, but other sequences might be missed with this technique.MethodsIn this case–control study, we enrolled 3–12-year-old children with allergic rhinitis combined with atopic dermatitis and food allergy (AR-AD-FA group), children with allergic rhinitis only (AR-only) and healthy controls (HC group). We employed full-length 16S rRNA gene amplification and sequencing for the detection of gut, nasal and skin microbiota.ResultsSamples with an average sequence length of 1,459 bp were obtained in this study. Significant differences in beta diversity in the three compartments were found between the disease groups and the HC group. Differentially expressed genera were present mainly in the gut compartment. Peptoniphilus, Prevotella and Anaerococcus were abundant in the gut in the disease groups. Specifically, Streptomyces, Thermus and Pseudomonas showed differential expression in both the nasal and skin compartments of children in the disease groups.ConclusionSome meaningful differences in the abundance of some microbiota from the three compartments were observed between the disease groups and the HC group. These findings could provide new insights into the prevention and treatment of allergic diseases through the regulation of specific microbiota in the future.

Background: Influenza A is the most common viral pathogen isolated from pediatric clinics during influenza seasons. Some young patients with influenza manifest rapid progression with high fever and severe sequelae, such as pneumonia and meningitis. Therefore, early diagnosis and prompt treatment are highly important. Specific diagnostic tests currently include antigen detection, antibody detection, nucleic acid test and virus isolation. Rapid antigen testing is the most commonly adopted method in the outpatient setting, but false negative results are frequently observed, which causes delayed treatment and severe outcome. Routine blood test is the most commonly used detection for the outpatients. Incorporating specific blood cell counts into rapid antigen test may overcome some technical issues and enable accurate early diagnosis. Methods: We enrolled 537 children with influenza-like symptoms like fever or respiratory symptoms from pediatric outpatients and 110 children without infectious diseases for control. Routine blood tests detected by a routine analyzer and influenza A virus antigen detection were performed in the patients. Significant blood routine parameters between groups were examined by statistical tests. Parameters in routine blood test were assessed by the receiver operating characteristic curve to find the screening indicators of influenza A. Multivariate logistic regression were used to establish the optimal combinations of blood routine parameters in our screening model. Results: Two subgroups were set according to age: <= 6 years old group and >6 years old group. In each group, patients were further divided into three subgroups: the influenza A-positive-result group (A+ group) (n=259), influenza A-negative-result group (A- group) (n=277) and healthy control group (H group) (n=110). Most routine blood parameters showed significant differences among the three subgroups in each age group. Notably, lymphocyte (LYM) number, platelet (PLT) number, lymphocyte-to-monocyte ratio (LMR) and LYM multiplied by PLT (LYM*PLT) exhibited extremely significant differences. Using A- group as a reference based on the area under the curve (AUC), both age groups had a similar trend. For A- group, the optimal cutoff value of LYM*PLT was 221.6, the AUC, the sensitivity and specificity were 0.6830, 55.71% and 76.92% in the <= 6 years old group. Meanwhile, the cutoff value of LYM*PLT was 196.7, and the AUC, the sensitivity and specificity were 0.6448, 53.97% and 70.81%, respectively in the >6 years old group. Screening model based on multivariate logistic regression model revealed that LYM*PLT was the optimal parameter combinations in <= 6 years old group (AUC =0.7202), while LYM and PLT were the optimal parameter combinations in >6 years old group (AUC =0.6760). Conclusions: Several blood routine parameters in children with influenza A demonstrate differential levels in both age subgroups. The LYM*PLT exhibits the potential screening value of influenza infection.

