Introduction:Allergic rhinitis (AR) and non-allergic rhinitis (NAR) share overlapping symptoms but differ in pathophysiology and treatment. Current AR diagnosis relies on skin prick testing (SPT) and serum IgE quantification, both of which are complex. This study aimed to develop a symptom-based model for early AR detection, explore allergen-symptom relationships, and evaluate its performance. Material and Methods:A prospective cohort study was conducted at Wuhan Tongji Hospital between June 2024 and October 2024, enrolling 1150 patients with clinically suspected AR. Participants completed a visual analogue scale (VAS) questionnaire evaluating nasal symptoms (itching, congestion, sneezing, rhinorrhea), ocular symptoms, and overall discomfort, and the final diagnosis of AR was confirmed by SPT. Patients were randomly divided into training and test cohorts (8:2). Logistic regression (LR), the classic artificial intelligence-machine learning algorithm, was used to build a prediction model after analyzing allergen-symptom associations, with evaluation of discrimination, calibration, and clinical utility. Results:A total of 758 patients (65.9%) were confirmed AR cases, and showed more severe nasal/ocular symptoms than NAR. Dust mites were the most common allergen, correlated with animal dander (r > 0.45) and negatively with age (r = -0.27), while allergen-symptom specificity was generally low. Sneezing was the strongest AR predictor (AUC = 0.758) with the highest sensitivity, specificity, and F1 score, and the multivariable model combining all symptoms performed better (AUC = 0.771 training, 0.765 test), outperforming clinician experience. The model showed good calibration and stable performance across subgroups. Discussion:This study developed a symptom-based AR predictive model that outperformed clinician experience. Sneezing demonstrated the highest AUC value for prediction, and the multivariable LR model using nasal and ocular symptoms further improved accuracy. Conclusions:The findings support VAS-based screening as a practical, cost-effective tool for early AR detection, therapeutic interventions, and targeted patient education regarding allergen avoidance strategies, helping optimize AR management, minimizing diagnostic delays, and facilitating precision treatment decisions.

The prevalence of allergic rhinitis (AR) continues to rise, severely impairing patients’ quality of life and causing enormous social and economic burdens. For refractory AR that cannot be adequately controlled by standardized firstline therapies, neurotomy has become an important secondline therapeutic option. However, due to various remaining controversial issues, there is currently a lack of internationally unified clinical guidelines, which restricts its clinical application and generalization. To better guide the clinical practice of neurotomy for AR in China, 49 experts in the field of rhinology and allergy nationwide, led by the Third Affiliated Hospital of Sun Yat-sen University, carried out the work of formulating a consensus. Using the Delphi method, we focused on seven dimensions: the purpose and significance of neurotomy for AR, relevant applied anatomy, pathophysiological basis, surgical indications and contraindications, surgical techniques, efficacy and evaluation criteria, and surgical complications and their management, ultimately generating a series of core viewpoints. This consensus is expected to further promote the standardized development of neurotomy for AR in China, and help improve the overall prevention and management of AR.

This review synthesizes current evidence on the bidirectional interactions between COVID-19 and chronic rhinosinusitis (CRS), focusing on how CRS influences SARS-CoV-2 infection risk and clinical outcomes, as well as the impact of COVID-19 on CRS management and prognosis. Recent findings highlight a complex interplay between CRS and COVID-19. Regional studies report mixed results on whether CRS increases SARS-CoV-2 susceptibility, with some cohorts suggesting higher infection risk and others finding no significant association. Subtypes of CRS may influence outcomes, as non-eosinophilic CRS (Non-ECRS) exhibits elevated ACE2/TMPRSS2 expression linked to higher infection risk, while eosinophilic CRS (ECRS) shows ACE2 downregulation that may offer protection. Behavioral changes during the pandemic, such as mask-wearing, reduced CRS incidence and symptom severity. However, SARS-CoV-2 infection, particularly with early variants, exacerbated CRS symptoms, such as nasal congestion, olfactory loss, and prolonged recovery, whereas infections with later variants correlated with milder outcomes. Prolonged or recurrent COVID-19 infections increased CRS exacerbations and secondary infections. Regarding treatment, nasal glucocorticoids remained safe without elevating COVID-19 risk, while surgical interventions required careful risk–benefit assessments due to aerosolization risks. Biological agents showed no adverse effects on COVID-19 outcomes, though long-term data are lacking. The interplay between CRS and COVID-19 is complex and influenced by CRS endotypes, viral variants, and geographic factors. While CRS may modulate COVID-19 susceptibility via inflammatory pathways, pandemic-related behavioral changes paradoxically improved CRS outcomes. Further research is needed to clarify subtype-specific risks, long-term impacts of repeated infections, and optimal treatment strategies in comorbid patients.

