Prevalence of pollen-induced allergic rhinitis with high pollen exposure in grasslands of northern China

Full consideration of the pollen exposure effect in clinical trial design for pollen-induced allergic rhinitis

INTRODUCTION

Allergic rhinitis (AR) is global health concern with an increasing prevalence. Among them, pollen-induced AR (PIAR) exhibits more severe and intense symptoms, decreased quality of life, prominent local inflammation, and is thus more challenging to control. Due to the difficulties in disease control, in recent years, an increasing number of treatment methods, including pharmacotherapy, allergen-specific immunotherapy, and newly developed biologics, have focused on PIAR. It has been shown that the pollen exposure has a significant impact on the symptoms of PIAR and the efficacy of intervention. From this perspective, clinical trials for PIAR need to take full account of pollen exposure, especially when assessing efficacy.

AREAS COVERED

This review summarized the effect of pollen exposure on PIAR, including immune responses, symptoms and clinic visits. Current definitions for the pollen season (PS) and the peak pollen season (PPS) are discussed. Based on the previous PIAR-related clinical studies and the available recommendations for clinical trial design, a detailed account of trial protocols which fully considered pollen exposure is provided.

EXPERT OPINION

Pollen exposure has a significant impact on PIAR. With fully considering the pollen exposure in the clinical trial design for PIAR, future protocols for PIAR-related studies may be more objective and better harmonized and, therefore, comparable.

An analysis of meteorological and environmental factors linked to Thunderstorm Asthma in China

BACKGROUND

Thunderstorm Asthma (TA) events are observed worldwide, but the precise triggering mechanisms remain elusive.

OBJECTIVE

This study aims to outline the environmental patterns associated with TA events in China.

METHODS

Environmental data was collected from Chinese cities that have experienced TA events, focusing on meteorological conditions in the seven days preceding the thunderstorms. This allowed for the identification of common environmental precursors to TA.

RESULTS

In China, TA events are primarily concentrated in the northwest plateau region. These locations have a temperate continental monsoon climate with infrequent rainfall, leading to a generally arid environment. The four cities that have reported TA incidents are situated predominantly in the vicinity of desert areas. The extensive cultivation of Artemisia arenaria exists in these areas, which are primarily used for windbreaks and sand stabilization. In early September, prior to the occurrence of thunderstorms, these cities typically experience higher temperatures, gentle breezes, and minimal rainfall. Under such environmental conditions, the concentration of Artemisia pollen in the urban areas is extremely high. Upon the arrival of thunderstorms, these allergens can trigger widespread asthma outbreaks among individuals sensitized to them.

CONCLUSION

The cities in China that experience TA events are primarily situated in the vicinity of deserts located on the plateau. Prior to the occurrence of TA, these cities are exposed to an environment characterized by elevated temperatures, gentle breezes, minimal rainfall, and exceptionally high concentrations of Artemisia pollen.

A novel combination mode for inhalant allergen screening based on 8-well microplates by LiCA

OBJECTIVE

Currently, allergen detection is primarily classified into two types: single detection and multiple combined detection. The challenges include large volume of serum required, high testing costs, and fixed combinations of test items. A cost-effective method that uses a small amount of serum and allows for the flexible combination of allergen screening is necessary. Light-initiated Chemiluminescence Assay (LiCA) requires no washing, only need little serum, and supports flexible combination detection of allergens.

METHODS

Based on the advantages of LiCA technology, which does not require washing, the '4 + 3X + 1' allergen detection mode was established in this study. The antigens are coated on chemibeads, which are selectively added into the detection wells to achieve flexible combination, supporting the simultaneous detection of eight allergens.

RESULTS

This study introduces a new allergen screening model termed "4 + 3X + 1", where "1" represents tIgE, "4" comprises four commonly encountered indoor inhalable allergens, and "3X" encompasses a variety of frequent inhalable allergens. Allergens from "3X" could be selected based on regional characteristics and patient-specific conditions. We tested the intermediate precision(3.59 %-9.71 %) and repeatability(2.81 %-9.31 %) of the four allergens in "4-fixed", and LoB(0.035-0.066 kUA/L), LoD(0.092-0.156 kUA/L), and LoQ(0.135-0.199 kUA/L) all showed good results. We compared the consistency of LiCA and ImmunoCAP/Dot-ELISA, each of which was greater than 0.8828. In addition, two allergens were selected from "4-fixed" and "3X-optional "respectively to detect the sensitivity(80 %-97.72 %) and specificity(93.75 %-100 %).

CONCLUSIONS

The proposed combined test model offers a new, economical, and rapid option for allergen screening that requires low blood volumes and can be customized for individual patients.

Impact of climate change on aerobiology, rhinitis, and allergen immunotherapy: Work Group Report from the Aerobiology, Rhinitis, Rhinosinusitis & Ocular Allergy, and Immunotherapy, Allergen Standardization & Allergy Diagnostics Committees of the American Academy of Allergy, Asthma & Immunology

Climate change is imposing a profound effect on health conditions triggered by environmental exposures. Climate change has affected aeroallergens in numerous ways, including: (1) changes in the vegetation microbiome distribution, (2) increases in C4 grasses globally, (3) increased occurrence of acute weather events, (4) increases in ambient temperature that amplify fungal spore concentration and pollen season duration, and (5) increased allergenicity of pollen and fungi due to exposure to higher levels of carbon dioxide, ozone, and diesel exhaust particles. In addition, greenhouse gases and air pollutants disrupt the epithelial barrier, trigger eosinophilic inflammation, and serve as adjuvants that stimulate IgE-mediated responses. All of these factors have influenced the prevalence and morbidity of allergic rhinitis, nonallergic rhinitis, and chronic rhinosinusitis. Data regarding changes in aeroallergen exposures due to climate change are lacking, and longitudinal sensitization data are rarely available. Allergists need to adapt diagnostic and treatment strategies to limit aeroallergen and air pollutant exposure and facilitate desensitization. Steps needed to address these challenges include: (1) expanding local measurement of pollen and fungal spores, (2) increasing the intensity of allergen avoidance measures, (3) addressing supply chain issues, and (4) promoting collaboration between allergists, insurance companies, aeroallergen manufacturers, and regulatory agencies.

A randomized controlled trial evaluating prophylactic treatment of Artemisia pollinosis using azelastine hydrochloride and fluticasone propionate nasal spray

Background

Prophylactic treatment for pollinosis is advantageous for managing nasal symptoms in patients with seasonal allergic rhinitis. Inadequate control of rhinitis symptoms increases the risk of acute asthma attacks. Nevertheless, there is limited research on the use of nasal glucocorticoids and antihistamines for the preventive treatment of pollinosis.

Objective

This study aimed to assess the efficacy of prophylactic treatment for nasal symptoms and acute asthma attacks by enrolling patients with Artemisia pollinosis to use a combined device of azelastine hydrochloride and fluticasone nasal spray prior to the pollen season.

Methods

The study was registered at Chictr.org.cn (ChiCTR2300073758). A total of 120 patients with Artemisia pollinosis were randomly assigned to either a prophylactic treatment group or a control group at a 1:1 ratio. In the prophylactic treatment group, the nasal spray was initiated approximately two weeks before the onset of the pollen season.

Results

During both the pollen season and the concurrent medication period, the prophylactic treatment group presented significantly lower total nasal symptom scores (TNSS) (means of 5.97 and 5.94) than the control group (means of 7.86 and 7.80) (P = 0.015 and 0.016). Although the prophylactic treatment group had a lower asthma attack rate than the control group, the difference was not statistically significant (P = 0.284).

Conclusions

Prophylactic treatment with azelastine hydrochloride and fluticasone propionate nasal sprays can alleviate nasal symptoms and may reduce acute asthma attacks during the pollen season.

Clinical Trial Registration

[Chictr.org.cn], identifier (ChiCTR2300073758).

Comparative safety analysis of coseasonal versus preseasonal Artemisia annua sublingual immunotherapy for allergic rhinitis

PURPOSE

Patients with seasonal allergic rhinitis (SAR) usually seek treatment when symptoms become unbearable during the pollen season. It remains unclear whether initiating sublingual immunotherapy (SLIT) during the pollen season affects patients' safety. This study aims to compare the tolerability of initiating Artemisia annua SLIT during the pollen season versus before the season.

