Aeroallergen Monitoring by the National Allergy Bureau: A Review of the Past and a Look Into the Future.

Monitoring aeroallergens has a long history within the American Academy of Allergy, Asthma & Immunology. The Aeroallergen Network of the National Allergy Bureau is composed mainly of members of the American Academy of Allergy, Asthma & Immunology, whose objectives are to enhance the knowledge of aerobiology and its relationship to allergy, increase the number of certified stations, maintain the standardization and quality of aerobiology data, improve the alert and forecast reporting system, and increase ties with other scientific entities inside and outside the United States. The public has a keen interest in pollen counts and pollen forecasts, as do many health professionals in the allergy community. In this review, we explore the past, present, and future of allergen monitoring with a focus on methods used for sampling, the training of those performing the analysis, and emerging technologies in the field. Although the development of automated samplers with machine intelligence offers great promise for meeting the goal of a fully automated system, there is still progress to be made regarding reliability and affordability.

The Clinical Relevance of Pollen Versus Fungal Spores in Allergic Diseases.

Pollen and fungal spores are associated with seasonal and perennial allergies. However, most scientific literature thus far suggests that pollen allergy is more clinically relevant than fungal allergy. Several environmental and biological factors and the difficulty in producing reliable fungal extracts account for this. Biodiversity, taxonomy, and meteorology are responsible for the types and levels of pollen and fungal spores, their fragments, and the presence of free airborne allergens. Therefore, it is difficult to accurately measure both pollen and fungal allergen exposure. In addition, understanding the enzymatic nature of fungal and some pollen allergens, the presence of allergenic and nonallergenic substances that may modulate the allergic immune response, and allergen cross-reactivity are all necessary to appropriately evaluate both sensitivity and exposure. The raw materials and manufacturing processes used to prepare pollen versus fungal extracts differ, further increasing the complexity to properly determine allergic sensitivity and degrees of exposure. The pollen extracts used for diagnosis and treatment are relatively consistent, and some have been standardized. However, obtaining clinically relevant fungal extracts is more difficult. Doing so will allow for the proper selection of such extracts to more appropriately diagnose and treat both pollen- and fungal-induced allergic diseases.

Impact of weather and climate change with indoor and outdoor air quality in asthma: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee.

Weather and climate change are constant and ever-changing processes that affect allergy and asthma. The purpose of this report is to provide information since the last climate change review with a focus on asthmatic disease. PubMed and Internet searches for topics included climate and weather change, air pollution, particulates, greenhouse gasses, traffic, insect habitat, and mitigation in addition to references contributed by the individual authors. Changes in patterns of outdoor aeroallergens caused by increasing temperatures and amounts of carbon dioxide in the atmosphere are major factors linked to increased duration of pollen seasons, increased pollen production, and possibly increased allergenicity of pollen. Indoor air pollution threats anticipated from climate changes include microbial and mold growth secondary to flooding, resulting in displacement of persons and need for respiratory protection of exposed workers. Air pollution from indoor burning of mosquito repellants is a potential anticipatory result of an increase in habitat regions. Air pollution from fossil fuel burning and traffic-related emissions can alter respiratory defense mechanisms and work synergistically with specific allergens to enhance immunogenicity to worsen asthma in susceptible subjects. Community efforts can significantly reduce air pollution, thereby reducing greenhouse gas emission and improving air quality. The allergist's approach to weather pattern changes should be integrated and anticipatory to protect at-risk patients.

Landscape Plant Selection Criteria for the Allergic Patient.

