RELATIONSHIP OF ALLERGIC DISEASES, POLLEN EXPOSURE AND COVID-19 IN GEORGIA.

Allergic diseases have been recognized as one of the global health issues and affect about a third of the worldwide population. COVID-19 pandemic has raised concerns about the risk of infection and the severity of COVID-19 infection in patients with asthma and allergic rhinitis. The aim of our study was to define the relationships between pollen exposures and SARS-CoV-2 infection rates in Georgia, as well as to characterize the Covid-19 autoimmune and antiviral responses in Georgian allergic patients with different sensitization patterns. Data on daily COVID-19 positivity rates, case fatality rates, and pollen concentrations from February 2020 to November 2022 were collected in Tbilisi, Kutaisi, and Batumi. Diagnostic parameters, including total IgE, specific IgE, eosinophil counts, anti-nuclear antibodies, and Covid-19 antibodies, were assessed in 181 atopic patients and 24 healthy controls with confirmed SARS-CoV-2 infection. Laboratory findings revealed significant variations in eosinophil counts and total IgE levels among the groups. ANA positivity did not exhibit substantial differences between atopic patients and healthy controls. Individuals with indoor allergies displayed lower SARS-CoV-2-specific antibody levels, potentially explained by variations in adaptive immune responses. There was no correlation between pollen concentration and COVID-19 epidemiological characteristics, indicating that pollen had no effect on virus epidemiology.

EVALUATION OF ANTINUCLEAR ANTIBODIES IN GEORGIAN ALLERGIC PATIENTS POLYSENSITIZED WITH CROSS REACTIVE ALLERGENS.

Western countries have been challenged with an "allergy epidemic" during the last three to four decades. Interestingly, there has been a parallel increase in the incidence rates of several autoimmune disorders.The aim of our study was to evaluate antinuclear antibodies (ANA) in Georgian allergic patientspolysensitized with cross reactive allergens, in order to establish connection between allergic and autoimmune diseases in our population. Two groups of patients were included in the study: patients with atopy (group 1, n=97) and without (group 2, n=42).ImmunoCAPPhadiatop and ISAC assay platforms were used for atopy screening and polysensitization patterns evaluation. Screening for ANAs was performed by IIFA (Indirect Immunofluorescence assay) on HEp-2 cells. In general 67(69.1%) allergic patients were sensitized to at least one of the cross reactive allergen. Among allergic patients 26 (26.8%) tested positive for the presence of auto-antibodies; for non-allergic patient this value was only 1(2.4%). 18(26.9%) patients sensitized to cross reactive allergens showed positive results for ANA testing and 8(26.7%) allergic patient without cross allergen sensitization were positive for ANA. The AC-2 was only one detected pattern among non-atopic individuals (1/2.4%) and the most frequent pattern in allergic patients (19/73%). In the ANA positive group of allergic patients the atopic dermatitis (13/50%) and asthma (6/23.1%) were most frequently diagnosed. The occurrence of antinuclear antibodies is more frequent in atopic patients and associate mostly with asthma and atopic dermatitis phenotypes of allergic diseases. The most frequent coexisting ANA pattern is dense fine speckled pattern (AC-2).The occurrence of ANA antibody in atopic patients and its role in allergy remains the subject for future research.

CYPRESS POLLEN SESITIZATION IN GEORGIA: CLINICAL AND MOLECULAR CHARACTERISTICS.

