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1. Diagnostic accuracy and safety of Dermatophagoides pteronyssinus extracts used for skin prick test

Author

Rui Tang, Xiaohong Lyu, Yuxi Liu, Ruiqi Wang, Lianglu Wang, Hong Li, Jinlyu Sun, Yuxiang Zhi, Jianqing Gu, Kai Guan, Liping Wen, Zixi Wang, Lisha Li, Le Cui, Yingyang Xu, Junxiong Zhou, Tao Xu, Jia Yin, and Lishao Guo

Subjects
Medicine
Abstract

Abstract. Background:. Dermatophagoides pteronyssinus is a common allergen causing allergic diseases in China. The aim of this study was to evaluate the efficacy and safety of D. pteronyssinus extracts produced by Peking Union Medical College Hospital (PUMCH) for the skin prick test (SPT) in the diagnosis of D. pteronyssinus allergy. Methods:. A total of 910 subjects with allergic diseases were prescribed D. pteronyssinus SPT and specific sIgE (sIgE) test among the Outpatients of Department of Allergy, PUMCH from August 10, 2015 to August 30, 2017. Receiver operating characteristic curve (ROC) analysis was performed according to the results of D. pteronyssinus-sIgE detection. The accuracy of D. pteronyssinus extracts used for SPT in the diagnosis of D. pteronyssinus allergy was evaluated under different cutoff values. Adverse events after SPT were recorded to evaluate safety. Results:. There were 796 and 618 subjects in the full analysis set (FAS) and the per protocol set (PPS), respectively. The areas under the curve of FAS and PPS were 0.871 and 0.873, respectively. According to the ROC of PPS, the optimal and 95% specificity diagnostic cutoff values of D. pteronyssinus SPT mean wheal diameter were 3.25 and 3.75 mm, respectively. No adverse events occurred. Conclusion:. The extracts of D. pteronyssinus for SPT were simple, highly accurate, and safe and should be considered for recommendation in the clinical diagnosis of D. pteronyssinus allergy.

Published
2022
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2. Prevalence of self-reported food allergy among adults in Jiangxi, China

Author

Hua Feng, PhD, Jiangdong Zhou, BD, Yuanan Lu, PhD, Qian Zhao, BD, Zifei Yang, BD, Xiujuan Xiong, PhD, Nan Luo, MD, Yan Chen, PhD, Lianglu Wang, PhD, and Yongning Wu, PhD

Subjects
Food allergy, Prevalence, Adult, China, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Food allergy has become an increasingly important public health problem. However, information regarding epidemiological studies of food allergy among Chinese adults is very limited. This study aims to estimate the prevalence of self-reported food allergy among adults in China. Method: A population-based cross-sectional study was administered to estimate the prevalence of self-reported food allergy on the basis of a face-to-face questionnaire survey. The participants were recruited by cluster random sampling from three prefectures in Jiangxi Province, China. Results: A total of 12 082 questionnaires were distributed, and 11 935 (98.8%) of completed ones were collected. The prevalence of self-reported food allergy was 4.0% (3.1% in men and 4.8% in women), self-reported doctor-diagnosed food allergy accounted for 1.4%. The most common allergic symptom was skin reaction showing in 63.9% of the participants with self-reported food allergy. The main allergic foods were shrimp, mollusks, and mango, accounting for the prevalence of 39.8%, 20.8%, and 18.7%, respectively. The self-reported food allergy was significantly linked with gender, age group, body height and other allergic conditions. Conclusions: The prevalence of self-reported food allergy is about 4.0% among adults in China. The three most common allergenic foods were shrimp, mollusks and mango. Gender, age, and other allergic diseases could be contributing factors associated with food allergy in adults. These findings will provide scientific basis for the further research and prevention of food allergy in adults.

Published
2023
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4. WAO-ARIA consensus on chronic cough – Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D’ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortego-Martell, MD, Olivia J.Ly Lesslar, MBBS BIR, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Upper airway cough syndrome, Lower airway disease, Reflux cough, Chronic cough management, Neuromodulators, Speech therapy, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.

