Weed Pollen Research Articles

High ambient levels of grass, weed and other pollen are associated with asthma admissions in children and adolescents: A large 5‐year case‐crossover study

Pollen is an important aeroallergen that triggers asthma exacerbations in children, but we know little about the impact of different pollen types in cities with varying climatic conditions and pollen seasons. We aimed to assess the role of ambient level of different types of pollen on a large time series of child and adolescent asthma hospitalizations in Sydney, Australia. Childhood asthma hospitalization and the daily ambient pollen concentrations of different species were collected in South-West Sydney. With a bidirectional case-crossover design, we fitted conditional logistic regression models to measure the associations between instantaneous and up to 3days lagged effects of pollen concentrations on asthma hospitalizations after controlling for potential confounders and testing for interactions. A total of 2098 children, more boys (59.7%) and 2-5years old (62.6%), were hospitalized due to asthma. The geometric mean concentration of Cupressus, 7.88 [5.02] grains/m3 , was the highest during the study period. The increase from 75th to 90th percentile of grass (OR=1.037, 95% CI 1.005-1.070), weed other than Plantago species (OR=1.053, 95% CI 1.009-1.098) and unclassified pollen (OR=1.034, 95% CI 1.010-1.058) were significantly associated with the odds of asthma hospitalizations. Boys were at greater risk of asthma exacerbations associated with grass (OR=1.046, 95% CI 1.003-1.090) and unclassified pollen (OR=1.041, 95% CI 1.010-1.073). There was evidence of effect modification by age groups for Cupressus, conifer, total tree and total pollen. Although boys are more vulnerable to grass pollen, weed, and other pollen are also important triggers of asthma exacerbations in all children and adolescents. These findings are important for urban green space planning and the development of pollen monitoring systems for families with children at risk of asthma exacerbations during peak pollen seasons.

Geographic and demographic variations of inhalant allergen sensitization in Koreans and non-Koreans

BackgroundTo diagnose and treat respiratory allergic diseases, it is important to identify the specific allergens involved. Many differences exist between common inhalant allergens depending on the residential environment and demographic factors. This study aimed to compare common inhalant allergens between Koreans and non-Koreans according to their residential region, age, and sex. MethodsThis study evaluated 15,334 individuals who underwent serum tests for multiple allergen-specific immunoglobulin E at a tertiary academic medical center between January 2010 and December 2016. The individuals included 14,786 Koreans and 548 non-Koreans. The AdvanSure™ Allostation assay (LG Life Science, Korea) was used to test for 33 inhalant allergens. ResultsThe house dust mite (HDM) was the most common allergen in both Koreans and non-Koreans, although the proportion of individuals with HDM sensitization was greater among Koreans. High sensitization rates for various pollen types were detected among Koreans in Gangwon region, whereas Japanese cedar pollen was unique among Koreans in Jeju region. Grass pollen and animal dander were relatively common among individuals from the Americas, whereas weed and grass pollen accounted for the 10 most common allergens for individuals from Central Asia. The total sensitization rate, sensitization to HDM, and sensitization to animal dander peaked among adolescents and young adults, then subsequently decreased with age. ConclusionsThis large-scale study demonstrates that various regional and age-related differences exist in the allergen sensitization rates of Koreans and non-Koreans. These data could be useful for development of avoidance measures, immunotherapy for causative allergens, and policymaking regarding allergic diseases.

Do Plantago lanceolata Skin Prick Test-Positive Patients Display IgE to Genuine Plantain Pollen Allergens? Investigation of Pollen Allergic Patients from the North-East of France