Patients with pollen-related allergies are concerned about the species within their landscape that provoke their symptoms. Allergists are often asked for guidance but few information sources are available to aid patients in the recognition of allergenic plants and strategies to avoid personal exposure to them. Landscaping and horticultural workers also have few reliable guidance references, and what is available usually extols the virtues of the plants rather than their negative features. The aim of this article was to provide the results of the Landscape Allergen Working Group that was formed by the AAAAI Aerobiology Committee, which aimed to fill these existing knowledge gaps and develop guidance on producing a low-allergenic landscape. Within the context that complete pollen avoidance is unrealistic, the workgroup introduces selection criteria, avoidance strategies, and guidance on low-allergenic plants that could be selected by patients to reduce the overall pollen burden in their landscape environment. Specific focus is placed on entomophilous plants, which require insects as dispersal vectors and generally produce lower quantities of pollen, compared with anemophilous (wind-pollinated) species. Other biological hazards that can be encountered while performing landscaping activities are additionally reviewed and avoidance methods presented with the aim of protecting gardeners, and workers in the landscape and horticulture industries. The guidance presented in this article will ultimately be a helpful resource for the allergist and assist in engaging patients who are seeking to reduce the burden of allergen in their landscape environment.

Fungal raw materials used to produce allergen extracts.

OBJECTIVE: To review the topic of fungal raw materials used for the production of allergen extracts and the associated challenges and highlight candidate areas for development before standardized fungal allergen extracts can be commercially produced. DATA SOURCES: A PubMed search was performed using focused keywords and combined with a review of regulatory documents and industry guidelines. Several books on mycology also were consulted. STUDY SELECTIONS: The information obtained through the literature, books, and industry was scrutinized and combined with personal experience and expertise to write this article. RESULTS: Fungi are complex ubiquitous organisms on Earth. They are beneficial and detrimental for humans. Fungi can cause hypersensitivity reactions, including types I, III, and IV. The procurement of fungal raw materials to prepare allergen extracts for diagnosis and possible allergen immunotherapy is complex owing to the intrinsic nature of fungi and their complex genome. Allergen manufacturers produce allergen extracts with variable qualitative and quantitative compositions, which can lead to unpredictable clinical outcomes. CONCLUSION: The clinician should be aware of the factors responsible for the qualitative and quantitative compositions of fungal allergen extracts and the reasons that currently preclude their standardization. Scientific advances and collaboration and cooperation between allergen manufacturing companies and regulatory agencies are necessary to improve the quality and consistency of fungal extracts. Moreover, clinicians should understand the limitations of currently available fungal extracts.

Something new in the air: Paying for community-based environmental approaches to asthma prevention and control.

Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma.

Pollen used to produce allergen extracts.

OBJECTIVE: To review the use of pollen for the production of allergen extracts to diagnose and treat allergic diseases, examine the associated regulations, and highlight candidate areas for improvement. DATA SOURCES: A PubMed search was performed using focused keywords combined with a review of regulatory documents and industry guidelines. STUDY SELECTIONS: The information obtained through literature, documents, and industry was scrutinized and used with personal experience and expertise to write this article. RESULTS: Both genetic and environmental factors affect the allergenic composition of pollen because it is a biologically active pharmaceutical ingredient obtained from nature. The potential effect of airborne contaminants in pollen requires major attention but can be properly addressed through careful collection practices, combined with a proper interpretation of the data on purity obtained for each pollen lot. The regulations associated with pollen used to manufacture allergen extracts in the United States and Europe and the numbers of pollen allergen extracts commercially available in both areas of the world differ. A critical parameter to select the appropriate extracts for diagnosis and allergen immunotherapy is to understand the phenomenon of cross-reactivity among pollen families, genera, and species. CONCLUSION: Physicians should be aware of the factors responsible for the qualitative and quantitative composition of pollen allergen extracts and the associated regulations to produce suitable extracts to diagnose and treat allergic diseases. Collaboration and cooperation among allergen manufacturing companies and regulatory agencies are necessary.

Considerations About Pollen Used for the Production of Allergen Extracts.