Published
2022
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5. Analysis of Prevalence and Risk Factors of Adult Self-Reported Allergic Rhinitis and Asthma in Plain Lands and Hilly Areas of Shenmu City, China

Author

Huiping Gao, Yongliang Niu, Qiang Wang, Guangliang Shan, Chao Ma, Haiying Wang, Yaoda Hu, Kai Guan, Jianqing Gu, Jing Wang, Tao Wang, Hongmei Zhao, Hui Han, Haiyuan Chen, Wenxia Ruan, Hanlin Zhang, Cong Cong, Lianglu Wang, and Yonglin Liu

Subjects
allergic rhinitis, asthma, prevalence, risk factors, plain lands and hilly areas, Public aspects of medicine, RA1-1270
Abstract

Objective: The main aim of this study was to investigate the prevalence and risk factors of adult self-reported allergic rhinitis and asthma in plain lands and hilly areas of Shenmu City in China, and analyze the differences between regions.Methods: The multi-stage stratified random sampling was applied in a cross-sectional survey of adult residents in Shenmu City, from September to December 2019. The unconditional logistic regression analysis was used to screen the influence factors of allergic rhinitis and asthma.Results: 4,706 adults participated in the survey, and 99% (4,655 in 4,706) completed the questionnaires. The prevalence of allergic rhinitis was 25.4%, and the prevalence of asthma was 9.4%. The prevalence of the allergic rhinitis without asthma, asthma without allergic rhinitis, and the combined allergic rhinitis with asthma were 18.9, 2.9, and 6.5%, respectively. The prevalence of allergic rhinitis and asthma existed regional differences. The prevalence of adult self-reported allergic rhinitis was 41.5% in plain lands areas and 22.1% in hilly areas. The prevalence of adult self-reported asthma was 12.8% in plain lands and 8.8% in hilly areas. The prevalence of allergic rhinitis and asthma existed seasonal differences, with the highest prevalence from July to September. The analysis of risk factors showed that higher education [middle and high school (OR 1.72, 95%CI 1.42–2.07); college and above (OR 2.67, 95%CI 1.99–3.59)], comorbidities of other allergic diseases (OR 3.90, 95%CI 3.23–4.70), family history of allergies (OR 2.89, 95%CI 2.36–3.53), and plain lands areas (OR 2.51, 95%CI 2.06–3.05) were the risk factors for the allergic rhinitis without asthma. Aging [40–49 years old (OR 4.29, 95%CI 1.02–18.13); 50–59 years old (OR 5.89, 95%CI 1.40–24.76); ≥60 years old: (OR 6.14, 95%CI 1.41–26.71)], never-smokers (OR 1.66, 95%CI 0.99–2.80), comorbidities of other allergic disorders (OR 2.17, 95%CI 1.42–3.32), and family history of allergies (OR 2.20, 95%CI 1.40–3.47) were the risk factors for the asthma without allergic rhinitis. Advanced age [30–39 years (OR 2.16, 95%CI 1.23–3.82); 40–49 years (OR 2.86, 95%CI 1.56 to 5.25); 50–59 years (OR 2.95, 95%CI 1.58–5.51); ≥60 years old (OR 2.27, 95%CI 1.09–4.72)], higher education [middle and high school (OR 2.23, 95%CI 1.62–3.07); college and above (OR 4.28, 95%CI 2.72–6.74)], non-agricultural workers (OR 1.70, 95%CI 1.18–2.43),never-smokers (OR 2.26, 95%CI 1.51–3.39), comorbidities of other allergic diseases (OR 4.45, 95%CI 3.37–5.88), family history of allergies (OR 5.27, 95%CI 3.98–6.97), and plain lands areas (OR 2.07, 95%CI 1.51–2.86) were the risk factors for the combined allergic rhinitis with asthma.Conclusions: The prevalence of allergic rhinitis and asthma in Shenmu City was relatively high, with regional differences. Genetic and environmental factors were the important risk factors associated with allergic rhinitis and asthma. Our research would provide data support for preventing and controlling allergic rhinitis and asthma in this region in the future, and appropriate prevention and control programs should be formulated according to the characteristics of different regions.

Published
2022
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6. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation — Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Multifactorial cough, Cough phenotypes, Type 2 inflammation, COVID 19, Reflux-cough, Upper airway cough syndrome, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. Outcomes: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

Published
2021
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7. WAO-ARIA consensus on chronic cough – Part 1: Role of TRP channels in neurogenic inflammation of cough neuronal pathways

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona Sulaiman AL-Ahmad, MD, FAAAI, FRCPCP, Anahí Yáñez, MD, Maryam Ali Y. AL-Nesf, MD, MSc, R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, R. Maximiliano Gómez, MD, PhD, Sandra N. González Díaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana Kase Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, PhD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, José Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, PhD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
TRP channel, P2X3, Pathogenesis, Chronic cough, Chemoreceptors, Mechanoreceptors, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. Outcomes: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases.

