Background Remibrutinib has recently become available for the clinical management of chronic spontaneous urticaria (CSU) in China, yet relevant clinical experience remains limited, highlighting an urgent demand for population-specific real-world evidence. We therefore evaluated the early effectiveness, safety and clinical utilization of remibrutinib in a heterogeneous Chinese outpatient cohort. Methods This interim analysis was conducted based on an ongoing prospective, multicenter observational cohort enrolling 32 adult patients with CSU receiving treatment in routine outpatient settings. Eligibility criteria did not restrict prior treatment regimens, nor did it limit physician-managed background or rescue therapies for CSU. The safety set consisted of 29 patients who received at least one dose of remibrutinib, and the Week 4 efficacy set comprised 25 patients with evaluable 7-day Urticaria Activity Score (UAS7) data. Assessed outcomes included UAS7, Urticaria Control Test (UCT), Dermatology Life Quality Index (DLQI), 7-day Angioedema Activity Score (AAS7), Angioedema Control Test (AECT), treatment patterns and adverse events. All analyses were descriptive. Baseline UAS7 > 6 was defined as failure to achieve well-controlled disease. Results At remibrutinib initiation, 22 of 27 patients (81.5%) with available baseline UAS7 had not achieved well-controlled disease. Baseline exposure to H1-antihistamines, omalizumab, and systemic corticosteroids was documented in 21 of 29 (72.4%), 19 of 29 (65.5%), and 12 of 29 patients (41.4%), respectively; 20 of 29 (69.0%) had exposure to at least two baseline CSU treatment classes. Two patients (6.9%) initiated remibrutinib after H1-antihistamines as their only documented baseline CSU drug class, and both had baseline UAS7 > 6. At Week 4, mean UAS7 decreased from 19.4 (95% confidence interval [CI], 14.20-24.68) to 5.3 (95% CI, 2.70-7.86). Nineteen of 25 patients (76%) had UAS7 ≤ 6, and 9 of 25 (36%) had UAS7 = 0. Mean UCT increased from 6.36 to 11.56 (P < 0.001), and mean DLQI decreased from 8.56 to 3.24 (P = 0.012). Among four patients with paired angioedema assessments, AAS7 decreased from 44.5 at baseline to 0 at Week 4, while median AECT increased from 3.0 to 16.0. These findings were exploratory because paired observations were limited. Ten of 29 patients (34.5%) reported at least one adverse event (AE); no serious or severe AEs occurred. Petechiae were recorded in 4 of 29 patients (13.8%). Conclusions Across patients with diverse baseline treatment exposures, remibrutinib was associated with rapid improvements in disease activity, disease control, and quality of life by Week 4. However, longer-term follow-up is necessary to assess the durability of these improvements and further characterize the safety profile of remibrutinib. (Chinese Clinical Trial Registry number: ChiCTR2600127540.)

Background:Polysensitization occurs in 80% of allergic patients. Allergen immunotherapy (AIT) formulations with multiple allergens remain debated for polysensitized patients. Objective:This study aims to evaluate the clinical effectiveness and safety profile of multiallergen AIT in polysensitized allergic rhinitis (AR) patients. Methods:We searched for polysensitized AR patients treated with multiple allergens in immunotherapy in PubMed, Embase, Web of Science and Cochrane Library until June 5, 2025. Results:Seven randomized clinical trials and 7 nonrandomized studies were included. Multiallergen immunotherapy significantly reduced combined symptom and medication scores versus placebo from baseline (SMD: -3.75, 95% CI (-5.85, -1.65; p < 0.001)). Compared to single-allergen AIT, symptom score changes were no difference (SMD: -0.34, 95% CI -1.21, 0.52; p = 0.44), while medication scores showed slight superiority (SMD: -1.36, 95% CI -2.44, -0.28; p = 0.01). But both scores at the last follow-up were significantly reduced compared with single-allergen treatment (SMD: -1.75, p = 0.01; SMD: -1.30, p = 0.007). Systematic review highlighted superior outcomes with dual-allergen AIT in some studies. The multiallergen group had a safer profile in randomized studies (OR 0.58, 95% CI 0.35, 0.96, p = 0.03). No significant differences were found in adverse events due to AIT treatment among non-randomized studies (OR 0.86, 95% CI 0.64, 1.15, p = 0.3). Multiallergen AIT demonstrated enhanced immune tolerance and modulation of the type 2 immune response similar to single-allergen treatment. Conclusion:Based on current evidence, multiallergen AIT demonstrates no significant difference in efficacy, a comparable safety profile, and equivalent immunological modulation compared to single-allergen AIT for the treatment of polysensitized allergic rhinitis. Dual-allergen approaches may optimize benefits in clinically relevant cases, though study heterogeneity necessitates standardized trials.