Cypress pollen allergy is a widely distributed, highly prevalent and severe winter pollinosis that may be caused by several Cupresaceae species around the Mediterranean basin, in North America and Asia. Exposure to cypress pollen has increased steadily over the last few decades and the prevalence of allergy to cypress pollen has also dramatically increased from 0.6% to 9.8% in the general population and from 9% to 35% in allergic patients, probably because of the allergen load has become more intense. The objective of the study was to evaluate cypress pollen allergy in Georgia and describe clinical characteristics and the molecular profile of sensitization. Patients attended to allergy clinic with suspected cypress pollen allergy (n=492) were included in the study. Diagnostic workup was performed according to local guidelines, specific IgE antibody against cypress allergen was performed using ImmunoCAP and ISAC assay platform. The airborne pollen monitoring was performed with a Burkard Seven Day Volumetric Spore-trap (Burkard Manufacturing Co Ltd, UK) during the seasons of 2019-2020, following the recommendations of European Aerobiology Society. 37.2% of studied cases were positive to cypress diagnostic test. From cypress positive 183 patients only 17 patients (9.2%) had no symptoms during the cypress season. The most frequent symptoms were sneezing and ocular itching (82.9% of patients for both symptoms), rhinorrhea was reported in 77.7% of cases and dry cough and shortness of breath - only in 22.3% (each symptoms). More than half of frequent symptoms were reported as severe. The cypress positive patients were mostly co-sensitized to plant allergen components: grasses (nCyn d1- 61.5% of ISAC positive cases, rPhl p 1 -72.5%, rPhl p 5 - 46.8%), trees (rBet v 1 - 27.5%, nCry j 1 - 78.9%, nPla a 2 - 32.1%) and weeds (nAmb a 1 - 48.6%, nArt v 1 - 20.2%). Our data show that in Georgia, the prevalence of sensitization to cypress pollen in patients attending the allergy clinic is high (every third patient). The clinical symptoms predominantly associated with allergic rhinitis and atopic conjunctivitis, in most cases which are expressing by acute sneezing and ocular itching during the pollen season and all patients are poly-sensitized. This was the first study to give a detailed description of the clinical characteristics of cypress pollen allergic patients in Georgia.

2020 ARIA CARE PATHWAYS FOR ALLERGIC RHINITIS - GEORGIA.

Allergic rhinitis is the most common chronic disease worldwide. Treatment guidelines have improved the knowledge on rhinitis and have had a significant impact on AR management. In 20 years, ARIA has considerably evolved from the first multi-morbidity guideline in respiratory diseases to the digital transformation of health and care. Allergic rhinitis in Georgia, Next-generation ARIA-GRADE guidelines and ARIA, 2020 care pathways for Allergen Immunotherapy have been discussed in this review.

Spatial and temporal variations in airborne Ambrosia pollen in Europe.

The European Commission Cooperation in Science and Technology (COST) Action FA1203 "SMARTER" aims to make recommendations for the sustainable management of Ambrosia across Europe and for monitoring its efficiency and cost-effectiveness. The goal of the present study is to provide a baseline for spatial and temporal variations in airborne Ambrosia pollen in Europe that can be used for the management and evaluation of this noxious plant. The study covers the full range of Ambrosia artemisiifolia L. distribution over Europe (39°N-60°N; 2°W-45°E). Airborne Ambrosia pollen data for the principal flowering period of Ambrosia (August-September) recorded during a 10-year period (2004-2013) were obtained from 242 monitoring sites. The mean sum of daily average airborne Ambrosia pollen and the number of days that Ambrosia pollen was recorded in the air were analysed. The mean and standard deviation (SD) were calculated regardless of the number of years included in the study period, while trends are based on those time series with 8 or more years of data. Trends were considered significant at p < 0.05. There were few significant trends in the magnitude and frequency of atmospheric Ambrosia pollen (only 8% for the mean sum of daily average Ambrosia pollen concentrations and 14% for the mean number of days Ambrosia pollen were recorded in the air). The direction of any trends varied locally and reflected changes in sources of the pollen, either in size or in distance from the monitoring station. Pollen monitoring is important for providing an early warning of the expansion of this invasive and noxious plant.

PLANT AEROALLERGENS IN TWO MAJOR CITIES OF GEORGIA - TBILISI AND KUTAISI.