Published
2021
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8. Expert consensus on the use of omalizumab in chronic urticaria in China

Author

Zuotao Zhao, MD, PhD, Tao Cai, MD, Hong Chen, MD, Liuqing Chen, MD, Yudi Chen, MD, Xiang Gao, MD, Xinghua Gao, MD, Songmei Geng, MD, Yinshi Guo, MD, Fei Hao, MD, Guodong Hao, MM, Yan Hu, MD, Hongzhong Jin, MD, Zhehu Jin, MD, Chengxin Li, MD, Haili Li, MD, Jie Li, MD, Yanming Li, MD, Yunsheng Liang, MD, Guanghui Liu, MD, Qiang Liu, MD, Hai Long, MD, Lin Ma, MD, Yuanyuan Shang, MM, Yuxin Song, MB, Zhiqiang Song, MD, Xiangyang Su, MD, Haijing Sui, MD, Qing Sun, MD, Yuemei Sun, MB, Jianping Tang, MD, Xunliang Tong, MD, Huiying Wang, MD, Gang Wang, MD, Lianglu Wang, MD, Siqin Wang, MB, Li Xiang, MD, Ting Xiao, MD, Zhiqiang Xie, MD., Leping Ye, MD, Yongmei Yu, MM, Chunlei Zhang, MD, PhD, Litao Zhang, MD, Shuchen Zhang, MD, PhD, Rui Zheng, MD, Lili Zhi, MM, Wei Zhou, MD, Ying Zou, MD, and Marcus Maurer, MD

Subjects
Chronic spontaneous urticaria, Chronic inducible urticaria, Treatment algorithm, Omalizumab, China, Immunologic diseases. Allergy, RC581-607
Abstract

Chronic urticaria (CU) is a debilitating skin disease that lasts for more than 6 weeks with wheals and/or angioedema, including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). In China, the prevalence of this disease is high, more than 1%, and on the rise. CU has a major impact on the quality of life (QoL) of patients who frequently experience sleep disturbance, depression, and anxiety. Nearly one-third of patients with CSU, in China, are resistant to second-generation H1-antihistamines (sgAHs), even at a fourfold dose (second line; off-label). Omalizumab is approved for the treatment of CSU treatment in Europe and shows remarkable efficacy and safety. In China, regulatory approval for the use of omalizumab is pending, and its use in clinical practice varies widely. Consensus on omalizumab CU treatment in China is urgently needed. The aim of this article is to propose a practical omalizumab treatment algorithm for the management of antihistamine-resistant CSU and CIndU in adults and special population including children and adolescents, and pregnant or breast feeding women, to guide daily clinical practice in China. In the development of this consensus, an expert group including mainly dermatologists, allergists, but also pulmonologists, ENTs, immunologists, and pediatricians in Allergic Disease Prevention and Control Committee, Chinese Preventive Medicine Association, reviewed the existing evidence and developed consensus on the use of omalizumab in CU patients from China. The goal of this consensus is to assist clinicians in making rational decisions in the management of refractory CU with omalizumab. The key clinical questions covered by the treatment algorithm are: 1) Omalizumab treatment routine strategy in both CSU and CIndU patients; 2) Recommended dose and treatment duration for different age stratification; 3) Treatment duration for CU patients with other allergic comorbidities; 4) Recommendation on omalizumab stopping strategy.

