Allergic Factors Research Articles

Allergic Rhinitis- An Updated Review for Healthcare Professionals

Background: Allergic rhinitis (AR) is an immunoglobulin E (IgE)-mediated condition characterized by nasal symptoms such as congestion, sneezing, rhinorrhea, and itching. It is prevalent globally, affecting about 15% of the population, and can significantly impact quality of life, productivity, and healthcare costs. Historically considered a localized disorder, AR is now recognized as part of a broader systemic allergic framework. The condition is categorized into seasonal, perennial, or mixed forms. Effective management relies on identifying triggers and applying appropriate pharmacologic and non-pharmacologic interventions. Aim: This review aims to provide an updated understanding of the etiology, epidemiology, diagnostic approach, and treatment strategies for AR, with a focus on practical management for healthcare professionals. Methods: A comprehensive review of current literature on allergic rhinitis, including pathophysiology, risk factors, diagnostic approaches, and treatment options. The article discusses pharmacologic therapies (e.g., corticosteroids, antihistamines), immunotherapy, and lifestyle modifications. Results: AR pathogenesis involves both early-phase IgE-mediated responses and late-phase inflammatory processes. Environmental, genetic, and lifestyle factors influence AR prevalence. The condition affects different age groups, with seasonal forms more common in children and perennial in adults. A combination of avoidance measures, pharmacotherapy (intranasal corticosteroids, antihistamines), and allergen immunotherapy remains central to management. Emerging treatments like monoclonal antibodies (omalizumab) have shown promise for severe cases. Personalized management strategies are crucial, given the variability in treatment responses. Conclusion: Allergic rhinitis is a common condition with substantial personal and societal impact. Effective management involves a comprehensive approach that includes identifying and avoiding triggers, using appropriate medications, and considering advanced therapies for severe cases. With individualized treatment plans, healthcare professionals can optimize patient outcomes and reduce the burden of AR.

Altered anthropometrics and HA1c levels, but not dyslipidemia, are associated with elevated hs-CRP levels in middle-aged adults: A population-based analysis.

Population-based studies of cardiovascular disease markers, such as hs-CRP, are crucial. However, studies exploring the effect of metabolic indices on hs-CRP while controlling for confounding variables adequately in middle-aged adults are limited. Using Wave 5 data from the National Longitudinal Study of Adolescent Health (Add Health), we examined the impact of various metabolic indices on hs-CRP in adults aged 32-42, controlling for eight allergic and infectious factors that may elevate hs-CRP levels. We used multiple linear regression analysis to determine which factors predict hs-CRP levels after log transformation of the dependent variable. The total number of participants was N = 1839 (weighted N = 1390763), with a mean age of 38.1 (SD = 2.0) and 46.4% having obesity. Among the controlled variables, recent surgery was the only confounder to significantly predict increased hs-CRP levels (P = 0.029, exponentiated estimate (EE) = 1.61; 95% Cl: [1.31-1.91]). Notably, current smoking and altered LDL or TG levels did not show a significant association with hs-CRP levels (P > 0.05). However, a significant increase in hs-CRP levels was observed in females compared to males (P < 0.001, EE = 1.43; 95%Cl: [1.35-1.51]). Similar findings were noted for diabetic HbA1c levels (P = 0.001, EE = 1.6; 95%CL: [1.42-1.78]), high waist circumference (P = 0.015, EE = 1.25; 95%CL: [1.15-1.35]), and grade 3 obesity (P = 0.006, EE = 7.62; 95%CL: [2.86-12.38]). Although not statistically significant, hs-CRP levels exhibited a gradual increase with rising BMI after controlling for other variables. These findings will improve the clinical application of hs-CRP in predicting coronary artery disease, especially in younger adults.

Granulocytes and mast cells in AllergoOncology-Bridging allergy to cancer: An EAACI position paper.

Derived from the myeloid lineage, granulocytes, including basophils, eosinophils, and neutrophils, along with mast cells, play important, often disparate, roles across the allergic disease spectrum. While these cells and their mediators are commonly associated with allergic inflammation, they also exhibit several functions either promoting or restricting tumor growth. In this Position Paper we discuss common granulocyte and mast cell features relating to immunomodulatory functions in allergy and in cancer. We highlight key mechanisms which may inform cancer treatment and propose pertinent areas for future research. We suggest areas where understanding the communication between granulocytes, mast cells, and the tumor microenvironment, will be crucial for identifying immune mechanisms that may be harnessed to counteract tumor development. For example, a comprehensive understanding of allergic and immune factors driving distinct neutrophil states and those mechanisms that link mast cells with immunotherapy resistance, might enable targeted manipulation of specific subpopulations, leading to precision immunotherapy in cancer. We recommend specific areas of investigation in AllergoOncology and knowledge exchange across disease contexts to uncover pertinent reciprocal functions in allergy and cancer and allow therapeutic manipulation of these powerful cell populations. These will help address the unmet needs in stratifying and managing patients with allergic diseases and cancer.