Type 2 (T2) inflammation is central to allergic disorders. Glycosylation, a post-translational modification, is emerging as a pivotal regulator in T2 inflammation and associated allergic diseases. This review synthesizes current knowledge on glycosylation patterns of key T2 inflammation players, including cytokines, immunoglobulins (e.g., IgE, IgG4) and their receptors, STAT6, mucins, and CTLA-4. We detail how site-specific glycosylation fine-tunes cytokine-receptor interactions, alters signaling pathways, and stabilizes proteins, thereby dictating their bioactivity. Moreover, we examine the enzymatic machinery orchestrating these glycosylation events and the regulatory factors modulating their activity in the context of T2 inflammation. By leveraging these mechanistic insights, we highlight how glycosylation aberrations contribute to food allergy, eosinophilic esophagitis, asthma, allergic rhinitis, and atopic dermatitis, while allergen immunotherapy exploits glycosylation reprogramming (e.g., sialylated IgG4 induction) to restore immune tolerance. Furthermore, we explore the diagnostic and prognostic potential of glycosylation patterns in predicting disease severity and allergen immunotherapy responsiveness, while underscoring the therapeutic promise of targeting glycosylation enzymes or glycan-immune receptor interactions to mitigate T2 inflammation-driven pathologies. A deeper understanding of glycosylation dynamics in T2 inflammation not only enhances our grasp of disease pathogenesis but also opens new avenues for innovative therapeutic interventions.

Allergic rhinitis (AR), as a common and challenging-to-cure allergic upper respiratory disease, poses severe health and economic burdens globally, including in China. Over the past two decades, the significant environment and lifestyle changes resulting from rapid socio-economic development and urbanisation had a profound impact on the onset and progression of AR in China. This review examines the epidemiological trends in China. Specifically, the regional variation in allergen sensitisation patterns, the changes of these patterns over the past two decades, and the implications of these changes for disease prevention and diagnosis are discussed. We also outline the effects of indoor and outdoor air pollution on AR development, along with exploring corresponding solutions. Allergen immunotherapy (AIT) is recommended as the first-line treatment for AR in China, and this review provides an overview of its current application, recent advancements, and remaining challenges in its implementation. Notably, biological therapies, administered as monotherapy or combined with AIT, are discussed in light of their revolutionary impact on AR management. Overall, this review highlights the trends and challenges of AR in China over the past two decades, along with their implications for disease prevention and treatment.

The optimal management of mucosal tissues during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) remains controversial. This systematic review and network meta-analysis aimed to compare the efficacy and safety between mucosa-preserving surgical techniques, such as functional endoscopic sinus surgery (FESS) and extended endoscopic sinus surgery (EESS), and radical mucosa-resecting endoscopic sinus surgery (RESS) for the treatment of CRSwNP. Nine studies involving 1,224 patients were included. RESS was associated with significantly lower recurrence rates compared to both FESS (relative risk [RR]: 2.37; 95