Published
2021
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9. Neuropsychiatric side reactions of leukotriene receptor antagonist, antihistamine, and inhaled corticosteroid: A real-world analysis of the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS)

Author

Sainan Bian, Lisha Li, Zixi Wang, Le Cui, Yingyang Xu, Kai Guan, Bin Zhao, Lianglu Wang, and Jia Yin

Subjects
Neuropsychiatric event, Leukotriene receptor antagonist, Antihistamine, Inhaled corticosteroid, Immunologic diseases. Allergy, RC581-607
Abstract

Background: There are limited real-world studies on the differences in leukotriene receptor antagonists (LTRA), H1-antihistamines (H1-AH), and inhaled corticosteroids (ICS) associated neuropsychiatric events. In this study, we aimed to analyze the characteristics of drug associated neuropsychiatric events, and compare the differences among different drug categories. Methods: Disproportionality analysis and Bayesian analysis were used in data mining to identify suspected neuropsychiatric events associated with LTRA, H1-AH, and ICS based on the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2004 to September 2020. Demographic information, time interval to onset, and death rates of LTRA, H1-AH, and ICS-associated neuropsychiatric events were also analyzed. Results: A total of 9475 neuropsychiatric events were identified. The number of neuropsychiatric events related to LTRA, H1-AH, and ICS were 5201 (54.89%), 3226 (34.05%), and 1048 (11.06%), respectively. LTRA related neuropsychiatric events were more common in patients aged 4–6 years (18.66%). H1-AH and ICS related neuropsychiatric events were more common in patients aged 18–44 years (29.92%) and older than 65 years (30.60%), respectively. Montelukast was highly associated with neuropsychiatric events, with a high reporting odds ratio (ROR). Most neuropsychiatric symptoms occurred within the first 10 days after drug initiation (78.63% for LTRA, 91.39% for H1-AH, and 84.07% for ICS). The death rate due to neuropsychiatric events of first generation H1-AH was significantly higher than that of LTRA and ICS (p

Published
2021
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11. Subcutaneous immunotherapy: a perspective from Peking Union Medical College Hospital

Author

Ying-Yang Xu, Kai Guan, Jia Yin, Lianglu Wang, Yu Xiang Zhi, Jin-Lu Sun, Hong Li, Li-Ping Wen, Jian-Qing Gu, Rui Tang, Zixi Wang, Li-Sha Li, and Le Cui

Abstract

Background Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment for IgE mediated disease. In china, AIT has been applied over 60 years and subcutaneous immunotherapy (SCIT) is the major route. This study analyzed the relatively comprehensive status of SCIT in our country. Methods Patients who initiated SCIT between January 1, 2015, and December 31, 2016 at Peking Union Medical College Hospital were collected and their medical records from January 1, 2015, to December 31, 2019 were obtained. The formulation and adherence of SCIT in different age groups and regions were analyzed. Results A total of 4731 patients receiving SCIT were analyzed, including 459 children (5-12 years), 624 adolescent (13-18 years) and 3648 adults. On a per-species allergen extract basis, multi-allergen SCIT were prescribed in 83% of patients. Mugwort, house dust mite and firebush were most frequently administered. On per-group allergen extract basis, 49% of SCIT were mixing formulations and weed pollen, tree pollen and house dust mite were most frequently used. The most common component of SCIT was mold in children (53%), whereas weed pollen in adolescents (59%) and adults (68%). Overall, 35% of patients completed at least 3-year SCIT. Children had the highest adherence of SCIT, followed by adolescents and adults (49%, 47% and 31%, respectively). Conclusions The majority of patients were prescribed SCIT of mixing formulation. Weed pollen was the most frequently used allergen group in SCIT, especially in Northern China. Real-life adherence in SCIT was still low which desiderate improvement of current procedure of SCIT.

Published
2022

12. Neuropsychiatric side reactions of leukotriene receptor antagonist, antihistamine, and inhaled corticosteroid: A real-world analysis of the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS)

Author

Kai Guan, Jia Yin, Le Cui, Sainan Bian, Zixi Wang, Bin Zhao, Lianglu Wang, Yingyang Xu, and Lisha Li

Subjects
Pulmonary and Respiratory Medicine, Drug, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Immunology, Leukotriene receptor antagonist, Article, Antihistamine, Neuropsychiatric event, Adverse Event Reporting System, Inhaled corticosteroid, Internal medicine, Case fatality rate, medicine, Immunology and Allergy, Montelukast, media_common, Leukotriene receptor, business.industry, Mortality rate, Odds ratio, RC581-607, Immunologic diseases. Allergy, business, medicine.drug
Abstract