The understanding of type 2 inflammatory diseases is undergoing a paradigm shift from “immune imbalance” toward “immune–metabolic crosstalk”. Energy metabolism not only fuels immune responses but also fundamentally dictates the functional phenotypes of immune cells through metabolic reprogramming. By systematically integrating metabolic programming data of key immune cells across diverse tissues (skin, gut, nasal, and ocular mucosa), this review constructs a cross-disease “metabolism–signaling network” atlas. The synthesis highlights that glycolysis and mTORC1 signaling are predominantly coupled with the pro-inflammatory outputs of Th2 cells and ILC2s, whereas fatty acid oxidation (FAO) and oxidative phosphorylation (OXPHOS) sustain the homeostasis of Tregs and M2-like macrophages. Furthermore, this review characterizes how the tryptophan, glutamine, and arginine pathways fine-tune the immune tolerance boundary via the IDO–AhR–mTOR axis. We also elucidate a conserved inter-organ “hypoxia–HIF-1α–lactylation” axis, which, in conjunction with tissue-specific metabolic branches (e.g., the ceramide pathway in the skin, the SCFA circuit in the gut, and the lactate–GPR81 loop in the mucosa), collectively sculpts local microenvironments and remodeling trajectories. Ultimately, a novel diagnostic and therapeutic framework centered on metabolic phenotyping is proposed, providing prospective insights into targeting metabolic checkpoints for precision immunotherapy in type 2 inflammation.

Artificial intelligence revolutionizes food and drug allergy care. In food allergy, it predicts risks via microbiome/IgE data, diagnoses via multi-modal analytics, optimizes therapies (OIT), and manages allergens (biosensors, hypoallergenic products). For drug allergy, AI predicts hypersensitivity (β-lactam risk), diagnoses via EHR NLP, explores therapeutic targets, and streamlines management (ADR classification, anaphylaxis surveillance). Despite progress, gaps remain: underrepresented population models, immunocompromised diagnosis, and global data standardization. AI drives precision in allergy prediction, diagnosis, therapy, and management, but needs refinement to fully address clinical complexity. This review highlights how artificial intelligence is transforming the landscape of food and drug allergy research, from early risk prediction to personalized management, while also addressing the current limitations and future opportunities.

Background:Bronchodilation testing (BDT) is routinely used to assess reversibility of airflow limitation. For patients with rhinitis who report asthma-related symptoms but often show preserved spirometry, the clinical patterns associated with bronchodilator responsiveness (BDR) are less clearly described. Understanding these patterns may help clinicians interpret lung function in real-world practice. Methods:We retrospectively analyzed 555 consecutive patients who underwent spirometry and BDT at a single tertiary allergy center. Data on clinical symptoms, allergic status, type-2 inflammatory markers, baseline spirometry results, and BDT outcomes were collected. Associations between symptoms, spirometric indices, and BDR were evaluated. Exploratory analyses examined the relationship between FEV1 improvements below the conventional ≥12% criterion and asthma-related symptoms. Results:Among all participants, 71.9% had allergic rhinitis, and 88.6% reported asthma-related symptoms. BDR was observed across a wide range of baseline spirometry values; 47.2% of BDT-positive patients had FEV1 ≥80% predicted. Small airway indices, especially FEF5 0 % predicted, were strongly associated with BDR. Wheezing and chest tightness demonstrated clearer physiological correlations than coughing alone did. FEV1 improvements slightly below the conventional ≥12% bronchodilator threshold were also associated with asthma-related symptoms, although these findings were exploratory and not intended as diagnostic criteria. Conclusion:In patients with rhinitis and suspected asthma, airflow variability may be present even when FEV1 appears preserved. Small-airway parameters and symptom profiles offer a useful context for interpreting BDT results. Modest FEV1 changes may be clinically relevant and warrant further prospective study. These findings may help clinicians judge when bronchodilation testing is informative during the routine evaluation of suspected airway disease.

