Objective: To analyze the age-specific differences and temporal trends in triggers of pediatric anaphylaxis from 2015 to 2024, aiming to provide evidence for optimizing clinical diagnosis, treatment, and allergy management strategies. Methods: This was a single-center retrospective study. Patients who attended the Department of Allergy, Beijing Children's Hospital, from January 2015 to December 2024 were initially screened based on based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes and clinical diagnoses. Cases meeting the diagnostic criteria for anaphylaxis were included after secondary verification by allergy specialists. A total of 635 children were included. According to age at first onset, they were divided into infant/toddler group (0-2 years, n=227), preschool group (3-6 years, n=143), school-age group (7-12 years, n=211), and adolescent group (13-17 years, n=54). Basic demographic data, suspected clinical triggers, and comorbid allergic diseases were collected. Suspected triggers were determined by integrating clinical history with allergen-specific immunoglobulin E (sIgE) results and skin prick test findings. The chi-square test and Cochran-Armitage trend test were employed for intergroup comparisons and trend analyses. Results: A total of 635 pediatric patients were enrolled, with the highest incidence of onset in the 0-2 years age group (227 cases, 35.7%). Males accounted for 64.6% (410/635) and females 35.4% (225/635). The most common comorbid allergic disease was allergic rhinitis/allergic conjunctivitis (303 cases, 47.7%), followed by bronchial asthma (145 cases, 22.8%). A total of 845 episodes of anaphylaxis were analyzed, with food being the predominant trigger (81.1%, 685/845), followed by food-dependent exercise-induced anaphylaxis/exercise-induced anaphylaxis (11.6%, 98/845), idiopathic causes (3.8%, 32/845), and suspect drugs (2.5%, 21/845). The leading food triggers were cow's milk (11.2%, 95/845), wheat (9.6%, 81/845), and hen's egg (8.5%, 72/845); fruits/vegetables and nuts/seeds accounted for 20.9% (177/845) and 10.1% (85/845), respectively. Overall trigger analysis showed that the proportion of food-induced anaphylaxis decreased significantly with increasing age, from 95.8% in the 0-2 years group to 52.7% in the 13-17 years group (Z=-10.718, P<0.001). In contrast, the proportion of food-dependent exercise-induced/exercise-induced anaphylaxis increased significantly with age, from 0.4% (1/284) in the 0-2 years group to 35.1% (26/74) in the 13-17 years group (Z=10.881, P<0.001). Age-trend analysis for specific food triggers revealed that allergies to cow's milk, hen's egg, and wheat all showed a significant downward trend with age (Z=-9.518, -9.797, -9.233, respectively; all P<0.001), while allergies to fruits/vegetables increased significantly with age (Z=5.909, P<0.001). Buckwheat and nut/seed allergies were most prevalent in the 3-6 years age group, with no statistically significant age-related trend (P=0.518 and P=0.174, respectively). Comparison of trigger proportions between the periods 2015-2019 and 2020-2024 demonstrated a significant decrease in the overall proportion of food triggers, from 88.0% to 79.0% (χ2=8.209, P=0.004). The proportion of food-dependent exercise-induced anaphylaxis/exercise-induced anaphylaxis increased significantly (χ2=16.758, P<0.001), while the proportion of drug-induced anaphylaxis decreased significantly (χ2=9.827, P=0.002). No statistically significant changes were observed in the proportions of idiopathic and other triggers (both P>0.05). Among specific food triggers, the proportions of nuts/seeds (χ²=12.46, P<0.001) and fruits/vegetables (χ2=7.636, P=0.006) increased significantly, whereas the proportions of cow's milk (χ2=24.999, P<0.001), wheat (χ2=5.891, P=0.015), legumes (χ2=7.394, P=0.007), and seafood/fish (χ2=4.161, P=0.041) decreased significantly. Conclusion: Based on this single-center 10-year retrospective data, triggers of pediatric anaphylaxis from 2015 to 2024 show age-related differences and temporal trends. Clinically, stratified and individualized allergy management strategies should be implemented, taking into account age-specific characteristics and period evolution, to provide evidence for precise prevention and control of pediatric anaphylaxis.

Feline herpesvirus-1 (FHV-1) modified live vaccine (MLV) is designated as a core vaccine for cats. As reported here, two 2-month-old domestic short hair cats (Cat 1 and Cat 2; the two were littermates) initially presented with sneezing, nasal and ocular discharge, and ocular discomfort (Day 0), which had persisted since their vaccination. At 1.5 months of age, both cats were vaccinated with a vaccine containing the FHV-1 MLV strain F2 at another clinic. A few days later, they developed sneezing and ocular discharge almost simultaneously. Ten days after vaccination, they were diagnosed with allergic conjunctivitis and administered corticosteroid eye drops for 7 days. On Day 0, both cats presented with dendritic ulcers in one eye and a superficial corneal ulcer in the other eye. Treatment with oral antiherpesvirus medication and hyaluronic acid eye drops was initiated. A genomic analysis of FHV-1 strains isolated on Day 0 and of specimens obtained on Day 3 for real-time PCR suggested that both cats were infected with the same strain as the F2 strain and that there was no mixed infection with the field strain. Real-time PCR was performed to identify ocular surface pathogens other than FHV-1, and feline calicivirus (FCV) was detected in specimens collected from the superficial corneal ulcers of both cats on Day 3. On Day 6, dendritic ulcers in both cats healed. On Day 15, superficial corneal ulcers in both cats developed corneal crystalline deposits and deep neovascularization. In the eyes with superficial corneal ulcers in both cats, symblepharon subsequently developed in Cat 1, and eosinophilic keratitis subsequently developed in Cat 2. In conclusion, findings suggested that corneal ulcers caused by the F2 strain may be associated with the development of specific corneal lesions in cats that were young, that had a coinfection with FCV, and that were administered corticosteroids.

