[New - epicutaneous - method for the causal treatment of allergic diseases]. / Új, epicutan módszer az allergia oki kezelésére.

The only causal treatment for the allergic diseases is the allergen immunotherapy. Besides oral and injection forms, an epicutaneous form is known as well. During the immunization process the use of an adjuvant material is advisable besides the allergen. That adjuvant material can be (besides of the aluminium hydroxid and tyrosine) a bacterial toxin, too. In idealistic circumstances we can substitute the native allergen with its recombinant variant, which could keep its immunogenicity but had lost the allergenicity. In the future the recommended therapy could be the safe, painless, epicutaneous hyposensitization, with recombinant allergens, with bacterial toxin as adjuvants. Orv Hetil. 2017; 158(23): 895-899.

[Physical exercise and bronchial asthma]. / A testedzés és az asztma kapcsolata.

An article was published in the Lancet in 1935 about the therapy of asthmatic patients, using a special breathing exercise (the authors used a control group, too). Swimming, as a complementary therapy for asthmatic children, was first recommended in 1968, by authors from the United States. In Hungary, regular swimming training for asthmatic children is in use since August, 1981. As the result of this exercise, the physical fitness of asthmatic children (using this method regularly for years) increased dramatically, and it is much better compared to that found in the non asthmatic, non swimming children of the same age group. The requirement for asthma medication decreased, and the severity of their disease significantly decreased, also. On the other hand, asthma is not a rarity even among elite athletes. It is most frequent in the endurance sports (for example in Northern Europe among cross-country skiers its prevalence is between 14-54%, among long distance runners 15-24%, and among swimmers 13-44%). The possible reason is related to the fact that elite athletes inspire 200 liter air/minute (mostly through the mouth). Air pollution and allergens can penetrate in the lower respiratory tract. The air causes cooling and drying of the mucosa of the airways and, as a consequence, mediators are liberated which produce oedema of the mucosa, and bronchoconstriction. Beta-2-receptor agonists inhalation can prevent (or decrease significantly) this phenomenon. These agents are used regularly by elite athletes, too. The non-medical possibilities for prevention include wearing a special mask, frequent ventilation of the swimming pool's air, consumption of omega-3-fatty acid, and inhalation of dry salt (very small, and very clear sodiumchloride particles).

[Theoretical basis and clinical benefits of dry salt inhalation therapy]. / A szárazsó-belégzéssel történo kezelés elméleti alapjai és gyakorlati haszna.

Dry salt inhalation (halotherapy) reproduces the microclimate of salt caves, with beneficial effect on health. Sodium chloride crystals are disrupted into very small particles (with a diameter less than 3 µm), and this powder is artificially exhaled into the air of a comfortable room (its temperature is between 20-22 °C, and the relative humidity is low). The end-concentration of the salt in the air of the room will be between 10-30 mg/m(3). The sick (or healthy) persons spend 30-60 minutes in this room, usually 10-20 times. Due to the greater osmotic pressure the inhaled salt diminishes the oedema of the bronchial mucosa, decreases its inflammation, dissolves the mucus, and makes expectoration easier and faster (expectoration of air pollution and allergens will be faster, too). It inhibits the growth of bacteria and, in some case, kills them. Phagocyte activity is also increased. It has beneficial effect on the well being of the patients, and a relaxation effect on the central nervous system. It can prevent, or at least decrease the frequency of the respiratory tract inflammations. It produces better lung function parameters, diminishes bronchial hyperreactivity, which is the sign of decreasing inflammation. Its beneficial effect is true not only in inflammation of the lower respiratory tract, but also in acute or chronic upper airways inflammations. According to the international literature it has beneficial effect for some chronic dermatological disease, too, such as psoriasis, pyoderma and atopic dermatitis. This treatment (called as Indisó) is available under medical control in Hungary, too.

[Occupational asthma in Hungary]. / A foglalkozási asztma napjainkban Magyarországon.

