\articletype Original Articles Background: Alternaria alternata is a major fungal allergen, yet standardized skin prick test (SPT) extracts are lacking in China, hindering the use of this simple, first-line diagnostic tool. This study aimed to clinically evaluate a novel, domestically developed A. alternata extract for SPT and establish a diagnostic cutoff in a Chinese population. Methods: In this prospective, single-center study, 910 patients with allergic diseases were consecutively enrolled. All underwent SPT with the in-house A. alternata extract (Alt a 1: 25.7–34.8 µg/mL). Serum-specific IgE (sIgE) (ImmunoCAP™) served as the reference standard. Diagnostic accuracy was analyzed using receiver operating characteristic (ROC) curves. Safety was assessed by monitoring adverse events. Results: The per-protocol set included 610 subjects. The area under the ROC curve was 0.868 (95% CI: 0.839–0.897). The optimal diagnostic cutoff was a mean wheal diameter of 3.25 mm, yielding a sensitivity of 79.32% (95% CI: 74.46%–84.18%) and specificity of 86.11% (95% CI: 82.35%–89.87%). To achieve 95% specificity, the cutoff increased to 4.25 mm. No adverse events were reported among all 910 participants. Conclusion: The novel A. alternata SPT extract demonstrates high diagnostic accuracy and an excellent safety profile. The established cutoff of 3.25 mm provides a population-optimized threshold for clinical diagnosis in China. This study addresses a critical gap in allergen standardization and supports the adoption of SPT as a reliable, first-line diagnostic tool for fungal allergy in clinical practice.

Background There are limited real-world studies about the differences of leukotriene receptor antagonist (LTRA), antihistamine and inhaled corticosteroid (ICS) associated neuropsychiatric events. We aimed in this study to summarize the clinical characteristics of drug associated neuropsychiatric events and compare the differences between different drug categories. Methods Disproportionality analysis and Bayesian analysis were used in data mining to screen the suspected neuropsychiatric events with LTRA, antihistamine and ICS based on the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2004 to September 2020. Results A total of 9475 neuropsychiatric events were identified. Neuropsychiatric events related to LTRA, antihistamine and ICS were 5201 (54.89%), 3226 (34.05%), and 1048 (11.06%), respectively. LTRA related neuropsychiatric events were more common in patients aged from 4 to 6 years old (18.66%), while antihistamine and ICS related neuropsychiatric events were more common in patients with 18 to 44 years old (29.92%) and older than 65 years old (30.60%), respectively. Montelukast was considered to have the tightest relationship to neuropsychiatric events, followed by the first generation of antihistamine. Most neuropsychiatric symptoms occurred within the first 10 days after drug initiation. Death rate due to neuropsychiatric events of antihistamine was significantly higher than LTRA and ICS (p<0.001). Conclusions LTRA associated neuropsychiatric events was most frequent in 4 to 6-year old children and most cases occurred with the first 10 days after drug initiation. Fatality rate due to antihistamine associated neuropsychiatric events was higher than LTRA and ICS.

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