METHODS

Ninety patients with Artemisia-induced SAR were recruited and equally randomized into the coseasonal initiation treatment (COS-SLIT) group and the preseasonal initiation treatment (PRE-SLIT) group. The COS-SLIT group started SLIT when allergic symptoms occurred during the 2022 pollen season, while the PRE-SLIT group began SLIT four months before the expected season in 2022. Patients were categorized as mild symptoms or moderate-severe symptoms group based on the level of visual analog scale (VAS) scores evaluated during the 2021 pollen season. The incidence, frequency, performance, and alleviating measures of adverse events (AEs) were analyzed after the up-dosing phase (5 weeks), at three months (13 weeks), six months (26 weeks), and twelve months (52 weeks).

RESULTS

A total of 72 patients (32 patients in the COS-SLIT group and 40 patients in the PRE-SLIT) were included in the analysis. Among these patients, 33 reported a total of 78 AEs. No significant difference was found in the frequency and number of patients experiencing AEs between the COS-SLIT and PRE-SLIT groups during the four follow-up periods (all p > 0.05). There were no significant differences in the symptoms or alleviating measures of AEs between the two groups in general (all p > 0.05). Furthermore, the most common AEs in the COS-SLIT group were nasal symptoms (n = 14), lip edema (n = 10), and cough (n = 4), while in the PRE-SLIT group were nasal symptoms (n = 12), lip edema (n = 8), and ocular pruritus (n = 6). Symptomatic drugs were the most common alleviating measures in both groups (61.29% in COS-SLIT and 64.52% in PRE-SLIT, p > 0.05). Patients with mild and moderate-severe symptoms showed comparable tolerability at different initiation timing (all p > 0.05).

CONCLUSION

This prospective study demonstrates the comparable safety and tolerability of initiating Artemisia annua SLIT during the pollen season and before the season.

Coseasonal initiation of Artemisia annua sublingual immunotherapy in children and adult patients with allergic rhinoconjunctivitis

PURPOSE

This study aimed to investigate the efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy (SLIT) for children and adult patients with allergic rhinoconjunctivitis (ARC).

METHODS

A total of 50 patients (aged 4-60 years) with ARC who visited hospital from July to September 2022 were enrolled and randomly divided into the SLIT (n = 25) and control group (n = 25). Patients in SLIT group received Artemisia annua SLIT and patients in control group only received symptomatic medication. The study continued for 1 year. Four nasal symptom scores, two eye symptom scores, and medication usage of the patients during 2021 (baseline) and 2023 pollen seasons were recorded, as well as adverse events (AEs) during the study.

RESULTS

Finally, 20 patients of SLIT group and 22 patients of control group completed this study. Compared with the baseline, the levels of total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and combined symptom and medication score for rhinoconjunctivitis (CSMS-RC) experienced significant reductions after 1 year SLIT. Additionally, these outcomes also decreased significantly in SLIT group when compared with the control group during 2023 pollen season. Especially, there were more patients showed symptoms reduction, medication use decrease, and efficacy improvement in the SLIT group. Notably, no severe AEs were observed throughout the treatment course among patients receiving SLIT.

CONCLUSIONS

Coseasonal initiating Artemisia annua SLIT demonstrated clinical efficacy and safety for children and adult patients with ARC.

The present and future of digital health, digital medicine, and digital therapeutics for allergic diseases

BACKGROUND

Digital health, digital medicine, and digital therapeutics integrate advanced computer technologies into healthcare, aiming to improve efficiency and patient outcomes. These technologies offer innovative solutions for the management of allergic diseases, which affect a significant proportion of the global population and are increasing in prevalence. BODY: This review examines the current progress and future potential of digital health in allergic disease management. It highlights key advancements, including telehealth, mobile health (mHealth), artificial intelligence, clinical decision support systems (CDSS), and digital biomarkers, with a focus on their relevance to allergic disease management. The role of digital tools in improving treatment adherence, enabling remote care, and integrating environmental and patient data into personalized care models is discussed. Challenges such as data privacy, interoperability, and equitable access are addressed, alongside potential strategies to overcome these barriers.

CONCLUSION

Digital therapy will play an important role in allergic diseases, and the further development of digital therapies will effectively promote the development of clinical research, digital biomarkers, hypoallergenic environments and digital twins. More research is needed to support the progress of digital therapy for allergic diseases.

Common pollen and related allergen components in patients with allergic diseases in the Beijing area

Background

Pollen is the most common outdoor allergen that causes allergic rhinitis and asthma, which seriously affects patient quality of life and extensive cross-reactivity occurs between pollen allergens.

Methods

The study enrolled 84 patients with respiratory allergies and at least one pollen allergy who visited the clinic. Specific-IgE was detected via immunoblotting in the sera of patients with positive respiratory allergies to pollen. IgE of the components and cross-reactive carbohydrate determinants (CCD) were evaluated using a fluorescence-encoded microsphere assay.

Results

Our results suggest that Artemisia absinthium, Artemisia vulgaris, Humulus scandens, Amaranthus, Parietaria micrantha allergies are most common in the northern region, and that weed pollen remains the major pollen allergen in the northern region. Among the different age groups, the positive rate of Platanus pollen allergens was significantly higher in patients ≤18 years of age than in those aged >18 years (55.56% vs. 9.17%, χ² = 0.55, p < 0.027). Patients with allergic rhinitis and asthma had an increased positive rate for Betula pollen allergen (20.00% vs. 37.93 χ² = 7.87, p = 0.005) and Platanus pollen allergen (27.27% vs. 51.72%, χ² = 11.05, p = 0.0008) than those with allergic rhinitis alone, although the allergen positivity rate did not significantly differ between sexes. In addition, the positivity of sIgE of allergen components did not reveal a correlation with clinical symptoms and anti-CCD IgE positivity was 1.19% (1/84) among all patients.

Conclusion

The study found the distribution characteristics of common pollen allergens in Beijing among patients of different ages and genders and with different allergic diseases, as well as the relationship between pollen allergen components and symptoms. The positivity rate of CCD for respiratory allergic diseases in Beijing was not high as well.

The impact of increasing ambient temperature on allergic rhinitis: A systematic review and meta-analysis of observational studies

INTRODUCTION

Global warming appears to initiate and aggravate allergic respiratory conditions via interaction with numerous environmental factors. Temperature, commonly identified as a factor in climate change, is important in this process. Allergic rhinitis, a common respiratory allergy, is on the rise and affects approximately 500 million individuals worldwide. The increasing ambient temperature requires evaluation regarding its influence on allergic rhinitis, taking into account regional climate zones.

METHODS

A detailed search of PubMed, EMBASE, Scopus, Web of Science, MEDLINE, and CINAHL Plus databases, was conducted, encompassing observational studies published from 1991 to 2023. Original studies examining the relationship between increasing temperature and allergic rhinitis were assessed for eligibility followed by a risk of bias assessment. Random effects meta-analysis was utilized to measure the association between a 1 °C increase in temperature and allergic rhinitis-related outcomes.

RESULTS

20 studies were included in the qualitative synthesis, with nine of them subsequently selected for the quantitative synthesis. 20 included studies were rated as Level 4 evidence according to the Oxford Centre for Evidence-Based Medicine, and the majority of these reported good-quality evidence based on the Newcastle-Ottawa Quality Rating Scale. Using the Risk of Bias In Non-Randomized Studies of Exposure tool, the majority of studies exhibit a high risk of bias. Every 1 °C increase in temperature significantly raised the risk of allergic rhinitis-related outcomes by 29 % (RR = 1.26, 95 % CI: 1.11 to 1.50). Conversely, every 1 °C rise in temperature showed no significant increase in the odds of allergic rhinitis-related outcomes by 7 % (OR = 1.07, 95 % CI: 0.95 to 1.21). Subsequent subgroup analysis identified climate zone as an influential factor influencing this association.

CONCLUSION

It is inconclusive to definitively suggest a harmful effect of increasing temperature exposure on allergic rhinitis, due overall very low certainty of evidence. Further original research with better methodological quality is required.

Main Airborne Pollen Species and Characteristics of Allergic Rhinitis Patients with Pollen-Related Allergies in 13 Northern Chinese Cities

Background

Pollen allergies have a high prevalence in northern China, whereas, the types of pollen allergens and population characteristics among different regions remain unclear.

Objective

To study the species and temporal distribution of the main allergenic pollen, as well as the characteristics of patients with pollen-related allergic rhinitis (AR) in different cities in northern China.

Methods

Pollen data were obtained from pollen-monitoring stations in 13 cities of northern China between 2020 and 2021. Questionnaire surveys and allergen testing were conducted in 494 patients with pollen-related allergies from Beijing in Central, Shenyang in Northeast, and Xi'an in Northwest China.

