Objective:To analyze the clinical features and risk factors of chest tightness variant asthma (CTVA) in children, so as to provide basis for the prevention and management of the disease.Methods:A cross-sectional study was conducted to analyze 178 children aged 6-17 years old who were admitted to the Department of Allergy, Capital Institute of Pediatrics Affiliated Children′s Hospital from January 2021 to January 2023 due to chest tightness. The age was 8.83(7.50, 11.58) years old, with 89 males (50%) and 89 females (50%). According to the diagnosis of CTVA, 130 cases were divided into CTVA group and 48 non-CTVA cases were divided into control group. Demographic data, personal history, family history, clinical features, auxiliary examination results and other data were collected. The clinical characteristics, allergens, FeNO level and pulmonary function parameters of the two groups were analyzed. Logistic regression analysis was used to explore the risk factors of the disease.Results:The proportion of school-age children (6-11 years old) in CTVA group was higher than that of adolescent children (≥12 years old) [(113/130,86.9%) vs (26/48,54.2%), Z=21.985, P<0.01]. The proportion of CTVA combined with eczema [(74/130,56.9%) vs (19/48,39.6%), χ2=4.225, P<0.05] and rhinitis symptoms [(98/130,75.4%) vs (27/48,56.2%), χ2=6.138, P<0.05] was higher. The positive rates of mold sensitization [(52/130,40.0%) vs (11/48,22.9%), χ2=4.474, P<0.05] and multiple sensitization [(71/130,54.6%) vs (18/48,37.5%), χ2=4.108, P<0.05] in inhaled allergens were significantly higher than those of control group. The proportion of elevated FeNO (>20 ppb) in CTVA children was 20.8% (27/130), which was significantly higher than that in control group 4.2%(2/48)( χ2=7.086 ,P<0.01). There were no statistical differences in spirometry parameters FEV 1 and FVC between CTVA group and control group ( P both>0.05). FEV 1/FVC, PEF, FEF 25, FEF 50, FEF 75 and MMEF were significantly lower than those in control group ( P all<0.05). Logistic regression analysis showed that rhinitis symptoms ( OR=2.351, 95% CI 1.105-5.002, P=0.026), multiple sensitizations ( OR=2.184, 95% CI 1.046-4.557, P=0.038), tIgE>60 kU/L( OR=3.080, 95% CI 1.239-7.654, P=0.015), FeNO>20 ppb ( OR=6.734, 95% CI 1.473-30.796, P=0.014) and small airway dysfunction ( OR=3.164, 95% CI 1.089-9.194, P=0.034) were risk factors for chest tightness variant asthma. FeNO combined with FEF 50 has the largest area under the curve ( Z=2.744, P<0.01) in diagnosing CTVA. Conclusion:CTVA is more common in school-age children than in adolescent children. Rhinitis symptoms, multiple sensitization, tIgE>60 kU/L, FeNO>20 ppb and small airway dysfunction are risk factors for chest tightness variant asthma. FeNO combined with small airway indexes can improve the diagnostic value of CTVA.

Objective To investigate the characteristics of pulmonary function changes in older children with pertussis.Methods Clinical data and pulmonary function date of older children diagnosed with pertussis in outpatient clinics from April 2021 to December 2023 were collected.The clinical data of the case group were collected.A group of healthy older children were included as the control group.Pulmonary function parameters included peak expiratory flow(PEF),forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC,expiratory flow at 50%of vital capacity(FEF50),maximum mid-expiratory flow(MMEF)and expiratory flow rate with 75%vigorous exhalation(FEF75).Results Seventy children(36 boys and 34 girls)with pertussis were recruited in the case group,including 54 children with pertussis only and 16 children with pertussis and asthma together.The incidence of paroxysmal cough was 40.0%(28/70)and inspiratory croup 8.5%(6/70)in the case group.Sixty healthy children(28 boys and 32 girls)were included in the control group.There were no significant differences in gender,age,height and body weight between children with pertussis alone group and the control group(P＞0.05).The pulmonary function parameters were significantly lower in the children with pertussis alone group than those in the control group,and PEF had the most obvious decline:PEF%pred[80.5(62.6,85.9)vs.109.8(103.2,118.7)].Compared with the pertussis alone group,pulmonary function was not decrease further in the pertussis combined with asthma group.After the improvement of clinical symptoms of children in the pertussis alone group,the level of pulmonary function(PEF and FEF50)increased significantly,but they were still lower than those of the control group.Conclusion The pulmonary function declines slightly in loder children with pertussis.The decreased PEF is most significant.