BACKGROUND:In China, therapeutic options are limited by the narrow availability of allergen preparations, with house dust mite (HDM) allergen immunotherapy (AIT) as the main choice for most patients. However, polysensitization is highly prevalent, and the benefit of HDM AIT in such patients remains uncertain. The study aims to evaluate the effectiveness of single-allergen HDM AIT on both perennial and coexisting allergen-specific symptoms in polysensitised allergic rhinitis (AR) patients and to explore predictors of treatment response. METHODS:We performed a multicenter retrospective cohort study including 81 patients with AR who were polysensitised to HDM and at least one other inhalant allergen (e.g., pollens, mould or animal dander). All participants received HDM subcutaneous immunotherapy (SCIT) for 12 to 36 months. Baseline characteristics, including serum allergen-specific IgE (sIgE) levels and comorbidities, were collected. Symptom severity was assessed using the Visual Analog Scale (VAS), and treatment response was defined as a ≥ 30% reduction in VAS scores from baseline. Statistical comparisons between responders and non-responders were conducted using Fisher's exact test for categorical variables and Mann-Whitney U tests for continuous data. Firth logistic regression was used to identify predictors of treatment response. RESULTS:The overall response rate for perennial symptoms was 68.8%, and varied in patients with co-existing allergies: 72.7% for moulds, 70.0% for animal dander, 65.5% for tree pollen, 70.2% for weed pollens. Allergen-specific symptom response rates varied across allergens: 68.2% for moulds, 30.0% for animal dander, 56.7% for tree pollens, 74.5% for weed pollens. Higher sIgE levels to HDM and mould were significantly associated with lower response rates in patients co-sensitised to both. A predictive model incorporating both sIgEs showed good specificity. CONCLUSION:Single-allergen HDM AIT is effective in many polysensitised AR patients; however, its efficacy varies by coexisting allergen type and sIgE level. Patients co-sensitised to mould with high HDM and mould sIgE appeared to have poorer outcomes. These preliminary findings require confirmation in larger prospective studies to guide tailored AIT strategies.

BackgroundSubcutaneous immunotherapy (SCIT) is a clinically effective and disease-modifying treatment for house dust mite (HDM)-induced allergic rhinitis (AR). Although SCIT provides long-term symptom improvement for most patients, a subset of patients shows inadequate clinical response. The underlying factors contributing to the heterogeneity in treatment efficacy remain unclear, and robust biomarkers capable of predicting SCIT outcomes are still lacking.ObjectiveThis study aimed to evaluate the clinical efficacy of one-year HDM-SCIT and to identify serum biomarkers associated with therapeutic response, with the goal of improving prediction of SCIT outcomes in patients with AR.MethodsEligible patients with HDM-induced allergic rhinitis were prospectively enrolled from two medical centers (Peking Union Medical College Hospital and the Affiliated Hospital of Qingdao University) and subsequently completed one year of HDM-SCIT. Symptom severity was evaluated using the visual analog scale (VAS) and total nasal symptom score (TNSS), and quality of life by the rhinoconjunctivitis quality of life questionnaire (RQLQ) at baseline and one year after treatment. Clinical remission was defined as ≥ 30% improvement of VAS and RQLQ scores. In addition, medication scores and TNSS were also included as secondary endpoints to support the response definition. Paired serum samples collected before and after treatment were analyzed using untargeted metabolomics and targeted bile acid profiling based on liquid chromatography–mass spectrometry. To validate metabolomic findings, an HDM-induced AR mouse model was established, followed by SCIT alone or SCIT combined with taurolithocholic acid (TLCA, a bile acid). Nasal histopathology, T cell subsets in the spleen, and cytokine levels in serum and nasal lavage fluid were assessed.ResultsOf the 32 patients who received one-year HDM-SCIT, 22 were responders and 10 were non-responders. No baseline differences in age, AR duration, comorbidities, total IgE, VAS, TNSS, or RQLQ were found between the two groups. However, responders had significantly greater reductions in VAS, TNSS, and RQLQ post-one-year treatment (p < 0.05). Untargeted metabolomics identified 956 differential metabolites (614 upregulated, 342 downregulated) between the pre-treatment group and post-treatment group, 1,389 (582 up, 807 down) and 1574 (342 up, 1232 down) between responders and non-responders at baseline and post-treatment, respectively. KEGG analysis highlighted bile secretion as a key differential pathway. Bile acid targeted metabolomics revealed TLCA as a potential biomarker associated with HDM-SCIT efficacy. Mouse models confirmed that HDM-SCIT combined with TLCA, particularly at high dose, alleviated nasal mucosal inflammation (reduced epithelial damage, eosinophils), increased splenic CD4+Foxp3+ regulatory T cells, reduced CD4+IL-4+ helper T 2 cells and serum IgG1, and dose-dependently decreased serum/nasal lavage interleukin (IL)-5, while increasing serum IL-10/interferon-γ.ConclusionSerum TLCA levels were associated with clinical response to HDM-SCIT. Animal model validation demonstrated that TLCA may enhance SCIT-induced immune tolerance. These findings support TLCA may serve as a potential metabolite-based biomarker and adjunct target for improving the efficacy of allergen immunotherapy.

