Background: The Visual Analogue Scale (VAS) is recommended for assessing allergic rhinitis severity and treatment response. Determination of the minimal clinically important difference (MCID) of the VAS assists physicians in making treatment decisions. Objective: This study aimed to determine the MCID of the VAS in Thai patients with allergic rhinitis. Methods: A prospective study was conducted in adult patients with allergic rhinitis. Participants recorded daily VAS scores for 28 days using a 100-mm scale (0 = not at all bothersome; 100 = most bothersome), and symptom change was evaluated using the Global Rating of Change Scale. MCID was calculated using anchor-based and distribution-based methods. The anchor-based estimate was determined as the primary value for interpretation because it directly reflects patient-perceived change. Results: A total of 316 patients were analyzed. Mean VAS scores decreased throughout the treatment period. The anchor-based MCID of VAS was 43.86 ± 27.49, whereas the distribution-based MCID was 32.25 mm. The mean VAS change reached the MCID threshold on day 5 after treatment. Conclusion: The MCID of the VAS for Thai patients with allergic rhinitis was 43.86 mm. Clinically meaningful improvement is generally perceived after 5 days of treatment, suggesting that this is an optimal follow-up time.

Mast cells represent key regulators within type 2 inflammation and contribute significantly to the pathophysiology of chronic inflammatory airway diseases. Nasal cytology has enabled their consistent identification, highlighting how their interaction with eosinophils influences inflammatory persistence, tissue remodeling, and disease severity in chronic rhinosinusitis with nasal polyps (CRSwNP). In contrast, conventional hematoxylin–eosin histopathology does not reliably visualize mast cells, potentially limiting comprehensive cellular characterization. Through cytological assessment, distinct inflammatory endotypes have been defined, including nonallergic rhinitis with mast cells and nonallergic rhinitis with eosinophils and mast cells, which may represent stages along a continuum progressing toward CRSwNP. The Clinical–Cytological Grading integrates cellular patterns with clinical parameters, identifying eosinophil–mast cell coinfiltration as a marker associated with increased disease severity and recurrence risk. Evidence from both sinonasal and extra-nasal mucosae, including eosinophilic esophagitis, further supports the relevance of mast cells within the broader network of type 2 inflammation. As therapeutic strategies increasingly target specific inflammatory pathways, accurate cellular endotyping becomes essential for refining risk stratification and optimizing biologic therapy selection. Integrating nasal cytology with histological and molecular approaches offers a pragmatic framework for advancing precision medicine in type 2 inflammatory diseases.

Pollen immunotherapy has increasingly gained attention in China. However, the majority of existing research is limited to evaluating therapeutic effects within a 1-year treatment period, with insufficient evidence regarding the longer-term course of treatment. Our study was designed to evaluate the clinical effectiveness and safety of 2-year Artemisia annua sublingual immunotherapy (SLIT) treatment in allergic rhinoconjunctivitis (ARC) patients of all ages. This study was conducted as a nonblind randomized controlled trial. Fifty eligible patients (7-57 years old) sensitized to Artemisia pollen were randomized into SLIT (n = 25) and control groups (n = 25). The SLIT group administered daily Artemisia annua SLIT for 2 years, and the control group only accepted symptomatic medications. Clinical outcomes including total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), combined scores of medication and rhinoconjunctivitis symptom (CSMRS), and the visual analog scale (VAS) scores were assessed across 3 consecutive pollen seasons (2021 as baseline, followed by 2022 and 2023). Additionally, the occurrence of adverse events (AEs) was used to evaluate its safety. Finally, 43 patients (SLIT: 21, control: 22) completed this study. When compared with the control group, the patients in SLIT group exhibited remarkable improvements in TRSS, TMS, CSMRS, and VAS scores during the 2023 pollen season (P < 0.001). Especially, more patients in the SLIT group showed greater improvement in symptoms, medication use, and the overall situation. Notably, no severe AEs were reported throughout the whole study. Two years of Artemisia annua SLIT treatment was effective and well-tolerated in patients with ARC, confirmed by their improved symptoms and reduced medication use.

Bronchial asthma (BA) is a chronic respiratory disease that significantly affects patients' quality of life if not well managed. The Global Initiative for Asthma (GINA) 2022 guidelines open a new, more effective direction in controlling asthma attacks for patients. The study was conducted to describe the current status of BA and the results of asthma control in patients after 3 months of treatment. A prospective longitudinal study was conducted on 47 patients over 12 years old with BA treated at the Department of Allergy, Immunology and Dermatology, Hospital E, from July 2023 to September 2024. The current study assessed BA control after treatment for patients according to GINA 2022 guidelines and the Asthma Control Test (ACT) score. Before treatment, the majority of patients' BA attacks were severe (55.3%) with moderate obstructive ventilatory disorder (42.6%). After treatment, patients' asthma was completely controlled at 93.6%, while respiratory function was significantly improved. After treatment, patients' asthma was well controlled on all 3 assessment scales: GINA 2022 symptom control, ACT score, and respiratory function. Widespread application of GINA 2022 guidelines in BA control in Vietnam is recommended.

