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.

AIM: To explore a more convenient and accurate method for evaluating the anterior chamber angle width based on the Van Herick method.METHODS:A total of 58 patients(69 eyes)with age-related cataract who visited our hospital between January and December 2021 were included. They were divided into the chamber angle width ≥1/2 corneal thickness(CT)group(44 eyes of 37 cases)and <1/2CT group(25 eyes of 21 cases)according to the Van Herick method. The central anterior chamber depths and the peripheral anterior chamber angle degrees were measured by ultrasound biomicroscopy.RESULTS: There were statistically significant differences in central anterior chamber depth between the two groups(2.64±0.27 mm vs. 2.23±0.29 mm, P<0.01), and the differences of chamber angle degrees of quadrants of superior, temporal, inferior and nasal compared between two groups were all statistically significant(P<0.01). The difference of chamber angle degrees of quadrants of superior and inferior in chamber angle width ≥1/2CT group was not statistically significant(P>0.05), while the differences of chamber angle degrees of other quadrants were all statistically significant(P<0.05). The differences of chamber angle degrees of quadrants of superior and nasal, temporal and the chamber angle degrees of quadrants of inferior and temporal were all statistically significant in chamber angle width <1/2CT group(P<0.05).CONCLUSION: In the overall evaluation of the anterior chamber angle, it would be more simple, fast and accurate when evaluating the temporal chamber angle width and inferior quadrant of chamber angle width by using the Van Herick method under silt lamp.

In recent years, rituximab has been gradually used in the treatment of idiopathic membranous nephropathy (IMN). Compared with traditional treatments, the safety and effectiveness of rituximab in the treatment of IMN have been confirmed, which induces remission in 60%-80% of patients. For the remaining 20%-40% patients, several mechanisms can explain rituximab resistance: decreased rituximab bioavailability; internalized by targeted B cells; the generation of anti-rituximab antibody; chronic and irreversible damage to the glomerular filtration barrier; autoreactive B-cell clones in secondary lymphoid organs that cannot be effectively eliminated. The treatment of patients with rituximab-refractory IMN remains controversial and challenging. The recognition of IMN as an antibody-mediated autoimmune disease has rationalized the use of immunosuppressive drugs such as B cell-targeted therapies, plasma cell-targeted therapies, and complement inhibitors. This review mainly summarizes recent advances in the understanding of the physiological mechanisms of rituximab resistance, and in the management of rituximab-refractory IMN, aiming to aid in the clinical management of IMN.

Recently, the number of children with asthma reported after thunderstorm weather in China has increased rapidly, which has aroused the public concern.At present, there are 28 documented episodes of epidemic thunderstorm asthma in the world, which can be life-threatening in severe cases.Children with allergic rhinitis or uncontrolled asthma were more susceptible to thunderstorm asthma.This article introduces the epidemiology, mechanism, risk factors, manifestations, management strategies and prevention of thunderstorm asthma, in order to improve pediatricians′ understanding of thunderstorm asthma and reduce the impact of it.

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.

Type 2 immunity involves Th2 cells, type 2 innate lymphoid cells(ILC2), and type 2 cytokines such as interleukin (IL)-4, IL-5, and IL-13.Invasion by allergens or harmful substances can cause an excessive type 2 immune response, resulting in type 2 inflammation characterized by the increase in type 2 cytokines, eosinophils, and serum total IgE/specific IgE.Type 2 cytokines are the core of type 2 inflammation, of which production and secretion involve Th2 cells and ILC2.Disruption of barrier function can activate type 2 inflammation and contribute to the vicious cycle.Type 2 inflammation is a common pathophysiological mechanism in many diseases, especially allergic diseases.Type 2 inflammatory disease in children mostly affects the skin, respiratory tract, and gastrointestinal tract.Multiple type 2 inflammatory diseases often co-exist, increasing the disease burden in children.With deepening research on the mechanism of type 2 inflammation, the biotherapy has gained more and more attention.This paper focused on the mechanism, identification and biologics of type 2 inflammation in order to improve clinicians′ understanding of type 2 inflammatory diseases in children.

Asthma is a common chronic respiratory disease in children.Adolescent asthma is characterized by high prevalence rate, high mortality and poor disease control.The optimal adolescent asthma management is crucial to improve asthma control, as well as reduce the burden of asthma including mortality.The key of the management in adolescents with asthma is the self-management, which involves individual, family and social aspects.The imbalance between physical development and psychological development in adolescents leads to many challenges in the self-management in adolescents with asthma.This review elaborates the current situation, influence factors and promotional strategies of self-management in adolescents with asthma so as to achieve the optimal asthma self-management.

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.

Asthma is the most common chronic respiratory disease in children, and its prevalence has shown an obvious upward trend in recent years.Adolescence is a critical stage when adolescents undergo rapid psychological and physical developmental changes.The management of asthma in adolescents is different from that in childhood and adulthood.Further attention should be paid to the diagnosis and management of asthma in adolescents.The Global Initiative for Asthma 2022 (GINA 2022) had updated the content of evaluation and treatment of severe asthma in adolescents.In this article, the contents related to the diagnosis, assessment, initial treatment and adjustment, severe asthma management and self-management of adolescent asthma in GINA 2022 were interpreted, in order to provide reference for the diagnosis and treatment of adolescent asthma and improve the management of asthma in adolescents.