Results

In 13 cities of northern China, the main sources of pollen were cypress, poplar, elm, pine, birch and ash in spring, and mugwort, goosefoot, hop and ragweed in autumn. In Northwest China, the spring and autumn pollen periods started earlier and lasted longer than that in Central and Northeast China, and the pollen counts in autumn in was significantly higher than that in Central and Northeast China. Furthermore, the nasal, ocular and respiratory symptom and quality of life scores of AR patients in Northwest China were significantly higher than that in Central and Northeast China. 69.32-73.28% of patients had annual cost of anti-allergic medication between 500-5000 yuan. However, 40.93-48.86% of patients reported minor control of symptoms.

Conclusion

Our results can be used as a basis for developing effective prevention and management measures for patients with pollen-related allergy in these regions, including timely pollen monitoring, patient guidance on protective measures, early intervention, and specific immunotherapy, to improve pollen-related allergy management.

Management of Allergic Rhinitis in the United Arab Emirates: Expert Consensus Recommendations on Allergen Immunotherapy

Allergic rhinitis (AR) is a chronic inflammatory condition of the upper airways caused by a type I hypersensitivity reaction triggered by environmental allergens. AR is associated with significant morbidity and affects patients' quality of life, emotional well-being, productivity, and cognitive functioning. As AR prevalence and morbidity have increased significantly worldwide, similar observations have been noted in the United Arab Emirates (UAE) with AR becoming a potential public health issue. Management of AR in the UAE is mainly provided by non-allergy specialists relying on first-line treatments such as intranasal steroids and antihistamines, with often suboptimal and short-term efficacy. Allergen Immunotherapy (AIT) is the only currently available disease-modifying treatment option in the form of either subcutaneous or sublingual allergen immunotherapy that has been proven to have long-term benefits. This article aims to provide recommendations regarding the use of AIT for managing AR in the UAE, considering both the current landscape in the Emirati healthcare system and local experience.

[Analysis of allergen distribution and indoor factors in allergic rhinitis in Chaoshan area]

Objective:To investigate the distribution of common allergens and indoor factors influencing the severity of allergic rhinitis in patients from the Chaoshan region. Methods:Patients diagnosed with allergic rhinitis from Shantou, Jieyang, and Chaozhou were selected for serum allergen-specific IgE testing. A questionnaire survey was conducted to analyze the distribution of allergens and indoor factors affecting the severity of the disease. Results:A total of 1 800 questionnaires were collected, with 1 646 valid responses, resulting in an effective response rate of 91.4%. Among the 1 646 included patients with allergic rhinitis, there were 1 285 children（≤14 years） ，361 adolescents and adults（>14 years）；of which 999 were males and 647 were females. The top three allergens with the highest positive rates were house dust mites（n=1 457, 88.5%）, milk（n=569, 34.6%）, and crab（n=360, 21.9%）. The proportions of allergen sensitization to house dust mites, house dust, dog dander, egg white, milk, fish, crab, shrimp, and beef showed statistically significant differences between children and adolescents and adults（P<0.01）. There were also statistically significant differences in crab and shrimp sensitization between males and females（P<0.01）. Multivariate analysis revealed that active/passive smoking, religious rituals, air conditioning usage, pet ownership, air purifier usage, and bedding drying were indoor factors influencing the severity of allergic rhinitis. Among them, active/passive smoking, religious rituals, air conditioning usage, and pet ownership were risk factors for exacerbating the disease, while air purifier usage and bedding drying were protective factors. Conclusion:House dust mites are the most common allergen in patients with allergic rhinitis in the Chaoshan region. Active/passive smoking, religious rituals, air conditioning usage, and pet ownership can worsen the condition, while air purifier usage and bedding drying can help control the disease. The results of this study can provide clinical reference.

Air pollution mixture associated with oxidative stress exacerbation and symptoms deterioration in allergic rhinitis patients: Evidence from a panel study

With allergic rhinitis (AR) on the rise globally, there has been a growing focus on the role of environmental pollutants in the onset of AR. However, the potential mechanisms by how and which these pollutants exacerbate AR conditions remain unknown. This panel study of 49 patients diagnosed with AR over one year aimed to assess the individual and combined effects of short-term exposure to multiple ambient pollutants on oxidative stress, symptoms, and quality of life among patients with AR. All participants underwent four repeated assessments of health conditions and personal environmental exposures (PM2.5, O3, SO2, and NO2) over warm and cold seasons during 2017-2018. We evaluated two oxidative stress biomarkers (malondialdehyde [MDA], and superoxide dismutase [SOD]) via nasal lavage. We collected information on self-reported symptoms and quality of life using the Rhinitis Symptom Scale (SRS), the Visual Analog Scale (VAS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) through in-person interviews. Bayesian kernel machine regression (BKMR) was used to evaluate the joint effects of pollutant mixture and identify key contributors. The results revealed a significant association of the pollutant mixture when all four pollutants were at or above their median levels, with increased oxidative stress. This was evidenced by elevated MDA and reduced SOD. We found a joint detrimental effect of the pollutant mixture on AR symptoms with a strong association with increased SRS scores, but a non-significant positive association with VAS and RQLQ scores. PM2.5, O3, and SO2 presented as the potentially primary contributors to the adverse health effects associated with the pollutant mixture in Taiyuan city. Patients with AR exposed to short-term air pollutant mixture are more likely to have greater nasal symptoms and worse quality of life from increased oxidative stress and reduced antioxidant capacity. Further research is warranted to better elucidate the underlying mechanisms.

Identification and Characterization of Pectate Lyase as a Novel Allergen in Artemisia sieversiana Pollen

INTRODUCTION

Artemisia species are widely spread in north hemisphere. Artemisia sieversiana pollen is one of the common pollen allergens in the north of China. At present, seven allergens were identified and had been listed officially from A. sieversiana pollen, but the remaining allergens are still insufficiently studied, which need to be found.

METHODS

Pectate lyase was purified from the extracts of A. sieversiana pollen by anion exchange, size exclusion, and HPLC-hydrophobic interaction chromatography. The gene of A. sieversiana pectate lyase (Art si pectate lyase) was cloned and expressed in Escherichia coli. The enzyme activity and circular dichroism (CD) spectrum of natural and recombinant proteins were analyzed. The allergenicity of Art si pectate lyase was characterized by enzyme-linked immunosorbent assay (ELISA), Western blot, inhibition ELISA, and basophil activation test. The allergen's physicochemical properties, three-dimensional structure, sequence profiles with homologous allergens and phylogenetic tree were analyzed by in silico methods.

RESULTS

Natural Art si pectate lyase (nArt si pectate lyase) was purified from A. sieversiana pollen extracts by three chromatographic strategies. The cDNA sequence of Art si pectate lyase had a 1191-bp open reading frame encoding 396 amino acids. Both natural and recombinant pectate lyase (rArt si pectate lyase) exhibited similar CD spectrum, and nArt si pectate lyase had higher enzymatic activity. Moreover, the specific immunoglobulin E (IgE) binding rate against nArt si pectate lyase and rArt si pectate lyase was determined as 40% (6/15) in patients' serum with Artemisia species pollen allergy by ELISA. The nArt si pectate lyase and rArt si pectate lyase could inhibit 76.11% and 47.26% of IgE binding activities to the pollen extracts, respectively. Art si pectate lyase was also confirmed to activate patients' basophils. Its structure contains a predominant motif of classic parallel helical core, consisting of three parallel β-sheets, and two highly conserved features (vWiDH, RxPxxR) which may contribute to pectate lyase activity. Moreover, Art si pectate lyase shared the highest sequence identity of 73.0% with Art v 6 among currently recognized pectate lyase allergen, both were clustered into the same branch in the phylogenetic tree.

CONCLUSION

In this study, pectate lyase was identified and comprehensively characterized as a novel allergen in A. sieversiana pollen. The findings enriched the allergen information for this pollen and promoted the development of component-resolved diagnosis and molecular therapy of A. sieversiana pollen allergy.

Profiles of apple allergen components and its diagnostic value in Northern China

Background

Limited is known on the profiles of apple allergy in China.

Objective

To explore the clinical significance of apple allergen components in northern China.

Methods

This study recruited 40 participants and categorized into apple tolerance (n = 19) and allergy (n = 21) group. The latter was categorized into oral allergy symptoms (OAS, n = 14) and generalized symptoms (GS, n = 7). All participants underwent ImmunoCAP screening to assess sIgE levels of birch, apple, and their components.