Objective:To analyze the clinical features and risk factors of chest tightness variant asthma (CTVA) in children, so as to provide basis for the prevention and management of the disease.Methods:A cross-sectional study was conducted to analyze 178 children aged 6-17 years old who were admitted to the Department of Allergy, Capital Institute of Pediatrics Affiliated Children′s Hospital from January 2021 to January 2023 due to chest tightness. The age was 8.83(7.50, 11.58) years old, with 89 males (50%) and 89 females (50%). According to the diagnosis of CTVA, 130 cases were divided into CTVA group and 48 non-CTVA cases were divided into control group. Demographic data, personal history, family history, clinical features, auxiliary examination results and other data were collected. The clinical characteristics, allergens, FeNO level and pulmonary function parameters of the two groups were analyzed. Logistic regression analysis was used to explore the risk factors of the disease.Results:The proportion of school-age children (6-11 years old) in CTVA group was higher than that of adolescent children (≥12 years old) [(113/130,86.9%) vs (26/48,54.2%), Z=21.985, P<0.01]. The proportion of CTVA combined with eczema [(74/130,56.9%) vs (19/48,39.6%), χ2=4.225, P<0.05] and rhinitis symptoms [(98/130,75.4%) vs (27/48,56.2%), χ2=6.138, P<0.05] was higher. The positive rates of mold sensitization [(52/130,40.0%) vs (11/48,22.9%), χ2=4.474, P<0.05] and multiple sensitization [(71/130,54.6%) vs (18/48,37.5%), χ2=4.108, P<0.05] in inhaled allergens were significantly higher than those of control group. The proportion of elevated FeNO (>20 ppb) in CTVA children was 20.8% (27/130), which was significantly higher than that in control group 4.2%(2/48)( χ2=7.086 ,P<0.01). There were no statistical differences in spirometry parameters FEV 1 and FVC between CTVA group and control group ( P both>0.05). FEV 1/FVC, PEF, FEF 25, FEF 50, FEF 75 and MMEF were significantly lower than those in control group ( P all<0.05). Logistic regression analysis showed that rhinitis symptoms ( OR=2.351, 95% CI 1.105-5.002, P=0.026), multiple sensitizations ( OR=2.184, 95% CI 1.046-4.557, P=0.038), tIgE>60 kU/L( OR=3.080, 95% CI 1.239-7.654, P=0.015), FeNO>20 ppb ( OR=6.734, 95% CI 1.473-30.796, P=0.014) and small airway dysfunction ( OR=3.164, 95% CI 1.089-9.194, P=0.034) were risk factors for chest tightness variant asthma. FeNO combined with FEF 50 has the largest area under the curve ( Z=2.744, P<0.01) in diagnosing CTVA. Conclusion:CTVA is more common in school-age children than in adolescent children. Rhinitis symptoms, multiple sensitization, tIgE>60 kU/L, FeNO>20 ppb and small airway dysfunction are risk factors for chest tightness variant asthma. FeNO combined with small airway indexes can improve the diagnostic value of CTVA.