Analyzing Racial Disparities in Pediatric Atopic Comorbidity Emergency Department Visitation Using Electronic Health Records

BackgroundAlthough atopic diseases and associated co-morbidities are prevalent in children, little is known about racial differences in emergency department (ED) visitation. ObjectiveWe sought to examine racial differences in ED visitation among children with allergic comorbidities. MethodsWe conducted a retrospective study of patients (<21 years) who visited the ED at a large pediatric hospital for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015 to 2019. We determined the probability of ED encounter-free using hazard ratios (HR) and time to recurrence (TTR) of ED encounter for patients identified as Black/African American (AA) and White/European American (EA). We assessed potentially underlying allergic, demographic, and place-based factors, and potential interactions between factors. ResultsA total of 30,894 patients (38% AA, 62% EA) had 83,078 ED encounters (38,378 first ED encounters, and 44,700 recurrent ED encounters) during the study period. Asthma and AR showed the highest rate of comorbidity in ED encounters in both AA and EA children. AA children exhibited higher HR for encounter following index AD and asthma encounters. We found an interaction between the type of insurance and race in ED encounters for AD, FA, AR, and EoE. In AA children, those insured by Medicaid demonstrated a higher HR for any encounter compared to those with commercial insurance. Conversely, in EA children, those with Medicaid insurance showed a lower HR compared to their commercially insured peers. Regardless of race, allergic comorbidity increased the HR of ED encounter (1.12-1.62) for all allergic diseases. At 5-years follow up, mean differences in TTR were shorter in AA children compared to EA children in AD, FA, and asthma. ConclusionIdentification of disease-specific racial disparities in ED visitation related to atopic diseases is a necessary first step toward the design and implementation of interventions capable of equitably reducing emergency care in atopic comorbid children.

Association between Allergic Rhinitis-Related Factors and Risk of Obstructive Sleep Apnea in Korean Adults over 40: The 8th Korea National Health and Nutrition Examination Survey (2019–2021)

Association between Allergic Rhinitis-Related Factors and Risk of Obstructive Sleep Apnea in Korean Adults over 40: The 8th Korea National Health and Nutrition Examination Survey (2019–2021)

Mast Cell–Neutrophil Communication Regulates Allergic Diseases

Allergic diseases (e.g., food allergies) are a growing problem, with increasing numbers of individuals experiencing them worldwide. Congruently, the adverse reactions (e.g., anaphylaxis) associated with the administration of vaccines against emerging infectious diseases such as coronavirus disease 2019 (COVID-19) have become a familiar problem. Allergic diseases, which have a wide variety of symptoms, are difficult to prevent or cure; treatment is currently limited to therapeutic drugs or allergen immunotherapy. Therefore, elucidating new allergic regulatory factors that control the allergic (i.e., mast cell) responses is important. While investigating the regulatory mechanisms of the wide range of allergic responses of mast cells, we found that the affinity of allergens to immunoglobin E (IgE) regulates allergic inflammation through the differences in the secretory responses of mast cells and the types and interactions of the cells infiltrating the tissues. Here, we present our recent findings regarding the affinity of allergens to IgE in regulating allergic inflammation, heterogeneous secretory granules inducing diverse secretory responses, and mast cells interacting with neutrophils, thereby regulating the various allergic responses.

Mother's smoking habits affects IL10 methylation but not asthma in Ecuadorian children.