Anti-TNF-α therapies, though known for their anti-inflammatory effects, have been associated with paradoxical inflammatory reactions, of which anterior uveitis is the most common. We report a case of recurrent bilateral cicatricial conjunctivitis linked to systemic adalimumab (ADA) treatment in a 66-year-old man with rheumatoid arthritis (RA). The patient experienced worsening bilateral red eyes, blurry vision, and discomfort following each ADA injection. Examination revealed signs of cicatricial inflammation, which responded to corticosteroids but recurred after subsequent ADA doses. Despite these ocular events, adalimumab was continued due to its effective control of systemic RA, with close ophthalmic monitoring. This case suggests a potential direct association between ADA and cicatricial conjunctivitis, a previously undescribed complication. Aggressive topical corticosteroid treatment may allow the continuation of ADA without compromising systemic disease control.

Dupilumab is a monoclonal antibody that targets interleukin (IL)-4 and IL-13, approved for the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). While common adverse effects such as conjunctivitis and injection-site reactions are well characterized, headaches reported in clinical trials are typically described as mild, non-specific, and rarely treatment-limiting. We describe two patients with CRSwNP who developed severe, recurrent headaches shortly after initiating dupilumab therapy. In one case, symptoms improved after discontinuation and recurred upon rechallenge; in the other, the headaches resolved after discontinuation. These observations raise the possibility that dupilumab-associated headaches may occasionally be more severe than previously appreciated. Clinicians should be aware of this potential association when evaluating new-onset headaches in patients receiving dupilumab.

Neisseria gonorrhoeae conjunctivitis is rare in adults but may rapidly progress to vision-threatening complications. Peripheral ulcerative keratitis (PUK) is an unusual and severe manifestation. A 42-year-old male presented with bilateral ocular pain, swelling, and profuse purulent discharge for 15 days, leading to inability to open his eyes. History revealed recent urethral discharge and multiple sexual contacts. Ocular examination showed severe conjunctival chemosis and peripheral corneal thinning with descemetocele formation. Gram stain of conjunctival swabs demonstrated intracellular gram-negative diplococci. Serology revealed positive VDRL and TPHA (late latent syphilis). HIV and Chlamydia trachomatis testing were unavailable. The patient received intravenous ceftriaxone 1 g twice daily, oral doxycycline, and topical fortified antibiotics. Due to progressive corneal thinning, bilateral amniotic membrane grafting with perilimbal conjunctival excision and bandage contact lens placement was performed. Syphilis was treated with three weekly doses of benzathine penicillin G. At 6 weeks, vision improved to 6/9 bilaterally with healed ulcers and clear corneas. Gonococcal conjunctivitis in adults can rapidly progress to peripheral ulcerative keratitis. Early diagnosis, broad STI screening, systemic therapy, and timely surgical intervention are critical for preserving vision.

We report a unique case of a 32-year-old woman with a 4-day history of painful right lacrimal gland swelling. MRI demonstrated enhancement and enlargement of the right lacrimal gland. There were nonenhancing, intraglandular foci, with low signal on T2-weighted sequences and marked restricted diffusion. Surgical excision revealed multiple dacryoliths centered on an impacted eyelash. Microbiological evaluation yielded Streptococcus pneumoniae and histopathology confirmed noncalcified ductal dacryoliths with a background of acute inflammation. At 1-month follow-up, symptoms completely resolved with no evidence of recurrence. Lacrimal gland dacryolithiasis is rare and usually presents as refractory conjunctivitis or a chronic lateral conjunctival or canthal mass, rather than acute dacryoadenitis. This case expands the clinicoradiological spectrum of this rare entity and highlights novel MRI patterns that may aid preoperative diagnosis and timely management.

This study reports a 50-year-old male case of Thelazia callipaeda infection without a history of pet contact. The patient exhibited chronic ocular surface inflammation after exposure to wild insects and was misdiagnosed multiple times with bacterial conjunctivitis before definitive diagnosis by an ophthalmic specialist. This report emphasizes the core steps of the T. callipaeda extraction procedure. These steps include preoperative preparation, topical ocular anesthesia using 0.4% oxybuprocaine hydrochloride eye drops, sufficient exposure of the surgical field with an eyelid speculum, precise clamping and complete removal of nematodes under ophthalmic visualization, and immediate postoperative management. The entire procedure was recorded in a supplementary operative video. Additionally, the procedure can be conducted under conventional outpatient clinic conditions, making it suitable for primary medical institutions. Postoperatively, the patient received anti-infective therapy with 0.5% levofloxacin eye drops, administered four times daily, and ocular surface moisturization with 0.1% sodium hyaluronate eye drops, administered four times daily, for 1 week, with standard follow-up at 1, 3, and 6 months postoperatively. The clinical manifestations, including conjunctival hyperemia and foreign body sensation, were completely alleviated without recurrence, and ocular surface function returned to normal. Etiological confirmation was verified through morphological observation, characterized by serrated cuticular striations, a hexagonal buccal capsule, and a gravid female reproductive system, and recombinase polymerase amplification-CRISPR-Cas12a molecular detection targeting the 18S ribosomal ribonucleic acid gene. Critical procedural precautions to prevent nematode fragmentation and residual inflammation are also underscored. This case enriches the clinical reports of T. callipaeda. infection without a pet contact history and offers a practical diagnosis and treatment protocol for ophthalmologists.