Objective:To explore the cutoff value for assessing small airway dysfunction in children with asthma.Methods:A total of 364 asthmatic children aged 5 to 14 years, with normal ventilatory function, followed up at the Asthma Clinic of the Children′s Hospital of Capital Institute of Pediatrics from January 2017 to January 2018, were selected as the case group. Concurrently, 403 healthy children of the same age range and without any symptoms in the community were chosen as the control group, and pulmonary function tests were conducted. The values of forced expiratory volume in 1 second (FEV 1), forced vital capacity (FVC), forced expiratory flow at 50% of FVC (FEF 50), forced expiratory flow at 75% of FVC (FEF 75) and maximum mid-expiratory flow (MMEF) were compared between case group and control group. Statistical tests such as t-test, χ2 test, or Mann-Whitney U test were used to analyze the differences between the groups. Receiver operating characteristic (ROC) curves were constructed, and the maximum Youden Index was utilized to determine the optimal cutoff values and thresholds for identifying small airway dysfunction in asthmatic children. Results:This study comprised 364 children in the case group (220 boys and 144 girls) and 403 children in the control group (198 boys and 205 girls). The small airway parameters (FEF 50%pred, FEF 75%pred, MMEF%pred) in the asthmatic group were significantly lower than in the control group (77% (69%, 91%) vs. 95% (83%, 109%), 67% (54%, 82%) vs. 84% (70%, 102%), 76% (66%, 90%) vs. 97% (86%, 113%), Z=12.03, 11.35, 13.66, all P<0.001). The ROC curve area under the curve for FEF 50%pred, FEF 75%pred, MMEF%pred was 0.75, 0.74, and 0.79, respectively. Using a cutoff value of 80% for FEF 50%pred achieved a sensitivity of 56.9% and specificity of 81.4%. A cutoff value of 74% for FEF 75%pred resulted in a sensitivity of 67.3% and specificity of 69.2%. Finally, using a cutoff value of 84% for MMEF%pred achieved a sensitivity of 67.9% and specificity of 77.2%. Conclusion:In the presence of normal ventilatory function, utilizing FEF 50<80% predicted or MMEF<84% predicted can accurately serve as criteria for identifying small airway dysfunction in children with controlled asthma.

Objective:To observe the expression of Galectin-7 in the serum and sputum of asthmatic children and to explore its significance in asthmatic children.Methods:The study prospectively case-control selected 183 children diagnosed with bronchial asthma at Department Ⅱ of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children′s Hospital of Capital Medical University. The control group consisted of 41 children with other bronchial diseases and 43 healthy children. Children in the asthma group were divided into acute and non-acute exacerbation groups. Acute exacerbation group was divided as mild acute, moderate acute and severe acute groups; non-acute exacerbation group was divided as mild persistent, moderate persistent and severe persistent groups. Children without acute exacerbation asthma in the asthma group were divided into high and low Galectin-7 groups based on median serum Galectin-7 levels. Serum and sputum were collected, Galectin-7 levels were measured using enzyme-linked immunosorbent assay. The study compared and analyzed the differences in Galectin-7 levels between children with asthma and the control groups using Mann-Whitney U test or the Kruskal-Wallis or the Chi-square test for inter-group comparisons. Results:Among 183 children, 61 cases had acute asthma exacerbation, and 122 cases had persistent asthma without acute exacerbation. The asthma group comprised 110 males and 73 females. The control group consisted of 41 children with other bronchial diseases, including 24 cases of bronchiectasis and 17 cases of obliterans bronchitis. The control group comprised 26 males and 15 females. Forty-three healthy children who underwent physical examination, including 22 males and 21 females. The levels of Galectin-7 in serum were significantly higher in children with an acute asthma exacerbation than that of healthy children (0.1 (0, 0.7) vs. 0 (0, 0.2) μg/L, Z=2.09, P=0.001). Galectin-7 levels in sputum were higher in children with an acute asthma exacerbation than that in children with other bronchial diseases (1.2 (0.1,3.7) vs. 0.4 (0.1, 1.5) μg/L, Z=2.20, P<0.001). Serum Galectin-7 levels were significantly higher in children with persistent asthma compared to children with other bronchial diseases and healthy children (0.6 (0.3, 1.2) vs. 0.1 (0, 0.5) and 0 (0, 0.2) μg/L, Z=-6.12 ,-7.63, both P<0.001), and the levels were significantly and positively correlated with asthma severity ( r=0.77, P<0.001), disease duration ( r=0.34, P=0.001), and number of previous attacks ( r=0.51, P<0.001). There were 61 children in the high-Galectin-7 group and 61 children in the low-Galectin-7 group. Children with high Galectin-7 had more asthma triggers, a greater proportion with a positive family history, more previous asthma attacks, longer duration of asthma, and higher serum total IgE levels compared to those with low Galectin-7 ( χ2=9.30, 22.46, Z=5.06, 3.57, 2.31, all P<0.05). Conclusion:The expression of Galectin-7 is found to be elevated in the serum and sputum of asthmatic children and correlated with asthma conditions.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Buckwheat is one of the most common source of food allergen in children.The clinical manifestations of buckwheat allergy are varied, which mainly affects the skin, and sometimes the respiratory and digestive system.Buckwheat allergy leads to a high incidence of anaphylaxis, which can even be life-threatening.In recent years, the prevalence of buckwheat allergy in Chinese children and adolescents is on the rise, although it is rarely reported in relevant literatures.This review summarized the prevalence, pathogenesis, clinical manifestations, diagnosis and management of buckwheat allergy in children, aiming to provide some suggestions.

