The incidence of allergic diseases is gradually increasing， and multi-system allergic diseases often co-occur in the same patient. It is very important to conduct comprehensive diagnosis and treatment with high quality， high efficiency， reasonable and standardized. The multi-disciplinary diagnosis and treatment provides a new way to solve the complicated and difficult comorbidities of allergic comorbidity and multimorbidity， which is an effective supplement to the traditional diagnosis and treatment mode， and is also the development trend of the diagnosis and treatment of allergic diseases. At present， the multi-disciplinary treatment of allergic comorbidity and multimorbidity is still in the exploratory stage at home and abroad， and has not yet formed a mature system or a operation mode. Based on the clinical exploration and practical experience of allergic disease expert team of the Third Affiliated Hospital of Sun Yat-sen University， this paper expounds the construction and implementation of the multi-disciplinary treatment system for allergic comorbidity and multimorbidity from the aspects of implementation objectives， organizational structure， basic requirements， operation mode， procedure， system guarantee， quality control and so on. Establishing a standardized， mature and perfect multi-disciplinary treatment system for allergic comorbidity and multimorbidity and ensuring its effective operation and implementation will help to improve the level of multi-disciplinary diagnosis and treatment for allergic comorbidity and multimorbidity.

Fractional exhaled nitric oxide （FeNO） is a biomarker of type 2 inflammation， and produced by nitric oxide synthase （NOS） expressed on the airway epithelial cells， with the substrates of L-arginine and oxygen. Type 2 cytokines such as interleukin （IL）-4 and IL-13 can up-regulate inducible NOS， which results in the abundant production of NO. NO plays an important role in the pathogenesis of bronchial asthma， and is closely associated with the airway inflammation and remodeling， reduction of lung function and eosinophil infiltration， etc. The technique of FeNO test is applied in the clinical diagnosis of asthma， predicting the response to steroids and evaluating the compliance of asthmatic patients. In recent years， it also plays a guiding role in choosing the optimal biologics for individual therapy for patients of asthma. As a non-invasive， convenient， and economical method， the role of FeNO in the diagnosis and treatment of asthma will be better understood and applied.

Objective To investigate the efficacy and safety of 4-week cluster immunotherapy with house dust mite extracts in patients allergic to house dust mites. Methods From August 2022 to May 2024， 80 patients with house dust mite-induced allergic rhinitis， complicated with or without asthma， were recruited from multiple centers （including Peking Union Medical College， et al） to undergo 4-week dose-escalation subcutaneous cluster immunotherapy with house dust mites. Patient symptoms， medication use， quality of life， asthma control test （ACT） results， as well as local and systemic adverse reactions were recorded at 0， 1， 6， and 12 months， respectively. Results Significant differences were observed in the daily total symptom scores （P < 0.001）， daily nasal scores （P < 0.001）， daily ocular scores （P = 0.009）， and total symptom and medication scores （P = 0.003） across different time points during cluster immunotherapy， respectively. Significant differences were also found in the activity RQLQ （P < 0.001）， sleep RQLQ （P = 0.002）， non-eye/nose symptom RQLQ （P = 0.032）， practical problems RQLQ （P < 0.001）， nasal symptom RQLQ （P < 0.001）， emotional RQLQ （P = 0.011）， total RQLQ （P < 0.001）， and children’s ACT scores （P < 0.001）， respectively. The longer the time， the lower the score. During the dose-escalation period， 22 patients （27.5%） experienced local adverse reactions， and 5 patients （6.3%） experienced systemic adverse reactions. A total of 35 （3.6%） injections resulted in adverse reactions， including 27 （2.8%） injections with local reactions and 8 （0.8%） injections with systemic reactions. Conclusion Four-week cluster immunotherapy with house dust mites shows significant efficacy in patients allergic to house dust mites.

Objective To evaluate the diagnostic value of total serum immunoglobulin E （IgE） levels， eosinophil （EOS） count and percentage in the diagnosis of allergic rhinitis （AR）， and to construct a diagnostic model for preliminary diagnosis of AR by combining total serum IgE and EOS. Methods Clinical data of 305 AR patients and 256 non-AR patients admitted to Department of Otolaryngology at the First Affiliated Hospital of Chongqing Medical University from April 2023 to April 2024 were retrospectively analyzed. The general information， total serum IgE level， EOS count and percentage were compared between two groups. Binary logistic regression analysis was used to screen for suitable indicators to construct the predictive model， and the receiver operating characteristic （ROC） curve was plotted. The area under the ROC curve （AUC） was used to determine the predictive value of this model. Clinical data from 216 patients with and without AR admitted to Department of Otolaryngology at the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2022 were collected for external validation. Stratification analysis was performed according to age [adolescent group （≤ 18 years old）， youth group （19-45 years old）， middle-aged group （46-60 years old）， and elderly group （> 60 years old）]， respectively. Results The percentage of EOS and total serum IgE level were the influencing factors of AR in the overall and all age groups. The combined diagnostic model for all patients was： Logit P = -4.174+6.856EOS count+ 0.048total serum IgE. Diagnostic model in adolescent group was： Logit P = -4.472+0.637EOS percentage+0.034total serum IgE； youth group： Logit P = -4.491+0.372EOS percentage+0.068total serum IgE； middle-aged group： Logit P = -4.759+5.768EOS count+ 0.062total serum IgE； elderly group： Logit P = -4.888+0.855EOS percentage+0.028total serum IgE， respectively. Hosmer-Lemeshow goodness-of-fit test， ROC curve analysis and external validation all indicated that this model had high diagnostic value. Conclusion The combination of total serum IgE levels and EOS count demonstrates good diagnostic value for AR in different age groups， which can be used to guide preliminary diagnosis of AR.

