Objective: To explore the clinical distribution characteristics and changes of common inhalant allergens and food allergens in all outpatient and inpatient children visiting Shanghai Children's Hospital from 2020 to 2024, and to provide a basis for the diagnosis, treatment and prevention of allergic diseases in children. Methods: A retrospective cohort study was conducted to retrospectively enroll all outpatient and inpatient children who visited Shanghai Children's Hospital and underwent serum allergen-specific IgE (sIgE) antibody testing from January 2020 to August 2024, and the characteristics and changing trends of allergens in the past 5 years were analyzed. A total of 127 310 tests were included. There were 76 776 male tests (60.31%) and 50 534 female tests (39.69%). There were 27 392 tests (21.52%) aged 0-3 years (infant group), 51 596 tests (40.53%) aged 4-6 years (preschool group), 44 574 tests (35.01%) aged 7-12 years (school-age group), and 3 748 tests (2.94%) aged 13-18 years (adolescent group). The χ2 test was used for statistical analysis. Results: The difference in total positivity rate between different years was statistically significant (χ2=2 907.478, P<0.001). The positive rates of inhalant allergens such as house dust, Dermatophagoides pteronyssinus/Dermatophagoides farinae, cockroach, cat dander, mugwort, Humulus scandens, mold fungi mix, and food allergens such as beef and mutton increased significantly with age (The χ2 values were 649.496, 3 414.686, 303.247, 1 277.408, 40.477, 189.952, 600.737, 203.198, and 15.301, respectively, and the P values were <0.001, <0.001, <0.001, <0.001, <0.001, <0.001,<0.001,<0.001, and 0.002, respectively). The positive rates of inhalant allergen such as Ambrosia elatior (1.59%) and food allergens such as egg white (17.36%), milk (30.48%), shrimp (8.27%), crab (8.13%), codfish (2.61%), salmon (0.66%), mytilus edulis (2.89%), lobster/scallop (5.27%), cashew nuts (5.09%), peanuts (3.54%), and soybean (1.73%) were highest at the age of 0-3 years and decreased significantly with age (The χ2 values were 10.365, 2 407.443, 139.085, 872.548, 870.245, 106.823, 47.674, 47.244, 559.422, 369.800, 384.788, 153.660, respectively, and the P values were 0.016, 0.000,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,<0.001, respectively). Inhaled allergens mainly have a greater impact on children with respiratory-related diseases such as allergic rhinitis and asthma, while food allergens mainly have a greater impact on children with atopic dermatitis/eczema. The positive rate of sIgE of various allergens in the allergic rhinitis combined asthma group were higher than that of allergic rhinitis alone, and the sIgE positive rate of total allergens and inhaled allergens was significantly higher than that of allergic rhinitis alone (χ2=20.851, 39.155, the P values were both<0.001). Among them, the sIgE positive rate of Ambrosia elatior and cashew nuts showed significant difference (χ2=5.044, 8.420, P=0.025, 0.004); and the sIgE positive rate of Dermatophagoides pteronyssinus/Dermatophagoides farinae, cat dander, grass pollens mix and mold fungi mix had extremely significant difference (χ2=26.409, 25.990, 21.283, 16.411, the P values were all <0.001). The inhaled allergens and food allergens with the highest positive rates in the 5 years were Dermatophagoides pteronyssinus/Dermatophagoides farinae (56.21%) and milk (47.47%), and as time went by, the positive rates gradually decreased. There is a moderate correlation between the three allergens of Ambrosia elatior, Amaranthus retroflexus, and tree pollens mix (0.55, 0.70, 0.63), and there is a moderate correlation between mango and tree pollens mix (0.50). Conclusion: Dermatophagoides pteronyssinus/Dermatophagoides farinae, cat dander, dog dander, egg white, and milk may be important allergens for children in Shanghai City from 2020 to 2024. The positive rates vary among different genders, age groups, and disease groups, but the positive rates of Dermatophagoides pteronyssinus/Dermatophagoides farinae, milk and cat dander allergens remain in the top three.
目的： 探讨2020—2024年在上海市儿童医院就诊的所有门诊和住院患儿常见吸入性过敏原和食物性过敏原的临床分布特征及其变化，为儿童过敏性疾病的诊断、治疗及预防提供依据。 方法： 采用回顾性队列研究，回顾性纳入2020年1月至2024年8月就诊于上海市儿童医院并进行血清过敏原特异性IgE（sIgE）抗体检测的所有门诊和住院患儿，分析近5年期间过敏原的特征及变化趋势，共计纳入127 310例次检测。男性76 776例次（60.31%），女性50 534例次（39.69%）。0~3岁（婴幼儿组）27 392例次（21.52%）、4~6岁（学龄前组）51 596例次（40.53%）、7~12岁（学龄组）44 574例次（35.01%）、13~18岁（青春期组）3 748例次（2.94%）。统计学方法采用χ2检验。 结果： 不同年份之间总阳性率差异具有统计学意义（χ2=2 907.478，P<0.001）。吸入性过敏原中的屋尘、屋尘螨/粉尘螨、蟑螂、猫毛皮屑、艾蒿、葎草、霉菌组合和食物性过敏原中的牛肉、羊肉等阳性率随着年龄的增长显著升高（χ2值分别为649.496、3 414.686、303.247、1 277.408、40.477、189.952、600.737、203.198、15.301，P值分别为<0.001、0.000、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、0.002）的趋势。吸入性过敏原中的矮豚草（1.59%）和食物性过敏原中的鸡蛋白（17.36%）、牛奶（30.48%）、虾（8.27%）、蟹（8.13%）、鳕鱼（2.61%）、鲑鱼（0.66%）、贝（2.89%）、龙虾/扇贝（5.27%）、腰果（5.09%）、花生（3.54%）、黄豆（1.73%）的阳性率在患儿0~3岁时最高，随着年龄的增长显著下降（χ2值分别为10.365、2 407.443、139.085、872.548、870.245、106.823、47.674、47.244、559.422、369.800、384.788、153.660，P值分别为0.016、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001）。吸入性过敏原主要对过敏性鼻炎、哮喘等呼吸道相关疾病患儿影响较大，而食物性过敏原主要对特应性皮炎/湿疹的患儿影响较大。过敏性鼻炎合并哮喘组在各项过敏原sIgE中的阳性率高于单纯过敏性鼻炎组，总过敏原和吸入性过敏原的sIgE阳性率均显著高于单纯过敏性鼻炎组（χ2=20.851、39.155，P值均为<0.001）；其中，矮豚草、腰果sIgE表现出显著性差异（χ2=5.044、8.420，P=0.025、0.004），屋尘螨/粉尘螨、猫毛皮屑、混合草、霉菌组合sIgE具有显著差异（χ2=26.409、25.990、21.283、16.411，P值均为<0.001）。5年间阳性率最高的吸入性过敏原和食物性过敏原分别为屋尘螨/粉尘螨（56.21%）、牛奶（47.47%），且随着时间的推移，阳性率逐步下降。矮豚草、苋、树花粉组合3种过敏原之间存在互为中度相关性（0.55、0.70、0.63），芒果与树花粉组合（0.50）之间存在中度相关性。 结论： 屋尘螨/粉尘螨、猫毛皮屑、狗毛皮屑、鸡蛋白、牛奶可能是2020—2024年上海地区儿童重要的过敏原，不同性别、年龄组、疾病组阳性率有差异，但屋尘螨/粉尘螨、牛奶、猫毛皮屑过敏原阳性率基本保持在前三位。.