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. It usually develops in childhood and may persist into adulthood. Dupilumab is a fully human monoclonal antibody directed against interleukin-4R-alpha, the common chain of interleukin-4 and interleukin-13 receptors. Dupilumab showed clinical improvements in patients with atopic dermatitis, asthma, and chronic rhinosinusitis and is currently under development for other indications. However, there are many adverse effects reported after dupilumab therapy including local injection site reactions, conjunctivitis, headache, and nasopharyngitis. We report a new case of a 4-year-old child who experienced anaphylaxis after dupilumab injection. In addition to, we summary and disscuss the rare adverse reactions caused by dupilumab injection by searching the literature in pubmed.

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.

PURPOSE:Artificial intelligence-based facial recognition (AI-FR) is promising in diagnosis of diseases with distinct facial features. Our team has retrospectively constructed an AI-FR system for Turner Syndrome (TS) based on 1295 facial photographs in previous research. This study aims to evaluate this AI-FR system for TS screening in a prospective cohort in real-world clinic setting. We also aim to elucidate the impact of complexity of facial features on diagnostic accuracy of AI-FR in this cohort. METHODS:Patients were recruited in a single-gate prospective cohort at a clinic. Facial images were collected for AI-FR diagnosis. Karyotype analyses were performed as the gold-standard diagnosis. Diagnostic performance of the AI-FR system was evaluated. Individual facial recognition intensity (iFRI) was proposed to characterize the complexity of individual facial features in patients. iFRI was calculated based on 26 facial landmarks of seven parts. Group comparison and regression analysis were performed on iFRI according to diagnosis classification. RESULTS:The prospective cohort included 218 patients (29 TS and 189 control). The AI-FR system showed performance: 89.0 % accuracy (95 % CI 84.1-92.5), 72.4 % sensitivity (95 % CI 54.3-85.3), and 91.5 % specificity (95 % CI 86.7-94.7). TS vs. control diagnosed by AI-FR had higher iFRI (p = 0.009), while TS vs. control diagnosed by gold standard showed no iFRI difference (p > 0.05). AI diagnosis classification positively correlated with iFRI (p = 0.033), while gold-standard classification did not (p > 0.05). CONCLUSION:This was one of the pioneering prospective cohorts in disease diagnosis with AI-FR. This system for TS screening achieved ideal performance and improved the diagnosis of TS. iFRI was proposed and proved influential to AI-FR diagnostic performance.

This case describes a patient with anaphylaxis caused by traditional Chinese medicine. Skin prick test with the traditional Chinese medicine decoction indicates that he was allergic to Suan Zao Ren. The patient had pollinosis and had never taken Suan Zao Ren before, thus we need to think the possibility of pollen food allergy syndrome. This paper also proposes a procedure for doctors to identify the specific culprit of traditional Chinese medicine decoction.