Background There are limited real-world studies on the differences in leukotriene receptor antagonists (LTRA), H1-antihistamines (H1-AH), and inhaled corticosteroids (ICS) associated neuropsychiatric events. In this study, we aimed to analyze the characteristics of drug associated neuropsychiatric events, and compare the differences among different drug categories. Methods Disproportionality analysis and Bayesian analysis were used in data mining to identify suspected neuropsychiatric events associated with LTRA, H1-AH, and ICS based on the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2004 to September 2020. Demographic information, time interval to onset, and death rates of LTRA, H1-AH, and ICS-associated neuropsychiatric events were also analyzed. Results A total of 9475 neuropsychiatric events were identified. The number of neuropsychiatric events related to LTRA, H1-AH, and ICS were 5201 (54.89%), 3226 (34.05%), and 1048 (11.06%), respectively. LTRA related neuropsychiatric events were more common in patients aged 4–6 years (18.66%). H1-AH and ICS related neuropsychiatric events were more common in patients aged 18–44 years (29.92%) and older than 65 years (30.60%), respectively. Montelukast was highly associated with neuropsychiatric events, with a high reporting odds ratio (ROR). Most neuropsychiatric symptoms occurred within the first 10 days after drug initiation (78.63% for LTRA, 91.39% for H1-AH, and 84.07% for ICS). The death rate due to neuropsychiatric events of first generation H1-AH was significantly higher than that of LTRA and ICS (p Conclusions LTRA associated neuropsychiatric events reported in FAERS were most frequent in 4 to 6-year-old children. Most reported cases occurred within the first 10 days after drug initiation. The second generation H1-AH was relatively safe for neuropsychiatric events compared with the first generation. The fatality rate due to first generation H1-AH associated neuropsychiatric events was higher than that of LTRA and ICS. More attention should be paid to specific patients treated with LTRA and H1-AH.

Published
2021

14. Sensitization Profiles of Timothy Grass Pollen in Northern China

Author

Jia Yin, Yongliang Niu, Yingyang Xu, Jinghong Zhang, Kai Guan, Li Sha, and Lianglu Wang

Subjects
Pulmonary and Respiratory Medicine, allergic rhinitis, business.industry, Timothy grass pollen, grass pollen allergy, Phleum pratense, medicine.anatomical_structure, Agronomy, Journal of Asthma and Allergy, Immunology and Allergy, Medicine, allergen components, business, China, Sensitization, Phl p 12, Original Research
Abstract

Yingyang Xu,1– 3 Kai Guan,1– 3 Li Sha,4 Jinghong Zhang,5 Yongliang Niu,6 Jia Yin,1– 3 Lianglu Wang1– 3 1Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China; 2Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, 100730, People’s Republic of China; 3National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, People’s Republic of China; 4Department of Allergy, Capital Institute of Pediatrics, Beijing, 100020, People’s Republic of China; 5Department of Allergy, The No.1 People’s Hospital of Shizuishan, Shizuishan, 753000, Ningxia Hui Autonomous Region, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Shenmu Hospital, Shenmu, 719300, Shanxi, People’s Republic of ChinaCorrespondence: Kai GuanDepartment of Allergy, Peking Union Medical College Hospital, #1 Shuaifuyuan, Wangfujing, Beijing, 100730, People’s Republic of ChinaTel +86 10 69151605Fax +86 10 69156346Email dr_guankai@126.comPurpose: Grass pollen is an important cause of IgE-mediated allergy in countries worldwide, especially within Europe. However, there has been no research on grass pollen allergy in northern China. We aimed to determine the status of grass pollen allergy and the sensitization patterns to Phleum pratense (P. pratense) in northern China.Patients and Methods: Pollen data were collected for three geographic areas (Beijing, Shenmu, Shizuishan) in northern China. The study enrolled 101 patients (62 men; age range, 1– 64 years; median age, 10 years) who had allergic rhinoconjunctivitis and/or asthma during the grass pollen season and positive skin prick test results positive to P. pratense. Serum-specific IgE (sIgE) against Phl p 1, Phl p 2, Phl p 5, Phl p 6, Phl p 7, Phl p 12 was measured by ImmunoCAP.Results: The pollen season of P. pratense was from June to September in Beijing, May to September in Shenmu and July to August in Shizuishan. P. pratense pollen accounted for 2– 3% of the annual pollen index of total pollen counts. Among 101 patients with positive skin prick test results to P. pratense, 72% had detectable sIgE to P. pratense. Phl p 12 was the most frequently recognized component (45%), followed by Phl p 1 (22%), Phl p 5 (14%), Phl p 6 (8%) and Phl p 7 (3%). No patients had sIgE to Phl p 2. Ten sensitization patterns to the six components were observed. High rate of sIgE to Phl p 12 was positively correlated with co-sensitization to weed or tree pollen.Conclusion: Considering the pollen concentration, P. pratense was a minor pollen allergen in northern China and its pollen season overlapped with that of weed pollen. IgE sensitization to P. pratense was likely to be induced by cross-reactivity between grass pollen allergy and weed/tree pollen allergy.Keywords: allergic rhinitis, allergen components, grass pollen allergy, Phleum pratense, Phl p 12

