Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991‐2018

Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8‐9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime (“ever had”) rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.

Atopic Status in Children with Asthma and Respiratory Allergies—Comparative Analysis of Total IgE, ImmunoCAP Phadiatop/fx5 and Euroimmun Pediatric Immunoblot

Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinically manifested allergies, multiscreen test ImmunoCAP Phadiatop/fx5 showed positivity and confirmed atopy. Our results showed a significant moderate to strong correlation between multiscreen ImmunoCAP Phadiatop/fx5, and Euroimmun specific IgE titers against aero-allergens—cats, mites, tree mix and food allergens—soy, wheat (р = 0.006), rice, р = 0.090), apple р = 0.007) and peanut. A sensitivity of 63% and specificity of 73.5% was observed for EUROIMMUN Pediatric (food allergens, IgE titer > 1) compared with the gold standard ImmunoCap/fx5. The mean value of total IgE is significantly higher in children with asthma and concomitant with allergic rhinitis compared to those without allergic rhinitis (mean 202.52 U/mL, IQR 102.50 (24.20–363.95) vs. 316.68, IQR 261.00 (109.20–552.50), p = 0.005). Conclusion: Establishing the spectrum of the most common respiratory and food allergens is an essential factor for maintaining asthma control, both through a strategy to avoid allergen exposure and by developing a recommendation plan. The immunoblotting technique is easily applicable in daily clinical and laboratory practice. It is also a cost-effective and reliable alternative to the “gold standard” ImmunoCAP Phadiatop/fx5 in diagnosing atopy in children.

Allergenicity to worldwide invasive grass Cortaderia selloana as environmental risk to public health

Allergies to grass pollen affects about 20% of the population worldwide. In the last few decades, the South American grass Cortaderia selloana (CS, Pampas grass) has expanded worldwide in a variety of countries including the USA, Australia and Western Europe. In many of these locations, CS has strikingly spread and has now been classified an invasive species. Many pernicious consequences of CS have been reported for local biodiversity, landscape and structures. However, the effect on human health has not been studied. To investigate this issue, we have chosen a European region on the northern cost of Spain where CS spread is overwhelming, Cantabria. We obtained CS pollen extract and analysed the allergenic reaction of 98 patients that were allergic to pollen of local grasses. We determined the skin reaction and the presence of specific IgE antibodies (sIgE) to CS or to a typical autochthonous grass, Phleum pratense. We also compared the seasonal symptoms with reported grass pollen counts in the area. The results strongly suggest that CS can cause respiratory allergies at a similar extent to the local grasses. Given that CS pollinises later than the local grasses, this would extend the period of grass allergies in the region for about three months every year, as stated by most of the patients. This is the first study reported on the effects of the striking expansion of CS on human health. Considering the strong impact that respiratory allergies have on the population, our results suggest that CS can currently constitute a relevant environmental health issue.

PLANT POLLINATION CALENDAR AND ITS IMPORTANCE FOR OPTIMIZATION OF THE TREATMENT AND REHABILITATION OF PATIENTS WITH SENSITIZATION TO PLANT POLLEN ON THE SOUTHERN COAST OF THE CRIMEA

Air-aerosol pollen of plants can influence the results of climatotherapy and elimination therapy of respiratory allergic diseases. The diversity of the flora, the poorly studied prevalence and etiology of pollinosis on the Southern coast of the Crimea determine the need for aeropalinological studies of this region to optimize the treatment and rehabilitation of patients with respiratory sensitization. Objective To determine the content of plant pollen in the air, to develop a calendar of palination of plants in the Yalta resort, to identify periods that are potentially unfavorable for the stay of patients with pollen sensitization on the Southern coast of the Crimea. Material and methods Plant pollen in the air was determined gravimetrically. The taxonomic affiliation was identified and the amount of pollen deposited on the glass-traps in the coastal and foothill areas of Yalta city was calculated. The data obtained were averaged over the city as a whole. Results In 2011-2013, 19 pollen taxa were identified in the air of the resort, including 10 with sensitizing properties. Of these, cypress pollen accounted for 49.7% of the average annual amount, deciduous trees with allergenic pollen 4.7%, cereals and weeds 1.6% each. 79.0% of pollen was recorded in spring, 7.7% in summer, 8.6% in autumn, 4.7% in winter. In the air of the coastal area of the city, 2.2 times less pollen was detected than in the air of the foothill. Three waves of plants pollination were revealed: winter-spring pollination of trees and shrubs, late spring pollination of cereals, summer-autumn pollination of weeds. The calendar of pollination of plants of the Yalta resort has been developed. Conclusion The greatest risk of sensitization and exacerbation of respiratory allergies in the Yalta resort is created by cypress pollen in March April. The most favorable for the treatment and rehabilitation of patients with respiratory allergies is the coastal area of the resort. The developed plant pollination calendar allows predicting unfavorable aeropalinological periods, optimizing the treatment and rehabilitation of patients with pollen sensitization at the Yalta resort.