To identify polymorphisms and methylation profiles in the IL10 gene associated with asthma in children aged 5 to 11. A case-control study was conducted with asthmatic and non-asthmatic children aged 5 to 11 years in Cuenca-Ecuador. Data on allergic diseases and risk factors were collected through a questionnaire for parents. Atopy was measured by skin prick test (SPT) to relevant aeroallergens. Three IL10 single nucleotide polymorphisms were evaluated in all participants, and methylation analysis was performed in 54 participants. Association between risk factors, allergic diseases and genetic factors were estimated using multivariate logistic regression. The results of polymorphisms showed no differences between cases and controls when comparing the SNPs rs3024495, rs3024496, rs1800896 allelic and genotypic frequencies. In the methylation analysis, no differences in the IL10 methylation profile were found between cases and controls; however, the multivariate analysis showed an association between the mother's smoking habits and the IL10 methylation profile. Smoking habit could be essential as an environmental exposure factor in regulating gene expression in children with asthma.

Coexisting Th1 and Th2 cytokines in patients with collagenous gastritis and implications for its pathogenesis.

Collagenous gastritis (CG) is a rare cause of refractory dyspepsia and anemia that frequently affects children and young adults and whose histological hallmark is chronic mucosal inflammation with a subepithelial collagen band. The etiology remains obscure, and no established treatments exist. We investigated the pathogenesis of CG by determining the expression profiles of genes related to immunity and inflammation in index biopsies. Gastric biopsies from 10 newly diagnosed patients with CG were evaluated using the NanoString nCounter assay. Gastric biopsies from 14 normal individuals served as controls. The gene expression ratios for CG versus controls were determined in pooled samples and confirmed in individual samples by quantitative reverse transcription polymerase chain reaction. The results were compared with previously reported expression data from a cohort of patients with collagenous colitis, a colonic disorder with similar morphology, including subepithelial collagen band. CG biopsies featured enhanced expression of key genes encoding both Th1 (IFNγ, TNF-α, IL-2, IL-10, IL-12A, IL-12B, and IL-18) and Th2 cytokines (IL-3, IL-4, IL-5, IL-6, and IL-13). In contrast, biopsies from patients with CC exhibited upregulated Th1 cytokines only. We show in this first published gene expression profiling study that CG involves simultaneous upregulation of Th1 and Th2 cytokines. This finding is unique, contrasting with other types of chronic gastritis as well as with collagenous colitis, which shares the presence of a collagen band. Involvement of Th2 immunity in CG would support further investigation of potential dietary, environmental, or allergic factors to guide future therapeutic trials.

In vivo evaluations of Lactobacillus-fermented Eucheuma spinosum polysaccharides on alleviating food allergy activity.

In order to explore the in vivo anti-food allergy activity of Lactobacillus sakei subsp. sakei-fermented Eucheuma spinosum polysaccharides F1-ESP-3, an ovalbumin (OVA)-induced food allergy mouse model was established by ascites immunization and gavage. The weight, temperature, incidence of diarrhea, levels of allergic mediators and inflammatory factors in the serum of mice were analyzed. We analyzed the differentiation of mouse spleen lymphocytes and the proportion of sensitized mast cells by flow cytometry. The intestinal barrier status of mice was analyzed by intestinal pathological tissue sections and microbiota sequencing. The results showed that F1-ESP-3 could alleviate the food allergy symptoms of mice, such as hypothermia and loose stool; levels of OVA-specific immunoglobulin E, mast cell protease and histamine in the serum of sensitized mice and the proportion of dendritic cells and mast cells in mouse spleen were significantly reduced; in addition, F1-ESP-3 may protect the intestinal barrier and further improve the intestinal microenvironment of food-allergic mice by regulating the abundance of Bacteroidetes and Firmicutes. F1-ESP-3 can further improve the intestinal microenvironment of food-allergic mice by upregulating the levels of Lachnospiraceae, and may affect the signal pathways such as NOD-like receptor, MAPK, I kappa B and antigen processing and presentation.

The ABC of prevention and treatment of diaper dermatitis

Diaper dermatitis (DD) is a common disease in the first two years of life, although incontinence DD is seen in all ages including the elderly. Its pathogenesis is not uniform since irritant, allergic, and infectious factors can be involved. Diagnosis is visual except for atypical cases. After birth, the skin adapts from aquatic to terrestrial life. The skin-gut microbiome develops. The focus of the prevention of DD lies in the stabilization of epidermal barrier function and a healthy microbiome. Treatment depends on DD etiology. It includes skincare, hygienic measures, and medical therapy.

Urticaria Revealing an Hepatitis B Infection: About a Case at the Dermatology-Venereology Unit of the National University Hospital Center (NUHC) of Bangui

Urticaria is a common syndrom which is manifested by pruritic edematous erythematous plaques. These plaques have no predilection site. They can migrate during the evolution of urticaria. Their second particularity is their fleeting character for they disapear after few hours without treatment. Urticaria has been associated with psychological, allergic and infectious factors. Among incriminated infections, hepatitis viruses have been cited. We are reporting a case of urticaria revealing an anicteric hepatitis B infection.