Background: English plantain (Plantago lanceolata) is an important weed pollen allergen source triggering allergic symptoms during summer. To elucidate genuine versus cross-reactive sensitization, we investigated IgE reactivity patterns and inhibition capacities of plantain-sensitized patients. Methods: Sera of 35 rhinoconjunctivitis patients from the north-east of France with positive skin prick tests (SPT) to Plantago lanceolata pollen were tested with clinically relevant allergen sources using ELISA, ImmunoCAP, and immunoblot inhibition. Results: The patients were multisensitized with additional reactivity to grass (94.3%), ash (74.3%), birch (71.4%), and mugwort (55.2%) pollen in SPT. Sensitization prevalence to allergen molecules was 34.3% (Pla l 1), 94.3% (Phl p 1/5), 60.0% (Ole e 1), 65.7% (Bet v 1), 37.1% (profilin), and 40.0% (CCD). In immunoblot, IgE reactivity to plantain pollen was inhibited with relevant pollen extracts and purified rPla l 1. Two sera did not reveal any IgE cross-reactivity, while reactivity to plantain was efficiently inhibited by grass pollen in the sera of 10 patients. The sera from 17 different patients could be inhibited by grass, birch, or ash pollen to varying degrees. Thus, only 37.1% of our patients demonstrated true plantain pollen sensitization, while 62.9% were solely positive due to IgE cross-reactive molecules from other clinically relevant pollen. Conclusions: Plantain pollen-sensitized patients are multi-reactors demonstrating varying and complex IgE-reactivity profiles. In vivo and in vitro tests using extracts are typically blurred due to the presence of homologous allergens or CCD in grass, birch, or ash pollen. So far, Pla l 1 represents the only indicative marker allergen for the diagnosis of genuine plantain pollen sensitization.

Does the increase in ambient CO2 concentration elevate allergy risks posed by oak pollen?

Oak pollen is a major respiratory allergen in Korea, and the distribution of oak trees is expected to increase by ecological succession and climate change. One of the drivers of climate change is increasing CO2, which is also known to amplify the allergy risk of weed pollen by inducing elevated allergenic protein content. However, the impact of CO2 concentration on tree pollen is not clearly understood due to the experimental difficulties in carrying out extended CO2 treatment. To study the response of pollen production of sawtooth oak trees (Quercus acutissima) to elevated levels of ambient CO2, three open-top chambers at the National Institute of Forest Science in Suwon, Korea were utilized with daytime (8am-6pm) CO2 concentrations of ambient (× 1.0, ~ 400ppm), × 1.4 (~ 560ppm), and × 1.8 (~ 720ppm) treatments. Each chamber had three sawtooth oak trees planted in September 2009. One or two trees per chamber matured to bloom in 2016. Five to six catkins were selected per tree and polyethylene bags were attached to collect pollen grains. The total number of catkins per tree was counted and the number and weight of pollen grains per catkin were measured. Oak allergen-Que a 1 (Allergon Co., Uppsala, Sweden)-was extracted and purified to make an ELISA kit by which the antigen levels in the pollen samples were quantified. Total pollen counts per tree of the × 1.4 and × 1.8 treatments showed significant increase of 353 and 1299%, respectively, from the × 1.0 treatment (p < 0.001). Allergenic protein contents at the × 1.4 and × 1.8 treatments also showed significant increase of 12 and 11%, respectively (p = 0.011). The × 1.8 treatment induced significant difference from the × 1.0 treatment in terms of pollen production and allergenic protein content, whereas the × 1.4 treatment showed mixed significance. In summary, the oak trees under the elevated CO2 levels, which are expected in the changing climate, produced significantly higher amount of pollen and allergenic protein than under the present air conditions.

The course of bronchial asthma associated with metabolic syndrome in children with different phenotypes depending on vitamin D3 level