Objective To analyze the characteristics of inhaled allergens in adult patients with allergic asthma in Beijing. Methods Clinical data of adult patients with allergic asthma who tested positive for inhaled allergens admitted to Department of Pulmonary and Critical Care Medicine from January 2021 to December 2023 were collected， and the characteristics of inhaled allergens were analyzed. Results A total of 1 568 patients with allergic asthma who were positive for inhaled allergens were enrolled， with a male-to-female ratio of 0.85 and an average age of （42.84±16.18） years old. The top 5 positive rates for inhaled allergens were house dust mite mix 2 （53.34%）， animal dander mix 1 （48.22%）， cocklebur （46.59%）， mugwort （39.51%）， and weed pollen mix 5 （37.19%）， respectively. The positive rates of Dermatophagoides farinae， house dust mite， house dust mite mix 2， and Aspergillus fumigatus in male patients were higher than those in female patients （all P < 0.05）， while the positive rate of animal dander mix 1 was lower than that in female patients （P = 0.001）. The positive rates of cat dander， dog dander， animal dander mix 1， house dust mite mix 2， and common ragweed showed a decreasing trend with age （all P < 0.05）. The positive rates of Aspergillus fumigatus and molds and yeasts mix 2 were the lowest among 40-49 years old and 30-39 years old， respectively， and significantly increased after 50 years old （all P < 0.001）. The positive rate of cockroach was gradually increased with the age of patients （P = 0.003）. Conclusions The proportion of young female patients with allergic asthma positive for inhaled allergens is higher than other counterparts. House dust mite mix 2 positive rate is the highest among all inhaled allergens. The positive rate of certain inhaled allergens varies among different genders and age groups.

Objective To evaluate clinical efficacy of chronic disease management based on a case management model in patients with allergic bronchial asthma. Methods Patients with allergic bronchial asthma admitted to the outpatient of Department of Pulmonary and Critical Care Medicine of Beijing Tsinghua Changgung Hospital from February 2020 to February 2023 were retrospectively included. The effect of case management on asthma symptom control and lung function was analyzed by tracking the asthma symptom control （ACT） score and lung function at 1， 3， 6 and 12 months after case management. Results A total of 175 patients with allergic asthma were included， comprising 70 male （40%） and 105 female （60%）， with a mean age of （45.58±13.78） years. Among these patients， 139 （79.4%） cases were complicated with allergic rhinitis. Pulmonary function parameters， including FEV₁%pred， FEV₁， FEV₁/FVC， MMEF75/25%pred and PEF， were improved significantly from （87.09±18.56）%， （2.65±0.88） L， （75.09±11.93）%， 52.20% （34.70%， 69.30%）， and （6.65±1.94） L/s to （97.80±13.81）%， （2.96±0.76） L， （84.72±11.18）%， 69.20% （53.70%， 86.90%）， and （7.57±1.89） L/s （all P < 0.001）， respectively. ACT score showed a 100% good control rate after 1-year case management， with a complete control rate of 69.7%. Repeated measures analysis of variance revealed no significant differences in symptom control based on gender or allergic rhinitis history （F = 0.575， P = 0.681； F = 2.317， P = 0.059）. There was interaction between age group and case management time. At 6-month case management， the ACT score of patients aged≥ 60 years old was significantly lower than those of patients ≤ 44 years old and 45-59 years old （both P < 0.05）. The proportion of inhaled drug usage rate and accuracy rate of using inhalation medication devices at 1-， 3-， 6- and 12-month case management was 98.8%， 86.8%， 68.0%， 51.4% and 98.8%， 100%， 100%， 100%， respectively. Conclusion The case management model can significantly improve both the usage rate and correct usage rate of inhaled medication device， enhance symptom control rate， and promote lung function recovery.