The Clinical and Biological Effects of Homeopathically Prepared Signaling Molecules: A Scoping Review

Background Signaling molecules such as cytokines and interleukins are key mediators for the immune response in responding to internal or external stimuli. Homeopathically prepared signaling molecules have been used therapeutically for about five decades. However, these types of products are not available in many countries and their usage by homoeopaths is also infrequent. The aim of this scoping review is to map the available pre-clinical and clinical data related to the therapeutic use of homeopathically prepared signaling molecules. Methods We conducted a scoping review of clinical and pre-clinical studies of therapeutically used signaling molecules that have been prepared in accordance with an officially recognized homeopathic pharmacopoeia. Articles in peer-reviewed journals reporting original clinical or pre-clinical research of homeopathically prepared signaling molecules such as interleukins, cytokines, antibodies, growth factors, neuropeptides and hormones, were eligible. Non-English language papers were excluded, unless we were able to obtain an English translation. An appraisal of eligible studies took place by rating the direction of the outcomes on a five-point scale. The quality of the papers was not systematically assessed. Results Twenty-eight eligible papers, reporting findings for four different manufacturers' products, were identified and reviewed. Seventeen papers reported pre-clinical studies, and 11 reported clinical studies (six experimental, five observational). A wide range of signaling molecules, as well as normal T-cell expressed specific nucleic acids, were used. A majority of the products (21 of 28) contained two or more signaling molecules. The most common clinical indications were psoriasis, vitiligo, rheumatoid arthritis, respiratory allergies, polycystic ovary syndrome, and herpes. The direction of the outcomes was positive in 26 papers and unclear in two papers. Conclusion This scoping review found that there is a body of evidence on the use of homeopathically prepared signaling molecules. From a homeopathy perspective, these substances appear to have therapeutic potential. Further steps to explore this potential are warranted.

Characterization of Medical Conditions of Children with Sickle Cell Disease in the United States: Findings from the 2007-2018 National Health Interview Surveys (NHIS)

Background: Sickle cell disease (SCD), one of the most common genetic disorders in the United States (US), affects 70,000 to 100,000 children. The burden is greatest among the African American population, where SCD impacts 1 in 365 live births. Children with SCD have been observed to have lower Health-Related Quality of life (HRQoL) due to the impact of severe disease-related complications and comorbidities, including infections, pain crises, acute chest syndrome, metabolic alterations and overt stroke. SCD and its related comorbidity and complications result in increased health care utilization, particularly emergency department use- which accounts for 80% of medical expenditure. Further, studies using US population-based data to characterize the health status and health care utilization for SCD children is lacking. With the exception of a study conducted by Boulet et al. in 2010, which examined the 1997-2005 National Health Interview Surveys (NHIS) data to describe health status and health services use among Black children aged 0-17 years with SCD. To fill this important gap, we used the 2007-2018 NHIS data to describe health status and health services use among SCD children aged 0-17 years and conducted a sub-analysis for Black children to better characterize SCD- related medical conditions affecting this population and health care utilization patterns. Methods: The study included an unweighted sample of 133,542 children, with 68,745 male children and 64,797 female children. Questionnaires were answered by a parent/guardian on behalf of the child. We examined (1) the prevalence of medical comorbidities; (2) indicators of functional status and perceived health status; (3) use of healthcare services; (4) barriers to accessing healthcare services; and (5) association of the comorbidities with the utilization of care. We hypothesized that Black children with SCD would have higher levels of disease-related complications and comorbidities, as well as healthcare utilization than their counterparts without SCD. We used logistic regression to compare the associations between 'SCD' and 'No SCD' on various medical conditions for all races and for Black children only groups. Results: Of the 133,542 children, 215 have SCD (.16%). Among the SCD children, 51.1% are male, Black: 170 (79.1%), White: 16 (7.44%), American Indian: 1(.47%), Asian 2 (.93%): other races: 21 (9.77%) and Multiple Races 5 (2.33%). Black children had a higher prevalence of SCD than other races and Black children with SCD were more likely to have a household income &lt; 1% of the federal poverty levels compared to those without. After applying the appropriate weights to each of the demographics, children of all races with SCD had higher adjusted odds (Adjusted Odds Ratio -AOR) of having anemia (AOR 37.6; CI: 22.3, 63.3: p=0.000), respiratory allergies (AOR 2.2; CI: 1.3, 3.8; p=0.005), food/digestive allergies (AOR 2.1; CI: 1.0, 4.1: p=0.042), eczema/skin allergies (AOR 2.1; CI: 1.3, 3.6: p=0.004), and frequent severe headaches/migraines (AOR 2.2; CI: 1.1, 4.3; p=0.024). Children with SCD are also more likely to experience frequent diarrhea/colitis, although statistically non-significant. Among Black children, those with SCD had higher odds of having the following medical conditions including anemia (AOR 18.7; CI: 10.7,32.3: p=0.000), and respiratory allergies (AOR 2.4; CI: 1.3, 4.4: p=0.004) and also more likely to experience other conditions including food/digestive allergies, eczema/skin allergies, and frequent severe headaches/migraines, although statistically non-significant (p&gt;0.5). Children of all races (26.0%) and Black children (28.8%) with SCD had at least 2 or more annual emergency room visits (p=0.000). Conclusion: Our study findings indicate that children with SCD for all races experienced significant comorbid conditions associated with disease status. Moreover, among Black children, those with SCD have increased SCD related comorbidity, worse health status, and an increased number of visits to the emergency room compared to children without SCD. This creates the urgency to address the health burden for Black children with SCD, by identifying 'beneficial' health care utilization services (non-emergency services) that improves the quality of life for SCD children. Future research should address residual gaps in information about health burden and healthcare utilization among SCD population in the US. Disclosures No relevant conflicts of interest to declare.