Allergic rhinitis (AR) subjects might have their microenvironment changed due to pathogenesis and living environment. Whether the nasal microbe in AR children differs from healthy subjects and how it interplays with dermal, oral and indoor dust microbe needs to be elucidated. In this case–control study, we analyzed and compared the bacterial characterization and associations in nasal, dermal, oral swab samples and dust samples in 62 children with physician-diagnosed AR(cases) and 51 age- and gender-matched healthy ones with no history of allergic diseases(controls). Full-length 16S rRNA sequencing(swabs) and shotgun metagenomics(dust) were applied. Bacterial diversity, composition, abundance difference characteristics and fast expectation–maximization for microbial source tracking(FEAST) analysis were performed and compared between cases and controls. The α-diversity of dust microorganisms in AR was lower than that in control group (P = 0.034), and the β-diversity indices of microorganisms in nasal cavity (P = 0.020), skin (P = 0.001) and dust (P = 0.004) were significantly different from those in control group. At species levels, a total of 10, 15, 12, and 15 bacterial species were differentially enriched in either cases or controls in nasal, dermal, oral, and dust samples, respectively(Linear Discriminant Analysis(LDA) score > 2, P < 0.05). Staphylococcus epidermidis was the single species simultaneously more abundant in nasal, dermal and dust samples in AR children. By FEAST analysis, 8.85

Importance:With the widespread use of anti-SARS-CoV-2 drugs, accumulating data have revealed potential viral load rebound after treatment. Objective:To compare COVID-19 rebound after a standard 5-day course of antiviral treatment with VV116 vs nirmatrelvir-ritonavir. Design, Setting, and Participants:This is a single-center, investigator-blinded, randomized clinical trial conducted in Shanghai, China. Adult patients with mild-to-moderate COVID-19 and within 5 days of SARS-CoV-2 infection were enrolled between December 20, 2022, and January 19, 2023, and randomly allocated to receive either VV116 or nirmatrelvir-ritonavir. Interventions:Participants in the VV116 treatment group received oral 600-mg VV116 tablets every 12 hours on day 1 and 300 mg every 12 hours on days 2 through 5. Participants in the nirmatrelvir-ritonavir treatment group received oral nirmatrelvir-ritonavir tablets with 300 mg of nirmatrelvir plus 100 mg of ritonavir every 12 hours for 5 days. Participants were followed up every other day until day 28 and every week until day 60. Main Outcomes and Measures:The primary outcome was viral load rebound (VLR), defined as a half-log increase in viral RNA copies per milliliter compared with treatment completion. Secondary outcomes included a reduction in the cycle threshold value of 1.5 or more, time until VLR, and symptom rebound, defined as an increase of more than 2 points in symptom score compared with treatment completion. The primary outcome and secondary outcomes were analyzed using the full analysis set. Sensitivity analyses were conducted using the per protocol set. Adverse events were analyzed using the safety analysis set. Results:The full analysis set included 345 participants (mean [SD] age, 53.2 [16.8] years; 175 [50.7%] were men) who received VV116 (n = 165) or nirmatrelvir-ritonavir (n = 180). Viral load rebound occurred in 33 patients (20.0%) in the VV116 group and 39 patients (21.7%) in the nirmatrelvir-ritonavir group (P = .70). Symptom rebound occurred in 41 of 160 patients (25.6%) in the VV116 group and 40 of 163 patients (24.5%) in the nirmatrelvir-ritonavir group (P = .82). Viral whole-genome sequencing of 24 rebound cases revealed the same lineage at baseline and at viral load rebound in each case. Conclusions and Relevance:In this randomized clinical trial of patients with mild-to-moderate COVID-19, viral load rebound and symptom rebound were both common after a standard 5-day course of treatment with either VV116 or nirmatrelvir-ritonavir. Prolongation of treatment duration might be investigated to reduce COVID-19 rebound. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR2200066811.

Posttransplant lymphoproliferative disorder (PTLD) is a rare lymphoid and/or plasmocytic proliferation that occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to identify the pathologic features and clinical outcomes of T-cell PTLD, an extremely rare subtype of PTLD, after allo-HSCT. In this study, six allo-HSCT recipients with T-cell PTLD from five transplant centers in China were enrolled. All the T-cell PTLD were donor-derived, and three patients were with monomorphic and three with polymorphic types, respectively. All patients received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy. Five patients achieved complete response (CR), and one experienced progressive disease (PD). The median time from HSCT to onset was 4 (range: 0.6-72) months, analyzed in combination with the other 16 patients with T-cell PTLD identified from previous reports. About 56.3% of the T-cell samples (9/16) were positive for in situ hybridization with an Epstein-Barr virus (EBV)-encoded small nuclear early region (EBER ISH). CHOP-based chemotherapy might be the optimal strategy for patients who showed no response to empiric therapy with a CR rate of 87.5%. In conclusion, our study observed that T-cell PTLD has distinct clinical manifestations and morphological features, which characterized by less relation to EBV, later occurrence, and poorer prognosis when compared with B-cell PTLD.