Results

The sensitization rates were 90% for Bet v 1, 85% for Mal d 1, 35% for Bet v 2, and 20% for Mal d 3. The overall positive rate for apple allergens was 97.5%, with half demonstrating mono-sensitization to Mal d 1. Birch, Bet v 1 and Mal d 1 sIgE levels had consistent areas under the curve (AUC 0.747, p = 0.037; AUC 0.799, p = 0.012; AUC 0.902, p < 0.001 respectively) in diagnosing apple allergy. The optimal cut-off values were determined to be 22.85 kUA/L (63.6% sensitivity, 85.7% specificity), 6.84 kUA/L (81.8% sensitivity, 71.4% specificity) and 1.61 kUA/L (93.8% sensitivity, 75.0% specificity), respectively. No allergens or components demonstrated diagnostic value in distinguishing between OAS and GS. Mal d 3 sensitization was correlated with mugwort allergy and higher risk of peach, nuts or legumes generalized allergy.

Conclusion

Mal d 1 was major allergen and the best for diagnosing apple allergy. Mal d 3 does not necessarily indicate severe allergic reaction to apples in northern China but may indicate mugwort sensitization and an increased risk of peach, nuts or legumes allergy.

An epicutaneous therapeutic pollen-allergen extract delivery system in an allergic rhinitis mouse model: based on allergen loading on DC-specific aptamers conjugated nanogolds

BACKGROUND

Gold nanoparticles (GNPs) have previously been suggested as appropriate carriers for allergen-specific immunotherapy (AIT). In this study, we assessed efficacy of GNPs and dendritic cells (DC)-specific aptamer-modified GNPs (Apts-GNP) for epicutaneous immunotherapy (EPIT) in the case of pollen allergen extracts containing a variety of allergenic and non-allergenic components.

METHODS

BALB/c mice were sensitized to the total protein extract of Platanus orientalis pollen and epicutaneously treated in different groups either with free P. orientalis total pollen extract, naked GNPs, total extract loaded GNPs, and total extract loaded Apts-GNPs with and without skin-penetrating peptides (SPPs). Then, the specific IgE level (sIgE), total IgE concentration (tIgE) in the serum sample, IL-4, IL-17a, IFN-γ, and IL-10 cytokine concentrations in re-stimulated splenocytes with the total extract and mixture of recombinant allergens, nasopharyngeal lavage fluid (NALF) analysis, and histopathological analysis of lung tissue were evaluated.

RESULTS

This study indicated the total extract-loaded GNPs, especially Pla. ext (50 μg)-GNPs, significantly decreased sIgE, tIgE, IL-17a, and IL-4 concentrations, immune cells and eosinophils infiltration in NALF, and increased IL-10 and IFN-γ concentrations compared with the PBS-treated group. In addition, the histopathological analysis of lung tissue showed a significant decrease in allergic inflammation and histopathological damage. The DC-targeted group revealed the most significant improvement in allergic-related immune factors with no histopathological damage compared with the same dose without aptamer.

CONCLUSION

Loading total protein extract on the GNPs and the Apt-modified GNPs could be an effective approach to improve EPIT efficacy in a pollen-induced allergic mouse model.

Pollen and sub-pollen particles: External interactions shaping the allergic potential of pollen

Pollen allergies, such as allergic rhinitis, are triggered by exposure to airborne pollen. They are a considerable global health burden, with their numbers expected to rise in the coming decades due to the advent of climate change and air pollution. The relationships that exist between pollens, meteorological, and environmental conditions are complex due to a lack of clarity on the nature and conditions associated with these interactions; therefore, it is challenging to describe their direct impacts on allergenic potential clearly. This article attempts to review evidence pertaining to the possible influence of meteorological factors and air pollutants on the allergic potential of pollen by studying the interactions that pollen undergoes, from its inception to atmospheric traversal to human exposure. This study classifies the evidence based on the nature of these interactions as physical, chemical, source, and biological, thereby simplifying the complexities in describing these interactions. Physical conditions facilitating pollen rupturing for tree, grass, and weed pollen, along with their mechanisms, are studied. The effects of pollen exposure to air pollutants and their impact on pollen allergenic potential are presented along with the possible outcomes following these interactions, such as pollen fragmentation (SPP generation), deposition of particulate matter on pollen exine, and modification of protein levels in-situ of pollen. This study also delves into evidence on plant-based (source and biological) interactions, which could indirectly influence the allergic potential of pollen. The current state of knowledge, open questions, and a brief overview of future research directions are outlined and discussed. We suggest that future studies should utilise a multi-disciplinary approach to better understand this complex system of pollen interactions that occur in nature.

Comparison of clinical traits for seasonal and perennial allergic rhinitis during allergen exposure

Background: Allergic rhinitis (AR) is traditionally subdivided into seasonal AR (SAR) and perennial AR (PAR) according to the type of allergen and the occurrence of symptoms during the year. There are currently no reports on the comparison of trait profiles for SAR and PAR during the allergen exposure. Purpose: The purpose of this study was to analyze the clinical characteristics of SAR and PAR during respective allergen exposure periods to provide valuable information for the development of treatment strategies. Methods: This study was performed between August 1, 2021, and January 31, 2022, in the Department of Allergy, Beijing Tongren Hospital. We continuously included diagnosed SAR and PAR outpatients who volunteered to participate in the survey. A questionnaire with regard to medical history, severity of symptoms, and diagnosis and treatment status was collected. Results: A total of 296 patients with SAR and 448 with PAR were finally recruited. Patients with SAR had more severe rhinorrhea compared with patients with PAR (p < 0.001), whereas there was no statistically significant difference in the severity of itching, sneezing, and congestion between the two entities (p ≥ 0.05). Both the gritty and watery eyes of patients with SAR were noticeably more severe than those of patients with PAR (PTotal Ocular Symptom Score [PTOSS] < 0.001). AR symptom severity is mainly associated with the comorbid allergic conjunctivitis (odds ratio 1.94 [95% confidence interval, 1.21-3.09]). SAR patients and PAR patients show no statistically significant differences in terms of their frequency of visits, annual expenditure, and choice of medication treatment for AR (p > 0.05). The overall control under standard medication of both patients with PAR and those with SAR is not ideal, especially in SAR. Conclusion: The current cross-sectional study demonstrated that the patients with SAR exhibited more severe overall clinical symptoms than those with PAR, especially nasal rhinorrhea and gritty and watery eyes. Both of the two disease entities have poor control under standardized medication treatment, especially in SAR. Further multicenter longitudinal studies that involve larger and more diverse populations should be conducted to provide a more accurate and comprehensive understanding of the condition.

Methylation-driven mechanisms of allergic rhinitis during pollen and non-pollen seasons using integrated bioinformatics analysis

Background

Allergic rhinitis (AR) is a widespread allergic airway disease that results from a complex interplay between genetic and environmental factors and affects approximately 10%-40% of the global population. Pollen is a common allergen, and exposure to pollen can cause epigenetic changes. However, the mechanism underlying pollen-induced DNA methylation changes and their potential effects on the allergic march are still unclear. The purpose of this study was to explore the methylation-driven mechanisms of AR during the pollen and non-pollen seasons using bioinformatics analysis and to investigate their relationship with asthma.

Methods

We downloaded DNA methylation and gene expression data from the GEO database (GSE50387: GSE50222, GSE50101) and identified differentially methylated positions (DMPs) and differentially expressed genes (DEGs) during the pollen and non-pollen seasons using the CHAMP and limma packages. Through correlation analysis, we identified methylation-driven genes and performed pathway enrichment analysis to annotate their functions. We incorporated external data on AR combined with asthma (GSE101720) for analysis to identify key CpGs that promote the transformation of AR to asthma. We also utilized external data on olive pollen allergy (GSE54522) for analysis to validate the methylation-driven genes. Weighted correlation network analysis (WGCNA) was employed to identify gene modules significantly correlated with pollen allergy. We extracted genes related to the key methylation-driven gene ZNF667-AS1 from the significant module and performed pathway intelligent clustering using KOBAS-i. We also utilized gene set enrichment analysis to explore the potential function of ZNF667-AS1.

Results

We identified 20 and 24 CpG-Gene pairings during the pollen and non-pollen seasons. After incorporating external data from GSE101720, we found that ZNF667-AS1 is a key gene that may facilitate the transformation of AR into asthma during the pollen season. This finding was further validated in another external dataset, GSE54522, which is associated with pollen allergy. WGCNA identified 17 modules, among which the blue module showed significant correlation with allergies. ZNF667-AS1 was located in the blue module. We performed pathway analysis on the genes correlated with ZNF667-AS1 extracted from the blue module and identified a prominent cluster of pathways in the KOBAS-i results, including Toll-like receptor (TLR) family, MyD88, MAPK, and oxidative stress. Gene set enrichment analysis around cg05508084 (paired with ZNF667-AS1) also indicated its potential involvement in initiating and modulating allergic inflammation from the perspective of TLR and MAPK signaling.