Occupational asthma belongs to communicable diseases, which should be reported in Hungary. During a 24-year period between January 1990 and December 2013, 180 occupational asthma cases were reported in Hungary (52 cases between 1990 and 1995, 83 cases between 1996 and 2000, 40 cases between 2001 and 2006, and 5 cases between 2007 and 2013). These data are unusual, because according to the official report of the National Korányi Pulmonology Institute in Budapest, at least 14,000 new adult asthma cases were reported in every year between 2000 and 2012 in Hungary. Also, international data indicate that at least 2% of adult patients with asthma have occupational asthma and at least 50 out of 1 million employees develop occupational asthma in each year. In 2003, 631 new occupational asthma patients were reported in the United Kingdom, but only 7 cases in Hungary. Because it is unlikely that the occupational environment in Hungary is much better than anywhere else in the world, it seems that not all new occupational asthma cases are reported in Hungary. Of the 180 reported cases in Hungary, 55 were bakers or other workers in flour mills. There were 11 metal-workers, 10 health care assistants, 9 workers dealing with textiles (tailors, dressmakers, workers in textile industry) and 9 employees worked upon leather and animal fur. According to international data, the most unsafe profession is the animal keeper in scientific laboratories, but only 4 of them were reported as having occupational asthma during the studied 24 years in Hungary. Interestingly, 3 museologists with newly-diagnosed occupational asthma were reported in 2003, but not such cases occurred before or after that year. In this paper the Hungarian literature of occupational asthma is summarized, followed by a review on the classification, pathomechanism, clinical presentation, predisposing factors, diagnostics and therapeutic aspects of the disease. Epidemiological data of adult asthma in Hungary and data from international studies on the occurrence of occupational asthma are also presented. Finally, the author draws attention to the low reporting activity of occupational asthma in Hungary and discusses the possible causes why this communicable disease is rarely reported.

[Occupational rhinitis and allergic conjunctivitis]. / Foglalkozási eredetu allergiás nátha és allergiás kötohártya-gyulladás.

Occupational rhinitis is an inflammatory disease of the nose, which is characterised by intermittent or persistent symptoms, arising from causes and conditions attributable to a particular work environment and not from stimuli encountered outside the workplace. Its clinical symptoms such as nasal congestion, sneezing, rhinorrhoea, itching, nasal airflow limitation are very similar to the symptoms of allergic rhinitis caused by other (classical) agents. Occupational allergic conjunctivitis is an IgE mediated disease, provoked by a substance in the air of the workplace. Its clinical signs (itching, tearing, conjunctival hyperaemia and oedema and, in some cases when the cornea is also involved, blurred vision, photosensitivity) are similar to other forms of allergic conjunctivitis. Risk factors (which in most of the cases occur in both diseases) include history of atopy, high concentration of the irritant agent and multiple irritant agents in the air of the workplace. Atopy has been associated with an increased risk of specific sensitisation to a variety of high molecular weight agents. For the diagnosis of occupational rhinitis and occupational allergic conjunctivitis objective investigations such as allergen specific provocations are necessary in addition to clinical and occupational history. Management of these occupational diseases needs environmental interventions (increasing ventilation, decreasing the time of exposure, substitution of the irritant agent). Medical treatment of occupational rhinitis is very similar to other allergic diseases: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine plus membrane stabilizer) eyedrops. The most important step in medical treatment of occupational allergic conjunctivitis is the daily application of combined eyedrops (for example: olopatadine). Orv. Hetil., 2014, 155(5), 170-175.

[Occupational rhinitis]. / A foglalkozási nátha.

Occupational rhinitis (OR) is an inflammatory disease of the nose, which is characterized by intermittent or persistent symptoms, arising out of causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace. Its clinical symptoms (nasal congestion, sneezing, rhinorrhea, itching, nasal airflow limitation) are very similar with the symptoms of the allergic rhinitis caused by other (classical) agents. According to the 27/1996 NM Departmental Order, OR in Hungary is a notifiable disease. Despite, between year 1997 and 2009, not even a single case was reported in Hungary. In the last 20 years the only Hungarian reference in this field was published in 2004, in the Textbook of Occupational Medicine, edited by Ungváry. This disease is not unknown in other European countries. It can be produced by both high and low molecular weight agents. For example, according to the publications, its prevalence among bakers can be 18-29%, and among workers with diisocyanates (painters, urethane mould workers) 36-42%. Risk factors are atopy, high concentration and multiple irritant agents in the air of workplace. Atopy has been associated with an increased risk of specific sensitization to a variety of HMW agents. Beside of the clinical and occupational history, objective investigations have to be used as well, for the diagnosis of OR. The gold standard for confirming the diagnosis of OR is the nasal provocation test. Objective methods that can be used for assessing nasal patency during the investigation of OR include rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow, and gravimetry of the nasal secret. The management of the OR needs environmental interventions. These are: increasing the ventilation, decreasing the time of exposure, substitution of the irritant agent, investigation of possible asthma in all workers with OR. Medical treatments are: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine+membrane-stabilizer) eyedrops.

