Background: Chronic rhinitis, including allergic rhinitis (AR) and nonallergic rhinitis (NAR), is frequently influenced by environmental factors such as temperature. This study aimed to investigate the characteristics of temperature-sensitive rhinitis patients and to explore the effects of temperature on nasal symptoms. Methods: A cross-sectional study was conducted from February 2023 to February 2024 at Beijing Tongren Hospital, enrolling 5,595 adult outpatients with chronic rhinitis. Patients were diagnosed with AR or NAR, with AR further classified into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Standardized questionnaires and serum-specific immunoglobulin E testing were performed. Nasal symptoms (congestion, itching, sneezing, and rhinorrhea) were assessed using a visual analogue scale. A generalized linear model with cubic spline functions was used to examine nonlinear associations between ambient temperature and nasal symptoms, adjusting for potential confounders. Associations between temperature sensitivity, symptom severity, and environmental exposures were analyzed. Results: A total of 83.6% of patients with AR and 84.5% of those with NAR reported temperature sensitivity. Patients sensitive to temperature changes had significantly higher nasal symptom scores than those insensitive to temperature changes ( P < 0.001). The proportion of temperature-sensitive individuals increased with the severity of chronic rhinitis symptoms. In SAR, symptoms exhibited an inverted U -shaped relationship with temperature, peaking around 20°C, which corresponded to the pollen peak. In PAR, low-temperature environments (<20°C) aggravated nasal congestion and were the main factor affecting quality of life. Conclusions: Temperature-sensitive rhinitis patients experience more severe nasal symptoms. Low-temperature environments have the greatest impact on patients with PAR, particularly exacerbating symptoms of nasal congestion. Temperature indirectly affects the nasal symptoms in SAR patients by influencing pollen exposure.

Background: The incidence of allergic rhinitis (AR) has been rising annually in China, correlating with the ongoing intensification of global climate change and industrialization. Objectives: This study aimed to investigate the self-reported prevalence of AR among adults in Xi’an, as well as the relevant influencing factors. Methods: The prevalence of AR was assessed among adult residents across 11 districts of Xi’an from June to October 2022. Additionally, an analysis was conducted to determine the relevant influencing factors associated with AR in these patients. Results: In total, 3,350 individuals from 11 districts in Xi’an participated in this survey, with a self-reported prevalence of 10.0%. Among AR patients, 20.1% had a family history of allergies, compared with 5.1% in those without AR. The prevalence of AR was 30.3% in patients with a family history of allergies and 8.5% in those without. Urban residents had a higher prevalence of AR (11.0%) than suburban residents (8.3%) ( P = 0.002). Among the patients, 22.8% had perennial AR and 77.2% had seasonal AR, mainly due to pollen. In terms of diagnosis and treatment, 38.0% of the patients underwent allergen testing, 55.4% received medication, and 66.4% achieved symptom control. Conclusion: The incidence of AR in Xi’an remained high. This study will enhance the understanding of AR patterns in Xi’an and inform public health policies, prevention strategies, and AR control systems.