Background: Olfactory dysfunction, ranging from mild impairment to complete loss, is a prevalent and bothersome symptom in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Objective: This study aimed to identify risk factors associated with the severity of olfactory dysfunction in the CRSwNP population, which have been largely overlooked. Methods: A total of 282 patients with CRSwNP were enrolled and categorized into normosmia, hyposmia, and anosmia groups according to their olfactory levels examined by the smell identification test specifically for the Chinese population (CSIT). Patients' demographic characteristics, history of asthma, computed tomography (CT)-based imaging scores, blood cytology, immunoglobulin E, and serum lipid profiles were recorded for all participants. Ordinal logistic regression analysis was used to identify risk factors of gradual olfactory dysfunction, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of those factors for discriminating different degrees of olfactory dysfunction from normosmia. Results: Significant differences were observed in age, prevalence of comorbid asthma, blood eosinophils, serum lipid profiles, and CT-based imaging scores of CRSwNP among the 3 groups stratified by olfactory outcomes ( P &lt; 0.05, respectively). Multivariate ordinal logistic regression analysis identified Lund-Mackay scores, ethmoidal-to-maxillary (E/M) sinus ratio, age, and total cholesterol as independent risk factors for gradual olfactory dysfunction in CRSwNP ( P &lt; 0.01, respectively). Correlation analysis indicated that the 4 identified risk factors were all significantly inversely correlated with the olfactory score measured by CSIT ( P &lt; 0.001, respectively). ROC analysis demonstrated that the combined model based on the 4 risk factors showed strong power to discriminate between anosmic and normosmia (area under the curve [AUC]: 0.893, 95% confidence interval [CI]: 0.848–0.939), and moderate accuracy in classifying hyposmia and normosmia (AUC: 0.716, 95% CI: 0.640–0.792). When compared the AUC between different models, the combined model shows a better prediction ability than E/M ratio, age, and total cholesterol alone ( P &lt; 0.05, respectively). Conclusion: Lund-Mackay score, E/M ratio, age, and serum total cholesterol are independent risk factors for gradual olfactory dysfunction in patients with CRSwNP, which can be used to develop a predictive model for olfactory outcomes.

Chronic urticaria (CU) is a biologically heterogeneous inflammatory skin disease characterized by recurrent wheals and/or angioedema. Despite its uniform clinical presentation, the disease encompasses diverse clinical phenotypes and molecular endotypes driven by distinct immune mechanisms. Integrating these patterns is essential for transitioning from empirical management toward precision medicine. This review explores the convergence of observable clinical phenotypes and underlying molecular endotypes to refine diagnosis and guide stratified therapeutic strategies. A comprehensive literature review was conducted, focusing on clinical clusters (eg, pediatric, elderly, and ethnic variations), immunological drivers (type I autoallergy and type IIb autoimmunity), and emerging targeted therapies. Linking clinical phenotypes with molecular endotypes enables a more personalized approach to CU management. Future directions include the validation of point-of-care biomarkers and the utilization of digital phenotyping to achieve disease modification and long-term remission.

Background: Children with food allergies must eliminate allergenic foods from their daily diet and face the risk of accidental ingestion, which can reduce their quality of life (QOL). Objective: This study aimed to develop and validate a Japanese QOL questionnaire consisting of approximately 10 items, specifically designed to align with Japanese cultural and social practices for children with food allergies. Methods: We collected QOL-related events through free-text responses obtained from children aged 9 to 15 years with food allergies and developed a preliminary questionnaire. Based on responses to the primary questionnaire, factor analysis was performed to select items, resulting in a secondary questionnaire comprising 9 items across 3 factors. To validate the secondary questionnaire, we examined its correlation with KINDL, a comprehensive health-related QOL scale for children. Additionally, we compared secondary-questionnaire scores according to the severity of food allergies. Results: A total of 170 children completed the secondary questionnaire, which showed a weak correlation with KINDL ( r = −0.283; P &lt; 0.001). Children who were allergic to 2 or more commonly consumed foods (hen’s eggs, milk, and wheat) scored higher on the questionnaire (≥2 foods vs &lt;2 foods; total score, 0.89 vs 0.56; P = 0.045), indicating lower QOL. However, the secondary questionnaire did not distinguish participants who reported anaphylaxis in the past 3 years. Conclusion: The developed questionnaire demonstrated validity as a QOL instrument for children with food allergies. This tool may improve pediatric food-allergy management, including oral food-challenge tests, oral immunotherapy, and educational programs, contributing to enhanced clinical practice and social support.