Objective: to establish specific features of BA course in children with various phenotypes on the background of metabolic syndrome, depending on serum vitamin D 3 level. Subjects and methods. 106 children with BA participated in the study. 42 patients had BA associated with metabolic syndrome (MS), and 64 had BA with no MS. By the phenotype 61 (57.5 %) of patients had allergen-induced (allergic) asthma and 45 (42.5 %) – virus-induced (non-allergic) BA. The control group consisted of 44 children (the patients with MS and those without MS and BA), average age 15.5 ± 1.3 years. All the patients underwent a unified complex of diagnostic investigations: general physical examination, measurement of waist circumference and body mass index (BMI), clinical blood test, spirometry, lipid profile. Weight categories (normal weight, excess weight and obesity) were determined by percentiles (P) of BMI variation series with regard to age, as indicated in WHO recommendations. Serum 25(OH)D levels were determined by enzyme immunoassay. Vitamin D level ≥20 ng/ml was considered sufficient, 11–20 ng/ml – insufficient, ≤10 ng/ml – deficient. General and specific serum IgE levels were determined by enzyme immunoassay. The data obtained were processed with Statistica 8 program, P values of less than 0.05 were considered to indicate statistical significance. Results. In the group of patients with vitamin D 3 level below 20 ng/ml, 19.5 % had controlled BA and 41.3 % – uncontrolled BA, while among the children with vitamin D level over 20 ng/ml, 30.4 % had controlled BA and 8.6 % – uncontrolled BA (χ 2 = 9.12, P < 0.05). Mean value of vitamin D 3 concentration in the control group was significantly higher than in the patients with BA associated with MS and BA without MS (P < 0.05). The relationship between OW, obesity and atopy was confirmed by high serum level of sIgE antibodies in those weight categories. High sIgE levels to allergens from the pollen of meadow grass, weeds and trees, animal epithelium, household dust mite, food and fungal allergens were determined much more frequently in the children with OW and obesity than in those with NW. In the patients with BA associated with MS and vitamin D 3 level below 20 ng/ml, FEV1 and FVLC values appeared to be significantly lower as compared to those with vitamin D 3 level over 20 ng/ml (P = 0.002). Inverse relationship between the most important parameters of external respiration function and BMI was established: VLC (r xy = -0.45, P = 0.002), FVLC (r xy = -0.52, P = 0.001), FEV1 (r xy = -0.78, P = 0.000), respectively. Conclusions. The severity of BA as well as the degree of its control in the patients with different phenotypes was found to be influenced by both the presence of MS and vitamin D 3 level. Therefore, vitamin D deficiency can be one of the risk factors of BA and MS development, and can affect the severity of both BA and MS course. Vitamin D 3 deficiency and the presence of MS greatly influence FEV1, FVLC, PEF values, decreasing the indices of external respiration in children and leading to more severe obstruction.

Profils clinique et allergénique des pollinoses en Tunisie

BackgroundPollinosis is a public health problem due to its prevalence, morbidity, impact on quality of life and cost. The objective of our study was to describe the clinical and allergenic profiles of pollen allergy in Tunisia. Patients and methodsWe conducted a descriptive retrospective study including all patients investigated for pollen allergy at the allergology department of the La Marsa internal security forces hospital in Tunis between 1993 and 2015. ResultsPollen sensitization involved 45.8% of the patients tested with a total of 2490 patients. Rhinitis was the most common manifestation (87.1%), followed by asthma (59.9%) and conjunctivitis (50.4%). Asthma was more common in children, while rhinitis and conjunctivitis were more common in adults. Clinical manifestations were most often associated (75.4%). An association between asthma and rhino conjunctivitis (24.5%) was the most frequent, followed by an association between asthma and rhinitis (24%). The allergenic profile showed predominance of sensitization to grass pollen (54.4%), followed by sensitization to tree pollen (48.8%) and grass pollen (48.1%). Parietaria was the most sensitizing grass pollen, with olive pollen being the most sensitizing tree pollen (35.5%). Polysensitization to pollen was found in 55.5% of patients. ConclusionPollinosis is extremely common among allergic subjects in Tunisia. Rhinitis is the most common clinical manifestation. Weed pollens are the most sensitizing with a high frequency of pollen polysensitization.

Exploratory palynological studies at the Tell el-Daba'a-Avaris archaeological site.

