[Allergic rhinitis in children and adults - international recommendations adapted to the clinical situation in Sweden]. / Allergisk rinit hos barn och vuxna.

Allergic rhinitis is the most common chronic disease in Sweden, with impact on quality of life and with a heavy economic burden for the society. More than 20 years have passed since national recommendations were launched, and meanwhile both ARIA (Allergic rhinitis and its impact of asthma) and EUFOREA (The European Forum for Research and Education in Allergy and Airway Diseases) have presented international guidelines which in this article have been adapted to the clinical situation in Sweden. Visual analogue scale (VAS) is recommended for symptom evaluation, and the importance of correct allergen analysis and examination for coexisting asthma is emphasized. Treatment is recommended according to EUFOREA. Follow-up is important, and if VAS is ≥5 the disease is regarded as uncontrolled and must lead to a change of treatment. Since self-treatment is common in allergic rhinitis the importance of patient cooperation and information is underlined.

Revealing new tick-borne encephalitis virus foci by screening antibodies in sheep milk.

BACKGROUND: Tick distribution in Sweden has increased in recent years, with the prevalence of ticks predicted to spread towards the northern parts of the country, thus increasing the risk of tick-borne zoonoses in new regions. Tick-borne encephalitis (TBE) is the most significant viral tick-borne zoonotic disease in Europe. The disease is caused by TBE virus (TBEV) infection which often leads to severe encephalitis and myelitis in humans. TBEV is usually transmitted to humans via tick bites; however, the virus can also be excreted in the milk of goats, sheep and cattle and infection may then occur via consumption of unpasteurised dairy products. Virus prevalence in questing ticks is an unreliable indicator of TBE infection risk as viral RNA is rarely detected even in large sample sizes collected at TBE-endemic areas. Hence, there is a need for robust surveillance techniques to identify emerging TBEV risk areas at early stages. METHODS: Milk and colostrum samples were collected from sheep and goats in Örebro County, Sweden. The milk samples were analysed for the presence of TBEV antibodies by ELISA and validated by western blot in which milk samples were used to detect over-expressed TBEV E-protein in crude cell extracts. Neutralising titers were determined by focus reduction neutralisation test (FRNT). The stability of TBEV in milk and colostrum was studied at different temperatures. RESULTS: In this study we have developed a novel strategy to identify new TBEV foci. By monitoring TBEV antibodies in milk, we have identified three previously unknown foci in Örebro County which also overlap with areas of TBE infection reported during 2009-2018. In addition, our data indicates that keeping unpasteurised milk at 4 °C will preserve the infectivity of TBEV for several days. CONCLUSIONS: Altogether, we report a non-invasive surveillance technique for revealing risk areas for TBE in Sweden, by detecting TBEV antibodies in sheep milk. This approach is robust and reliable and can accordingly be used to map TBEV "hotspots". TBEV infectivity in refrigerated milk was preserved, emphasising the importance of pasteurisation (i.e. 72 °C for 15 s) prior to consumption.

[Allergic rhinitis affects one third of the population]. / Allergisk rinit drabbar en tredjedel av befolkningen - Individualiserad behandling viktig för att uppnå symtomfrihet.

Allergic rhinitis is the most common form of allergy with a prevalence of 30%. Allergic rhinitis is associated with substantial health economic costs and patient suffering. Asthma is strongly associated with allergic rhinitis. The treatment of allergic rhinitis should be individualized and include the whole airway. The treatment goals should be a patient free of symptoms affecting their daily life or sleep.

Local and systemic cytokine and chemokine responses after parenteral influenza vaccination.

BACKGROUND AND OBJECTIVE: In this study we investigated the levels of cytokines and chemokines produced locally and systemically after influenza vaccination of patients undergoing tonsillectomy. METHODS: Blood and saliva were collected prior to, and 1 or 2 weeks after vaccination at the time of the tonsillectomy. The cytokine and chemokine concentrations were determined in both unstimulated (whole blood, serum and saliva) and in vitro influenza stimulated peripheral blood mononuclear cell (PBMC) and tonsillar lymphocyte (TMC) cultures. RESULTS: We found that influenza vaccination elicited protective levels of serum haemagglutination inhibition antibodies and a significant local antibody response in the saliva. No significant differences were observed in the cytokine or chemokine levels 1 or 2 weeks post-vaccination in either the serum or saliva. Similarly, no significant differences were found in the gene expression levels in PBMC after vaccination, but interleukin (IL)-2, IL-4, gamma-interferon and transforming growth factor-beta were slightly elevated at 1 week post-vaccination but decreased by 2 weeks post-vaccination. In contrast, increased concentrations of a mixture of type 1, type 2 and inflammatory cytokines were produced 1 and 2 weeks after influenza vaccination by in vitro-stimulated PBMC and TMC. CONCLUSION: We show that cytokine responses can be measured after influenza vaccination in in vitro-stimulated lymphocytes but not directly in the blood or saliva. These results will provide a useful baseline that can be used for comparison of the immune response in human volunteers involved in clinical trials of novel influenza vaccines.