Conclusion

We identified methylation-driven genes and their related pathways during the pollen and non-pollen seasons in patients with AR and identified key CpGs that promote the transformation of AR into asthma due to pollen exposure. This study provides new insights into the underlying molecular mechanisms of the transformation of AR to asthma.

The Burden of Asthma and Allergic Rhinitis: Epidemiology and Health Care Costs

Allergic rhinitis affects up to 78% of people with asthma, and asthma occurs in 38% of people with allergic rhinitis. Asthma has a prevalence of 8.7% among adults and 6.2% among children and accounts for $50 billion in medical costs and $32 billion in indirect and mortality costs in the United States, respectively. Allergic rhinitis occurs in 5% to 15% of people in the United States. Allergic rhinitis also accounts for a significant health care cost burden, predominantly in terms of indirect costs related to reduced quality of life and presenteeism.

Comparison of the therapeutic effects of medication therapy, specific immunotherapy and anti-IgE (Omalizumab) in patients with hay fever

Background

Hay fever, characterized by seasonal allergic reactions, poses a significant health challenge. Existing therapies encompass standard drug regimens, biological agents, and specific immunotherapy. This study aims to assess and compare the effectiveness of anti-IgE (omalizumab), medication therapy, and subcutaneous immunotherapy (SCIT) for hay fever.

Methods

Conducted as a retrospective cohort study, this research involved 98 outpatient hay fever patients who underwent routine medication, omalizumab treatment, or SCIT before the onset of the spring pollen season. A follow-up was performed one month after the start of the pollen season. The comprehensive symptoms and drug scores were used to evaluate patients with different intervention methods, facilitating a comparative analysis of therapeutic outcomes.

Results

Compared with before treatment, the symptoms of patients treated with the three methods were all significantly relieved, and the medication score were significantly reduced. Patients treated with omalizumab demonstrated higher symptoms and medication scores than SCIT group before treatment, but similar scores after treatment, which were both lower than medicine treatment group. After treatment with omalizumab or SCIT, patients in both groups had significantly lower medication scores than the medication group and were close to no longer using medication for symptom relief. The mountain juniper-sIgE was significantly higher after treatment than before treatment in both medicine treatment group and omalizumab treatment group.

Conclusion

Omalizumab and SCIT offer superior effects than medication therapy in hay fever patients.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

Association between allergic rhinitis and hypertension risk: A bidirectional 2-sample mendelian randomization study

Previous studies have suggested a potential association between allergic rhinitis (AR) and hypertension, but the genetic basis remains unclear. In this study, we aimed to explore the genetic correlation and potential causal association between AR and hypertension. Using a large-scale genome-wide association study (GWAS) public database, we conducted meticulous screening to acquire the most up-to-date GWAS data on single nucleotide polymorphisms (SNPs) relevant to AR and hypertension, with a significance threshold of P < 5 × 10-8. Then, we investigated the causal association between AR and hypertension through mendelian randomization (MR) analysis. We also performed reverse MR analysis to assess the possibility of reverse causality. Sensitivity analyses encompassed various factors, including horizontal pleiotropy, heterogeneity testing, and stepwise exclusion sensitivity checks. To investigate the causal relationship between AR and hypertension, we utilize the odds ratio (OR) and 95% confidence interval (CI) as our evaluative metric. This study leveraged a database comprising 112583 samples for AR and 461880 samples for hypertension. After meticulous screening, we identified 32 SNPs as instrumental variables. By employing the aforementioned 2-sample Mendelian randomization approaches, the estimated causal effects showed striking concordance. A discernible causal association between AR and hypertension was found using the IVW method (OR = 0.91, 95% CI: 0.86-0.98, P = .008), with horizontal pleiotropy and heterogeneity tests supporting the validity of our MR study. MR-Egger regression findings provided reassurance against bias stemming from genetic pleiotropy (intercept = -0.0006802, P = .6947). Interestingly, "leave-one-out" analysis yielded no evidence of nonspecific SNP influences, further consolidating our findings. Moreover, our reverse MR analysis yielded no indication of reverse causality from hypertension to AR, effectively discounting any influence from the latter on the former. Our study found evidence of a causal association between AR and hypertension in individuals of European ancestry. It demonstrated that AR reduced the risk of hypertension, suggesting a protective effect on hypertension due to the negative correlation with AR.

Profiles of Birch Allergen Component Sensitization and Its Association with Pollen Food Allergy Syndrome in Northern China

Purpose

To investigate the major allergen components associated with birch pollen allergy in northern China and elucidate clinical relevance to pollen food allergy syndrome (PFAS).

Methods

Fifty-eight patients were recruited for a cross-sectional study and categorized into two groups: PFAS group and non-PFAS group, as well as apple allergy group and non-apple allergy group. The sIgE levels of birch pollen and its components, namely Bet v 1, Bet v 2, Bet v 4, and Bet v 6, were analyzed.

Results

Among 58 participants, 44 individuals (75.9%) reported PFAS. 32 out of 44 (72.7%) participants reported apple allergy. Bet v 1 exhibited the highest sensitization rate at 82.8%, followed by Bet v 2 (29.3%) and Bet v 6 (1.7%). The combined sensitization rate for Bet v 1 and/or Bet v 2 was 93.1%. A total of 77.6% of the subjects demonstrated sensitization to single component, while 19.0% exhibited sensitization to two components. The sIgE levels of birch pollen and Bet v 1 were significantly elevated in PFAS group compared to non-PFAS group (p=0.001, p<0.001, respectively), as well as in apple-allergic and non-apple-allergic group (p<0.001, p<0.001, respectively). The optimal cut-off values for birch pollen and Bet v 1 sIgE were determined to be 7.09 kUA/L (with a sensitivity of 84.1% and specificity of 78.6%) and 5.11 kUA/L (with a sensitivity of 75.0% and specificity of 85.7%) when diagnosing PFAS. In terms of apple allergy, the optimal cut-off value were 9.40 kUA/L (with a sensitivity of 81.3% and specificity of 76.9%) and 6.53 kUA/L (with a sensitivity of 84.4% and specificity of 84.6%), respectively.

Conclusion

The predominant sensitization pattern is mono-sensitization to Bet v 1, but when considering immunotherapy, Bet v 2 should also be taken into account. Bet v 1 serves as a valuable biomarker for diagnosing PFAS and apple allergy.

Clinical efficacy in one-year treatment with Artemisia annua-SLIT drops in monosensitized and polysensitized individuals

PURPOSE

Seasonal allergic rhinoconjunctivitis (SARC) caused by Artemisia seriously affects patients' quality of life in northern China. This study aimed to estimate further the efficacy and safety of a one-year course of Artemisia annua-sublingual immunotherapy (SLIT) on SARC patients.

MATERIALS AND METHODS

This was an open-label, randomized, controlled, single-centre study involving 150 SARC patients induced by Artemisia, randomized to SLIT group (n = 75, SLIT along with pharmacotherapy) or control group (n = 75, pharmacotherapy only). According to the skin prick test (SPT) results, the SLIT group was divided into monosensitized and polysensitized groups to analyze the influence of sensitization status on the efficacy of Artemisia annua-SLIT. The clinical indicators of this study were total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), combined scores of medication and rhinoconjunctivitis symptom (CSMRS), and score of visual analog scale (VAS). Safety was evaluated by the occurrence of adverse events (AEs). Daily administration of the drops was recorded in diaries by the patients.

RESULTS

After nearly one year of treatment and follow-ups, there was a significant decline in TRSS, TMS, CSMRS, and VAS from the baseline scores in the SLIT group (p < 0.001). However, as pollen counts increased in 2022, indicators above in the control group increased significantly during the peak pollen phase (PPP) in 2022 grass pollen season (GPS) compared to the baseline. Meanwhile, we found no significant difference in TRSS, TMS, CSMRS, and VAS between the monosensitized and polysensitized groups (p > 0.05). Moreover, the result indicated that the clinical improvement in TRSS, TMS, CSMRS, and VAS was still observed in polysensitized patients who were allergic to Artemisia pollen and sensitized to house dust mite (HDM) (n = 15) in PPP of 2022, compared to the baseline value (p < 0.001).

CONCLUSION

Artemisia annua-SLIT was proven effective, tolerable and safe in patients with SARC after nearly one year of treatment, whether monosensitization or polysensitization.

Effect of Air Pollutants and Meteorological Factors on Daily Outpatient Visits of Allergic Rhinitis in Hohhot, China

Objective

There is limited evidence that atmospheric pollutants are associated with the number of allergic rhinitis (AR) visits. This study aimed to investigate the relationship between atmospheric pollutants and meteorological factors and the number of daily visits for AR in Hohhot City, providing a theoretical basis for further research on the effects of atmospheric pollutants on AR.

