Objective:To investigate the efficacy and safety evaluation of omalizumab in patients with chronic urticaria who are not well treated with antihistamine and have a history of anaphylactic shock.Methods:A retrospective observational real-world study was conducted in which patients with chronic urticaria who were admitted to Peking University First Hospital from November 2018 to January 2024 who were poorly treated with antihistamine drugs and had a history of anaphylactic shock were selected as the study subjects, and 300 mg of omalizumab was injected subcutaneously every 4 weeks, and the occurrence of UCT (urticaria control test), the number of occurrences of anaphylactic shock and other adverse events were recorded during the treatment.Results:Among the 11 patients who started omalizumab treatment for 3 months, 10 patients had complete control of chronic urticaria (UCT=16), 1 patient was partially controlled (UCT=15), and 9 patients did not have anaphylactic shock during follow-up (10 cases after 12 months of follow-up and 1 case after 2 months of follow-up). Two patients developed anaphylactic shock after omalizumab injection. In this study, during the follow-up period (2-38 months), 11 patients were well tolerated with omalizumab, of which 4 continued to use omalizumab for urticaria, 6 stopped using omalizumab due to good urticaria control and no recurrence of anaphylactic shock, and 1 was lost to follow-up.Conclusion:Omalizumab may have good efficacy and safety in patients with chronic urticaria who are poorly treated with antihistamines and have a history of anaphylactic shock, and may have a potential role in preventing anaphylactic shock.

Objective:To investigate the pathogenesis and clinical manifestations of anaphylactic shock and to evaluate the effectiveness of existing treatments, so as to improve the understanding of anaphylactic shock and to properly manage patients with anaphylactic shock.Methods:A retrospective observational study was conducted to select 63 patients with anaphylactic shock who were diagnosed and treated in Peking University First Hospital from July 2017 to June 2023 as the study objects, and the clinical data including basic information, present medical history, vital signs, past medical history, emergency treatment measures and prognosis were collected, and the causes, clinical manifestations and emergency treatment measures of anaphylactic shock were descriptively analyzed.Results:The causes of anaphylactic shock in 63 subjects could be divided into drug allergy (50.79%), food allergy (15.87%), blood product allergy (11.11%), others (3.17%), radiotherapy (1.59%), strenuous exercise (1.59%), hemodialysis (1.59%), and the triggers in 9 cases (14.29%) were unclear. The clinical manifestations can be abnormalities of the skin, respiratory system, cardiovascular system, gastrointestinal system and urinary system, among which the most common skin manifestations are wheal rash, itching, redness and swelling (79.37%), the most common manifestation of the respiratory system is dyspnea (30.16%), and the highest proportion of cardiovascular manifestations is blood pressure lower than 90 mmHg or baseline blood pressure drop of 30 mmHg (100.00%). The most commonly used therapeutic drugs were epinephrine (49.2%), glucocorticoids (69.8%), antihistamines (52.4%), vasopressors (12.7%), and others.Conclusion:The causes of anaphylactic shock are different, and the clinical manifestations are complex and diverse, and the condition can be severe and life-threatening. Clinically, attention should be paid to the early and accurate identification of high-risk patients, the prevention of anaphylactic shock, and the timely taking of corresponding measures to protect the life safety of patients once anaphylactic shock occurs. Early diagnosis and prompt treatment are key to managing anaphylactic shock.

The neuroimmune mechanism of rosacea has not been fully elucidated, and it is believed that the innate immune system, immune cells, immune regulation, neuroimmune system, signaling pathway abnormalities and microbial dysbiosis are involved in the progress of the neuroimmune mechanism of rosacea. This article reviews the neuroimmune mechanism of rosacea.