[Increase in prevalence of childhood asthma in Budapest between 1995 and 2003: correlation with air pollution data and total pollen count]. / A gyermekkori asztma prevalenciájának növekedése Budapesten 1995 és 2003 között a (változatlan) légszennyezettségi és pollen adatok tükrében.

INTRODUCTION: According to the data of the Hungarian pulmonological network, the prevalence of asthma in the last 15 years has increased (almost linearly) in Hungary. In 2004 it was 1.8%. There are only a few data about the prevalence of childhood asthma. AIMS: The aim of the authors was to measure the prevalence of bronchial asthma in childhood in Budapest in 1995, 1999 and 2003, using questionnaires directed to district pediatricians. METHODS: There were only two questions in these questionnaires: how many children are in their districts, and how many are suffering from asthma? Besides of this survey the dust, CO, NO(2) and SO(2) concentrations in the air were measured on-line at 8 points in Budapest, while ozone level measurements were also made at 2 stations. The counts of pollen and of fungal elements in the air were calculated separately for Buda and for Pest. RESULTS: In 1995, replies were received from 118 pediatricians in 11 districts, who were responsible for the supervision of 104,060 children, out of these 1.88+/-0.87% had been diagnosed as having asthma. In 1999 replies were sent by 153 physicians in 22 of the 23 districts, who had a total of 142,679 children under their care. These included 3228 asthmatics, i.e. a prevalence of 2.26+/-0.95%. In 2003 the authors received answers from all of the 23 districts of Budapest. The 204 pediatricians were responsible for the supervision of 176 049 children. The number of patients with the diagnosis of asthma was 4712 (corresponding for a prevalence of 2.68+/-1.3%). The increase between 1995 and 1999, and between 1999 and 2003 was highly significant (p < 0.0001). This significant increase was valid even when the authors analysed only those 11 districts, which answered already in 1995. The level of air pollution in Budapest did not deteriorate in the period in question, and the concentration of pollen grains of plants causing allergy did not increase compared to previous years. CONCLUSIONS: On the basis of the results of more than 100 thousand children, the authors conclude that between 1995 and 2003 the proportion of asthmatic children increased by 50% in Budapest, while the air pollution did not deteriorate and the pollen concentration from sensitizing plants did not increase.

[The prompt effect of emedastine eye drop and the safety of its permanent use in children suffering from acute seasonal allergic conjunctivitis]. / Emedastine hatóanyagú szemcsepp hatékonysága és biztonságossága heveny szezonális allergiás kötohártya-gyulladásban szenvedo gyermekeken.

INTRODUCTION: In the treatment of any disease, it is advantageous if the concentration of the administered drug is highest in the target organ. It follows that, if possible, diseases of the conjunctiva should primarily be treated with eye drops. AIMS: The author investigated the effect of an eye drop with selective H1-receptor antagonist properties, on children suffering from acute seasonal conjunctivitis. METHOD: During the first experiment 20 children (suffering from acute seasonal allergic conjunctivitis) had received Emadine eye drop (containing emedastine difumarate, an H1 antihistamine agent). The severity of the itching of the eye and the grade of hyperemia of the conjunctiva were scored on scales ranging 0 to 4 (score 4 representing the most severe symptoms). In the second experiment 232 other children had received this eye drop during two pollen seasons and the author investigated its effectiveness and side effects. RESULTS: The conjunctival itching decreased within less than 3 minutes significantly, and the redness was also reduced in an average of 8 minutes. In the second experiment none of the 232 children had to change this drug because of its ineffectiveness or side effects. CONCLUSIONS: Emadine eye drop decreases the itching and the redness of the conjunctiva very quickly and effectively. It is usable even for three-year-old patients, and it keeps its effectiveness during the long-term treatment, too.

[First Hungarian report of olopatadine eyedrop therapy in children and adults suffering from seasonal allergic conjunctivitis]. / Elso magyarországi beszámoló olopatadin hatóanyagú szemcseppel allergiás gyermek es felnott betegeken szerzett tapasztalatokról.