BACKGROUND:Identifying predictive biomarkers for allergen immunotherapy response is crucial for enhancing clinical efficacy. This study aims to identify such biomarkers in patients with allergic rhinitis (AR) undergoing subcutaneous immunotherapy (SCIT) for house dust mite allergy. METHODS:The Tongji (discovery) cohort comprised 72 AR patients who completed 1-year SCIT follow-up. Circulating T and B cell subsets were characterized using multiplexed flow cytometry before SCIT. Serum immunoglobulin levels and combined symptom and medication score (CSMS) were assessed before and after 12-month SCIT. Responders, exhibiting ≥30% CSMS improvement, were identified. The random forest algorithm and logistic regression analysis were used to select biomarkers and establish predictive models for SCIT efficacy in the Tongji cohort, which was validated in another Wisco cohort with 43 AR patients. RESULTS:Positive SCIT response correlated with higher baseline CSMS, allergen-specific IgE (sIgE)/total IgE (tIgE) ratio, and frequencies of Type 2 helper T cells, Type 2 follicular helper T (TFH2) cells, and CD23+ nonswitched memory B (BNSM) and switched memory B (BSM) cells, as well as lower follicular regulatory T (TFR) cell frequency and TFR/TFH2 cell ratio. The random forest algorithm identified sIgE/tIgE ratio, TFR/TFH2 cell ratio, and BNSM frequency as the key biomarkers discriminating responders from nonresponders in the Tongji cohort. Logistic regression analysis confirmed the predictive value of a combination model, including sIgE/tIgE ratio, TFR/TFH2 cell ratio, and CD23+ BSM frequency (AUC = 0.899 in Tongji; validated AUC = 0.893 in Wisco). CONCLUSIONS:A T- and B-cell signature combination efficiently identified SCIT responders before treatment, enabling personalized approaches for AR patients.

Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease （N-ERD） is a chronic respiratory disease characterized by eosinophilic inflammation, featuring chronic rhinosinusitis （CRS）, asthma, and intolerance to cyclooxygenase 1 （COX-1） inhibitors. The use of these medications can lead to an acute worsening of rhinitis and asthma symptoms. This condition has not yet received sufficient attention in China, with a high rate of misdiagnosis and a lack of related research. The Chinese Rhinology Research Group convened a group of leading young experts in otolaryngology from across the country, based on the latest domestic and international evidence-based medical practices to formulate this consensus.The consensus covers the epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies for N-ERD, including pharmacotherapy, surgery, biologic treatments, and desensitization therapy. The goal is to improve recognition of N-ERD, reduce misdiagnosis, and enhance treatment outcomes.

Background: Allergic rhinitis (AR) is a common hyperreactive nasal disease in otolaryngology, mainly manifested as rhinorrhea, nasal obstruction, nasal itching, and sneezing. Despite medication and immunotherapy, a large proportion of patients do not completely eliminate rhinorrhea. In recent years, the use of nasal anticholinergics in the treatment of AR has gained attention. However, there is currently no consensus on the timing and selection of nasal anticholinergics for AR treatment. Summary: We reviewed previous studies on nasal anticholinergic drugs in AR and summarized the pathogenesis of AR, the role of anticholinergic drugs, cholinergic neural pathways, the mechanisms of nasal anticholinergic drugs, common types and clinical efficacy of nasal anticholinergic drugs, and precautions for their use. We also provided some suggestions for their clinical application. Key Messages: At present, the main drugs of nasal anticholinergics are ipratropium bromide and phencyquine bromide. The cholinergic nervous system is the main neural pathway mediating nasal secretion. Anticholinergic drugs work by blocking the interaction between Ach and the high density of M receptors in the nasal cavity. The clinical effect of nasal anticholinergics is generally good, and there are almost no major or systemic adverse reactions. Nasal anticholinergics provide a more complete treatment for AR patients with poorly controlled rhinorrhea. In the future, nasal anticholinergics will be assessed in high-quality clinical trials and applied clinically.