Objective To construct a nomogram prediction model for adverse reactions of mite subcutaneous immunotherapy（SCIT） in children with allergic asthma， and to evaluate and validate it. Methods Clinical data of children with allergic asthma who were managed by mite SCIT in Department of Pediatrics， the Second Hospital of Tianjin Medical University were retrospectively analyzed. According to the adverse reactions in the initial treatment stage of SCIT， they were divided into adverse reaction group and no adverse reaction group， which together formed the modeling group. Through univariate logistic regression analysis and multivariate logistic regression analysis， independent risk factors were screened out. Then construct the prediction model， draw a nomogram， eventually evaluate and validate the model. Results A total of 350 children were included， including 176 in the adverse reaction group and 174 in the no adverse reaction group. Univariate logistic regression analysis was performed on the baseline data of the children in the modeling group， and the results were as follows. Gender， age， number of asthma exacerbations in the past 1 year， percentage of eosinophils （EOS%）， forced expiratory volume in the first second in percent predicted values（FEV₁%pred）， total IgE（tIgE）， dermatophagoides pteronyssinus （Der p） sIgE， dermatophagoides farinae （Der p） sIgE， and the number of other inhaled allergenic species were the risk factors of SCIT-related adverse reactions （all P < 0.1）. These were included in the multivariate logistic regression analysis， and the results showed that： age， the number of asthma exacerbations in the past 1 year ， tIgE， Der p sIgE， Der f sIgE， and the number of other inhaled allergen species were independent risk factors （all P < 0.05）. Based on the results， nomogram was drawn in R language. Model evaluation by receiver operating characteristic curve showed an area under curve of 0.877， a predictive model sensitivity of 73.9%， and a specificity of 90.8%. The predicted probability was consistent with actual probability of occurrence. The model has good prediction performance. Conclusions Age， number of asthma exacerbations in the past 1 year， tIgE， Der p sIgE， Der f sIgE， and the number of other inhaled allergen species were independent risk factors for adverse reactions to mite SCIT in children. The nomogram drawn in this study has good predictive value.

Objective To analyze the distribution characteristics of constitution and traditional Chinese medicine syndrome of allergic rhinitis patients complicated with asthma， aiming to provide basis for integrated traditional Chinese and western medicine treatment for allergic rhinitis complicated with asthma. Methods After preliminary screening of traditional Chinese medicine constitution identification of allergic patients in the allergic WeChat applet of Gamma on Cloud， patients with allergic rhinitis complicated with asthma or other allergic diseases receiving multi-disciplinary diagnosis and treatment of Department of Allergy of the Third Affiliated Hospital of Sun Yat-sen University from January 2020 to May 2024 were selected. General data such as gender and age， constitution of traditional Chinese medicine and traditional Chinese medicine syndrome of allergic rhinitis patients complicated with asthma were collected and retrospectively analyzed. According to the new concept of “allergic 5A grading diagnosis and treatment” proposed by the team from Department of Allergy， all patients were divided into three groups： 2A patient group （ allergic rhinitis complicated with asthma）， 3A patient group （allergic rhinitis complicated with asthma， and any of atopic dermatitis， allergic conjunctivitis or food allergy） and 4A or 5A patient group （allergic rhinitis complicated with asthma， and any two or three of atopic dermatitis， allergic conjunctivitis or food allergy）. Results There were 42 patients in the 2A group， 18 males and 24 females， aged （26.4±16.6） years old， 40 patients in the 3A patient group， 19 males and 21 females， aged （25.0±15.5） years old， and 8 patients in the 4A or 5A patient group， 5 males and 3 females， aged （15.5±13.2） years old， respectively. In the 2A patient group， the most frequent constitutions were yang-deficiency constitution （n = 17）， qi-deficiency constitution （n = 14） and inherited special constitution （n = 11）. In the 3A patient group， the most common constitutions were qi-deficiency constitution （n = 23）， inherited special constitution （n = 16） and yang-deficiency constitution （n = 9 ）. In the 4A or 5A patient group， the most prevalent constitutions were qi-deficiency constitution （n = 6） and inherited special constitution （n = 4）. Fisher’s exact test found that there were differences in the distribution of yang-deficiency constitution among all groups （all P < 0.05）. In terms of traditional Chinese medicine syndromes， the most common traditional Chinese medicine syndromes in the 2A patient group were yang deficiency with congealing cold syndrome （n = 10）， wind-cold-dampness syndrome （n = 8） and lung-spleen qi deficiency syndrome （n = 6）. The most common traditional Chinese medicine syndromes of 3A patients were lung-spleen qi deficiency syndrome （n = 12）， yang deficiency with congealing cold syndrome （n = 7） and wind-cold-dampness syndrome （n = 6）. The most common traditional Chinese medicine syndrome of 4A or 5A patients was lung-spleen qi deficiency syndrome （n = 5）. There were differences in the distribution of traditional Chinese medicine syndromes among the three groups （all P < 0.05）. The difference between 2A patients and 4A or 5A patients was statistically significant （P < 0.001）. The difference between 3A patients and 4A or 5A patients was also statistically significant （P < 0.001）. Conclusions The most common constitutions of allergic rhinitis patients complicated with asthma are yang-deficiency constitution， qi-deficiency constitution and inherited special constitution. The most prevalent traditional Chinese medicine syndromes are yang deficiency with congealing cold syndrome， wind-cold-dampness syndrome and lung-spleen qi deficiency syndrome. There are differences in the distribution of constitution and traditional Chinese medicine syndrome among patients with different grades of allergic rhinitis complicated with asthma.