Purified Native and Recombinant Major Alternaria Alternata Allergen (Alt a 1) Induces Allergic Asthma in the Murine Model

Aeroallergens such us the spores of Alternaria alternata are described as the most important agents associated with respiratory allergies and severe asthma. Various experimental models of asthma have been developed using A. alternata extracts to study the pathogenesis of asthma, establishing the main parameters that trigger the asthmatic response. In this study, we describe a mouse model of asthma induced only by Alt a 1. To induce the allergic response, mice were challenged intranasally with the major allergen of A. alternata, Alt a 1. The presence of eosinophils in the lungs, elevated concentrations of Th2 family cytokines, lymphocyte proliferation and elevated IgE total serum levels indicated that the sensitisation and challenge with Alt a 1 induced the development of airway inflammation. Histological studies showed an eosinophilic cellular infiltrate in the lung tissue of mice instilled with Alt a 1. We demonstrate that Alt a 1 alone is capable of inducing a lung inflammatory response with an increase in IgE serum levels mimicking the allergic asthma immunoresponse when it is administered into BALB/c mice. This model will allow the evaluation of the immunoregulatory or immunotolerant capacity of several molecules that can be used in targeted immunotherapy for fungal allergic asthma.

Human allergy to cats: A review for veterinarians on prevalence, causes, symptoms and control

Practical relevance: Human allergy to cats affects a substantial and growing proportion of the global population, and cat allergy is regarded as the third most common cause of human respiratory allergies, and the second most common indoor cause. Veterinarians will frequently encounter owners who are cat-allergic, and having an understanding of this disease and the methods available to help control the allergy will assist them in giving appropriate advice, alongside human healthcare professionals. Aim: The aim of this review is to summarise currently available data on the prevalence, causes, symptoms and control of human allergy to cats. In terms of managing cat allergy, the emphasis is on reviewing current and emerging modalities to reduce environmental exposure to cat allergens rather than on pharmacotherapy or immunotherapy, as it is in these areas in particular that the veterinarian may be able to offer help and advice to complement that of human healthcare professionals. Evidence base: The information in this review is drawn from the current and historical literature on human allergy to cats, and approaches to reduce exposure to cat allergens and manage symptoms of cat allergy.

Rhinovirus Infection and Familial Atopy Predict Persistent Asthma and Sensitisation 7 Years after a First Episode of Acute Bronchiolitis in Infancy

Background: We set out to assess the risk factors for asthma outcome in a cohort of infants who experienced their first episode of acute bronchiolitis. Methods: A cohort of 222 infants who were included during a first episode of acute bronchiolitis was prospectively followed. Herein, we present the results of their assessments (symptom history, skin prick tests, specific IgE assay, respiratory function tests) at age seven. Results: Of the 68/222 (30.6%) children assessed at age seven, 15 (22.05%) presented with asthma and were mainly males (p = 0.033), 14 (20%) had respiratory allergies, 17 (25%) presented atopic dermatitis and none had a food allergy. Family history of atopy was associated with asthma and sensitisation to aeroallergens at age seven (p = 0.003, p = 0.007). Rhinovirus (hRV) infection and rhinovirus/respiratory syncytial virus (RSV) co-infection were significantly associated with asthma at age seven (p = 0.035, p = 0.04), but not with the initial severity of bronchiolitis. Eosinophil counts at ages three and seven were significantly higher in the asthmatics (p = 0.01, p = 0.046). Conclusion: Any infant, especially male, presenting a first episode of acute bronchiolitis due to hRV with a family history of atopy should be closely monitored via follow-up due to a higher risk for asthma at school age.

Respiratory allergy with concentration ability in young adults

Introduction: Respiratory allergies prevalence in Indonesia, Asia, and the world ranges from 4-10%. Patients with respiratory allergies and other chronic respiratory diseases often experienced deterioration of productivity and concentration ability. This study aims to observe the correlation between respiratory allergy and concentration ability in adults.