Risk factors of systemic allergic reactions caused by subcutaneous allergen immunotherapy / 中华预防医学杂志

Objective: To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy (SCIT) in patients undergoing SCIT injections in Peking Union Medical College Hospital (PUMCH). Methods: This is a single center retrospective cohort study. Using the outpatient information system of PUMCH, the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT. Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis, and multiple logistic regression was used for multiple-factor analysis. Results: A total of 2 897 patients received 18 070 SCIT injections in Allergy Department during the four years, and 40 systemic allergic reactions occurred, with the overall incidence rate of 0.22%. The incidence of systemic allergic reaction was 0.37% when using imported dust mite preparation and 0.15% when using domestic multi-component allergen preparation. The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old (OR=3.186,95%CI: 1.255-8.085), highest injection concentration (OR value could not be calculated because all patients with systemic reactions were injected with highest concentration), and large local reaction in previous injection (OR=22.264,95%CI: 8.205-60.411). The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens (OR=3.455,95%CI: 1.147-10.402), highest injection concentration (OR=3.794,95%CI: 1.226-11.740) and large local reaction in previous injection (OR=63.577,95%CI: 22.248-181.683). However, SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction. Conclusion: The incidence of SCIT-induced systemic allergic reactions was low in the Chinese patient population of this study. Patients with one or more risk factors, such as multiple allergen injection, highest injection concentration, large local reaction in previous injection, should be given high attention and vigilance against systemic allergic reactions.

Risk factors of systemic allergic reactions caused by subcutaneous allergen immunotherapy / 中华预防医学杂志

Objective: To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy (SCIT) in patients undergoing SCIT injections in Peking Union Medical College Hospital (PUMCH). Methods: This is a single center retrospective cohort study. Using the outpatient information system of PUMCH, the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT. Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis, and multiple logistic regression was used for multiple-factor analysis. Results: A total of 2 897 patients received 18 070 SCIT injections in Allergy Department during the four years, and 40 systemic allergic reactions occurred, with the overall incidence rate of 0.22%. The incidence of systemic allergic reaction was 0.37% when using imported dust mite preparation and 0.15% when using domestic multi-component allergen preparation. The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old (OR=3.186,95%CI: 1.255-8.085), highest injection concentration (OR value could not be calculated because all patients with systemic reactions were injected with highest concentration), and large local reaction in previous injection (OR=22.264,95%CI: 8.205-60.411). The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens (OR=3.455,95%CI: 1.147-10.402), highest injection concentration (OR=3.794,95%CI: 1.226-11.740) and large local reaction in previous injection (OR=63.577,95%CI: 22.248-181.683). However, SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction. Conclusion: The incidence of SCIT-induced systemic allergic reactions was low in the Chinese patient population of this study. Patients with one or more risk factors, such as multiple allergen injection, highest injection concentration, large local reaction in previous injection, should be given high attention and vigilance against systemic allergic reactions.

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China / 中华医学杂志(英文版)

Background@#Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients.@*Methods@#We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis.@*Results@#We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents.@*Conclusions@#In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.

Comparison and evaluation of several Dermatophagoides pteronyssinus allergen extracts for skin prick test / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the significance of several Dermatophagoides pteronyssinus allergen extracts for skin prick test (SPT) in patients allergic to Dermatophagoides pteronyssinus.</p><p><b>METHODS</b>Two hundred and nineteen patients enrolled in Peking Union Medical College Hospital underwent SPT and serum specific IgE assay to detect the Dermatophagoides pteronyssinus allergen. Three kinds of house dust mite allergen extracts were used for SPT, including the Dermatophagoides pteronyssinus extract prepared by our laboratory (group A), standardized Dermatophagoides pteronyssinus extract (group B), and mixed extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae (group C). Human serum specific IgE result was regarded as the reference standard for diagnosis of Dermatophagoides pteronyssinus allergy. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of SPT with the extracts of three groups.</p><p><b>RESULTS</b>SPT results showed that the median wheal diameter of group A, group B, and group C was 0.43, 0.35, and 0.28 cm, respectively, with significant difference among three groups (P<0.05). The difference was significant between group A and B (P<0.01) as well as group A and C (P<0.01), but not between group B and C (P>0.05). There was no local urticaria or systemic allergic reactions following the procedure of SPT. Local reaction was observed in 5 patients and delayed reaction was in 2 patients of group A. As for group B and C, local reaction occurred in 3 cases and delayed reaction in 2 cases in each group. The area under ROC curve of SPT with extract in group A, group B, and group C was 0.765, 0.801, and 0.782, respectively. Based on the detection results of serum specific IgE, the sensitivity of SPT in diagnosis of Dermatophagoides pteronyssinus allergy with extract of group A, group B, and group C was 92.4%, 87.0%, and 81.5%, and the specificity was 60.6%, 73.2%, and 74.8%, respectively.</p><p><b>CONCLUSION</b>The Dermatophagoides pteronyssinus extract for SPT prepared by our laboratory offers good sensitivity and specificity comparable to commercially available allergen extracts, and it may be an appropriate candidate for clinical screening and diagnosis of Dermatophagoides pteronyssinus allergy.</p>