New Perspective on the Interaction Behavior Between Riboflavin and β Lactoglobulin-β Casein Complex by Biophysical Techniques.

Riboflavin (RF) is a vitamin that only exists in plants and microorganisms and must be procured externally by humans. On the other hand, there are two major allergic factors in cow's milk, including β-lactoglobulin (βLG) and β-casein (βCN), while their allergic properties can be eliminated by binding to micronutrients. In this regard, we examined the binding process of RF to βLG and βCN in the binary and ternary systems by different spectroscopies such as zeta potential, electric conductivity, and molecular modeling. According to the result of the fluorescence spectrum regarding the interaction of RF with βLG and βCN in binary and ternary systems, an increase in RF concentration declined the fluorescence intensity of three systems and also caused the quenching of proteins. Static quenching plays a pivotal role in the formation of stable interactions. The obtained thermodynamic parameters by Van't Hoff equation ascertained the predominance of hydrogen bonds and van der Waals interaction in all the systems. Considering how the negative value of ΔH0 resulted in the negative value of ΔG0, the systems were assumed to be enthalpy driven. The outcomes of circular dichroism (CD) disclosed that the attachment of RF to the targets of systems increased their a-helix content, which particularly included the binding of RF to βLG that led to the conversion of β-sheet to α-helix content. As indicated by the results of zeta potential, the low concentration of RF contained the dominance of hydrophobic forces in the interactions, whereas the enlargement of this concentration prevailed electrostatic forces. Moreover, conductometry measurements showed an extension in the rate of ionizable groups due to the addition of RF to the systems, which may increase the probability of an interaction between RF, βCN, and βLG in binary and ternary systems. In consistency with the outcomes of molecular dynamics simulation, the data of molecular docking approved the capability of RF in forming strong and stable interactions with βCN and βLG.

Self-Reported Allergic Rhinitis Prevalence and Risk Factors in Employees of the China National Railway.

BACKGROUND: Allergic rhinitis (AR) is a common allergic disease globally and its prevalence is increasing year by year. This study aimed to analyze the prevalence and risk factors of self-reported AR among the Chinese National Railway train crew in the China Railway Beijing Group.METHODS: This prospective questionnaire study surveyed 1511 randomly recruited train crewmembers from 20 cities in the China National Railway network, and 494 reported having AR. A structured questionnaire was tailored, designed, and delivered electronically to all subjects. Prevalence of and risk factors for AR were analyzed based on self-reported results.RESULTS: The prevalence of self-reported AR among train crewmembers was 32.6%. Among respondents, 86.03% worked in passenger cars and 64.6% reported having worse AR symptoms while on trains. AR frequencies were 40.15% perennially and 59.85% seasonally. Among the Total Nasal Symptoms Scores (TNSS), significant differences were found between rhinorrhea and sneezing and between nasal itching and sneezing. The Rhino-Conjunctivitis Quality of Life Questionnaire (RQLQ) showed significant correlations between all seven sections. TNSS was significantly associated with the RQLQ. Scores of both the TNSS and RQLQ showed that the severity of AR symptoms (rp = 0.103) and the impact on quality of life (rp = 0.113) correlated significantly with seniority.CONCLUSIONS: The prevalence of self-reported AR among train crew working in passenger cars is higher than that of the general Chinese population. The severity of AR symptoms and the impact on quality of life are associated with seniority, meaning the number of years working on trains.Yu R-L, Ning H-Y, Lan T-F, He H, Zheng C-B, Wang X-Y, Wang H-T, Wang X-Y. Self-reported allergic rhinitis prevalence and risk factors in employees of the China National Railway. Aerosp Med Hum Perform. 2023; 94(11):821-826.