Pollen allergy is caused by a hypersensitivity reaction mainly of the respiratory tract and eye conjunctivae to pollen grains. The number of people allergic to plant aeroallergens has substantially increased in big cities and industrial areas. The monitoring of aerobiological parameters is of paramount importance for the characterization of allergenic risks. The aims of presented study were as follows: to profile the plant aeroallergens in two major cities of Georgia, to compare the character of pollination curves, to determine the dates of beginning of pollen seasons and their duration in particular cities. Two Burkard 7-day samplers were located in cities: Tbilisi, with climate transitional from humid subtropical to relatively mild continental and Kutaisi, with humid subtropical with a well-defined on-shore/monsoonal flow. Pollen counts were expressed as a daily mean value in number of pollen grains/spores per m3 of air. Data was obtained in 2016 year. The main tree pollen types for both centers were: Alnus (Alder), Betula (Birch), Carpinus (Hornbeam), Castanae (Chestnut), Corylus (Hazel), Cupressaceae (Cypress), Fagus (Beech), Fraxinus (Ash), Juglans (Walnut), Morus (Mulberry), Pinus (Pine), Platanus (Plane Tree), Quercus (Oak), Salix (Willow), Tilia (Lime), and Ulmus (Elm Tree). Comparison analysis had shown that the pollination season of the most trees began earlier in Kutaisi. As an example, the beginning of pollination was about 10-15 days earlier for Corylus and Alnus. The difference in pollen count of particular taxa was observed as well. It was much higher in Kutaisi for Corylus, Alnus and Cupressaceae and significantly higher in Tbilisi for Platanus and Pinus. Main grass pollen was Gramineae (Grasses): the pollination started a little bit earlier in Kutaisi, but the pollen count was generally higher in Tbilisi. The features of pollen seasonal distribution and amount were revealed also for the weeds (mainly Ambrosia (Ragweed) and Artemiasia (Mugwort)). The differences noted in pollen count between two major cities of Georgia may be due to a different composition of local flora and the influence of weather.

SENSITIZATION PATTERN AND CLINICAL PECULARITIES OF FOOD ALLERGY IN GEORGIA.

The aim of our study was to investigate sensitization pattern to food allergens in different age groups of atopic patients in Georgia and reveal the associations between food sensitization and clinical manifestations of allergic disease reflecting the development of atopic march. 1000 patients (children-783, adult-217) with different clinical manifestations were involved in the study. Specific IgE antibodies to food mix, cow's milk, casein, egg, wheat, fish, nuts mixture and inhalant allergens were measured by using ImmunoCap (Phadia, Uppsala, Sweden). The prevalence of positive specific IgE to food mix was - 7.08%, cow's milk-4.61%, casein - 4.68%, hen's egg - 2.72%, fish mix - 0.77%, wheat -1.57% and to nuts mixture - 2.86%. The frequency of atopic dermatitis (p<0.0017), urticaria (p<0.0223) and anaphylactic shock (p<0.001) were significantly increased in patients with specific IgE to food mix. Allergic skin manifestations to ingested food were age-dependent, more frequent in children groups. Cow's milk and hen's egg are the commonest food allergens in the age group of <2 years. Sensitization to food mix, cow's milk, casein, hen's egg and wheat were predominated in male patients. Egg allergy was significantly associated with atopic dermatitis, fish allergy to bronchial asthma and severe milk allergy to anaphylactic shock. Present study is a first comprehensive investigation, providing unique data of the prevalence of food allergies in Georgian population. The results of this study are contributing to a better understanding of the disease, serving as a basis for the development of strategies for preventing and treating food allergies.

Trends in the prevalence of childhood asthma and allergy in Western part of Georgia.

Internatinal time trend analyses, using the ISAAC (Phase Three) protocol, have yielded variable results and observed a rise in prevalence especially in areas where allergic diseases were previously less common. In 2003 and 2012, we performed cross-sectional studies in Kutaisi (western part of Georgia) schoolchildren aged 6-7 and 13-14 yr., using the validated ISAAC methodology, aiming to provide the prevalence trends of asthma and allergy in this population. Both cross-sectional studies were carried out in the same city, same season and used identical methodologies. In 2003, number of participants in 6-7 and 13-14 yrs old groups was 2666 and 2650 and in 2012 - 3039 and 2339 correspondently. Significant alteration in prevalence of asthma related symptoms was obtained in both age groups. The symptom of severe asthma had increased only in 13-14 year old adolescents and was not change in 6-7 year old group. There were significant increases (all to p < 0.001) in the symptoms of current sneezing (16.4% vs 8.7% and 28.4% vs 15.3% in 6-7 yr group and 13-14 yr group correspondently) and rhinoconjunctivitis (5.2% vs 2.9% and 9.6% vs 4.5% yr group and 13-14 yr group correspondently). Symptoms of current eczema (affecting flexural dermatitis) were increased in both age groups. The prevalence of asthma and allergies markedly increase among both age groups of schoolchildren in the western part of Georgia. The exact reasons for such trends remain to be explored.

Risk factors of asthma in Georgian schoolchildren.