Chronic nasal inflammation， such as rhinitis and sinusitis， is a common chronic disease that affects people’s quality of life for a long period of time. Its pathogenesis and mechanism are still unclear. The establishment of animal models is an effective approach to explore the pathogenesis， among which the establishment of mouse models of chronic nasal inflammation has been rapidly developed in recent years. The aim of this review is to summarize the research status of chronic rhinosinusitis and allergic rhinitis modeling in mice at home and abroad， especially the progress in eosinophilic chronic rhinosinusitis mouse models， which plays an important role in the development of new drugs to prevent and control chronic nasal inflammation or further elucidation of its pathogenesis.

Dermatophytosis is distributed worldwide， with a global prevalence of 20%-25%， while allergic diseases have a high prevalence of 10%-45% in the global population. In recent years， research on the correlation between dermatophytosis and allergic diseases such as allergic rhinitis， atopic dermatitis， and asthma has been reported successively， highlighting a previously overlooked relationship between dermatophytes and allergic diseases. This review summarizes the research progress on fungal allergens， the correlation between dermatophytosis and allergic diseases， as well as the mechanisms of interaction， aiming to provide insights for the clinical diagnosis and treatment of dermatophytosis and allergic diseases.

Atopic dermatitis （AD） is a common chronic inflammatory skin disease characterized by dry skin， recurrent itching， and eczema-like lesions， which can significantly reduce the quality of life. In recent years， the global prevalence of AD has been increasing， with a particularly marked rise in China. Research has shown that air pollutants can damage the skin barrier through mechanisms like oxidative stress， thereby increasing the risk of AD. Various exposure factors， including diet and allergens， also significantly influence the onset and progression of AD through different mechanisms. Furthermore， psychological factors such as anxiety and stress can exacerbate AD through neuroendocrine regulation. Obesity is closely associated with AD， particularly among children and adolescents. Given the diversity of factors and mechanisms influencing AD， a comprehensive approach to primary prevention that considers multiple factors is warranted.

Objective To understand the cognitive influencing factors affecting the use of epinephrine by medical staff for the treatment of serve allergic reactions and the current state of research at home and abroad. Methods Using searching terms such as “adrenaline” “anaphylactic shock”“severe anaphylactic reaction”“allergic reaction”“epinephine”“anaphylaxis”in Chinese and English. Literature review was performed from China National Knowledge Infrastructure （CNKI）， Wanfang Data， Chongqing VIP Database， PubMed， Web of Science. The retrieval time is from the inception of the databases to July 20， 2024. Literature contents were extracted and analyzed. Results A total of nine articles were retrieved， and eight international studies showed that there were differences in the correct use of adrenaline in patients with severe allergic reactions among medical staff of different professions， levels of hospitals， ages， and years of service. Through targeted training and education， the correct use rate of adrenaline by medical staff in the treatment of severe allergic reactions could be significantly improved. Only one Chinese study suggested that clinicians and nurses had severe cognitive deficiencies in the proper use of adrenaline. Conclusion Medical staff have varying degrees of cognitive insufficiency of correct use of adrenaline for the treatment of severe allergic reactions， which is influenced by multiple factors.

In clinical practice， the application of surface disinfectants for skin disinfection is a prerequisite for venipuncture. Chlorhexidine， a widely recognized disinfectant， is frequently employed for this purpose. However， during intravenous infusions， minute quantities of chlorhexidine can be inadvertently introduced into the bloodstream via the puncture needle， potentially precipitating immediate-type （type ） hypersensitivity reactions. Regrettably， these reactions are often erroneously attributed to administered medications， such as antibiotics， which can result in both misdiagnosis and underdiagnosis. This article details a case of an allergic reaction that occurred subsequent to multiple intravenous infusions and was ultimately identified as chlorhexidine-induced after antibiotic allergy was ruled out. The objective of this report is to deepen the clinical physcians’ comprehension of chlorhexidine-induced allergies in the context of infusion-related allergic reactions， thereby offering a valuable reference for accurate diagnosis and effective treatment strategies.