Introduction Eosinophilia is a rare disease characterized by an increase in eosinophils. Suplatast tosilate is a selective Th2 cytokine inhibitor that can reduce eosinophils. There is currently a lack of clinical studies of suplatast tosilate in the treatment of eosinophilia. Research objective To explore whether suplatast tosilate can reduce blood eosinophil levels in eosinophilia and the factors that might influence the improvement. Methods A real-world retrospective study of 20 patients with eosinophilia was conducted using electronic medical record information. The main outcome measure was the difference in peripheral blood absolute eosinophil count (AEC) and percentage (EOS%) before suplatast tosilate (baseline) and the lowest AEC during the 1-year period of suplatast tosilate treatment (post-treatment). Data on age, gender, disease duration, involved organs, and concomitant medication were collected, and subgroup analysis and linear regression analysiswere performed. Results Subjects were predominantly male, with a mean age of 33 years and a disease duration of approximately 30 months. After treatment with suplatast tosilate, the patient's AEC (p=0.029) and EOS% (p=0.016) significantly decreased. The decline in eosinophils was more pronounced in patients who were male, age < 33 years, disease duration < 30 months and gastrointestinal system involvement. In addition, the shorter the course of the disease, the greater the relative decrease in eosinophils after suplatast tosilate treatment (β=-0.018, p<0.001). Conclusions Suplatast tosilate is effective in reducing peripheral blood eosinophil levels in patients with eosinophilia. Large-scale prospective cohort studies are needed for further confirmation.

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.