Published
2021

15. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation — Updates in COVID-19

Author

Lianglu Wang, Sami L. Bahna, Luis Caraballo, Jean Bousquet, David B. Peden, Sandra Nora González Díaz, Luciana Kase Tanno, Georges S. Juvelekian, Giorgio Walter Canonica, Ludger Klimek, Ignacio J. Ansotegui, Yoon-Seok Chang, Jose Antonio Ortego-Martell, Adnan Custovic, Moussa A. Riachy, Bryan Martin, Samar A. Idriss, Peter K. Smith, Gary W.K. Wong, René Maximiliano Gómez, Erika Jensen-Jarolim, Mona Al-Ahmad, Tanya M. Laidlaw, Jonathan A. Bernstein, Cecilio Azar, Philip W. Rouadi, Alessandro Fiocchi, Michael Levin, Eliane Abou-Jaoude, Motohiro Ebisawa, Talal M. Nsouli, Mário Morais-Almeida, Usamah Hadi, Maryam Ali Al-Nesf, Fares Zaitoun, Glenis Scadding, James L. Sublett, Manana Chikhladze, Anahí Yáñez, Peter Hellings, Beirut Eye & ENT Specialist Hospital (BESH), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Brigham and Women’s Hospital [Boston, MA], Harvard Medical School [Boston] (HMS), American University of Beirut [Beyrouth] (AUB), Middle East Institute of Health, Clemenceau Medical Center (CMC), Kuwait University, Investigaciones en Alergia y Enfermedades Respiratorias (InAER), Hamad Medical Corporation [Doha, Qatar], International Cough Institute (ICI), Louisiana State University (LSU), LAU Medical Center-Rizk Hospital, American University of Beirut Faculty of Medicine and Medical Center (AUB), Department of Microbiology, Immunology and Transplantation [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University Hospitals Leuven [Leuven], Ghent University Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), The Royal National Throat, Nose and Ear Hospital [London, UK], University College of London [London] (UCL), Griffith University [Brisbane], Hospital CUF Descobertas, Catholic University of Salta, Universidad Autonoma de Nuevo Leon [Mexique] (UANL), Center for Rhinology and Allergology Wiesbaden, University Hospital Mannheim, Saint George Hospital University Medical Center [UOB LIBAN], University of Balamand [Liban] (UOB), Hôtel-Dieu de France (HDF), Université Saint-Joseph de Beyrouth (USJ), Humanitas Clinical and Research Center [Rozzano, Milan, Italy], University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), The Chinese University of Hong Kong [Hong Kong], University of Louisville, University of Cincinnati College of Medicine, Peking Union Medical College Hospital [Beijing] (PUMCH), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), World Health Organisation (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Akaki Tsereteli State University, University of Cape Town, Seoul National University Bundang Hospital (SNUBH), The Ohio State University Wexner Medical Center., University of Cartagena, Imperial College London, Universidad Autónoma del Estado de Hidalgo (UAEH), Medizinische Universität Wien = Medical University of Vienna, Sagamihara National Hospital [Kanagawa, Japan], Bambino Gesù Children’s Hospital [Rome, Italy], Hospital Quirónsalud Bizkaia [Bilbao], and Salvy-Córdoba, Nathalie