Methods

Microsoft Excel 2016 was used to collect and organize the AR outpatient consultation data, air pollution and meteorological data in Hohhot City during 2018-2020, and the data were descriptively analyzed and Spearman correlation test was performed using SPSS22.0; A generalized additive model was built in R4.2.3 to analyze the effect of air pollution on the number of AR visits and its lagged and cumulative effects, while the robustness of the model was tested using a two-pollutant analysis. Finally, we analyzed the effects of the interaction of temperature, relative humidity and pollutants on the number of AR visits.

Results

The daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 in Hohhot during 2018-2020 were 38.1 μg/m3, 83.3 μg/m3, 36.1 μg/m3, 15.1 μg/m3, 14.2 mg/m3, and 99.95 μg/m3, respectively, with the concentrations of PM2.5 and PM10 exceeding the secondary limit of the national standard. The results of the generalized additive model analysis showed that the RR and 95% CI of the effect of each 10 μg/m3 increase in pollutant concentration (1 mg/m3 increase in CO) on the number of AR outpatient clinics were 1.008 (1.001-1.016), 1.002 (1-1.005), 1.072 (1.033-1.113), 1.020 (1007-1.034), 1.033 (1.014-1.052), 0.987 (0.9804-0.9936).

Conclusion

Short-term exposure to PM2.5, PM10, SO2, NO2, and CO was significantly associated with an increase in AR clinic visits, and short-term exposure to O3 was significantly associated with a decrease in allergic rhinitis clinic visits.

Self-Reported Allergic Rhinitis Prevalence and Risk Factors in Employees of the China National Railway

BACKGROUND: Allergic rhinitis (AR) is a common allergic disease globally and its prevalence is increasing year by year. This study aimed to analyze the prevalence and risk factors of self-reported AR among the Chinese National Railway train crew in the China Railway Beijing Group.METHODS: This prospective questionnaire study surveyed 1511 randomly recruited train crewmembers from 20 cities in the China National Railway network, and 494 reported having AR. A structured questionnaire was tailored, designed, and delivered electronically to all subjects. Prevalence of and risk factors for AR were analyzed based on self-reported results.RESULTS: The prevalence of self-reported AR among train crewmembers was 32.6%. Among respondents, 86.03% worked in passenger cars and 64.6% reported having worse AR symptoms while on trains. AR frequencies were 40.15% perennially and 59.85% seasonally. Among the Total Nasal Symptoms Scores (TNSS), significant differences were found between rhinorrhea and sneezing and between nasal itching and sneezing. The Rhino-Conjunctivitis Quality of Life Questionnaire (RQLQ) showed significant correlations between all seven sections. TNSS was significantly associated with the RQLQ. Scores of both the TNSS and RQLQ showed that the severity of AR symptoms (rp = 0.103) and the impact on quality of life (rp = 0.113) correlated significantly with seniority.CONCLUSIONS: The prevalence of self-reported AR among train crew working in passenger cars is higher than that of the general Chinese population. The severity of AR symptoms and the impact on quality of life are associated with seniority, meaning the number of years working on trains.Yu R-L, Ning H-Y, Lan T-F, He H, Zheng C-B, Wang X-Y, Wang H-T, Wang X-Y. Self-reported allergic rhinitis prevalence and risk factors in employees of the China National Railway. Aerosp Med Hum Perform. 2023; 94(11):821-826.

Efficacy and safety of Artemisia annua sublingual immunotherapy in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons

OBJECTIVE

This study investigates the efficacy and safety of sublingual immunotherapy (SLIT) with A. annua allergens in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons.

METHODS

Seventy patients with moderate-severe seasonal allergic rhinoconjunctivitis were divided evenly into the SLIT and control groups. The SLIT last from 3 months before the summer-autumn pollen season in 2021 till the end of the summer-autumn pollen season in 2022. The daily individual symptom score, total rhinoconjunctivitis symptom score (dTRSS), total medication score (dTMS), combined score of medication and rhinoconjunctivitis symptom (dCSMRS), visual analog scale (VAS) score, and adverse events (AEs) were evaluated.

RESULTS

The average pollen concentration in 2022 was twice that previous two-year during the pollen season. Fifty-six patients completed treatments (SLIT group: 29, control group: 27). Compared with baseline, the individual symptoms, dTRSS, dTMS, dCSMRS, and VAS scores of SLIT group declined in 2021. After 16 months of SLIT, all efficacy indexes in 2022 were still lower than baseline and equivalent to those in 2021. In control group, the efficacy indexes in 2022 were higher than that in 2020 and 2021. The efficacy indexes of SLIT group were lower than those of control group in 2021 and 2022. SLIT is effective for both mono- and poly-sensitized patients. AEs incidence in SLIT group was 82.7% without severe AEs.

CONCLUSIONS

The A. annua-SLIT can obtain efficacy and safety over two pollen seasons for patients with moderate-severe seasonal allergic rhinoconjunctivitis.

HMGN2 and Histone H1.2: potential targets of a novel probiotic mixture for seasonal allergic rhinitis

Background

Allergic rhinitis (AR) is a common nasal inflammatory disorder that severely affects an individual's quality of life (QoL) and poses a heavy financial burden. In addition to routine treatments, probiotic intervention has emerged as a promising strategy for preventing and alleviating allergic diseases. The main objective of this study was to determine the effect of a novel multi-strain probiotic mixture on AR symptoms and investigate potential targets underlying the probiotic intervention.

Methods

A randomized, double-blind, placebo-controlled clinical study was conducted on AR patients who were allergic to autumnal pollens (n = 31). Placebo or a novel probiotic mixture, composed of Lactobacillus rhamnosus (L. rhamnosus) HN001, L. acidophilus NCFM, Bifidobacterium lactis (B. lactis) Bi-07, L. paracasei LPC-37, and L. reuteri LE16, was administered after 2 months. The therapeutic efficacy was evaluated by a symptom assessment scale. Before and during the pollen season, blood samples were collected, and peripheral blood mononuclear cells (PBMCs) were isolated for further tandem mass tags (TMTs)-based quantitative proteomic analyses. Potential targets and underlying pathological pathways were explored using bioinformatics methods.

Results

During the pollen season, the rhinoconjunctivitis symptom score of participants who were administered probiotics (probiotic group, n = 15) was significantly lower than those administered placebo (placebo group, n = 15) (P = 0.037). The proteomic analyses identified 60 differentially expressed proteins (DEPs) in the placebo group, and subsequent enrichment analyses enriched a series of pathways and biological processes, including signaling pathways of inflammation, coagulation cascade, lipid, carbohydrate and amino acid metabolic pathways, and transcription and translation processes. Least Absolute Shrinkage and Selection Operator (LASSO) regression extracted five main elements, namely, GSTO1, ATP2A2, MCM7, PROS1, and TRIM58, as signature proteins. A total of 17 DEPs were identified in the probiotic group, and there was no pathway enriched. Comparison of DEPs in the two groups revealed that the expression levels of the high-mobility group nucleosome-binding domain-containing protein 2 (HMGN2) and Histone H1.2 presented an opposite trend with different interventions.

Conclusion

Our data showed that AR symptoms alleviated after treatment with the novel multi-strain probiotic mixture, and the proteomic analyses suggested that HMGN2 and Histone H1.2 might be targets of probiotic intervention for seasonal AR.

The Assessment of TLR1 Gene Polymorphism Association with the Risk of Allergic Rhinitis in the Chinese Han Population from Northern China

Background

Environmental factors and genetic predisposition can influence the occurrence and development of AR. Toll-like receptor 1 (TLR1) belongs to the TLR receptor family, which plays a fundamental role in the activation of innate immunity. This study aimed to explore the association between TLR1 genetic loci and AR susceptibility in the Han Chinese from northern China.

Methods

Genotyping of three SNPs in the TLR1 has proceeded using the Agena MassARRAY platform. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the correlation between candidate SNPs and AR susceptibility. Using FPRP (false-positive report probability analysis) to detect whether the positive results are noteworthy findings. The SNP-SNP interactions were detected by multifactor dimensionality reduction (MDR).

Results

TLR1-rs72493538 (Allele "G": OR=0.77, p = 0.034) and -rs76600635 (Allele "G": OR=0.75, p = 0.024) were associated with reducing the risk of AR among Han Chinese in northern China. In addition, we found evidence that TLR1-rs72493538 (males, participants with aging > 43 years, or coming from the wind-blown sand region) and -rs76600635 (males, participants with BMI ≤ 24 kg/m2, or coming from the wind-blown sand region) were associated with AR risk in stratified analyses. FPRP showed that all positive results are noteworthy findings. MDR analysis showed that a two-loci genetic model composed of rs72493538 and rs76600635 can be chosen as the best genetic model to predict the risk of AR.