Interleukin 5, IL6, IL12, IFN-gamma, RANTES and Fractalkine in human nasal polyps, turbinate mucosa and serum.

Polyps are considered to develop as an end result of an inflammatory process. Cytokines and chemokines in the respiratory mucosa may be a key to polyp pathophysiology. The main objective was to identify IL-5, IL-6, IL-12, RANTES, IFN-gamma and Fractalkine in humans on the protein level in nasal polyps and mucosa from the inferior turbinate (IT). Furthermore, the cytokines and chemokines RANTES and Fractalkine were analyzed in plasma. Tissue homogenates and plasma from 13 patients were analyzed by the ELISA technique. All the patients had longstanding nasal/paranasal polyposis. Fractalkine was detected in polyps and IT in two different patients. IL-5 was expressed in polyps and IT. IL-6 was expressed in all patients with a higher level in polyps than IT. IL-12 was present in plasma, polyps and IT, though at an increased level in polyps. RANTES was present at a higher level in plasma than in polyps and IT. IFN-gamma was detectable in polyps and IT. Fractalkine is detected in nasal polyps, which is a new observation. The overall results indicate a mixed T(H)1/T(H)2 cytokine profile in nasal polyps. RANTES and IL-12 are strongly present in plasma, suggesting an ongoing inflammatory "drive". IL-6 and IL-12 are up-regulated in polyps versus the IT. Up-regulation of IL-6 may be explained by increased fibroblast activity dependant on an ongoing local inflammation possibly initiated by an infection. IL-5, RANTES and IFN-gamma are equally represented in polyps and IT, indicating equilibrium between the nasal polyps and surrounding tissue, and that an up-regulation of cytokines in the polyp indicates a potential for polyp growth.

Lymphocyte distribution in the tonsils prior to and after influenza vaccination.

The tonsils, consisting of the adenoid, tubal, palatine and pharyngeal tonsils, form a ring like structure in humans called Waldeyer's ring. The ring of tonsils is rich in lymphocytes and may play an important role as a reservoir of memory and immune competent cells serving the respiratory tract. The tonsils may also function as an activating and effector site for immune responses against respiratory pathogens. In this study, we have examined histological tissue sections from palatine tonsils for influenza specific antibody secreting cells (ASC) and several cell surface markers, from non-vaccinated and influenza vaccinated subjects. We found an increase in the number of influenza specific ASC in the tonsils of the influenza vaccinated subjects. These ASC was found scattered inside and surrounding the germinal centres, indicating that they may have homed to the tonsils. In addition, we observed a significant decrease in CD4 positive cells in tonsils of vaccinated subjects. Similar trends were also detected for CD45RA and CD45RO positive cells, which were significantly reduced in the vaccinated tonsils. The number of macrophages bearing the CD68 surface marker increased in numbers in vaccinated subjects. This shows that dynamic changes takes place in the tonsils after parenteral influenza vaccination, which may point to an important role of the tonsils in combating respiratory pathogens.

Parenteral vaccination against influenza does not induce a local antigen-specific immune response in the nasal mucosa.

The immune response in the nasal mucosa to influenza vaccination in 23 patients scheduled for tonsillectomy was studied. A statistically significant increase in influenza virus-specific serum and oral fluid antibodies was observed 7 days after vaccination. The numbers of influenza virus-specific antibody-secreting cells (ASCs) in peripheral blood also increased significantly 1 week after vaccination. The numbers of ASCs in tonsils and nasal mucosa were compared with data from a recent study of nonvaccinated volunteers. The numbers of influenza virus-specific ASCs in tonsils were significantly higher in the vaccinated group, but, surprisingly, there was no significant difference between the groups in the numbers of ASCs in nasal mucosa. This suggests that the influenza virus-specific antibodies detected in oral fluid are not produced locally in the nasal mucosa and may originate from a systemic source, indicating that the vaccination may favor a systemic immune response.