Subjects
Pulmonary and Respiratory Medicine, Allergy, Upper airway cough syndrome, medicine.medical_treatment, Cough reflex, Immunology, GASTROESOPHAGEAL-REFLUX DISEASE, AIRWAY COUGH, Lower airway disease, OBSTRUCTIVE PULMONARY-DISEASE, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, TRP CHANNELS, Article, CLINICAL CHARACTERISTICS, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, CHEST GUIDELINE, medicine, Immunology and Allergy, Continuous positive airway pressure, VARIANT ASTHMA, Cough phenotypes, COPD, Science & Technology, POSTNASAL-DRIP-SYNDROME, business.industry, Type 2 inflammation, RC581-607, medicine.disease, Obstructive sleep apnea, respiratory tract diseases, ALLERGIC RHINITIS, Chronic cough, Upper respiratory tract infection, BRONCHIAL HYPERRESPONSIVENESS, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, GERD, Reflex, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Multifactorial cough, Immunologic diseases. Allergy, medicine.symptom, business, Life Sciences & Biomedicine, COVID 19, Reflux-cough
Abstract

BACKGROUND: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others. ispartof: WORLD ALLERGY ORGANIZATION JOURNAL vol:14 issue:12 ispartof: location:United States status: published

Published
2021

17. Thiol peroxiredoxin, a novel allergen from

Author

Hui, Wang, Wei, Hu, Zhiling, Liang, Lu, Zeng, Jianjie, Li, Hao, Yan, Pingchang, Yang, Zhigang, Liu, and Lianglu, Wang

Subjects
fungi, Original Article, respiratory tract diseases
Abstract

Bombyx mori (B.mori, also known as silkworm) plays a role in the pathogenesis of allergic diseases. However, its allergens are to be characterized. The aim of this paper is to identify new silkworm allergens. Two-dimensional gel electrophoresis (2-DE) and mass spectrometry were employed to separate and identify potential allergens from silkworm pupa. Six potential allergens were identified in this study. Thiol peroxiredoxin (TP), one of the 6 allergens, reacted to serum IgE from patients sensitized to silkworm. By sensitizing with TP allergic asthma like symptoms were induced in mice, including elevation of the levels of serum IgE, IL-4 from bronchoalveolar lavage fluid and culture supernatant of spleen cells. In vitro experiments showed that TP significantly induced RAW264.7 cells (a macrophage cell line) apoptosis via modulating the BCL2 and Caspase9 pathways. The levels of CD80, CD40, CD83 and TNF-α in DC2.4 cells (a dendritic cell line) were increased in the culture after exposure to TP. In summary, TP is an allergic component of silkworm. It induces allergic asthma, and modulates the functions of macrophages and dendritic cells.

Published
2016

18. Continuous Subcutaneous Insulin Infusion as an Effective Method of Desensitization Therapy for Diabetic Patients with Insulin Allergy: A 4-year Single-center Experience

Author

Yingyue Dong, Tao Yuan, Naishi Li, Lianglu Wang, and Weigang Zhao

Subjects
Male, medicine.medical_specialty, Pediatrics, Adolescent, Injections, Subcutaneous, medicine.medical_treatment, 030209 endocrinology & metabolism, Single Center, Drug Hypersensitivity, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, medicine, Humans, Hypoglycemic Agents, Insulin, Pharmacology (medical), 030212 general & internal medicine, Aged, Retrospective Studies, Desensitization (medicine), Pharmacology, business.industry, Insulin allergy, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, Subcutaneous insulin, Regimen, Diabetes Mellitus, Type 2, Desensitization, Immunologic, Female, business
Abstract

Purpose This article summarizes our experiences in the application of continuous subcutaneous insulin infusion (CSII) as a method of rapid desensitization therapy for diabetic patients with insulin allergy that was subsequently switched to a regimen of multiple-dose injections for long-term insulin therapy. Methods The clinical data of 11 diabetic patients with insulin allergy in Peking Union Medical College Hospital from April 1, 2008, through December 31, 2011, were retrospectively analyzed. Findings All 11 conditions were diagnosed by case history, skin testing, determination of serum specific anti-insulin IgE, and reaction to withdrawal of insulin. Seven patients accepted the traditional injection method of desensitization, and 5 patients accepted CSII with the protocol designed for this study (1 patient accepted CSII after failure by the formal method). Six of the 7 patients who accepted the traditional method and all 5 patients who accepted CSII had successful results. All 5 patients in the CSII group switched to a regimen of multiple dosage injections. In a survey of 28 nurses, both experienced nurses and practical nurses preferred to use CSII as the method of desensitization. Implications It is feasible and effective for diabetic patients with insulin allergy to use CSII as a method of rapid desensitization with subsequent switching to a regimen of multiple-dose injections for long-term insulin therapy.

Published
2016

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