Effects of Xianling Gubao capsules for the treatment of bone loss induced by glucocorticoid / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of Xianling Gubao capsules for the treatment of glucocorticoid-induced osteoporosis.</p><p><b>METHODS</b>From 2005.6 to 2007.8, 50 patients with primary glomerulonephritis treated with glucocorticoids were divided into two groups randomly. The treatment group were dealed with Xianling Gubao capsules and the control group with calcitriol and Caltrate D 600. TCM Synrdome integral before and after treatment were estimated. And the bone mineral density (BMD) of lumbar spine and femoral neek was measured by dual-energy X-ray absorptionm etry (DEXA). Osteo-calcin, intact parathyroidhormone (IPTH), urine excretion of calcium and phosphorus, serum calcium and phosphorus were detected before and after treatment, and adverse effects were investigated too.</p><p><b>RESULTS</b>TCM Synrdome integral in two groups decresed apparently (P<0.05), which decresed more apparently in the treatment group than that in control group (P<0.05). BMD of lumbar spine and femoral neek increased in two groups (P<0.05), but there were no statistical deferences between them (P>0.05). Serum osteocalcin after treatment reduced significantly in two groups (P<0.05) compared with pre-treatment,but there were no statistical deferences between the treatment and the control group (P>0.05). In the control group, serum calcium after treatment increased significantly (P<0.05), but there were no statistical deferences compared with the treatment group (P>0.05). There were no statistical deferences in intact parathyroidhormone, urine excretion of calcium and phosphorus, serum phosphorus in the treatment and the control group before and after therapy.</p><p><b>CONCLUSION</b>Both the treatment group and the control group have clinical effects in prevention and treatment of GC-induced osteoporosis, but the treatment group has more remarkable therapeutic effect and less adverse effects.</p>

Baboon syndrome induced by mercury:a case report / 中华皮肤科杂志

A case of mercury-induced Baboon syndrome is reported.A 31-year-old female presented with a 2-3 day history of pruritic symmetric erythematous papules on both axillas,popliteal fossa,buttocks and groins.The patient was exposed to a broken mercury thermometer two days before the onset of the eruption.Patch testing showed that the patient was sensitive to ammoniated mercury,mercury,mercuric chloride and mercurochrome.The mercury levels in serum and full blood reached the up limit of normal value three days after the onset,and gradually decreased over time.The patient was diagnosed with Baboon syn- drome caused by mercury according to the clinical manifestation and results from laboratory studies.

Detection of BK virus in urine of renal allograft recipients and its significance / 中华泌尿外科杂志

Objective To investigate the value of detecting BK virus(BKV)in urine of renal al- lograft recipients for the diagnosis and treatment of BKV infection.Methods Using polymerase chain re- action(PCR)method combined with DNA sequencing,61 urine samples from renal allograft recipients,30 u- fine samples from dialytic patients and 30 urine samples from healthy volunteers(controls)were detected. The results were compared among the 3 groups.Results The BKV positive rate in renal allograft recipi- ents was 36.1%,compared with 13.3% in dialytic patients(P＜0.05)and 0.0% in controls(P＜0.05). One renal allograft recipient who was positive for BKV developed ureteral obstruction.The BKV positive rate was 40.9%(9/22)in renal allograft recipients with rejection episode,compared with 33.3%(13/39)in the recipients without rejection episode(P＞0.05);and the BKV positive rate was 36.0%(18/50)in the recip- ients with normal graft function,compared with 36.4%(4/11)in the recipients with abnormal graft function (P＞0.05).Conclusions Renal allograft recipients are the high risk population who may develop BKV viruria.There is no correlation between recipients with or without rejection episode and BKV viruria,and also no correlation between recipients with normal or abnormal graft function and BKV viruria.Detection of BKV in the urine of renal allograft recipients is helpful in differential diagnosis of BKV induced ureteral obstruc- tion,and PCR method for detecting BKV DNA can be used to screen for BK virus-associated nephropathy (BKVAN).