Background: Nasal allergen challenge (NAC) is the gold standard for confirming allergen reactivity in allergic rhinitis (AR), especially in complex cases. However, its application is limited due to a lack of standard procedure. The European Academy of Allergy and Clinical Immunology (EAACI) issued guidelines in 2018 to standardize NAC procedure. This study aims to validate the EAACI diagnostic criteria. Methods: 120 adult participants were recruited: 40 with house dust mite-induced AR, 40 with non-allergic rhinitis (NAR), and 40 healthy controls (HC). NAC was performed, and symptoms were evaluated using subjective scales (Total Nasal Symptom Score [TNSS], Linder, Lebel, and Visual Analog score [VAS]) and objective measures (Active Anterior rhinomanometry [AAR], Acoustic Rhinometry [AcRh], and Four-Phase Rhinomanometry[4PR]). A positive NAC diagnosis was defined per EAACI criteria: either a single clearly positive objective or subjective result, or moderate positive findings in one objective and one subjective criterion. Results: NAC sensitivity ranged from 77.5% to 100%; specificity was slightly lower (61.3% to 93.8%). False positives in the HC group were mainly due to clearly positive objective assessments. In the NAR group, false positives resulted from either clearly positive objective changes or concurrent moderate changes in both objective and subjective assessments. Subjective parameters showed higher diagnostic accuracy (area under the curve [AUC] 0.9933–1) compared to objective parameters (AUC 0.7229–0.864). Conclusion: The sensitivity of the EAACI criteria was generally high, albeit with somewhat lower specificity. Relying solely on clearly positive objective parameters or moderate concurrent changes in both objective and subjective measures may lead to false-positive NAC diagnoses. When subjective measures remain negative at sub-maximal allergen concentrations, escalating the concentration is recommended. Among objective assessments, AAR and AcRh are preferred methods.

Background: Inappropriate penicillin skin testing practices can worsen allergy mislabelling and antimicrobial resistance. This issue is likely more pronounced in Mainland China due to mandatory pre-emptive penicillin skin testing prior to any penicillin prescriptions. In contrast, Hong Kong follows guidelines more aligned with international recommendations on penicillin allergy testing. This study aimed to explore the disparities in drug allergy labelling, penicillin consumption, and antimicrobial resistance between Mainland China and Hong Kong. Methods: This multi-centre, real-world study analyzed drug allergy label prevalence, antibiotic use, and AMR between 2018 to 2022 in Mainland China and Hong Kong. Results: Penicillin allergy labels were significantly higher in Mainland China (47.13%) compared to Hong Kong (21.57%, p<0.01). Penicillin consumption was lower in Mainland China, where antimicrobial resistance to amoxicillin-clavulanate was also lower. Penicillin allergy delabeling rates were significantly higher in Mainland China (99.26%) compared to Hong Kong (93.13%, p=0.03). Conclusion: Significant differences in drug allergy labeling and antibiotic use between Mainland China and Hong Kong highlight the impact of non-evidence-based penicillin skin testing practices in Mainland China. Urgent reforms are needed to adopt international guidelines and reduce allergy mislabeling.

Changes in sensitization rates in patients with asthma and/or rhinitis in China between 2008 and 2018: a national cross-sectional studyWanjun Wang1*, Jianhong Wang2*, Guihua Song3*, Hua Xie4*, Xiaoping Lin4*, Ruonan Chai4*, Rongfei Zhu5*, Yong He6*, Jun Tang7*, Junge Wang8*, Jinghua Yang9*, Lili Zhi10*, Lin Wu11*, Yan Jiang12*, Xiaoqin Zhou13*, Dongming Huang14*, Ning Wang15*, Rui Xu16*, Yuan Gao17*, Zhimin Chen18*, Jinling Liu18*, Xiaoli Han19*, Guolin Tan20*, Jinzhun Wu21*, Deyu Zhao22*, Jianjun Chen23*, Xiwei Zhang24*, Mengrong Li24*, Yuemei Sun25*, Yi Jiang26*, Weitian Zhang27*, Qianhui Qiu28*, Chuanhe Liu29*, Jie Yin30*, Guodong Hao31*, Huabin Li32*, Yongsheng Xu33*, Shaohua Chen34*, Hua Zhang35, Shi Chen36, Juan Meng37, Dan Zeng38, Wei Tang39, Chuangli Hao40, Jing Li1†, Nanshan Zhong1†, for the China Alliance of Research on Respiratory Allergic Disease*Contributed equally†Joint corresponding authors1 National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University;2 The First People’s Hospital of Yibin, Sichuan;3 The First Affiliated Hospital of Henan University of Traditional Chinese Medicine;4 General Hospital of Northern Theater Command;5 Tongji Hospital, Tongji Medical College, Huazhong University of Science&Technology;6 The Affiliated Hospital of Medical School, Ningbo University;7 Foshan First people’s hospital;8 Beijing Hospital of Traditional Chinese Medicine;9 GuangDong Provincial Hospital of Chinese Medicine;10 The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases;11 Hangzhou Hospital of Traditional Chinese;12 The Affiliated Hospital of Qingdao University;13 Hubei Province Maternal and Child Health Hospital;14 Boai Hospital of Zhongshan City;15 Xi’an Children’s Hospital;16 The First Affiliated Hospital of Sun-Yat University;17 The First Affiliated Hospital of Zhengzhou University;18 Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health;19 Hebei General Hospital;20 Third Xiangya Hospital of Central South University;21 The Women and Children’s Hospital affiliated to Xiamen University;22 Children’s Hospital of Nanjing Medical University;23 Union hospital of Tongji medical college;24 The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University;25 Yu Huang Ding Hospital;26 The First Hospital of Shanxi Medical University;27 Shanghai Jiao Tong University Affiliated Sixth People’s Hospital;28 Zhujiang Hospital of Southern Medical University;29 Children’s Hospital Capital Institute of Pediatrics;30 Chengdu First People’s Hospital;31 Tangshan Gongren Hospital;32 ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University;33 Children’s Hospital of Tianjin University;34 Guangdong Provincial People’s Hospital;35 The First Affiliated Hospital of Xinjiang Medical University;36 Hainan provincial people’s Hospital;37 West China Hospital of Sichuan University;38 Chongqing General Hospital, University of Chinese Academy of Sciences;39 Ruijin Hospital of Shanghai Jiaotong University;40 Children’s Hospital of Soochow University.