Chronic rhinosinusitis (CRS) is a prevalent and heterogeneous inflammatory disease that affects millions of people worldwide. Olfactory dysfunction (OD) is one of the most common symptoms of CRS patients. Increasing evidence suggests that the mechanisms underlying OD in different clinical subtypes and inflammatory endotypes of CRS may show discrepancy. Additionally, assessing the severity of OD in CRS patients, and selecting appropriate and effective treatment approaches have emerged as critical concerns in clinical practice. This article aims to provide new insights into the pathogenesis, diagnosis and treatment of OD in patients with CRS. Recent studies have further highlighted the heterogeneity of CRS, categorizing it into Type 2 and non-Type 2 subtypes based on distinct inflammatory patterns. Furthermore, the diverse mechanisms of OD in patients with different subtypes of CRS have been revealed. Beyond the conventionally recognized conductive factors, inflammatory factors are increasingly being identified as crucial pathogenic contributors to OD in patients with CRS. Generally, the evaluation methods for OD mainly include three different categories, including self-reported assessments based on questionnaires or scales, psychophysical tests, and electrophysiological or imaging assessments. Despite considerable efforts on new approaches, the long-term and effective treatments of OD in CRS still remain elusive. Olfactory training (OT) can be recommended for patients with OD, although it requires further evaluation in CRS patients. This article, based on recent progress, overviewed the epidemiological characteristics and pathophysiological mechanisms of OD in CRS patients, and summarized the methods of clinical assessment and treatment strategies of OD. We emphasized the diverse mechanisms of OD in different subtypes of CRS. Although drugs, biological products, and OT may be beneficial for improving olfactory function in CRS patients, further research is needed to confirm their long-term efficacy and develop more effective treatment approaches for OD in CRS.

BACKGROUND: Reliable noninvasive methods are needed to identify endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) to facilitate personalized therapy. Previous computed tomography (CT) scoring system has limited and inconsistent performance in identifying eosinophilic CRSwNP. We aimed to develop and validate a radiomics-based model to identify eosinophilic CRSwNP. METHODS: Surgical patients with CRSwNP were recruited from Tongji Hospital and randomly divided into training (n = 232) and internal validation cohort (n = 61). Patients from two additional hospitals served as external validation cohort-1 (n = 84) and cohort-2 (n = 54), respectively. Data were collected from October 2013 to May 2021. Eosinophilic CRSwNP was determined by histological criterion. The least absolute shrinkage and selection operator and the logistic regression (LR) algorithm were used to develop a radiomics model. Univariate and multivariate LR were employed to build models based on CT scores, clinical characteristics, and the combination of radiological and clinical characteristics. Model performance was evaluated by assessing discrimination, calibration, and clinical utility. RESULTS: The radiomics model based on 10 radiomic features achieved an area under the curve (AUC) of 0.815 in the training cohort, significantly better than the CT score model based on ethmoid-to-maxillary sinus score ratio with an AUC of 0.655. The combination of radiomic features and blood eosinophil count had a further improved performance, achieving an AUC of 0.903. The performance of these models was confirmed in all validation cohorts with satisfying predictive calibration and clinical application value. CONCLUSIONS: A CT radiomics-based model is promising to identify eosinophilic CRSwNP. This radiomics-based method may provide novel insights in solving other clinical concerns, such as guiding personalized treatment and predicting prognosis in patients with CRSwNP.

Although the expression of Mex3 RNA-binding family member B (MEX3B) is upregulated in human nasal epithelial cells (HNECs) predominately in the eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) subtype, its functions as an RNA binding protein in airway epithelial cells remain unknown. Here, we revealed the role of MEX3B based on different subtypes of CRS and demonstrated that MEX3B decreased the TGF-β receptor III (TGFBR3) mRNA level by binding to its 3′ UTR and reducing its stability in HNECs. TGF-βR3 was found to be a TGF-β2–specific coreceptor in HNECs. Knocking down or overexpressing MEX3B promoted or inhibited TGF-β2–induced phosphorylation of SMAD2 in HNECs, respectively. TGF-βR3 and phosphorylated SMAD2 levels were downregulated in CRSwNP compared with controls and CRS without nasal polyps with a more prominent downregulation in the eosinophilic CRSwNP. TGF-β2 promoted collagen production in HNECs. Collagen abundance decreased and edema scores increased in CRSwNP compared with control, again more prominently in the eosinophilic type. Collagen expression in eosinophilic CRSwNP was negatively correlated with MEX3B but positively correlated with TGF-βR3. These results suggest that MEX3B inhibits tissue fibrosis in eosinophilic CRSwNP by downregulating epithelial cell TGFBR3 expression; consequently, MEX3B might be a valuable therapeutic target against eosinophilic CRSwNP.