Indoor microorganisms impact asthma and allergic rhinitis (AR), but the associated microbial taxa often vary extensively due to climate and geographical variations. To provide more consistent environmental assessments, new perspectives on microbial exposure for asthma and AR are needed. Home dust from 97 cases (32 asthma alone, 37 AR alone, 28 comorbidity) and 52 age- and gender-matched controls in Shanghai, China, were analyzed using high-throughput shotgun metagenomic sequencing and liquid chromatography-mass spectrometry. Homes of healthy children were enriched with environmental microbes, including Paracoccus, Pseudomonas, and Psychrobacter, and metabolites like keto acids, indoles, pyridines, and flavonoids (astragalin, hesperidin) (False Discovery Rate < 0.05). A neural network co-occurrence probability analysis revealed that environmental microorganisms were involved in producing these keto acids, indoles, and pyridines. Conversely, homes of diseased children were enriched with mycotoxins and synthetic chemicals, including herbicides, insecticides, and food/cosmetic additives. Using a random forest model, characteristic metabolites and microorganisms in Shanghai homes were used to classify high and low prevalence of asthma/AR in an independent dataset in Malaysian schools (N = 1290). Indoor metabolites achieved an average accuracy of 74.9% and 77.1% in differentiating schools with high and low prevalence of asthma and AR, respectively, whereas indoor microorganisms only achieved 51.0% and 59.5%, respectively. These results suggest that indoor metabolites and chemicals rather than indoor microbiome are potentially superior environmental indicators for childhood asthma and AR. This study extends the traditional risk assessment focusing on allergens or air pollutants in childhood asthma and AR, thereby revealing potential novel intervention strategies for these diseases.

Viral respiratory infections are recognized risk factors for the loss of control of allergic childhood asthma and exacerbations.Children with severe asthma are more susceptible to viruses and are more likely to induce acute exacerbations after infection.During the immune response to the virus,innate immunity is activated,resulting in the production of large amounts of interferon,which is essential for the antiviral response.Children with severe asthma aren't at increased risk of SARS-CoV-2 infection or disease progression when treated with biologics compared to the non-asthmatic population.Omalizumab has been shown to enhance the body's antiviral immune response and to reduce the acute attack rate of virus-induced seasonal asthma in children with asthma.This review focuses on the safety of biologics used in children with asthma during COVID-19 and their effects on respiratory viruses.

The contribution of lymphocyte subset composition of the graft on the outcomes following haploidentical peripheral blood stem cell transplantation (haploPBSCT) is not fully elucidated. We retrospectively analyzed 314 patients with hematological malignancies who underwent haploPBSCT from 2016 to 2020 in our center. We obtained a cutoff value of CD3+ T cell dose (2.96 × 10 8 /kg) that separated the risk of II–IV acute graft-versus-host disease (aGvHD) and divided patients into the low CD3+ T cell dose group (CD3+ low) and the high CD3+ T cell dose (CD3+ high) group. Significantly higher incidences of I-IV aGvHD, II–IV aGvHD, and III–IV aGvHD were identified in the CD3+ high group (50.8%, 19.8%, and 8.1% in the high group, 23.1%, 6.0%, and 0.9% in the low group, P < 0.0001, P = 0.002, and P = 0.02, respectively). We found that CD4+ T cell and its naïve and memory subpopulations of grafts had a significant impact on aGvHD ( P = 0.005, P = 0.018, and P = 0.044). Besides, we found an inferior reconstitution of natural killer (NK) cells in the CD3+ high group than in the low group within the first-year posttransplant (239 cells/μL vs 338 cells/μL, P = 0.0003). No differences in engraftment, chronic GvHD (cGvHD), relapse rate, transplant-related mortality (TRM), and overall survival (OS) were identified between the two groups. In conclusion, our study found that a high CD3+ T cell dose led to a high risk of aGvHD and inferior reconstitution of NK cells in the haploPBSCT setting. In the future, carefully manipulating the composition of lymphocyte subsets of grafts might reduce the risk of aGvHD and improve the transplant outcome.