UNLABELLED: The eye drop Opatanol (its main component is olopatadine, which has an antihistaminic and membrane-stabilizing effect) in Hungary is not well known yet. PATIENTS AND METHODS: In 2004 and 2005 in the ragweed season we had treat with olopatadine eyedrop for 2 weeks (two times daily) 37 children, who had ragweed allergy. The average age of the 23 boys was 8.8 years, and for the 14 girls 10.5 years. In July and August of 2004 10 adult allergic female (average of their age: 29,2 years) also had receive olopatadine for 2 weeks. The severity of the symptoms was recorded by using a scale from 0 to 3 (where 3 indicates the most severe symptoms) before and 2 weeks after the beginning of the treatment, and the average was calculated. RESULTS: The discomfort feeling decreased from 2.4 +/- 0.5 to 0.8 +/- 0.2 in children, and from 1.5 +/- 0.9 to 0 in adults, the itching from 2.5 +/- 0.4 to 0.2 +/- 0.1 in children, and from 1.6 +/- 1.2 to 0 in adults, the foreign body sensation from 1.6 +/- 0.9 to 0.7 +/- 0.4 in children, and from 1.3 +/- 1.1 to 0 in adults, the tearing from 1.9 +/- 0.9 to 1.0 +/- 0.3 in children, and from 1.0 +/- 1.0 to 0.1 in adults, and the redness from 2.2 +/- 0.4 to 1.1 +/- 0.2 in children and from 1.9 +/- 0.8 to 0.5 +/- 0.5 in adults. We observed side effect in one child (the redness of the conjunctiva increased after the application of the eye drop) and in two adults (burning sensation for short time, in the other case foreign body sensation for 30 seconds). CONCLUSIONS: The anti-allergic eye drop olopatadine is a safe and effective treatment for seasonal allergic conjunctivitis even in childhood. It is comfortable, to use twice daily is sufficient.

[Prevalence of the most common respiratory allergens generating positive prick-reaction based on the examination of 2124 children suffering from respiratory allergy, between 1992-2000]. / A pozitív prick-reakciót kiváltó leggyakoribb légúti allergének gyakoriságának alakulása 1992 és 2000 között, 2124 légúti allergiában szenvedo gyermek vizsgálata alapján.

UNLABELLED: The absolute number and the rate of allergic diseases among the population are increasing worldwide. The sequence of the allergens can change during the years even in the same area. METHODS: The authors examined the results of skin prick tests of 2124 children between the age of 3 and 18 suffering from respiratory diseases caused by allergy between 1992 and 2000. RESULTS: According to their results, in each year the number of boys was double of the number of girls, most of the patients were sensitive to grass pollen (32.8%), 27.6% was allergic to ragweed pollen, 22% to tree pollen. The prevalence of mould allergy increased by the years. 37.9% of the patients allergic to indoor allergens were sensitive to animals, the most frequent among them was cat allergy. The rate of house dust mite allergy was 27.8% and 25.2%. CONCLUSIONS: The authors' findings are similar to those of other investigators.

[Effects of emedastine eyedrops on acute seasonal allergic conjunctivitis in children]. / Emedastin szemcsepp hatása gyermekek heveny szezonális allergiás kötóhártya-gyulladására.

The developments of the symptoms of acute allergic inflammation of the conjunctiva (itching of the eye, conjunctival hyperaemia and oedema, and lacrimation) is largely due to the histamine released in the course of the allergic reaction. A major role in its treatment is therefore played by eyedrops with an antihistamine effect. The aims of the present study were to establish whether there is a rapid effect of eyedrops containing the selective H1 receptor blocker emedastine on acute seasonal allergic conjunctivitis and, if so, the time required for this effect to develop. Eyedrops containing emedastine were administered in the ragweed season to 20 children (12 boys and 8 girls) with acute allergic inflammation of the conjunctiva resulting from a hypersensitivity to ragweed pollen, the average age of the 20 children was 12.3 years (range: 5-19). The degrees of itching of the eye and of conjunctival hyperaemia were each characterised on a scale ranging from 0 to 4 (4 denoting the most severe symptoms). It was found that, after a single administration of 1 emedastine eyedrop, the degree of itching of the eye fell from the starting score of 2.85 +/- 0.75 to 0.45 +/- 0.51 within an average of 2.95 minutes, while the conjunctival hyperaemia fell from 2.35 +/- 0.59 to 0.55 +/- 0.51 in an average of 7.7 minutes. The level of the improvement for both symptoms was highly significant. An undesirable side effect (a burning sensation on the eyeball) was observed in one case. It may be stated that the eyedrop containing emedastine effectively decreases the extents of itching of the eye and conjunctival hyperaemia in children with acute allergic conjunctivitis, its effects are exerted within minutes.