A palynological study of samples collected from the Tell el-Daba'a (Avaris) archaeological site, the capital of the Hyksos located in the Northeastern Nile Delta, Egypt, was conducted. A range of samples were analyzed for pollen content: mudbricks from tomb walls dating from the Middle (cal. 2124–1778 BC) and New Kingdom ages (cal. 1550–1750 BC), kitchen remains dating from the Middle Kingdom, kitchen middens from the 19th Dynasty (cal. 1750–1058 BC), and tomb offering jars from the Late Period (cal.1000-600 BC). Floristic composition of modern vegetation analysis at different habitats revealed four community types and nine associated types, providing an indicator of high soil salinity and moisture content. Cereal and Achillea-type pollen were common in the mudbrick samples, indicating the probable use of these plants as temper during mudbrick manufacturing in the Middle and New Kingdoms. The kitchen samples were dominated by cereals, broad bean, celery, and other weed pollen types, indicating the importance of cereals, legumes, and celery as strategic crops for food or medicines during the Middle Kingdom period. Weed pollen types were probably associated with crops, with “Cheno-am” pollen type recorded at highest abundance in the tomb filling jar, which may indicate the use of these aromatic herbs to repel insects and animals from tombs.

Prevalence and clinical characteristics of local allergic rhinitis to house dust mites.

Local allergic rhinitis (LAR) is a recently classified subtype of rhinitis defined by a nasal allergic response in patients without systemic evidence of atopy. Recent studies have reported the prevalence, clinical course, culprit allergens, diagnostic methods and treatment outcomes of LAR. The purpose of this review is to summarize the most relevant and updated scientific evidence for LAR, especially focusing on its prevalence and clinical characteristics. LAR is found in a significant proportion (3.7-61.9%) of patients previously diagnosed with nonallergic rhinitis, but the prevalence may differ among ethnic groups and countries. Common allergens of LAR are similar to those of allergic rhinitis, in which house dust mites are the most common cause, followed by grass pollen, tree pollen, weed pollen and animal dander confirmed by provocation tests. Although the nasal provocation test to a single allergen is considered the gold standard method, the detection of allergen-specific IgE and other inflammatory mediators from nasal secretions and the basophil activation test can assist in the diagnosis of LAR. Conjunctivitis and asthma are the most common comorbid conditions, and the occurrence rate of asthma increases over period. However, the conversion rate to allergic rhinitis was not significantly different between LAR and healthy controls. LAR is a well-differentiated entity of rhinitis, which should be considered in patients with persistent and severe symptoms without any systemic evidence of atopy. Further research is needed to investigate the long-term outcome, and geographic and ethnic differences of LAR.

A retrospective study of 10 spontaneous cases of feline atopic dermatitis (1995-1997)

Ten atopic cats (5 DSH, 4 Siamese, one Persian) were admitted to the Clinic of Companion Animal Medicine, Faculty of Veterinary Medicine, A.U.T., because of a seasonal (3/10) or nonseasonal (1/10) pruritic skin disease. The seasonal pattern of the clinical signs could not be established in the rest 6 cats. The presenting cutaneous syndromes were miliary dermatitis (6 cats), self- induced alopecia - hypotrichosis (5 cats), indolent ulcer (one cat), linear eosinophilic granuloma (one cat) and head and neck self - inflicted dermatitis (one cat), some appearing alone (5/10) or in various combinations (4/10). One cat had a generalized but non - lesionai pruritus. The onset of these manifestations ranged from 6 months to 8.5 years. The aeroallergens implicated by the ID skin test were Dermatophagoides farinae (9/10), D. pteronyssinus (4/10), Acarus siro (4/10), house dust, cottonseed and tree pollens (2/10) and grass and weed pollens (1/10). ID test reactions to single or multiple aeroallergens were detected in 2 and 8 cats, respectively. Although 5 of the 10 atopic cats also reacted positive to ID test with flea allergen, there was not strong evidence that flea allergic dermatitis had been coexisting in 4 of them. Other conditions associated (conjuctivitis, bronchial asthma) or not (otodectic otitis externa) with feline atopy were seen in 3 cats.