IgE介导的鸡蛋过敏是儿童最常见的食物过敏之一,烘烤鸡蛋可以降低其致敏性,因此部分鸡蛋过敏的儿童可以耐受烘烤鸡蛋.但是儿童能够耐受烘烤鸡蛋的免疫特征有待进一步研究.烘烤鸡蛋饮食可能缩短鸡蛋过敏的自然进程,提高鸡蛋过敏儿童的生活质量,目前推荐轻度鸡蛋过敏的儿童添加烘烤鸡蛋饮食.本文就烘烤鸡蛋的抗原改变、耐受、耐受儿童的免疫特征、耐受烘烤鸡蛋的临床意义和进行烘烤鸡蛋对轻度鸡蛋过敏儿童管理进行综述.

Although there are many methods for desensitization of donor-specific anti-HLA antibodies (DSAs) in allogeneic haematopoietic stem cell transplantation (allo-HSCT), but could not satisfy the clinical need. The report by Liu et al. suggests double filtration plasmapheresis (DFPP) in combination with rituximab, as a new method for desensitization of DSAs, has a promising activity. The successful engraftment of donor haematopoietic stem cells in recipients is the critical basis for allo-HSCT, whereas it is affected by many factors, including the preconditioning and graft-versus-host disease (GVHD) prophylaxis regimens, ABO blood type compatibility, sepsis and myelosuppressive agents (such as ganciclovir, trimethoprim/sulfamethoxazole). For mismatched donor transplantation, especially haploidentical transplantation, DSAs have been recognized as an important barrier against successful engraftment of donor cells. The relationship of DSAs and primary graft failure (PGF) has been clarified and DSAs not only significantly increase the risk of PGF, but also could result in a higher incidence of primary poor graft function.1-3 To reduce the risk of PGF, several desensitization methods have been used to decrease DSA levels or inhibit its production that would permit successful donor stem cell engraftment (Table 1). These desensitization methods are mostly based on experiences in solid organ transplantation. Some of these interventions have also been used in haploidentical haematopoietic cell transplantation (HHCT) and mismatched donor transplantation. However, most results with these desensitization methods were from case report or small studies with limited number of samples and variety of graft outcomes.4 Combination of plasmapheresis, rituximab and bortezomib could effectively prevent PGF Plasmapheresis alone could decrease DSA levels, but not effectively prevent PGF These methods alone do not effectively prevent PGF Splenectomy was traumatic DSA is reduced significantly by platelet transfusions The reduction of DSA level is not immediate by buffy coat infusion Platelet transfusions only specific to HLA class I antigens Buffy coat infusion specific to both HLA class I and II antigens IVIG alone do not effectively prevent PGF DFPP is a semi-selective method for blood purification, which can avoid the unnecessary loss of plasma proteins and increase the efficiency of purification. Some studies have demonstrated that DFPP was effective for treatment of many immune-related diseases such as myasthenia gravis.5, 6 However, there are no studies to evaluate the effect of DFPP for DSA desensitization in allo-HSCT. In their papers, the authors7 reported their clinical trial results of investigating the effectiveness of the desensitization protocol including DFPP and rituximab. A total of 132 patients undergoing HHCT were enrolled in the nested case–control retrospective study, including 33 with DSAs and 99 without DSAs. All patients with DSAs had a mean fluorescence intensity (MFI) >2000 and received treatments including two sessions of alternate-day of DFPP, followed by a single dose of rituximab (375 mg/m2). The DSA levels after DFPP treatment were significantly lowered as compared with that before DFPP, which suggested that DFPP could effectively reduce the level of circulating DSAs of HHCT recipients. All DSA-positive patients achieved successful engraftment after DSA desensitization with DFPP in combination with rituximab, which suggested the combination regimen could overcome the negative effects of DSAs on engraftment of HHCT patients. The probability of PGF was correlated with the titre of DSAs and increased along with an increased DSA level of MFI. However, the cut-off values of MFI for DSA positivity were not defined. Several results suggested that MFI levels >5000 pose a higher risk of engraftment failure, although rejection can occur with DSAs at any MFI levels.4 Chang et al.3 reported that MFI levels of DSAs ≧10 000 were significantly associated with PGF, while >2000 were with primary poor graft function. Many factors, including different underlying diseases and preconditioning regimens, various GVHD prophylaxis strategies, affected the effects of DSAs on engraftment. These results suggested that different levels of DSAs might need be managed with different DSA desensitization methods. In this study, DSA MFI >2000 was the criterion for DSA desensitization and patients with DSA MFI >10 000 only accounted for 27.3%. It will be better for more patients with higher titre of DSAs receiving DFPP to further illuminate its effects. Although further studies on larger number of patients are needed, the present study provided a new method of DFPP for DSA desensitization and it is value to be explored in clinical activities. The authors declare no competing financial interests.