To the Editor: Meat is an important source of protein and could be roughly classified into red and white meat. White meat, which encompasses poultry, seafood such as fish and shrimp, and reptiles, etc., is characterized by its pale color when uncooked. Red meat is basically mammalian meat, including domestic animal meats, such as pork, beef, lamb, and wild animal meat in certain regions, such as kangaroos, seals, and whales. Uncooked mammalian meat appears red due to the presence of myoglobin in skeletal muscles. The clinical presentations of mammalian meat allergy comprise two types of allergic reactions, immediate-type and delayed-type, although both are mediated by immunoglobulin E (IgE). The immediate-type hypersensitivity manifests as allergic symptoms occurring shortly after ingestion of red meat and is primarily triggered by serum albumin and immunoglobulin which are the major allergenic components. This is the classic pattern of food allergy. The delayed-type hypersensitivity is characterized by delayed onset of allergic symptoms 2–6 h after red meat ingestion and is mediated by oligosaccharide α-gal-specific IgE which is a recently discoveried pattern of food allergy.[1] Unlike most allergic diseases, the allergen of delayed-type red meat allergy, α-gal, is not protein but rather oligosaccharide. In nature, α-gal epitope (Galα1-3Galβ1-4Glc NAC-R) is abundantly expressed on glycoconjugates of protein-linked glycan chains in non-primate mammals, prosimians, and "New World monkeys", but not expressed in "Old World monkeys", apes, or humans. The β-galactose α-1,3-galactosyltransferase (referred to as glycosyltransferase UDP-Gal, α-1,3-GT, or α-1,3-glycosidic bond transferase) was inactivated by deletion mutations during evolution, which prevented the formation of α-1,3-glycosidic bonds. Alpha-gal could be found in various foods of mammalian origin, not only in skeletal muscle but also in visceral organs, fascia, smooth muscle, dairy products, and other products. Additionally, α-gal can be present in gelatin, which is processed and produced from connective tissues such as mammalian bone and fascia, as well as in biological drugs and vaccines containing mammalian α-gal.[1–3] Currently, sensitization of α-gal and clinical manifestation of allergic reaction to α-gal is denoted as alpha-gal syndrome (AGS). Platts Mills' research revealed that patients with red meat allergy had a fairly high incidence of α-gal-specific IgE positivity, and the distribution of red meat allergy or higher α-gal-specific IgE coincided with that of the spectrum of Rocky Mountain spotted fever (RMSF) and Amblyomma americanum activity. A prospective study was performed revealing that after being bitten by ticks, total IgE and specific IgE antibodies to α-gal increased proportionally in three individuals.[1] The first case of red meat allergy in China was reported at the Annual Meeting of the Chinese Allergy Association in 2011. A female developed anaphylaxis at midnight, 5 h after ingesting pork. The intradermal test of pork, beef, and lamb was positive. The ticks on her dog were identified as Haemaphysalis longicornis.[2] Specific IgE to α-gal was strongly positive (>100 kU/L), specific IgE to dog, cat, milk, pork, beef, and lamb was also positive. Western blotting was performed and confirmed the specific binding of mammal meat extract and viscera (liver, kidney, etc.) with the patient's serum. In recent years, we have published more AGS cases, including red meat allergy case series research and vaccine-induced anaphylaxis.[3,4] It is hypothesized that α-gal in the digestive tract of ticks and salivary glands originates from non-primate mammals that were previously bitten. As soon as α-gal-bearing ticks attack immune-susceptible humans, α-gal is injected into the victims and stimulates the victims' immune system to produce α-gal-specific IgE antibodies. Compared to delayed-type red meat allergy due to tick bites in Europe and the United States, a case series study of red meat allergy in China has shown that most of the patients with AGS had not noticed tick bites, and some of them denied having been bitten by ticks or insects even after careful questioning.[1,3] This may be related the relatively moderate or gentle tick bite pattern in Northeast Asia (identified as Haemaphysalis longicornis in both China and Japan), which differs from that of previous studies in Europe and the United States. These ticks inject a variety of biologically active substances into the host simultaneously to facilitate its blood-sucking, encompassing not only proteins that anchor the mouthparts to the host's skin but also enzymes and vasodilators, alongside a specialized cocktail of anti-coagulants to prevent blood clotting, anesthetics to reduce the likelihood of detection by minimizing sensation at the bite site, immunosuppressants to inhibit local immune responses, and anti-inflammatory agents to decrease inflammation, all of which contribute to the stealth of the tick by ensuring that the bite remains undetected due to the absence of significant local pain or itching.This poses difficulties for the awareness of both victims and medical workers. It is recommended that if AGS is suspected, medical workers should evaluate not only patients' atopy constitution but also their risk of tick exposure carefully, such as residential region (suburban, rural, pasture, or forested areas); outdoor hobbies (hiking, fishing, etc., during tick active seasons such as spring to autumn); exposure of domestic or wild mammals (dog, pig, cattle, horse, deer, etc.).[1] Cetuximab was the first medication discovered to be associated with α-gal. Some patients experienced anaphylaxis during or soon after their first cetuximab injection. Subsequent research indicated that the mechanism by which cetuximab causes anaphylaxis may be related to the presence of specific IgE antibodies in patients against the oligosaccharide α-gal epitope at the 88th amino acid on Fab portion of the heavy chain of cetuximab. And these patients were sensitized to red meat and some of them had experienced delayed-type anaphylaxis after ingestion of red meat before cetuximab allergy.[1] Gelatin is a complex combination of proteins and peptides produced through partial hydrolysis of collagen extracted from the skin, bone, or connective tissue of bovine or porcine animals or fish. It is widely utilized as a food ingredient or additive, substitute for infusion colloidal plasma, and stabilizer in vaccines. Alpha-gal was detected in gelatin of mammal origin. Most patients allergic to red meat were sensitized to gelatin, and yet only a subset of gelatin allergy patients was clinically allergic to red meat.[4] Cases of allergy or anaphylaxis to gelatin-containing food, vaccines, and plasma substitutes have been reported. The duration of onset depends on the route by which gelatin was introduced. The fastest onset is caused by exposure to a hemostatic sponge containing gelatin when filling a wound during intraoperative hemostasis, which usually manifests 5 min after exposure, followed by intravenous infusion of gelatin as a colloidal capacity supplement. For suppositories containing gelatin, allergic reactions may occur half an hour afterward, slightly longer than after intravenous preparations. Allergy symptoms caused by gelatin in vaccines usually occur 0.5–1 h after vaccine injection. Gelatin in vaccines for measles, mumps, and rubella (MMR), chickenpox, encephalitis, rubella, and influenza virus has been documented to cause allergies, with MMR being the most prevalent.[4] We reported anaphylaxis caused by gelatin components in chickenpox and hepatitis A vaccines. The specific IgE of α-gal, gelatin, cow's milk, pork, mutton, beef, cat dander, and dog dander was positive in the patients yet they did not manifest immediate-type or delayed-type red meat allergy,[4] which was consistent with previous studies. The absence of red meat allergy history is not a guarantee of safety from gelatin allergy. Evaluation of specific IgE antibodies to α-gal is recommended in patients with a high risk of anaphylaxis. Human blood type was associated with the prevalence of red meat allergy under an equivalent exposure density of tick bites. Individuals of types A or O are more likely to produce anti-α-gal-specific IgE antibodies following tick bites, whereas individuals of types B and AB are more likely to develop tolerance to α-gal antigens and are therefore less susceptible to red meat allergy and AGS. In our clinical investigation, most of the patients with a history of red meat allergy were non-B blood types (A or O), which was consistent with previous researches. Human ABO blood group substances, expressed on the membrane of erythrocytes, are primarily oligosaccharides. Human type B substances are formed by a combination of α-gal and fucose residue, similar to that of α-gal structure in non-primate mammals, thus the immune systems are prone to immune tolerance rather than sensitized to α-gal exposure. Red meat allergy usually manifests as a delayed pattern, i.e., allergic symptoms typically begin 2–6 h after meat consumption, which is different from traditional IgE-mediated food allergy. However, some patients reported a shorter delay, which was typically associated with alcohol consumption, high α-gal content in food, and exercise after a meal. It is currently believed that the delayed symptoms of red meat allergy are related to the digestion, absorption, and transfer of related glycoproteins and/or glycolipids. Compared to proteins, lipids are digested through a distinct, slower mechanism. Since lipids are digested and absorbed more slowly than proteins, the combination of α-gal and lipids may induce delayed reactions in patients with α-gal allergies. Diagnosis of red meat allergy is based on the delayed onset of allergic symptoms or anaphylaxis after intake of red meat, and proven sensitization to red meat (skin test and/or serum IgE) and α-gal specific IgE ≥0.35 kU/L (ImmunoCap) as well. The absence of tick bites does not exclude AGS because tick bites may be easily ignored. Currently, diagnosis of red meat allergy is difficult and challenging, partly due to the delay of symptoms. It is recommended to conduct a red meat skin prick test as a primary screening, but the sensitivity of skin prick tests to red meat extracts is rather low. The sensitivity of intradermal tests is higher than that of skin prick tests, but commercial intradermal reagents for red meat are not available in many countries, including China. Detection of α-gal specific IgE is crucial to the diagnosis of AGS. We detected α-gal specific IgE in patients with clinically confirmed red meat allergies, all of whom were positive for α-gal. Basophil activation tests based on cluster of differentiation (CD) 63 expression can also be considered. Sensitization to dog or cat dander may serve as collateral evidence of red meat allergy or AGS since all of our patients tested positive for dog and/or cat dander. Based on our experience, the semiquantitative allergen panels currently available in China exhibit rather poor accuracy in detecting red meat allergy. AGS is an unusual clinical syndrome and a latent fatal disease characterized by α-gal sensitization and may manifest as delayed food allergy or anaphylaxis after consuming mammalian meat. If exposed to medications, vaccines, or medical instruments containing α-gal through oral, injection, transplantation, or surgical routes, sensitized individuals are at risk of developing urticaria, anaphylaxis, or even death. Tick bites are regarded as an important sensitization pathway, particularly in populations with blood groups A or O (non-B type). Currently, the pathogenesis of AGS is not completely understood. Further research on the pathogenesis of AGS will provide a deeper understanding of the pathogenesis, diagnosis, and treatment of infection, allergic diseases, and even tumors.[5] Funding This work was supported by grants from the National High Level Hospital Clinical Research Funding (Nos. 2022-PUMCH-B-088 and 2022-PUMCH-B-032). Conflicts of interest None.