Systemic Reactions in Pediatric Patients Receiving Standardized Allergen Subcutaneous Immunotherapy with and without Seasonal Dose Adjustment

The 2003 Joint Task Force on Practice Parameters recommended standardizing allergen subcutaneous immunotherapy (SCIT). Data from longitudinal surveillance survey in North America reported a systemic reaction (SR) rate of 0.1% to 0.2% of injection visits. The rate of SR to standardized SCIT in pediatric patients has not been well evaluated. The objective of this study was to evaluate the rate of SRs to standardized SCIT in pediatric patients aged 5 to 18 years in a single tertiary care center in the United States. A retrospective chart review was conducted in 2 groups: group 1 started SCIT within a period extending from January 2009 to June 2012, whereas group 2 started SCIT within a period extending from January 2013 to June 2016. The protocol was modified in group 2 such that updosing and maintenance doses were adjusted in the spring for tree and grass pollen and in the fall for weed pollen. There were a total of 128 patients in group 1 and 118 patients in group 2. The rate of SR was 0.429% in group 1 and 0.364% in group 2, which was not significant. There was no difference in the severity of SR in the 2 groups with no-fatal or near-fatal SR noted. Asthma was a significant risk factor in the younger age subgroup aged 5 to 11 years. Standardized SCIT appears to be associated with an SR rate of 0.429% to 0.364% of visits in pediatric patients. Protocol modification did not lead to a significant drop in SR. Larger multicenter studies are required to further evaluate the rate of SRs from standardized SCIT.

Relation of allergic rhinitis, allergen sensitization, and air pollutants in preschool children

Purpose: We aimed to investigate the prevalence and allergen sensitization of allergic rhinitis (AR) in preschool children. We as sessed the relationship of AR, allergen sensitization, and air pollutants. Methods: Between 2012 and 2016 in Jincheon, skin prick testing and questionnaire survey were performed on 2,958 children. AR have diagnosed on the basis of current symptoms and sign of AR on the Korean International Study of Asthma and Allergies in Childhood questionnaire and 1 or more proven allergen sensitization. Results: A total of 2,052 children completed survey and skin prick testing, and were included in the analysis. The prevalence of AR symptom within last 12 months and AR were 27.0% and 10.9%, respectively. During study, both prevalences were increased from 20.1% and 8.6%, respectively in 2012 to 29.1% and 12.8%, respectively in 2016. The total inhalant allergen sensitization rate was 32.6%. The most common inhalant allergen was Dermatophagoides farinae (23.1%), followed by Dermatophagoides pteronyssinus (22.5%), tree pollens (5.3%), weed pollens (5.2%), fungi (4.7%), dog hair (4.5%) cat fur (3.6%), grass pollens (1.1%), and cockroach (0.8%). Although there was no difference tree or weed pollen sensitization, pollen seasonal prevalence of current AR symptoms is highest in spring (80%) versus autumn (52.3%). Seasonal PM10 (particulate matter with a median aerodynamic diameter less than or equal to 10 μm in diameter) and SO2 (sulfur dioxide) levels were correlated with the prevalence of seasonal AR symptoms. Pollen sea sonal current AR symptoms were significantly related to seasonal pollen sensitization, but not inhalant allergens including dust mites. Conclusion: There was a rapid increasing prevalence of AR in preschool children in the areas of urbanization and industrialization. Pollen seasonal current AR symptoms have a close relationship with PM10 and seasonal pollen sensitization. (Allergy Asthma Respir Dis 2018;6:197-205)

Persistence of a vegetation mosaic in a peripheral region: could turbulent medieval history disrupt Holocene continuity of extremely species-rich grasslands?