Abstract Aim: To explore the tolerance march in children and identify potential factors that affect the prognosis of egg allergy (EA). Methods: Two hundred children(age range, 6 months-2.5 years)with atopic dermatitis (AD) were recruited from 2018 to 2019. EA was diagnosed based on medical history, skin prick test (SPT), and the oral food challenge (OFC) test. EA was diagnosed in 78 children; among these, 7 were allergic only to egg yolk (Only EYA), 20 to egg white (Only EWA), and 51 to whole egg (WEA). Logistic regression analysis was used to identify risk factors for outcomes during the disease course. Receiver operating characteristic (ROC) curve analysis was performed to establish a predicting model. Results: The Scoring Atopic Dermatitis score in the WEA group was more severe and persistent than that in the other groups. Forty-three cases of EA developed clinical tolerance (average age, 32.3 ± 8.7 months). The tolerance rate of EYA and EWA was 75.9% and 56.3%, respectively. The SPT wheal diameter at initial diagnosis (SPTdiag) was a risk factor for persistent EA. The SPT wheal diameter after 6 months (△SPT6mo) in the tolerant group was markedly decreased compared to that in the persistent EA group. Tolerance was higher when △EW-SPT6mo ≥ 39.5% or △EY-SPT6mo ≥ 27%. Conclusion: The initial SPTdiag and SPT6mo values were significantly correlated with and can predict outcomes of EA.

In the last few decades, there has been a progressive increase in the prevalence of allergic rhinitis (AR) in China, where it now affects approximately 250 million people. AR prevention and treatment include allergen avoidance, pharmacotherapy, allergen immunotherapy (AIT), and patient education, among which AIT is the only curative intervention. AIT targets the disease etiology and may potentially modify the immune system as well as induce allergen-specific immune tolerance in patients with AR. In 2017, a team of experts from the Chinese Society of Allergy (CSA) and the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) produced the first English version of Chinese AIT guidelines for AR. Since then, there has been considerable progress in basic research of and clinical practice for AIT, especially regarding the role of follicular regulatory T (TFR) cells in the pathogenesis of AR and the use of allergen-specific immunoglobulin E (sIgE) in nasal secretions for the diagnosis of AR. Additionally, potential biomarkers, including TFR cells, sIgG4, and sIgE, have been used to monitor the incidence and progression of AR. Moreover, there has been a novel understanding of AIT during the coronavirus disease 2019 pandemic. Hence, there was an urgent need to update the AIT guideline for AR by a team of experts from CSA and C2AR2G. This document aims to serve as professional reference material on AIT for AR treatment in China, thus improving the development of AIT across the world.