Conclusion

TLR1-rs72493538 and -rs76600635 have a close association with reducing the risk of AR.

Clinical efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy on patients with Artemisia-induced rhinoconjunctivitis

PURPOSE

Patients with seasonal allergic rhinoconjunctivitis (SARC) might seek evaluation and treatment when symptoms appear during the pollen season. It is unclear whether coseasonal-initiated sublingual immunotherapy (SLIT) would be effective and safe for SARC. This study aims to identify the feasibility of initiating Artemisia annua SLIT during the pollen season.

MATERIALS AND METHODS

Sixty patients with Artemisia-induced SARC were equally recruited into the SLIT and control groups during the pollen season in 2021. The SLIT group was treated with standardized Artemisia annua SLIT drops using a modified dosing schedule combined with pharmacotherapy, while the control group only received pharmacotherapy. Diary cards for clinical symptoms, rescue medication use, and adverse events (AEs) were recorded during the pollen seasons. Objective measures, including average daily combined scores of medication and rhinoconjunctivitis symptoms (CSMRS), total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and the score of visual analog scale (VAS) were calculated to evaluate the efficacy of SLIT. Safety was assessed through the occurrence and severity of AEs.

RESULTS

In total, 80.0 % (24/30) patients in the SLIT group and 86.67 % (26/30) patients in the control group completed the study. The severity of SARC, which was assessed by objective measures including CSMRS, TRSS, TMS, and VAS of the SLIT group and the control group, was generally at the same level during the 2021 pollen season, except for the medical consumption, which the score of TMS was slightly higher in the SLIT group. After one year of treatment, the scores of CSMRS, TRSS, and VAS in the SLIT group were significantly improved compared with the control group (all P < 0.001), and the difference in the TMS between the two groups disappeared (P > 0.05). Moreover, clinical improvement of the four objective measures was also observed in the SLIT group compared with the baseline value (P < 0.001). Overall, 9/24 patients in the SLIT group experienced mild local AEs, and two patients experienced mild systemic AEs during the SLIT period.

CONCLUSIONS

This controlled preliminary study identified that coseasonal-initiated Artemisia annua SLIT treatment for one year was generally safe and effective in improving the symptoms of SARC patients induced by Artemisia annua pollen.

Common Allergens and Immune Responses Associated with Allergic Rhinitis in China

Allergic rhinitis (AR) is a chronic allergic disease of the upper respiratory system that affects approximately 10-40% of the global population. Due to the large number of plant pollen allergens with obvious seasonal variations, AR is common in China. AR is primarily caused by the abnormal regulation of the immune system. Its pathophysiological mechanism involves a series of immune cells and immune mediators, including cytokines. The present review summarizes the common allergens in China and the complex pathophysiological mechanism of AR. Additionally, host allergen contact, signal transduction, immune cell activation, cytokine release, and a series of inflammatory reactions are described according to their sequence of occurrence.

Pollen respiratory allergy: Is it really seasonal?

Allergic rhinitis (AR) is a highly prevalent respiratory condition that carries a heavy burden and can have a significant impact on patient quality of life. AR is caused by seasonal or perennial exposure to outdoor pollens and molds as well as indoor allergic triggers. In this review article, we discuss the factors associated with the development of AR throughout the year and the fact that patients with AR need continuous treatment rather than seasonal treatment. Conventionally, AR has been mainly categorized into seasonal AR and perennial AR, but these classes do not seem to be well-adapted. Climate changes, temperature changes, and high carbon dioxide (CO₂) concentration affect the growth of plants and increase the length of pollen seasons and pollen allergenicity. Air pollution aggravates allergic sensitization symptoms in AR sensitized individuals. Due to increased air pollution and indefinite pollen seasons AR symptoms are present throughout the year. Patients with AR often need continuous treatment, which should be considered while making the strategy for treating allergic rhinitis sufferers. Management of AR involves avoiding the allergen, medications for symptomatic relief, anti-inflammatory therapies, and allergy immunotherapy. Although the first-generation H₁-antihistamines reduce AR symptoms, they cause sedation and impair cognitive functions; thus, second-generation antihistamines (ie, levocetirizine, loratadine, bilastine, fexofenadine) are preferred. The efficacy and safety of fexofenadine for the treatment of seasonal allergic rhinitis (SAR) symptoms have been demonstrated by numerous clinical studies, irrespective of the season and underlying allergen. In this review, we discuss the allergic rhinitis classification, the role of climate change, air pollution, and factors contributing to year-round symptoms in patients with AR and the need for continuous pharmacological treatment for management.

Meteorological and environmental factors that impact pollen counts, allergenicity, and thresholds: A scoping review

Background: Pollen is a key source of aeroallergens responsible for allergic rhinitis, conjunctivitis, and asthma. Objective: The goal of this scoping review was to summarize current available literature on the factors that affect pollen counts, allergenicity, and thresholds that induce symptoms in individuals who were sensitized. Methods: Several databases showed no published articles with a similar scope as of January 2022. A search of these data bases yielded 373 articles for assessment. These were then reviewed for relevance, and articles were selected to demonstrate the breadth of available data on pollen counts, allergenicity, and thresholds that induce symptoms in individuals who were sensitized. Additional articles were identified through examination of bibliographies of search-identified articles. Results: Several environmental factors have shown a correlation with pollen counts and allergen load, including the distance from the source, wind characteristics, pollen size, terrain, urban environments, air composition (particulate matter, CO₂ levels, ozone, NO₂), and weather conditions (humidity, thunderstorms, precipitation). Pollen thresholds at which symptoms were induced varied by study, pollen type, symptom, disease, and location. In addition, there was heterogeneity in study designs, threshold definition, and outcome measures. Conclusion: This scoping review demonstrates the plethora of variables that influence the relationship between pollen and the symptoms of allergic diseases. Analysis of the available data sheds light on the complex interaction between environmental and biologic factors that affect pollen's role in allergic diseases and provides guidance on multiple areas for further investigation.

[Sensitization characteristics of ragweed pollen in Beijing area]

Objective:To investigate the sensitization characteristics of ragweed pollen in patients with allergic rhinitis（AR） and（or） allergic asthma in Beijing area, and to provide basis for the prevention and treatment of ragweed pollen sensitized population. Methods:Patients with allergic rhinitis and/or asthma from January 2017 to December 2019 in the outpatient department of Allergy Department of Beijing Shijitan Hospital were retrospectively analyzed in this study. Skin prick test（SPT） was performed with ragweed pollen allergen reagents to compare different ages, genders and respiratory diseases allergen distribution, and to observe the sensitization characteristics of its population. All of the analyses were performed using SAS software version 9.4. Results:A total of 9 727 patients were enrolled in the end. The total positive rate of ragweed pollen SPT was 45.50%（4 426/9 727）, the highest positive rate was 65.54% in 13-17 years old group; The positive rate of ragweed pollen SPT was 49.79% in allergic rhinitis combined with asthma patients, followed by 46.46% in allergic rhinitis patients, and the lowest rate was 19.42% in single allergic asthma patients. There were more females than males in both ragweed pollen sensitized and non-ragweed pollen sensitized groups（P<0.05）, and the proportion was higher in 30-39 years old than in other age groups（P<0.05）. Ragweed pollen sensitization was higher than non-ragweed pollen sensitization in the allergic rhinitis group（98.49% vs 94.76%, P<0.05）. Ragweed pollen with other summer and autumn pollen allergens in patients with positive SPT, the top three were Chenopodium pollen, Humulus pollen and Artemisia grandis pollen, with positive rates of 90.42%, 89.63% and 85.40%, respectively. Ragweed combined with other pollen sensitization accounted for 99.57%（4 407/4 426）. Allergic rhinitis was the main disease in patients sensitized with ragweed pollen alone or combined with other pollens, and there was no significant difference between the two groups（94.97% vs 98.50%, P>0.05）. Conclusion:Ragweed pollen is highly sensitized in Beijing area, single ragweed pollen sensitization is rare, often combined with multiple pollen sensitization, and allergic rhinitis is the main disease.