Background: Identification of gene polymorphisms and SNP analysis of individual patients have become crucial to select the best drug response and ensure optimal care, especially for genes directly related to asthma, such as CYSLTR1 and GSDML gene polymorphisms, an efficient and accurate detection method is helpful for the development of precision therapy. The novel detection kit we used has a reading accuracy of 99.999% for each base and the cost of detection is only 80 minutes. Objectives: In this study, a novel kit produced by Wuhan healthcare Biotechnology Co., LTD was used to detect CYSLTR1 and GSDML gene polymorphisms in asthma patients and the reliability of the novel kit was verified. Methods: The efficiency of the new kit was validated compared to gold standard, gene sequencing methods, and the close association of CYSLTR1 and GSDML SNPs with allergic asthma was also tested. As a result, the most effective drugs were obtained for patients with different gene locus expressions. Results: Identifying 367 publication participants for analysis by two different methods, we validated the reliability of the reagents with “gold standard” assays in full agreement with the DNA direct sequencing method. Our study focused on CYSLTR1 and GSDML gene polymorphisms to select the most effective drugs for asthma treatment, with leukotriene modulators being more effective in patients with the AA genotype of CYSLTR1 rs320995 and β2 agonists being more effective in patients with the TC genotype of CYSLTR1 rs320995.

Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for Parkinson's disease (PD) in whom medical treatment fails to provide adequate symptom control. Skin-related complications, particularly skin erosion, may lead to exposure of the DBS device, compromising the effectiveness of the DBS device. We presented a patient who suffered from skin erosion over bilateral burr hole site. A Multidisciplinary Team (MDT) approach was used to provide staged surgical treatment for scalp reconstruction. Without the removal of the DBS system. No alteration of DBS system efficacy was observed and the bilateral wounds healed well during the follow-up period.