Purpose of Review A number of sequelae after acute coronavirus disease 2019 (COVID-19) significantly affect the quality of life of patients. The chemosensory disorders including olfactory dysfunction (OD) and gustatory dysfunction (GD) are two of the commonest symptoms complained by patients with COVID-19. Although chemosensory function has been reported improved in over 60% of COVID-19 patients in a short time after acute infection, it may last as a major symptom for patients with long COVID-19. This narrative review discussed current literatures on OD and GD in long COVID-19 including the prevalence, risk factors, possible mechanisms, and potential therapies. Recent Findings Although the prevalence of OD and GD has declined continuously after acute COVID-19, a considerable number of patients had persistent chemosensory disorders 3 months to 2 years after symptom onset. Female gender, initial severity of dysfunction, nasal congestion, emotional distress and depression, and SARS-CoV-2 variants have been identified as risk factors for persistent OD and GD in long COVID-19. The pathogenesis of OD and GD in long COVID-19 remains unknown, but may be analogous to the persistent OD and GD post common respiratory viral infection. Corticosteroids and olfactory training might be a potential choice regarding the treatment of lasting OD and GD after SARS-CoV-2 infection; however, more studies are needed to prove it. Summary OD and GD are common long-term consequences of COVID-19 and influenced by gender, initial severity of dysfunction, emotional distress and depression, and SARS-CoV-2 variants. More studies are needed to illustrate their pathogenesis and to establish therapeutic strategies.

OBJECTIVES:To review the current literature on immunological mechanisms and treatable traits of chronic rhinosinusitis (CRS) in Asia.DESIGN:This is a narrative review of published data on the immunological mechanisms and treatable traits of CRS in Asia. Published English literature on CRS in Asian and Western countries was reviewed. Where available, the data extracted included epidemiology, immunology, bacterium, phenotype, endotype and treatment.RESULTS AND CONCLUSION:CRS is a heterogeneous disease characterised by persistent locoregional mucosal inflammation of the paranasal sinuses. The inflammatory signatures of CRS vary across patients with distinct racial and ethnic backgrounds and geographic areas. Compared to CRS patients in Western countries, Asian CRS patients display less eosinophilic and Type 2 inflammation, which is associated with lower asthma and allergic rhinitis comorbidities. In contrast, Asian patients with CRS have more prominent non-eosinophilic inflammation than those in Western countries. In addition, Asian CRS patients may have different bacterial colonisation than patients in Western countries. Our review suggests that the distinct immunological mechanisms between Asian and Western CRS patients may influence the clinical phenotype, responses to treatment and outcomes. The treatable trait is a new strategy and therapeutic target identified by phenotype or endotype and has been proposed as a new paradigm for the management of diseases. Improved understanding of CRS phenotypic and endotypic heterogeneity and incorporation of treatable traits into clinical care pathways may facilitate more effective selections of therapeutic interventions, including surgery and biologics.

•There is a considerable portion of patients having persistent olfactory dysfunction 24 months after SARS-CoV-2 infection when evaluated by psychophysical tests, even for those without self-reported symptoms.

Follicular helper T (T FH ) cells are a specialized subset of CD4 + T cells that essentially support germinal center responses where high-affinity and long-lived humoral immunity is generated. The regulation of T FH cell survival remains unclear. Here we report that T FH cells show intensified lipid peroxidation and altered mitochondrial morphology, resembling the features of ferroptosis, a form of programmed cell death that is driven by iron-dependent accumulation of lipid peroxidation. Glutathione peroxidase 4 (GPX4) is the major lipid peroxidation scavenger and is necessary for T FH cell survival. The deletion of GPX4 in T cells selectively abrogated T FH cells and germinal center responses in immunized mice. Selenium supplementation enhanced GPX4 expression in T cells, increased T FH cell numbers and promoted antibody responses in immunized mice and young adults after influenza vaccination. Our findings reveal the central role of the selenium–GPX4–ferroptosis axis in regulating T FH homeostasis, which can be targeted to enhance T FH cell function in infection and following vaccination.