Sensitization characteristics in allergic rhinitis and transport pathway for Artemisia pollen in northern Beijing, China

The genus Artemisia, an important allergen related to Allergic Rhinitis (AR), is widespread in temperate regions. However, the sensitization rate of Artemisia pollen varies significantly, and the source of Artemisia pollen is not clear. Based on continuous daily airborne pollen monitoring in the summer and autumn of 2019 and 2020 in northern Beijing, the daily number of AR patient visits during the same period, and the detection of allergen serum-specific immunoglobulin E (sIgE) in some AR patients, this study discusses the sensitization rate of Artemisia pollen and its transmission pathway and possible source area. The results show that (1) Artemisia pollen is the most important airborne pollen in summer and autumn in northern Beijing, and the pollen concentration is significantly related to the daily number of AR patient visits; (2) the rate of AR patients testing positive for Artemisia pollen allergens is 32.35 %, which is the first risk allergen and is consistent with the high sensitization rate of Artemisia pollen in northern China; and (3) in addition to local sources, central and southern Inner Mongolia, southern Mongolia and northwestern China are potential source areas of Artemisia pollen within the study area. This study provides first-hand data for accurately understanding the allergenic characteristics and sources of Artemisia pollen in northern Beijing and provides a scientific basis for the prevention of AR induced by Artemisia pollen in patients in China.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study

Background

The prevalence of allergic rhinitis (AR) has been increasing steadily worldwide, especially in countries with increasing industrialization such as China. However, available evidence regarding AR prevalence among Chinese adults is scarce and limited to regional data collected in earlier years. We therefore aimed to provide a more recent and robust estimate of AR prevalence using a nationwide representative cross-sectional study in China.

Methods

Data of 184 326 participants aged 18 years or older were obtained from the China Chronic Disease and Risk Factor Surveillance conducted in 2018-2019. AR was determined by self-reported sneezing, nasal itching, obstruction, or rhinorrhea symptoms for at least 1 h in the absence of a cold or flu within the last 12 months. Multivariable logistic model was used to examine the risk factors of AR, and a possible non-linear relationship was further tested by restricted cubic spline. Potential additive interactions of risk factors with sex, residence, and geographic region were assessed by relative excess risk due to interaction (RERI).

Results

The weighted prevalence of AR was 8.1% (95% confidence interval [CI], 7.4%-8.7%), of whom 23.7% (95% CI, 21.3%-26.0%) were aware of their diagnosis. Increased odds of AR were associated with younger age, men, living in urban area or north region, more education, smoking, underweight, and higher income. Despite the nonsignificant linear trend, the spline regression demonstrated a non-linear association between AR and sleep duration, with higher odds at both ends. Additionally, the observed associations were generally stronger among men and people living in urban area and north region, with significant RERI ranging from 0.07 (95% CI, 0.00-0.14) to 0.40 (95% CI, 0.12-0.67).

Conclusions

AR is prevalent in China and the associated factors and interactions are helpful to design targeted preventive strategies towards certain subpopulations. The low awareness of AR calls for a national effort on AR screening.

Pollen allergens sensitization characteristics and risk factors among allergy rhinitis of children in mainland China: A multicenter study

Background

No comprehensive multicenter study of sensitization patterns among patients with allergic rhinitis (AR) to various common pollen allergens was available nationwide, and risks factors of pollen-induced allergic rhinitis (PiAR) in mainland China was unclear. This study aimed to fill this gap.

Methods

A multicenter study was performed on 736 AR patients aged below 18 from four regions of mainland China. Patients completed a standardized questionnaire asking for the environmental risk factors and AR severity, and undertook skin prick tests (SPT) with 14 common pollen allergens.

Findings

Among the 736 patients, 341 patients (46.33%) suffered at least one positive pollen allergen sensitization. The positive rate of pollen allergens was significantly higher in the high-age group (Damato et al., 2007; Wang et al., 2018; Luo et al., 2016; Demoly et al., 2011; Sampson and Albergo, 1984; Li et al., 2009; Luo et al., 2021; Ziska and Beggs, 2011; Melén et al., 2020; Jensen-Jarolim, 2017; Rönmark et al., 2017; Ge et al., 2017) [6-17] than the low-age group ( ≤ 5), while no significant difference was found between the sexes. The sensitizations to pollen allergens varied widely among four geographical areas. The positive rate was higher in north China and west China than in east China, and south China had the lowest positive rate. The region of residence, ages, ethnic minorities, history of pollen exposure, the material of living room floor and material of pillow were statistically significant risks of PiAR.

Interpretation

This study provides new insights into the pollen allergens sensitization characteristics in AR and the factors affecting PiAR in mainland China.

Identification and characterization of natural PR-1 protein as major allergen from Humulus japonicus pollen

BACKGROUND

The Humulus japonicus pollen is one of the most common allergenic pollens in China. However, little is unveiled regarding the allergenic components in Humulus japonicus pollen. Our study aimed to purify and identify the pathogenesis-related 1 (PR-1) protein from Humulus japonicus pollen, and to characterize the molecular and immunochemical properties of this novel allergen.

METHODS

The natural PR-1 protein (named as Hum j PR-1) was purified from Humulus japonicus pollen extracts with a combined strategy of chromatography, and identified by mass spectrometry. The coding sequence of Hum j PR-1 was confirmed by cDNA cloning. The recombinant Hum j PR-1 was expressed and purified from Escherichia coli. The allergenicity was assessed by immunoblot, enzyme-linked immunosorbent assay (ELISA), inhibition ELISA, and basophil activation test using Humulus japonicus allergic patients' whole blood. The physicochemical properties and 3-dimensional structure of it were comprehensively characterized by in silico methods.

RESULTS

The allergenicity analysis revealed that 76.6 % (23/30) of the Humulus japonicus pollen allergic patients displayed specific IgE recognition of the natural Hum j PR-1. The cDNA sequence of Hum j PR-1 had a 516-bp open reading frame encoding 171 amino acids. Physicochemical analysis indicated that Hum j PR-1 was a stable and relatively thermostable protein. Hum j PR-1 shared a similar 3-dimensional folding pattern with other homologous allergens, which was a unique αβα sandwich structure containing 4 α-helices and 6 antiparallel β-sheets, encompassing 4 conserved CAP domain.

CONCLUSION

The natural PR-1 was firstly purified and characterized as a major allergenic allergen in Humulus japonicus pollen. These findings would contribute to developing diagnostic and therapeutic strategies for Humulus japonicus pollinosis.

Upregulated antimicrobial immune response mediated by neutrophils in the development from allergic rhinitis to asthma

Background

Allergic rhinitis (AR) and asthma are closely related, and AR is regarded as an important risk factor for the onset of asthma. However, the pathogenesis of the development of asthma from AR is still undefined.

Objective

The aim of this study was to investigate the mechanisms underlying the development of asthma from AR by comparing the transcriptome features of patients with AR with and without asthma.

Methods

Patients with AR with or without asthma caused by weed pollen who presented to the Allergy Clinic of Peking Union Medical College Hospital were recruited for this study. Peripheral blood samples of all the patients were collected during the weed pollen season (September) when the patients had allergic symptoms and outside the pollen season (November) when the patients had no symptoms. Transcriptomic analysis was conducted, and the differentially expressed genes (DEGs) and enriched immune pathways between the patients with AR with asthma (AR-asthma group) and those without asthma (AR group) were identified. In addition, the expression levels of some pivotal differentially expressed RNAs were quantified using quantitative polymerase chain reaction (PCR).

Results

During the weed pollen season, the immune-related Gene Ontology (GO) terms with P value < 0.05, enriched by the upregulated genes in the AR-asthma group compared to the AR group included antifungal humoral response, neutrophil-mediated killing of bacterium, antibacterial humoral response, antimicrobial humoral immune response mediated by antimicrobial peptides, and regulation of the T cell receptor signaling pathway. The immune-related GO terms with P values <0.05 enriched by downregulated genes were positive regulation of natural killer cell-mediated cytotoxicity, microglial cell activation, natural killer cell activation, and leukocyte-mediated cytotoxicity. The GO term of antimicrobial humoral immune response mediated by antimicrobial peptides was upregulated both during and outside the pollen season, and the upregulated expression of three DEGs (LTF, PF4, and ELANE) included in this term was verified through quantitative PCR.

Conclusions

The activation of the antimicrobial immune response mediated by neutrophils and the depression of cytotoxicity mediated by natural killer cells may play roles in the progression from AR to asthma.

Emerging Hop Japanese Pollinosis in Asia

Hop Japanese (Hop J) pollen has been considered one of the major causative pollen allergens in Far East Asia in the autumn season. The sensitization rate, pollen count, and allergenicity of Hop J pollens are increasing in this region because of increased air pollution and global warming. However, commercial skin test agents for the diagnosis and allergen extracts for the allergen immunotherapy are not available. This review summarizes recent data on clinical impact of Hop J pollinosis in order to facilitate the development of diagnostic and therapeutic agents for this region.

Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

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