Objective:To investigate the efficacy and safety evaluation of omalizumab in patients with chronic urticaria who are not well treated with antihistamine and have a history of anaphylactic shock.Methods:A retrospective observational real-world study was conducted in which patients with chronic urticaria who were admitted to Peking University First Hospital from November 2018 to January 2024 who were poorly treated with antihistamine drugs and had a history of anaphylactic shock were selected as the study subjects, and 300 mg of omalizumab was injected subcutaneously every 4 weeks, and the occurrence of UCT (urticaria control test), the number of occurrences of anaphylactic shock and other adverse events were recorded during the treatment.Results:Among the 11 patients who started omalizumab treatment for 3 months, 10 patients had complete control of chronic urticaria (UCT=16), 1 patient was partially controlled (UCT=15), and 9 patients did not have anaphylactic shock during follow-up (10 cases after 12 months of follow-up and 1 case after 2 months of follow-up). Two patients developed anaphylactic shock after omalizumab injection. In this study, during the follow-up period (2-38 months), 11 patients were well tolerated with omalizumab, of which 4 continued to use omalizumab for urticaria, 6 stopped using omalizumab due to good urticaria control and no recurrence of anaphylactic shock, and 1 was lost to follow-up.Conclusion:Omalizumab may have good efficacy and safety in patients with chronic urticaria who are poorly treated with antihistamines and have a history of anaphylactic shock, and may have a potential role in preventing anaphylactic shock.

Objective:To investigate the pathogenesis and clinical manifestations of anaphylactic shock and to evaluate the effectiveness of existing treatments, so as to improve the understanding of anaphylactic shock and to properly manage patients with anaphylactic shock.Methods:A retrospective observational study was conducted to select 63 patients with anaphylactic shock who were diagnosed and treated in Peking University First Hospital from July 2017 to June 2023 as the study objects, and the clinical data including basic information, present medical history, vital signs, past medical history, emergency treatment measures and prognosis were collected, and the causes, clinical manifestations and emergency treatment measures of anaphylactic shock were descriptively analyzed.Results:The causes of anaphylactic shock in 63 subjects could be divided into drug allergy (50.79%), food allergy (15.87%), blood product allergy (11.11%), others (3.17%), radiotherapy (1.59%), strenuous exercise (1.59%), hemodialysis (1.59%), and the triggers in 9 cases (14.29%) were unclear. The clinical manifestations can be abnormalities of the skin, respiratory system, cardiovascular system, gastrointestinal system and urinary system, among which the most common skin manifestations are wheal rash, itching, redness and swelling (79.37%), the most common manifestation of the respiratory system is dyspnea (30.16%), and the highest proportion of cardiovascular manifestations is blood pressure lower than 90 mmHg or baseline blood pressure drop of 30 mmHg (100.00%). The most commonly used therapeutic drugs were epinephrine (49.2%), glucocorticoids (69.8%), antihistamines (52.4%), vasopressors (12.7%), and others.Conclusion:The causes of anaphylactic shock are different, and the clinical manifestations are complex and diverse, and the condition can be severe and life-threatening. Clinically, attention should be paid to the early and accurate identification of high-risk patients, the prevention of anaphylactic shock, and the timely taking of corresponding measures to protect the life safety of patients once anaphylactic shock occurs. Early diagnosis and prompt treatment are key to managing anaphylactic shock.

The neuroimmune mechanism of rosacea has not been fully elucidated, and it is believed that the innate immune system, immune cells, immune regulation, neuroimmune system, signaling pathway abnormalities and microbial dysbiosis are involved in the progress of the neuroimmune mechanism of rosacea. This article reviews the neuroimmune mechanism of rosacea.

Autologous serum skin test (ASST) is commonly used as a screening test to assess immune subtypes of chronic spontaneous urticaria (CSU) in clinical practice, but its immunological mechanisms and associations with clinical features and prognosis of CSU are not yet clear. Studies have shown that positive ASST is associated with increased immunoglobulin G autoantibodies, decreased eosinophil and basophil counts, increased CD63 expression on basophils, and changes in circulating inflammatory cytokine levels in CSU patients, but not associated with age, disease duration, and personal or family history of CSU patients, and may be a predictor of severity of chronic urticaria. ASST-positive patients may respond poorly to second-generation H1 antihistamines, slowly to omalizumab, but respond well to cyclosporine and autologous whole blood/serum injections. This review summarizes the immunological and clinical characteristics of ASST-positive patients, and discusses the predictive value of positive ASST for the efficacy of different treatment regimens.