Background:Asthma is a chronic respiratory condition affecting 3,340 cases per 100,000 individuals globally. The significant global health burden of asthma necessitates the development and use of valid diagnostic tools for epidemiological purposes.Objective:This study evaluated the diagnostic accuracy of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire among participants from the Singapore/Malaysia Cross-sequential Genetic Epidemiology Study (SMCGES).Methods:Investigators administered the ISAAC survey questionnaire to SMCGES participants. Symptoms related to asthma were compared against diagnosed asthma, which was characterized by a questionnaire-reported history of asthma and exhibiting a positive skin prick reaction to allergen extracts from 2 dust mite species. Diagnostic accuracy was assessed via sensitivity (Se), specificity (Sp), positive and negative predictive values, and Youden’s Index (J).Results:This study analyzed data from 4,028 participants from Malaysia and 11,473 participants from Singapore. Asthma symptom prevalence differed between Malaysia and Singapore, with ever wheeze being the most prevalent in both populations. Diagnosed asthma was more prevalent in Singapore (17.3%, 95% confidence interval [CI]: 16.6–18.1%) than in Malaysia (9.7%, 95% CI: 8.8–10.7%). Ever wheeze showed the best diagnostic performance for diagnosed asthma in Malaysia (Se = 0.548, Sp = 0.831, J = 0.379) and Singapore (Se = 0.679, Sp = 0.888, J = 0.566). Combining symptoms or asthma medication usage improved accuracy slightly, with the most valid combinations being ever wheeze or exercise-induced wheeze in Malaysia (Se = 0.557, Sp = 0.824, J = 0.381) and usage of bronchodilators, beta-agonists, inhaled steroids, or leukotriene modifiers in Singapore (Se = 0.771, Sp = 0.871, J = 0.642).Conclusion:The modified ISAAC questionnaire used by the SMCGES showed good Se and Sp for diagnosed asthma, especially when combining various symptom indicators or usages of different asthma medications. These findings substantiate the continued use of the ISAAC questionnaire as a valuable survey tool in epidemiological studies across diverse populations.

Background:While phenotyping assists in selecting the right biologic agent for severe asthma, the frequency of patients transitioning to a different biologic is also significant.Objective:We sought to identify the factors that predict switching between biological agents.Methods:The study involved 165 adults with severe asthma and included a 3-year follow-up period. Clinical and spirometric data were evaluated alongside the demographic characteristics of the patients. In addition to skin prick tests and specific immunoglobulin E (IgE) tests, eosinophil counts and total IgE measurements were assessed.Results:The patient group comprised 124 female participants (75%); the average age was 48 ± 13 years. Over half of the patients had eosinophilic asthma (56%) and allergic asthma (52%). In the first-line treatment, 111 patients (68%) were started on omalizumab, 43 patients (26%) on mepolizumab, and 11 patients (6%) on benralizumab. A total of 37 patients required a change in their biologic treatment. The 2 key factors influencing this switch were the initial annual number of asthma attacks and the level of improvement in the asthma control test score assessed during the first evaluation after starting the biologic (odds ratio 2.23 [95% confidence interval: 1.49–3.33]; P < 0.001 and 0.42 [0.30–0.58]; P < 0.001, respectively).Conclusion:Patients with higher annual attacks at baseline and lower responsiveness at the first postbiologic efficacy assessment can be useful in predicting switching status. However, further well-designed studies involving a larger number of patients and conducted over a longer term are needed to identify additional factors that could assist in selecting the most appropriate biologic.

We present an interesting case that demonstrated that delayed beta-lactam hypersensitivity can be lost, as demonstrated by both the initial skin test and challenge, and gained, as proven by a repeat delayed skin test positivity 4 weeks after the initial evaluation in this case. We postulate that positivity over the intradermal site following the completion of prolonged challenge occurs due to the priming and resensitization of circulating T cells and the homing of these drug-specific T cells to the skin (sites of intradermal testing) where the penicillin antigens are still present. Of note, post-inflammatory hyperpigmentation following skin tests is rare, as typical wheals and flare reactions associated with skin testing resolve completely. Thus, we postulate that the postinflammatory hyperpigmentation that is seen in this case may be representative of T cell mechanisms similar to that of a fixed drug eruption.

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that can be triggered by food, drugs, or venom. Anaphylaxis to toothpaste, a generally well-tolerated household product, is rare. In this report, we describe a rare case of anaphylaxis in a child triggered by mint-containing toothpaste. The case involves a 9-year-old boy with a history of allergic rhinoconjunctivitis, who initially experienced localized lip pruritus from toothpaste, which progressed to systemic anaphylaxis secondary to mint allergy. Mint allergy is rarely reported, with most documented cases involving type IV hypersensitivity reactions, resulting in cheilitis. This case highlights the need for clinicians to be aware that allergic reactions, including anaphylaxis, to toothpaste are possible. A thorough review of all product ingredients is essential to ensure accurate diagnosis and appropriate management.

Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, characterized by rhinorrhea, nasal congestion, sneezing, and itching. Among these symptoms, rhinorrhea and nasal congestion are the most common complaints of AR patients. By blocking acetylcholine binding with muscarinic (M) receptors, intranasal anticholinergics have been recommended by guidelines as an “add-on” or second-line therapy to control rhinorrhea in patients with AR. Bencycloquidium bromide is a highly selective M1/M3 receptor antagonist that can reduce excessive mucus secretion and suppress type 2 inflammation in AR, while also demonstrating efficacy in alleviating overall nasal symptoms. In this consensus, we systematically review the role of acetylcholine and M receptors in AR pathogenesis, the key findings from clinical trials on intranasal anticholinergics for AR management and the evidence-based recommendations from experts in Allergy and Rhinology, hoping to guide physicians in the standardized and precise use of intranasal anticholinergics for AR patients.

A tamarind seed extract-based solution containing xyloglucan forms a protective layer over the nasal epithelium. However, there is no previous study evaluating xyloglucan efficacy in children with allergic rhinitis (AR). To evaluate the safety and efficacy of xyloglucan as an adjunctive treatment for AR in children. This randomized, double-blind, placebo-controlled crossover study assessed the efficacy of xyloglucan nasal spray in managing AR symptoms in children. Participants 6-18 years with AR were randomized to receive either xyloglucan or placebo in addition to their current AR therapy for 2 weeks, followed by a 2-week washout and crossover to the alternate treatment for 2 weeks. Primary outcomes were changes in visual analog scale scores analyzed using linear mixed models, adjusting for treatment, period, sequence, and compliance. Subgroup analyses included children with moderate symptoms and good compliance. Seventy-nine children with AR were enrolled, median age 10 years (IQR: 8-12). Treatment with xyloglucan was associated with a significantly greater reduction in nasal congestion compared to placebo (β = -1.013, 95% confidence interval [CI], -1.729 to -0.298, P = 0.006). In children with moderate symptoms and good compliance, the effect on nasal congestion was more pronounced (β = -1.588, P = 0.046). Improvements in rhinorrhea, sneezing, and itching were observed but did not reach statistical significance. Both treatments were well tolerated, with only mild adverse events in both groups. Xyloglucan nasal spray, as an adjunct to standard AR treatment, demonstrated potential benefits in alleviating rhinitis symptoms, particularly nasal congestion, in children with AR. This clinical trial was registered with the Thai Clinical Trials Registry (No. TCTR20240318004).

Background:Allergic diseases are a growing health concern, with house dust mites being a prevalent allergen linked to various allergies. Rush subcutaneous immunotherapy (RIT) achieves maintenance dose rapidly but carries higher risks than conventional immunotherapy (CIT). The combination of Omalizumab with allergen immunotherapy (AIT) has been shown to improve AIT safety. This study investigates the safety of RIT combined with anti-immunoglobulin E (IgE) pretreatment.Methods:This retrospective analysis compared patients with allergic rhinitis and/or allergic asthma sensitive to dust mites who underwent RIT with anti-IgE pretreatment versus CIT at our facility from July 2022 to January 2024. We collected and analyzed demographic data, adverse events, and baseline metrics including visual analog scale scores, daily medication scores, allergic blood test outcomes, and lung function parameters.Results:Our study enrolled 50 patients in the RIT group and 60 in the CIT group. The RIT group demonstrated superior safety, with significantly fewer local adverse reactions during the up-dosing phase compared with CIT (P < 0.01). While systemic reactions were analogous between groups, the RIT group had a lower incidence of respiratory symptoms (P < 0.05). Logistic regression analysis established a predictive model for systemic reactions during up-dosing phase, with receiver operating characteristic analysis indicating its predictive accuracy exceeded that of individual factors (area under the curve = 0.815).Conclusion:RIT combined with anti-IgE pretreatment demonstrated low systemic adverse reaction rates and high safety. A combined visual analogue scale scores (VASs) and maximal mid-expiratory flow at 25%–75% prediction model was more accurate in forecasting systemic reactions than individual factor. Further research is required to determine its clinical utility.