Background: Chronic rhinitis, including allergic rhinitis (AR) and nonallergic rhinitis (NAR), is frequently influenced by environmental factors such as temperature. This study aimed to investigate the characteristics of temperature-sensitive rhinitis patients and to explore the effects of temperature on nasal symptoms. Methods: A cross-sectional study was conducted from February 2023 to February 2024 at Beijing Tongren Hospital, enrolling 5,595 adult outpatients with chronic rhinitis. Patients were diagnosed with AR or NAR, with AR further classified into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Standardized questionnaires and serum-specific immunoglobulin E testing were performed. Nasal symptoms (congestion, itching, sneezing, and rhinorrhea) were assessed using a visual analogue scale. A generalized linear model with cubic spline functions was used to examine nonlinear associations between ambient temperature and nasal symptoms, adjusting for potential confounders. Associations between temperature sensitivity, symptom severity, and environmental exposures were analyzed. Results: A total of 83.6% of patients with AR and 84.5% of those with NAR reported temperature sensitivity. Patients sensitive to temperature changes had significantly higher nasal symptom scores than those insensitive to temperature changes ( P &lt; 0.001). The proportion of temperature-sensitive individuals increased with the severity of chronic rhinitis symptoms. In SAR, symptoms exhibited an inverted U -shaped relationship with temperature, peaking around 20°C, which corresponded to the pollen peak. In PAR, low-temperature environments (&lt;20°C) aggravated nasal congestion and were the main factor affecting quality of life. Conclusions: Temperature-sensitive rhinitis patients experience more severe nasal symptoms. Low-temperature environments have the greatest impact on patients with PAR, particularly exacerbating symptoms of nasal congestion. Temperature indirectly affects the nasal symptoms in SAR patients by influencing pollen exposure.

Dear Editor I have read the article titled “Hypersensitivity to liraglutide: A case report” by Marino-Fernández et al. [1] with great interest. However, while reading the case report, I have some questions about the diagnostic and treatment process of this patient. Clarification of these questions regarding this case report would help to better understand the study. There are confusing statements when you read about the performance of skin tests and the evaluation of the intradermal and epidermal tests. For example, intraepidermal 1/1, was this 1/1 undiluted, that is, 1/2 diluted or not diluted at all? In addition, the epidermal skin prick test is called “intraepidermal,” causing misunderstanding. There are 2 types of skin testing utilized in the clinical practice of allergy: percutaneous testing (prick or puncture) and intracutaneous testing (intradermal) [2]. Again, in the interpretation of the intradermal test, “acute positive reaction” is mentioned, and it is not correctly stated whether an early reading of the intradermal test is meant here or another reaction [1]. I think based on this test, the immediate reaction is mentioned in the keywords [1], but this patient did not have an obvious clinical finding of immediate hypersensitivity reaction as described. The rash is said to have started at the site of local injection and then spread to the abdomen, but this was not immediate. Here, I think different types of hypersensitivity are also responsible beyond being IgE-mediated. Even if this reaction was thought to be IgE-mediated, other hypersensitivity mechanisms should have been investigated by patch testing. In addition, although the patient did not meet the criteria for desensitization, they offered it to the patient, but the endocrine team and the patient did not accept it. In the discussion, the authors contradicted themselves by saying that this patient did not deserve desensitization [1]. Figure 1 is not well understood [1]. Also, I think the control test with physiological saline solution for intradermal does not appear to be negative, although it is said to be negative [1]. The initial recommended dose of Liraglutide is 0.6 mg once daily for the first week in the package leaflet. In this case, it is understood that 1.2 mg was started [1]. The starting dose appears to be incorrectly high, and it is not said where this dose was administered subcutaneously. Could these have played a role in the development of this reaction? Such side effects seen in this case are already written in the package leaflet as common and uncommon side effects and are well known. The package insert lists common side effects as injection site reactions (such as bruising, pain, irritation, itching, and rash), and less common are allergic reactions, including skin rash. These commonly reported and known side effects make the case not unique [3]. In the cases reported in the literature, either the drug Liraglutide was changed or such rashes disappeared over time [4]. However, I agree that it is necessary to understand whether these side effects are IgE-mediated or not. In addition, individualized management is not involved in this case either [1]. Because the person’s original medication was not continued or modified in any way. The reason why the patient was started on Liraglutide does not disappear even if this drug is stopped. Tolerable alternative medicines that can be tested and used, for example, semaglutide, have not been identified [4]. In conclusion, I would like to thank the authors for this beautiful case report that allowed us to discuss hypersensitivity reactions to glucagon-like peptide-1 receptor agonists. Conflicts of interest The authors have no financial conflicts of interest.