Fluctuations in intensity of human impact and corresponding vegetation changes have been reported from different parts of Europe for the period from the beginning of the 1st millennium ad to the high Middle Ages. In the Bile Karpaty mountains (White Carpathians), a region well-known for its biologically valuable ancient grasslands, an extensive spread of woodland could have occurred in the Migration period (4th–6th century) and especially in the Confinium period (11th–12th century), when settling of this border region was legally prohibited. However, Holocene continuity of non-woodland vegetation was suggested as an explanation for the unique species richness of the local grasslands. If this explanation is true, then the turbulent times in medieval history could not have led to complete re-establishment of woodland. To test this idea palaeoecologically, we analysed four new profiles from wetland deposits for pollen, macrofossils and abiotic proxies, and re-dated some old profiles from the area. The results show the continual presence of human impact indicators since the Migration period in the southwest of the Bile Karpaty, where these unique grasslands occur. Agricultural activities were indicated by pollen of crops, ruderals, weeds and grassland taxa and by macrofossils of fen-grassland plants. Grazing and burning seem to have been the main disturbances during the older period, while mowing of meadows by scythe became more important since the 17th century. Fossil records differed among the sites as a consequence of differences in altitude and disturbance regimes, but converged gradually with time. Despite intensification of human activities, the landscape remained mosaic-like. Indicators of undisturbed woodlands have been detected only in the northeast. Continuous yet perhaps never too intensive disturbances might therefore have maintained the ancient grassland species pool in the long term.

Molecular Approach to Optimal Choice of Specific Immunotherapy for Patients with Sensitization to Weed Pollen Allergens

Molecular Approach to Optimal Choice of Specific Immunotherapy for Patients with Sensitization to Weed Pollen Allergens

Conjugation of wildtype and hypoallergenic mugwort allergen Art v 1 to flagellin induces IL-10-DC and suppresses allergen-specific TH2-responses in vivo

Allergies to weed pollen including members of the Compositae family, such as mugwort, ragweed, and feverfew are spreading worldwide. To efficiently treat these newly arising allergies, allergen specific immunotherapy needs to be improved. Therefore, we generated novel vaccine candidates consisting of the TLR5-ligand Flagellin A from Listeria and the major mugwort allergen Art v 1 including either the wild type Art v 1 sequence (rFlaA:Artv1) or a hypoallergenic variant (rFlaA:Artv1hyp) with reduced IgE-binding capacity. Immune modulating capacity of these constructs and respective controls was evaluated in vitro and in vivo. Incorporation of hypoallergenic Art v 1 derivative did not interfere with the resulting fusion proteins’ immune stimulatory capacity. Both rFlaA:Artv1 and rFlaA:Artv1hyp induced a prominent, mTOR-dependent, IL-10 secretion from murine dendritic cells, and suppressed allergen-specific TH2-cytokine secretion in vitro and in vivo. Both conjugates retained the capacity to induce rFlaA-specific antibody responses while efficiently inducing production of Art v 1-specific IgG1 and IgG2a antibodies in mice. Interestingly, only the suppression of TH2-cytokine secretion by rFlaA:Artv1 (but not rFlaA:Artv1hyp) was paralleled by a strong secretion of IFN-γ. In summary, we provided evidence that incorporating hypoallergens into flagellin:allergen fusion proteins is a suitable strategy to further improve these promising vaccine candidates.

A prospective cohort study on ambient air pollution and respiratory morbidities including childhood asthma in adolescents from the western Cape Province: study protocol

BackgroundThere is evidence from existing literature that ambient air pollutant exposure in early childhood likely plays an important role in asthma exacerbation and other respiratory symptoms, with greater effect among asthmatic children. However, there is inconclusive evidence on the role of ambient air pollutant exposures in relation to increasing asthma prevalence as well as asthma induction in children. At the population level, little is known about the potential synergistic effects between pollen allergens and air pollutants since this type of association poses challenges in uncontrolled real life settings. In particular, data from sub-Sahara Africa is scarce and virtually absent among populations residing in informal residential settlements.Methods/designA prospective cohort study of 600 school children residing in four informal settlement areas with varying potential ambient air pollutant exposure levels in the Western Cape in South Africa is carried-out. The study has two follow-up periods of at least six-months apart including an embedded panel study in summer and winter. The exposure assessment component models temporal and spatial variability of air quality in the four study areas over the study duration using land-use regression modelling (LUR). Additionally, daily pollen levels (mould spores, tree, grass and weed pollen) in the study areas are recorded. In the panel study asthma symptoms and serial peak flow measurements is recorded three times daily to determine short-term serial airway changes in relation to varying ambient air quality and pollen over 10-days during winter and summer. The health outcome component of the cohort study include; the presence of asthma using a standardised ISAAC questionnaire, spirometry, fractional exhaled nitric-oxide (FeNO) and the presence of atopy (Phadiatop).DiscussionThis research applies state of the art exposure assessment approaches to characterize the effects of ambient air pollutants on childhood respiratory health, with a specific focus on asthma and markers of airway inflammation (FeNO) in South African informal settlement areas by considering also pollen counts and meteorological factors. The study will generate crucial data on air pollution and asthma in low income settings in sub-Sahara Africa that is lacking in the international literature.