Prevalence of Allergic Diseases and Risk Factors in Preschool Children

Allergic diseases are very common in children. The aim of this study is to obtain information about the frequency and risk factors of allergic diseases in kindergarten children aged 3-6 years. This study was carried out between 13.02.2018 and 30.12.2018 in kindergartens, in accordance with the ISAAC Phase I protocol for children aged 3-6 years. The study was carried out by distributing 3000 questionnaires in 20 kindergartens. 2001 out of 2040 collected questionnaires were included in the study. Of the participants, 986 (49.3%) were female and 1015 (50.7%) were male. The frequency of asthma symptoms was 30.4% (n=608). The frequency of allergic rhinitis symptoms was found to be 37.1% (743 people). The risk of asthma symptoms was significantly higher in males, those whose mothers smoked during pregnancy, those born preterm, those with a smoker at home and those with mold in the home (p

Hydroxysafflor yellow A attenuates allergic response of ovalbumin induced allergic rhinitis via Nrf2/HO-1 and inflammatory signaling pathways.

Allergic reaction is the most common nasal conditions worldwide and it will remain throughout life. The symptoms of an allergic reaction include sneezing, itching, hives, swelling, difficulty breathing, and a runny nose. Hydroxysafflor yellow A (HYA) is a flavonoid compound which is the active phyto-constituent of flower of Carthamus tinctorius L., and exhibited the various medicinal activities like antioxidant, anti-inflammatory and cardiovascular protective effects. This study aimed to assess the efficacy and mode of action of HYA against the allergic rhinitis induced by ovalbumin in mice. HYA was given orally to the Swiss BALB/s mice once daily, 1 h before, they were challenged with ovalbumin (OVA) via intranasal administration, after that the mice were sensitized via intraperitoneal injection of OVA. Allergic nasal symptoms, body weight, spleen weight, OVA-specific immunoglobulins, inflammatory cytokines, Th17 cytokines and Th17 transcription factors also estimated. HYA had a significant (p < .001) effect on body weight and reduced spleen weight. It effectively decreased the nasal symptoms of allergy such as sneezing, rubbing, and redness. HYA significantly reduced the level of malonaldehyde (MDA) and improved levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and glutathione (GSH). It also remarkably decreased the levels of Th2 cytokines and Th17 transcription factors like RAR-related orphan receptor gamma (ROR-γ), signal transducer and activator of transcription 3 (STAT3) and phosphor signal transducer and activator of transcription 3 (p-STAT3), while increasing levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1). The treatment with HYA improved the lung histology in mice with allergic rhinitis. The results suggest that HYA may have therapeutic potential against ovalbumin-induced allergic rhinitis in mice, by altering the Th17/Treg balance and improving the Nrf2/HO-1 signaling pathway.

Adıyaman İlindeki 13-14 Yaş Grubundaki Çocuklarda Astım ve Alerjik Hastalıkların Prevalansı ve İlişkili Risk Faktörlerinin İncelenmesi

Aim: While the prevalence of allergic diseases in Turkey cannot be determined clearly due to the regional nature of the studies, it is known that the frequency is increasing. The aim of this study is to evaluate the frequency of allergic diseases and risk factors in Adıyaman province.&#x0D; Material and Method: The research was conducted as a cross-sectional prospective. The research was carried out in Adıyaman province between November 2021 and January 2022. The universe of the research consists of students aged 13-14 studying in secondary and high schools.&#x0D; Results: In our study, the prevalence of wheezing in the chest at any time during their lifetime was determined as 10.5%. In the last year, this rate has been determined as 4.9%. 4.9% of the participants stated that their child was diagnosed with asthma by the doctor. The rate of participants diagnosed with hay fever was 3.1%.&#x0D; Conclusion: Although allergic diseases and asthma are diseases with an increasing frequency, it is striking that they are not yet fully recognized by the society. Studies have shown that family burden is an important risk factor. The necessity of using all communication channels in order to increase the health literacy of the society shows itself in every research.

Endometriosis - Pathogenesis, diagnosis and treatment

Introduction: Endometriosis is defined as a chronic gynecological disease characterized by endometrial tissue outside the uterus. The condition affects 5-10% of women of reproductive age worldwide and is associated with pelvic pain and infertility. Despite its prevalence, diagnosis is usually delayed for many years which postpones the introduction of appropriate treatment.&#x0D; Aim of the study: Summary of the current state of knowledge on endometriosis, analyzing the pathogenesis, the current diagnostic approach, highlighting the problem of fertility in this disease entity and presenting treatment options.&#x0D; Methods and materials: A review of the literaturę available in the PubMed database and GoogleScholar from the last 5years was conducted,using the following keywords: endometriosis”, „endometriosis pathogenesis”, „endometriosis diagnosis”, „infertility in endometriosis”, „endometriosis treatment”&#x0D; Results: Among the etiological factors mentioned are congenital, environmental, epigenetic, autoimmune and allergic factors. The main theory for the formation of the condition is retrograde menstruation through the fallopian tubes into the peritoneal cavity and implantation of endometrial cells. Laparoscopy is nowadays the gold standard for diagnosis, but less invasive methods that can shorten the time to diagnosis are being sought. Current treatment is limited to surgery, hormonal treatment and analgesics which are associated with many side effects.&#x0D; Conclusion: Endometriosis is the cause of infertility, chronic pain and reduced quality of life in many women. Non-invasive diagnostic tests such as imaging studies, genetic tests, biomarkers or miRNAs have diagnostic potential but more analysis is needed to be applied in daily clinical work. Future research should focus on learning and understanding the pathogenesis, identifying subtypes of the disease, and a modern approach to diagnosis and comprehensive treatment taking into account concomitant general symptoms.