Pollen is a biological product obtained to manufacture tree, weed, and grass allergen extracts, used to diagnose and treat allergies. Genetic and environmental factors affect the composition of pollen, e.g., the plant varieties from which pollen are obtained, weather, and levels of air pollution during plant growth. Therefore, appropriate guidelines and training of personnel to perform the activities associated with pollen are essential to produce appropriate allergen extracts. Various regulatory institutions, which vary in different countries, including the Food and Drug Administration (FDA) in the USA, control how such products should be produced. For example, the FDA regulates the manufacturing of pollen extracts but not the quality of the pollen used to prepare them, relying on each manufacturer to set its own standards to do so. To the contrary, European regulatory agencies, including the European Medicines Agency, control both the quality of the pollen and the manufacturing process to produce pollen extracts. Regulatory agencies, allergen manufacturers, scientific institutions, and pollen collection entities should collaborate to develop and implement guidelines appropriate for worldwide use for both the collection and processing of pollen raw materials. This article provides an overview of the subject of pollen for use in allergen extracts.

Guide for interpreting reports from inspections/investigations of indoor mold.

Inspections and testing of indoor environments for mold growth increased dramatically in the past decade. Allergists can now be presented copies of reports and laboratory data and asked to provide an interpretation, although allergists are seldom trained to review environmental data. There is no single sampling method that is both specific for mold growth and robust enough to reliably detect mold growth. There is no standard method for these inspections or testing and no widely recognized credential for investigators, and therefore reports also vary in quality, objectives, and thoroughness. Despite these issues, observations from informed inspections coupled with results from qualified analyses of samples that are collected with a useful strategy can usually indicate whether mold growth is present in a building, but the nature of the report should be assessed before any interpretation of the results and data are attempted. This rostrum discusses objectives of inspections, describes qualifications for investigators, outlines the limitations of various sampling methods applicable to mold and to some degree endotoxin, and provides guidance for data interpretation.

Prevalencia de diabetes mellitus y factores de riesgo relacionados en una población urbana / Prevalence of diabetes mellitus and relacted risk in an urban population

Conocer la prevalencia de la diabetes mellitus y sus factores de riesgo en una población urbana de Lima ciudad. Material y métodos. Se realizó un estudio transversal descriptivo, aleatorio y por conglomerados a 213 sujetos mayores de 15 años del distrito de Breña, en Lima ciudad. Se registró los valores de presión arterial, peso, talla, medición de cintura, glicemia basal, colesterol y triglicéridos. Resultados. Se encontró: una prevalencia de diabetes mellitus de 7, 04 por ciento (IC95 por ciento : 3,60 por ciento- 10, 48 por ciento); intolerancia a los carbohidratos de 2,82 por ciento (IC95 por ciento : 29, 70 por ciento- 42, 60 por ciento); hipercolesterolemia 19,25 por ciento (IC95 por ciento : 3,96 por ciento- 24, 54 por ciento); hipertrigliceridemia 27, 70 por ciento (IC95 por ciento : 21, 69- 33, 71 por ciento) ; obesidad 21, 60 por ciento (IC95 por ciento (IC95 por ciento : 16, 07 por ciento - 27, 13 por ciento) sobrepeso 37, 56 por ciento (IC95 por ciento : 26, 11 por ciento- 38, 68 por ciento) y consumo de bebidas alcohólicas 62, 44 por ciento (IC95 por ciento : 55, 94 por ciento- 68, 94 por ciento ). Conclusiones. Se encontró un prevalencia relativamente alta (7, 04 por ciento) de diabetes mellitus en el distrito de Breña en Lima ciudad. Los factores de riesgo relacionados a la diabetes fueron baja actividad física, sobrepeso, hipertensión arterial y obesidad.

Diferencias en la prueba e perfusión miocardica entre diabeticos sintomáticos y diabeticos con isquemia silente

Los pacientes diabeticos con isquemia silente presentan mayor prevalencia de EKG de reposo anormal, comparado con el grupo sintomático (p<0.001) Prueba de Chi cuadrado. No hay diferencias en cantidad y extensión de isquemia entre diabéticos con isquemia silente y diabéticos con angina. Los pacientes diabéticos con angina presentaron mayores evidencias de sifunción ventricular ixquierda transitoria, comprados con los pacientes con isquemia silente (p<0.001) Prueba de chi cuadrado. La prueba de perfusión miocárdica con radionúclidos constituye una alternativa viable para evaluar la presenica de isquemia enpacientes diabéticos .