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Objective:To establish the long-term trajectories of lung function in children with bronchial asthma (asthma) and explore the risk factors of persistent pulmonary dysfunction.Methods:A retrospective cohort study was conducted.Children with asthma aged above 14 years who had been followed up regularly and completed pulmonary function testing in Children′s Hospital of Capital Institute of Pediatrics were enrolled in the study from January to December 2019.Their lung function data and clinical information were collected.The latent class growth model (LCGM) was used to fit the change of lung function in children with asthma, and different trajectory groups were established.Comparison between groups was performed by t-test, ANOVA or Chi- square test.The risk factors for the lung function trajectory were analyzed by the multivariate Logistic regression method. Results:A total of 173 children with asthma, aged from 6 to 17, were enrolled, and 1 160 lung function tests were completed.Four forced expiratory volume in the first second/forced vital capacity (FEV 1/FVC) latent class trajectory groups were established, including persistent high level [27 cases (15.6%)], above average level [66 cases (38.1%)], below average level [66 cases (38.1%)], and persistent low level [14 cases (8.1%)]. In all the 4 different trajectory groups, the FEV 1/FVC values were significantly different among patients of different ages (all P<0.05). The FEV 1/FVC values of patients at all ages in the persistent high level group were above 90%.The FEV 1/FVC values of patients in other 3 level groups decreased as a whole as the age increased.FEV 1/FVC of patients in the persistent low level group decreased to below 80% when they entered the school age period and approached 70% in adolescence.The trajectory and fluctuation of maximal midexpiratory flow (MMEF), which represents the small airway function, were similar to those of FEV 1/FVC.Risk factor analysis showed that the risk of lung function decreasing below the average level in children with typical asthma was 11.940 times higher than that in children with cough variant asthma ( P=0.008). The risk of lung function deteriorating to below the average level in children with multiple allergen sensitivities was 7.462 times higher than that in children with single allergen sensitivity ( P=0.015). Children taking drugs irregularly were 6.337 times more likely to suffer persistent low lung function than children taking drugs regularly ( P=0.035). Boys were 6.186 times more likely to suffer a lung function reduction to below the average level than girls ( P=0.002). Conclusions:Four long-term trajectories of lung function in asthmatic children aged 6 to 17 years can be established: persistent high level, above average level, below average level and persistent low level.The long-term lung function of nearly a half of the asthmatic children is below the average level.Many children develop persistent airflow limitation in adolescence, and few at school age.Typical asthma, multiple allergen sensitivities, irregular medication and boy were the risk factors of long-term lung function reduction.

The prevalence of food allergy among children has significantly increased, which seriously affects the quality of life of children and increases the burden of society and family.The understanding of food allergy in Chinese pediatric clinicians is lacked, and oral food challenge test and oral immunotherapy have not been widely carried out, which need to be further improved and standardized.In the present review, the author summarized the clinical classification, auxiliary examination, prevention and management of food allergy based on the current situation in China and the Japanese Guidelines for Food Allergy 2020, aiming to provide references for clinicians.