Fungus is one of common allergens in allergic disease that affects the susceptibility, severity, and disease control of allergic airway disease in children.A spectrum of respiratory diseases associated with fungal sensitization has been described as allergic fungal airway disease (AFAD), including severe asthma with fungal sensitization, allergic bronchopulmonary aspergillosis, thunderstorm asthma, and allergic fungal rhinosinusitis.Glucocorticoids, biologics, antifungal therapy, and immunotherapy can reduce the airway inflammation, fungal burden, and tissue damage associated with AFAD.This review introduced fungus, the mechanism of fungal sensitization and the detection, as well as the scope and treatment of AFAD in children, aiming to improve the understanding of AFAD among pediatricians.

Trained immunity has been a novel term in immunology for over a decade, referring to the memory immunity produced by the innate immune system upon re-stimulation.Non-specific training of the immune system enhances the immune defense function and is also involved in allergic inflammation and autoimmune diseases.An increasing number of researchers are focusing on the role of immune training in the prevention, treatment, onset and progression of diseases.This review explains the definition, mechanism, and inducers of immune training and its impact on children′s health and disease, in order to enhance pediatricians′ comprehension of trained immunity.

Since 2022, there has been an increasing trend in the incidence of scarlet fever and deaths due to Group A Streptococcus (GAS) in the UK and some European countries, with the paediatric population particularly affected, a phenomenon that has attracted widespread international attention.The author believes that GAS has not received sufficient attention and that there are significant national differences in early surveillance, treatment strategies, management and control.Here, author present professional insights on the unresolved scientific issues related to GAS infections, with a view to attracting the attention of domestic colleagues and jointly promoting GAS-related research, prevention and control.

Group A Streptococcus (GAS) are important human pathogens.In recent years, the M1 UK strain has attracted widespread attention in the United Kingdom and other countries because it has been associated with a surge in scarlet fever and an increase in invasive GAS infections.Author conducted a whole-genome sequencing study of 42 GAS strains from 2016 to 2018 in Shenzhen, and found that a GAS strain isolated from a child with scarlet fever in Shenzhen area in 2018 was homologous to M1 UK, which is the first strain of M1 UK confirmed in the mainland of China.For this reason, hereby publish it with a view to attracting the attention of our domestic counterparts and safeguarding public health safety.

Objective:To analyze the influence of meteorological factors on children and adolescents with asthma of different characteristics.Methods:This study was a retrospective study.A total of 2 600 children and adolescents with asthma who used the electronic version of the China Children's Asthma Action Plan（CCAAP）from June 2021 to June 2022 were enrolled.This study collected the basic information，symptoms and environmental monitoring data of children and adolescents with asthma.The influence of air quality index（AQI），temperature and humidity on children and adolescents with asthma were analyzed.Results:From June 2021 to June 2022，a total of 49 107 daily symptoms were recorded.Among them，the symptoms of "yellow zone" and "red zone" were 3 274 times.Multivariate Logistic regression analysis showed that compared with excellent AQI grade，the occurrence of asthma symptoms increased when the AQI grade was good（ OR=1.270，95% CI：1.162-1.389， P<0.05）and polluted（ OR=1.640，95% CI：1.436-1.873， P<0.05）；compared with the daily temperature of 21-30 ℃，the occurrence of asthma symptoms increased when the daily temperature was 11-20 ℃（ OR=1.545，95% CI：1.400-1.706， P<0.05），1-10 ℃（ OR=1.583，95% CI：1.415-1.770， P<0.05）and more than 30℃（ OR=1.393，95% CI：1.122-1.730， P<0.05）；compared with the air humidity of 41%-60%，the occurrence of asthma symptoms increased when the air humidity was 0-20%（ OR=1.767，95% CI：1.381-2.259， P<0.05）and 21%-40%（ OR=1.456，95% CI：1.273-1.665， P<0.05）.The occurrence of asthma symptoms decreased with increasing age（ OR=0.916，95% CI：0.903-0.930， P<0.05）and adherence of using the electronic version of CCAAP（ OR=0.930，95% CI：0.927-0.933， P<0.05）.Among the single self-reported triggers in children and adolescents with asthma，the most common trigger was respiratory infection accounting for 56.03%，climate change accounted for 23.99%，and air pollution accounted for 5.08%.The comparison between groups showed that children and adolescents with asthma who were adolescent，living in North China，and obese were more susceptible to air pollution.Children and adolescents with asthma living in East China，Southern China and Central China were more susceptible to climate change. Conclusion:Poor air quality，low temperature，high temperature，low air humidity，younger age and decreased compliance with electronic CCAAP were risk factors for the occurrence of asthma symptoms.

Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.

Acute necrotizing encephalopathy (ANE) is a subtype of acute encephalopathy presented with disturbance of consciousness and symmetric bilateral thalamic necrosis in neuroradiology.Patients with ANE had a high mortality or severe neurological sequela.ANE usually secondary to virus infectious disease, in which influenza is a common etiology.During the 3 years of the worldwide pandemic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection, ANE has become a severe complication and cause of death in children, which has aroused much concern.Here is a review of the research progress of epidemiology, pathogenesis, diagnosis, treatments and prognosis of ANE, in order to improve the knowledge of clinicians on this disease.

Recently, there have been outbreaks of Group A Streptococcus (GAS) infection in foreign countries.The reasons are varied.With the relaxation of control for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection, it is very likely that concurrent or secondary GAS infection peaks will occur at the same time as the number of Corona Virus Disease 2019(COVID-19) cases increases dramatically.Children are generally susceptible to GAS and are more vulnerable.In response to possible outbreaks, early identification of GAS infections and rational use of antibiotics are particularly important.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.