Objective:To evaluate efficacy and safety of dupilumab in the treatment of atopic dermatitis (AD) .Methods:A retrospective study was conducted among patients with AD who showed poor response to topical agents and then received standardized injections of dupilumab for 16 weeks in Department of Dermatology, Peking University First Hospital from June 1, 2020 to September 1, 2021. Basic information on the patients was collected, so were the Investigator′s Global Assessment (IGA), Eczema Area and Severity Index (EASI), Itch Numeric Rating Scale (NRS), Dermatology Life Quality Index (DLQI), and Patient-Oriented Eczema Measure (POEM) scores recorded before and at weeks 2, 4, 8, 12, and 16 during treatment. Adverse reactions were recorded during treatment. Wilcoxon rank sum test was used to compare the scores of all patients at the end of follow-up with those before treatment.Results:A total of 57 patients were enrolled in the study, and all completed 16-week injections and follow-up. At week 16, the patients′ IGA, EASI, NRS, DLQI, and POEM scores significantly decreased from 4.0 (4.0, 5.0), 30.0 (17.2, 36.0), 9.0 (7.0, 10.0), 15.0 (11.5, 20.5), and 19.0 (15.5, 23.0) points respectively at baseline to 1.0 (1.0, 1.0), 4.0 (1.6, 7.3), 1.0 (0.0, 1.0), 3.0 (1.0, 4.0), and 4.0 (2.0, 4.0) points respectively ( Z = 6.65, 6.57, 6.59, 6.57, and 6.57 respectively, all P < 0.001). All the 5 scale scores showed a continuous downward trend within 16 weeks after the start of dupilumab treatment. During the follow-up period, no serious adverse reaction was observed, and only two patients developed conjunctivitis. Conclusion:Dupilumab shows marked efficacy in the treatment of AD, with favorable safety.

Objective:To evaluate the efficacy and safety of baricitinib in the treatment of moderate-to-severe atopic dermatitis (AD) .Methods:From June 2020 to June 2021, patients with moderate-to-severe AD who were insensitive or intolerant to topical agents were enrolled from Department of Dermatology, Peking University First Hospital. Before treatment, the patients were evaluated by 4 scales, including the Investigator′s Global Assessment (IGA), Eczema Area and Severity Index (EASI), Itch Numeric Rating Scale (NRS), and Dermatology Life Quality Index (DLQI) ; meanwhile, photos of skin lesions were taken, routine blood test was performed, blood biochemical indices and total IgE levels were measured. After exclusion of contraindications, the patients were treated with oral baricitinib at a dose of 2 mg/d for 16 weeks. Regular follow-up was conducted at weeks 1, 2, 4, 8, 12, 16 and 20 after the start of treatment, clinical evaluation was carried out with the above 4 scales, and adverse events were recorded during the treatment.Results:A total of 24 patients were enrolled in the study, and all completed 16-week oral treatment and 20-week follow-up. All the 4 scale scores showed a continuous downward trend within 20 weeks after the start of treatment. At week 20, the patients′ IGA, EASI, NRS, and DLQI scores significantly decreased from 4.13 ± 0.61, 37.59 ± 14.86, 6.83 ± 2.26 and 18.67 ± 8.64 points respectively at baseline to 1.12 ± 0.49, 4.53 ± 3.78, 0.72 ± 0.58 and 1.39 ± 0.85 points respectively ( t = 22.70, 10.55, 10.69, 8.40, respectively, all P < 0.001). During the follow-up period, no serious adverse reactions were observed; 3 patients experienced gastric discomfort at the start of oral treatment, but the symptoms disappeared after the treatment continued; 3 developed acute allergic manifestations (1 case of allergic conjunctivitis, 2 cases of acute urticaria), which resolved rapidly after the use of antihistamines without recurrence. Conclusion:Baricitinib can provide a safer and more effective treatment option for patients with moderate-to-severe AD, especially those who are insensitive or intolerant to topical agents and need systemic treatments.

The pathogenesis of rosacea has not been fully elucidated. It is currently believed that genetic factors, local skin immune imbalance, neuroimmune and neurovascular dysfunction, skin barrier function abnormalities, microbiota imbalance, etc., are all involved in the occurrence and development of rosacea. This review summarizes research progress in the pathophysiological pathogenesis of rosacea.