Cow′s milk protein allergy (CMPA) is one of the most common presentations of food allergy seen in early childhood.It is an abnormal immune response caused by cow′s milk protein.CMPA can be clinically subdivided into either immediate-onset IgE mediated or delayed onset non-IgE mediated, or both.At present, concerns regarding the early and timely diagnosis of CMPA have been high-lighted over the years and there are many expert consensus on CMPA in China, but these consensus did not distinguish IgE mediated or non-IgE mediated CMPA.In view of the obvious clinical differences between the two type of CMPA and non-IgE mediated CMPA is more common in infancy, experts focus on pediatric gastroenterology, allergy/immunology, dermatology, nutrition and child healthcare convened by the Allergy Prevention and Control Professional Committee of Chinese Preventive Medicine Association present this guideline to help practitioners in primary care settings to early recognize and make suitable management of non-IgE mediated CMPA in China.The guideline incorporates the cutting-edge international guidance and the actual situation of Chinese children describing in detail the types, clinical features, diagnosis and nutritional intervention of non-IgE mediated CMPA.There are 42 recommendations in 7 categories in total referring to the common questions related to non-IgE mediated CMPA.

目的 多维效能分析透射比浊法及散射比浊法测定血清总IgE与荧光酶免疫法(ImmunoCAP法)测定血清总IgE的相关性和一致性,为临床进行不同检测方法间的相互参照提供支持.方法 取184例9个月到13岁患儿血清标本,全部采用荧光酶免疫法(ImmunoCAP法,德国赛默飞Phadia100)测定总IgE,其中108例样本同时应用散射比浊法测定总IgE,76例样本应用透射比浊法测定总IgE,对两组数据进行相关分析、等级分组一致性分析,以及对散射比浊法组进行随机敏感性分析.结果 相关性分析发现,透射比浊法与荧光酶免疫法结果具有高度相关性(Spearman相关系数为0.982,P＜0.001),等级分组一致性良好(κ值为0.774,P＜0.001).散射比浊法与荧光酶免疫法结果具有高度相关性(Spearman值为0.955,P＜0.001),等级分组一致性良好(K值为0.766,P＜0.001).且透射比浊法在不同浓度等级组都与荧光酶免疫法有较紧密的相关性.结论 透射比浊法或散射比浊法与荧光酶免疫法检测血清总IgE具有高度一致性,当荧光酶免疫法无法获得时,比浊法得出的结果可做参照.

Mycopiasma pneumoniae is a common pathogen causing respiratory disease in children. We sought to investigate the epidemiology of M. pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the coronavirus disease 2019 (COVID-19) pandemic. Eligible patients were prospectively enrolled from January 2020 to June 2021. Throat swabs were tested for M. pneumoniae RNA. M. pneumoniae IgM was tested by a colloidal gold assay. Macrolide resistance and the effect of the COVID-19 countermeasures on M. pneumoniae prevalence were assessed. Symptom scores, treatments, and outcomes were evaluated. Eight hundred sixty-two eligible children at 15 centers in China were enrolled. M. pneumoniae was detected in 78 (9.0%) patients. Seasonally, M. pneumoniae peaked in the first spring and dropped dramatically to extremely low levels over time until the next summer. Decreases in COVID-19 prevalence were significantly associated with decreases in M. pneumoniae prevalence (r = 0.76, P = 0.001). The macrolide resistance rate was 7.7%. The overall sensitivity and specificity of the colloidal gold assay used in determining M. pneumoniae infection were 32.1% and 77.9%, respectively. No more benefits for improving the severity of symptoms and outcomes were observed in M. pneumoniae-infected patients treated with a macrolide than in those not treated with a macrolide during follow-up. The prevalences of M. pneumoniae and macrolide resistance in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs. IMPORTANCE This is the first and largest prospective, multicenter, active, population-based surveillance study of the epidemiology of Mycoplasma pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the COVID-19 pandemic. Nationwide measures like strict face mask wearing and restrictions on population movement implemented to prevent the spread of COVID-19 might also effectively prevent the spread of M. pneumoniae. The prevalence of M. pneumoniae and the proportion of drug-resistant M. pneumoniae isolates in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for screening and diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.