Air pollution is associated with multiple health problems worldwide, contributing to increased morbidity and mortality. Atopic dermatitis (AD) is a common allergic disease, and increasing evidence has revealed a role of air pollution in the development of atopic dermatitis. Air pollutants are derived from several sources, including harmful gases such as nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO), as well as particulate matter (PM) of various sizes, and bioaerosols. Possible mechanisms linking air pollution to atopic dermatitis include damage to the skin barrier through oxidative stress, increased water loss, physicochemical injury, and an effect on skin microflora. Furthermore, oxidative stress triggers immune dysregulation, leading to enhanced sensitization to allergens. There have been multiple studies focusing on the association between various types of air pollutants and atopic dermatitis. Since there are many confounders in the current research, such as climate, synergistic effects of mixed pollutants, and diversity of study population, it is not surprising that inconsistencies exist between different studies regarding AD and air pollution. Still, it is generally accepted that air pollution is a risk factor for AD. Future studies should focus on how air pollution leads to AD as well as effective intervention measures.

Background and Objective:Asthma and allergic rhinitis have been reported to be strongly associated with genetic factors. The aim of this study was to evaluate the accuracy of the TaqMan-MGB (minor groove binder) qPCR method for detecting CYSLTR1 rs320995 (T927C) and GSDMB rs7216389 (G1199A) gene polymorphisms as well as to explore the association of CYSLTR1 rs320995 and GSDMB rs7216389 polymorphisms with genetic susceptibility of Chinese patients with asthma and allergic rhinitis.Methods:In this study, 310 asthmatic patients and 60 healthy individuals were recruited in Peking Union Medical College Hospital. The CYSLTR1 rs320995 (T927C) and GSDMB rs7216389 (G1199A) gene polymorphisms in each group were analyzed by TaqMan-MGB qPCR and DNA sequencing which was regarded as the gold standard. After the validation of this method, additional 71 patients with allergic rhinitis and 72 patients with asthma combined with allergic rhinitis were selected and tested by using TaqMan-MGB qPCR.Results:The TaqMan-MGB qPCR results were fully consistent with DNA sequencing results (Kappa = 1, P<0.001). In addition, the results of the TaqMan-MGB qPCR assay were not affected by bilirubin and lipids. We found differential distribution of CYSLTR1 rs320995 genotypes in female patients with asthma combined with allergic rhinitis (χ 2=6.172, P=0.046, statistical power = 0.591). Specifically, the TT genotype is more frequent in women suffering from asthma with allergic rhinitis, whereas the TC genotype is more prevalent in healthy women. However, no such associations were observed in the GSDMB rs7216389 polymorphism.Conclusion:We have established a reliable TaqMan-MGB qPCR method for the detection of CYSLTR1 rs320995 and GSDMB rs7216389 polymorphisms. Moreover, the CYSLTR1 rs320995 polymorphism may be associated with genetic susceptibility of Chinese female patients with asthma and allergic rhinitis. Multicenter studies with larger sample sizes are required in the future.

Objective To explore the simulation degree of the 3D printed removable transnasal pituitary adenoma resection model, and to discuss the possibility of teaching operation with the model. Methods Using patient CT modeling, fine optimization and 3D printed technology, a removable pituitary adenoma resection model was constructed. Nineteen evaluators from Peking Union Medical College Hospital were selected, who were divided into “lower seniority group”(seniority ＜10 years) and “higher seniority group” (seniority ≥10 years). Each physician operated on the 3D printed pituitary adenoma resection model. They filled out questionnaires and evaluation scales before and after the operation. Results The higher seniority group have more operation experience than the lower seniority group. The scores of the simulation degree items are all around 4, and there is no significant difference found in different scoring items. The simulation degree score of “pituitary adenoma removal” is relatively low. The scores from the higher seniority group are generally lower than those of the lower seniority group. Before the operation, the scores in the lower seniority group were significantly lower than those of the higher seniority group, while the confidence scores of the two groups after the operation tended to be the same. The difference between scores before and after operation were significantly higher in lower seniority group (P＜0.05). Conclusions The model has high simulation degree and can be used in teaching experiments.

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.