Epidemiology of Allergic Diseases and Risk Factors in Children: A Population based Study in 2022

The International Study of Asthma and Allergies in Childhood (ISAAC) investigated the worldwide prevalence of allergic disease and risk factors. Korea has also participated in several ISAAC surveys: three nationwide surveys in 1995, 2000 and 2010. Research on school aged children will be a helpful to understand the epidemiology of the allergic diseases in the pediatric population. In this perspective, we researched the prevalence and risk factors of allergic diseases in school aged children in Korea.

Type 2 cytokine genes as allergic asthma risk factors after viral bronchiolitis in early childhood.

Genome-wide association studies of asthma have identified associations with variants in type-2 related genes. Also, specific interactions between genetic variants and viral bronchiolitis in the development of asthma has been suggested. To conduct a gene-based analysis of genetic variants in type 2 cytokine related genes as risk factors for allergic asthma at school age, and further, to study their interaction with specific viral infections in early childhood. A prospectively investigated cohort of children with previous bronchiolitis and controls came for follow-up at school age. The research visit, blinded to viral exposure, included detailed lung function tests, laboratory investigation, and questionnaires. Allergic asthma was defined as typical symptoms plus objective variable airway obstruction, in addition to laboratory verified atopy (elevated eosinophil count or sensitization to an allergen). Targeted and complete sequencing was performed for nine type 2 cytokine candidate genes: IL4, 5, 13, 25, 33 and 37, IL17RB, CRLF2 and TSLP. At follow-up, there were 109 children with genetic data, 91 with a history of bronchiolitis (46% respiratory syncytial virus, 24% human rhinovirus, 15% human metapneumovirus and 14% mixed viral etiology) and 18 without. The median age was 9.4 years (range 6-13) and 41 (38%) had laboratory verified atopy. Twenty-one children (19%) met the definition of allergic asthma. After adjusting for age, sex and five viral categories, IL33 achieved nominal significance (p = 0.017) for a positive association with allergic asthma development. In the gene-virus interaction analysis, the variant set in IL17RB demonstrated a nominally significant positive interaction with human metapneumovirus infection (p=0.05). The results highlight the multifactorial nature of allergic asthma risk, with both viral infection and inherited genetic variants contributing to increasing risk. Results for IL33 and IL17RB were nominally significant and are potential candidate targets for designing therapeutics and early screening, but these results must be replicated in an independent study.

Psychological Stress and Atopic Dermatitis: A Focus Group Study.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. It is often reported to be worsened by psychological stress. To explore the role of psychological stress and related triggers in AD, and its connection to worsening of this disease, focusing on patients' perspectives. In total, 28 patients with AD were included in focus groups. Topics regarding psychological stress and psychological triggers were discussed. The hypothesis that psychological stress may have impact on eczema and its pruritus was supported by all of the patients. Distinguishing the worsening effect of psychological stress from effects of physiological triggers, such as infection, climate and allergic factors, was claimed to be difficult by many patients. Most of the patients thought that chronic stress affected the AD more when compared to acute stress. Family problems, financial problems, work overload, school exam periods, lack of structure at work, and unforeseen events were identified as important psychological triggers. Conventional treatment/therapy with topical corticosteroids and emollients, UV light treatment, were suggested as possible treatments, as well as psychological intervention and physical exercise. Psychological stress is an important factor to consider in the management of patients with AD. In particular, chronic stress tends to worsen AD. The type of stress can possibly also affect the quality of the pruritus experienced by the patients. Unforeseen events and decision making were frequently mentioned as important triggers. Furthermore, physical exercise was reported to provide beneficial effects.