Eosinophilic esophagitis in children under the age of 5 years: Clinical characteristics.

To delineate clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in the youngest of children. Retrospective chart review. A 7-year retrospective chart review of children with clinicopathologic diagnosis of EoE was performed with specific analysis of patients under 5 years old. EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high-power field [EOS/HPF]) unresponsive to reflux therapy. Patient parameters and clinical results were systematically reviewed. Of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years). This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare. Liquid dysphagia was present at all ages but significantly more common in younger children (P = .0101). The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%). Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%). After treatment, 86% of parents reported symptom improvement. Mean reduction of EOS in pos-treatment biopsy was 33.5 EOS/HPF (P < .0001), and 67 patients showed histologic resolution of EoE (56.8%, P < .0001). Approximately one-quarter of children with EoE present under 5 years of age with multiple esophageal symptoms, comorbidities, and allergen-sensitization profiles. These patients demonstrate substantial clinicohistologic improvement following therapy. 4. Laryngoscope, 128:798-805, 2018.

Proteomic profiling of the weed feverfew, a neglected pollen allergen source

Feverfew (Parthenium hysterophorus), an invasive weed from the Asteraceae family, has been reported as allergen source. Despite its relevance, knowledge of allergens is restricted to a partial sequence of a hydroxyproline-rich glycoprotein. We aimed to obtain the entire sequence for recombinant production and characterize feverfew pollen using proteomics and immunological assays. Par h 1, a defensin-proline fusion allergen was obtained by cDNA cloning and recombinantly produced in E. coli. Using two complementary proteomic strategies, a total of 258 proteins were identified in feverfew pollen among those 47 proteins belonging to allergenic families. Feverfew sensitized patients’ sera from India revealed IgE reactivity with a pectate lyase, PR-1 protein and thioredoxin in immonoblot. In ELISA, recombinant Par h 1 was recognized by 60 and 40% of Austrian and Indian sera, respectively. Inhibition assays demonstrated the presence of IgE cross-reactive Par h 1, pectate lyase, lipid-transfer protein, profilin and polcalcin in feverfew pollen. This study reveals significant data on the allergenic composition of feverfew pollen and makes recombinant Par h 1 available for cross-reactivity studies. Feverfew might become a global player in weed pollen allergy and inclusion of standardized extracts in routine allergy diagnosis is suggested in exposed populations.

A 10-year experience of a novel and safe modified environmental rush immunotherapy protocol.

Allergen immunotherapy (AIT) is an effective treatment option for allergic rhinitis. Although conventional AIT takes 6 months to reach maintenance dosing, rush AIT accelerates the build-up period and reaches the maintenance dose months earlier. However, accelerated schedules of AIT carry an increased risk of systemic reactions (SR). We aimed to describe a novel 1-day, eight-step modified environmental rush immunotherapy (MERIT) protocol, characteristics of the patients who underwent this therapy, and the safety of this procedure. We also compared distinguishing features of those patients with SRs. We retrospectively analyzed demographic and clinical data of 362 adult patients seen in an outpatient university allergy clinic, from January 2005 to January 2015, and who underwent MERIT protocol treatment for allergic rhinitis. In a univariate analysis, the factors significantly associated with SR were lower body mass index (BMI); younger age; a higher number of allergens in the extracts; and the presence of cat, dust mite, and certain weed pollens. In a multivariate analysis, cat, dust mite, and mugwort were significantly associated with SRs. Over the 10-year period, 50 patients experienced SRs (13.81%), with a total number of 68 SRs. Only 4.7% of the SRs occurred on the MERIT day. Most SRs occurred >30 minutes and were mild. Our MERIT protocol continuation rate for all the patients was 49.2% and did not seem to be influenced by having an SR versus no SR. We present a modified rush AIT protocol that seems to be effective and safe. Most patients tolerated therapy, and only a minority of patients developed SRs, which generally were mild. We identified novel risk factors for SRs that may help determine optimal dosing to decrease the risk of SRs. Ultimately, future studies will be needed to compare the safety of our MERIT protocol with traditional AIT.

