Background: Subcutaneous immunotherapy (SCIT) is now the only treatment that can modify the natural course of allergic rhinitis (AR). However, not all children with AR benefit from SCIT. Objective: To evaluate the efficacy of SCIT in dust-mites-induced AR children and explore correlative factors predicting treatment response to SCIT. Methods: 225 children aged 4–17 years old with AR were recruited from January 2016 to September 2019, and monitored at baseline, 4, 12, and 24 months after the start of SCIT treatment. The visual-analogue-score (VAS) was used to assess the clinical symptoms. Multivariate binary logistic regression analyses and receiver operating characteristic curves were used to explore correlative factors in predicting the efficacy of SCIT. Results: The significant declines in VAS started after 4 months of SCIT and continued to improve throughout the study compared with baseline. An increase in children’s age (OR=0.688, 95%CI: 0.479–0.988) and those with allergic history (OR=0.097, 95%CI: 0.009–1.095) were negatively associated with the risk of poor efficacy. Polysensitized children were more likely to suffer poor efficacy (OR=15.511 95%CI: 1.319–182.355). The clinical response at month 4 (r=0.707) and month 12 (r=0.925) was related to that at month 24. The area under the curve (AUC) for improvement at month 4 and month 12 was 0.746 and 0.860, respectively. Conclusion: Our study confirmed the clinical efficacy of SCIT in AR children. Children with younger age, negative allergic history, and multiple allergens may predict a worse efficacy. The onset of action and the clinical response to SCIT in the second year can be predicted as early as by month 4.

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Since toys are the potential sources of lead contamination for young children, we aim to compare blood lead levels (BLLs) of young children and lead-levels in toys played by the children. A total of 2249 children under 7 years old were investigated using stratified cluster sampling in 6 districts of Shanghai, their parents completed questionnaires and children’s whole blood was collected, and then BLLs were measured using tungsten atomizer absorption spectrophotometer. At the same time, 294 toys from the 6 supermarkets/ toy-stores located in the surrounding 5 districts were collected using stratified cluster sampling and lead levels in toys were measured by a portable X-ray Fluorescence instrument. The geometric mean of the BLLs was 2.02 μg/dL. After adjusting for related confounders, playing with plastic toys is a significant risk factor (β=0.067, P =0.019) for BLL-increment. Plastic toys accounted for the highest proportion (156/294, 53.06%) among the studied toys and had the highest average lead level (39.13 ppm). In the 3 districts where children’s BLLs and toys’ lead levels were both measured, the districts with higher toy lead levels had higher children’s BLLs (the average toy lead levels in Pudong-suburban vs. Xuhui vs. Yangpu supermarkets/ toy-stores: 24.62 vs. 0 vs. 15.43 ppm, P<0.01; the medians of BLLs in Pudong-suburban vs. Xuhui vs. Yangpu children: 2.07 vs. 1.55 vs. 1.50 μg/dL, P<0.001). Lead levels in toys may be associated with the BLLs of young children, and lead contamination in plastic toys need cautions for preventing young children from potential lead exposure.