All existing contemporary data are indicating a relatively low prevalence of asthma in Georgia. The aim of the study, which was undertaken as part of ISAAC Phase II, was to assess some potential risk factors of asthma among schoolchildren in Georgia. In this study the current wheezing was revealed in 9.2% of 9 to 11-year-old children. The presence of asthma symptoms was strongly associated with presence of symptoms of rhino-conjunctivitis (OR=8.60, 95% CI=4.82-15.33, p=0.000) and eczema (OR=5.30, 95% CI=2.80-10.04, p=0.000). The logistic regression analysis revealed that environmental factor such as dampness/moulds at home, in addition to family history of allergy, was significant risk factor for asthma in Georgia. Future epidemiological study of risk factors for asthma, at both the host and environmental level, is desirable in order to help detect strategies of allergen avoidance.

International variation in prevalence of rhinitis and its relationship with sensitisation to perennial and seasonal allergens.

The relative importance of atopy in the aetiology of rhinitis is largely unknown. The present study investigated the geographical variations in rhinitis in relation to atopy. The cross-sectional study involved 54,178 children (aged 8-12 yrs) from 30 study centres in 22 countries worldwide. Symptoms of rhinoconjunctivitis and rhinitis without conjunctivitis in the last 12 months were reported in parental questionnaires and children were skin-prick tested. The prevalence of rhinoconjunctivitis and rhinitis without conjunctivitis varied widely (1.5-24.5% and 1.4-45.2%, respectively). For rhinoconjunctivitis, the population attributable fraction (PAF) varied 0-71% for a positive skin-prick test to one or more seasonal allergens and 0-41% for perennial allergens. The PAF for sensitisation to seasonal and perennial allergens was higher in affluent countries (36 and 25%, respectively) than nonaffluent countries (1.3 and 12.6%, respectively). For rhinitis without conjunctivitis, the PAF for perennial allergens was 8 and 4% for affluent and nonaffluent countries, respectively. No significant PAF was found for seasonal allergens. Overall, atopy explained only a limited proportion of rhinitis symptoms, suggesting that the importance of other environmental factors has been under emphasised, particularly in less affluent countries. Atopy seems to be only marginally relevant for rhinitis without conjunctivitis, which seems mainly to reflect nonatopic rhinitis.

Prevalence of asthma and allergies among adolescents in Georgia: comparison between two surveys.

Since healthcare costs for asthma and allergies are a heavy burden for a society, it is a general interest to know whether this temporal trend is still ongoing or whether a plateau has been reached over the last decade. We therefore aimed to follow the trends in the prevalence of asthma, allergic rhino-conjunctivitis, and atopic eczema in Georgian schoolchildren of 13-14 years of age between 1996 and 2003. Surveys were carried out according to the ISAAC methodology in Tbilisi and Kutaisi centres. The mean prevalence increased steadily for current wheezing from 3.6% to 5.6% (p=0.0001) and current rhino-conjunctivitis from 4.6% to 5.7% (p=0.008), while the prevalence of current atopic eczema has remained actually constant, 4.1% and 4.3%, respectively. The prevalence of allergic diseases showed diverging gender trends. The prevalence of rhino-conjunctivitis and eczema in girls has decreased, while in boys increased. The prevalence changes, particularly the increasing pattern, were more evident in Tbilisi vs. Kutaisi centre. The differences could be associated with so-called westernization processes in the capital of Georgia. The investigation of risk factors at regional level could be important in order to undertake preventive measures.

ISAAC I and III in Georgia: time trends in prevalence of asthma and allergies.

ISAAC I and III surveys were carried out in schoolchildren aged 6-7 years from two centres of Georgia to estimate time trends and geographic variations in the prevalence of asthma, rhino-conjunctivitis and atopic eczema symptoms. A standard core questionnaire was used following the ISAAC methodology and was completed by the schoolchildren's parents. The prevalence of symptoms of allergic diseases in Phase I and Phase III was compared. The average prevalence of "current wheezing" almost not changed over 7 years, however there was some heterogeneity across the centres, particularly in Tbilisi centre the prevalence of current wheezing increased by 2.6% and in Kutaisi (it decreased by 2.4%. The symptoms of current rhino-conjunctivitis slightly decreased, but not statistically significant. More significant reduction was observed for symptoms atopic eczema, which was revealed in both centres. The results indicate that the epidemiological features of asthma and allergies in Georgia are changing, although the causes are still uncertain. Different patterns of time trends between centres suggested that there may be local differences in risk factors.