Characteristics of airborne pollen in Incheon and Seoul (2015-2016).

BackgroundPollen allergens are one of the main contributors to the development and/or aggravation of allergic rhinitis, allergic conjunctivitis, and asthma.ObjectiveAn examination of the airborne pollen in residential areas should be conducted to aid the diagnosis and treatment of allergic diseases.MethodsAirborne pollen samples were collected from 2 sites in Incheon and 2 in Seoul from 2015 to 2016.ResultsThe highest monthly concentration of airborne pollen was observed in May and September each year. Pollen from 32 families and 50 genera was identified over the 2 years; of these, Pinus spp. showed the highest pollen concentration (41.6%), followed by Quercus spp. (25.3%), and Humulus spp. (15.3%), the latter of which had the highest concentration among weed pollen. The total pollen concentration was significantly higher in Incheon than in Seoul (p = 0.001 in 2015, p < 0.001 in 2016) and higher in 2016 than in 2015. The concentrations of pollen from weed species (Cupressaceae, Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae) and grass species (Gramineae) were significantly higher (p < 0.001) than those from tree species. Pollen was distributed from February to November. The first pollen identified in both regions in each year was Alnus spp. Overall, the total concentration of Quercus spp., Betula spp., Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae pollen increased significantly over the 2 years.ConclusionRegion-specific differences exist in the pollen of major allergenic plants. Continuous monitoring of pollen is thus essential for management of pollen-related allergic disorders in each region.

Greater Real-Life Diagnostic Efficacy of Allergen Molecule-Based Diagnosis for Prescription of Immunotherapy in an Area with Multiple Pollen Exposure

Background: Allergen molecule-based diagnosis has been suggested to facilitate the identification of disease-causing allergen sources and the prescription of allergen-specific immunotherapy (AIT). The aim of the current study was to compare allergen molecule-based IgE serology with allergen extract-based skin testing for the identification of the disease-causing allergen sources. The study was conducted in an area where patients are exposed to pollen from multiple sources (trees, grasses, and weeds) at the same time to compare the diagnostic efficiency of the 2 forms of diagnosis. Methods: Patients from Astana, Kazakhstan, who suffered from pollen-induced allergy (n = 95) were subjected to skin prick testing (SPT) with a local panel of tree pollen, grass pollen, and weed pollen allergen extracts and IgE antibodies specific for marker allergen molecules (nArt v 1, nArt v 3, rAmb a 1, rPhl p 1, rPhl p 5, rBet v 1) were measured by ImmunoCAP. Direct and indirect costs for diagnosis based on SPT and marker allergen-based IgE serology as well as direct costs for immunotherapy depending on SPT and serological test results were calculated. Results: The costs for SPT-based diagnosis per patient were lower than the costs for allergen molecule-based IgE serology. However, allergen molecule-based serology was more precise in detecting the disease-causing allergen sources. A lower number of immunotherapy treatments (n = 119) was needed according to molecular diagnosis as compared to extract-based diagnosis (n = 275), which considerably reduced the total costs for diagnosis and for a 3-year treatment from EUR 1,112.30 to 521.77 per patient. Conclusions: The results from this real-life study show that SPT is less expensive than allergen molecule-based diagnostic testing, but molecular diagnosis allowed more precise prescription of immunotherapy which substantially reduced treatment costs and combined costs for diagnosis and treatment.