Upper-airway dysbiosis related to frequent sweets consumption increases the risk of asthma in children with chronic rhinosinusitis.

BACKGROUND: Innate immunity response to local dysbiosis seems to be one of the most important immunologic backgrounds of chronic rhinosinusitis (CRS) and concomitant asthma. We aimed to assess clinical determinants of upper-airway dysbiosis and its effect on nasal inflammatory profile and asthma risk in young children with CRS. METHODS: We recruited one hundred and thirty-three children, aged 4-8 years with doctor-diagnosed CRS with or without asthma. The following procedures were performed in all participants: face-to-face standardized Sinus and Nasal Quality of Life questionnaire, skin prick test, taste perception testing, nasopharynx swab, and sampling of the nasal mucosa. Upper-airway dysbiosis was defined separately by asthma-specific microbiome composition and reduced biodiversity. Multivariate methods were used to define the risk factors for asthma and upper-airway dysbiosis and their specific inflammatory profile of nasal mucosa. RESULTS: The asthma-specific upper-airway microbiome composition reflected by the decreased ratio of Patescibacteria/Actinobacteria independently of atopy increased the risk of asthma (OR:8.32; 95%CI: 2.93-23.6). This asthma-specific microbiome composition was associated with ≥ 7/week sweet consumption (OR:2.64; 95%C:1.11-6.28), reduced biodiversity (OR:3.83; 95%CI:1.65-8.87), the presence of Staphylococcus strains in the nasopharynx (OR:4.25; 95%CI:1.12-16.1), and lower expression of beta-defensin 2, IL-5, and IL-13 in the nasal mucosa. The reduced biodiversity was associated with frequent antibiotic use and with a higher nasal expression of IL-17 and T1R3 (sweet taste receptor). In asthmatic children, reduced sweet taste perception was observed. CONCLUSIONS: Specific upper-airway dysbiosis related to frequent sweet consumption, frequent antibiotic courses, and altered nasal immune function increases the risk of asthma in young children with CRS.

Prevalence, risk factors and underdiagnosis of asthma in the general population aged over 60 years.

INTRODUCTION: Bronchial asthma is one of the frequent chronic diseases in elderly persons. Global data show that 6.5-17% of the elderly suffer from asthma. However, there are no Polish data available on asthma prevalence in this group. AIM: This article is a retrospective analysis of the Polish Multicentre Study of Epidemiology of Allergic Diseases (PMSEAD) results aimed at assessing prevalence and clinical characteristics in the elderly. MATERIAL AND METHODS: The study was conducted in 1998-1999 in 11 research centres in Poland, including the Lodz centre. The study included randomly selected subjects of both sexes. Demographics and prevalence were assessed among adults (aged 16-80 years) based on the nationwide database and the detailed clinical analysis was based on the Lodz centre database. RESULTS: Nationwide data were obtained from 12 970 adults, including 1057 respondents in the Lodz Province; 20.3% of respondents in Poland and 23.6% in the Lodz Province were over 60 years of age. In both groups, elderly participants significantly more frequently suffered from asthma (asthma prevalence in this group was 6.7% for Poland and 12.0% for the Lodz Province). The multivariate analysis demonstrated that age over 60 years (OR = 2.08), residence in the city centre (OR = 3.30), and occurrence of seasonal allergic rhinitis (OR = 3.11) were significant risk factors for asthma occurrence among the residents of the Lodz Province. Among the elderly in Lodz, almost 50% of patients with asthma had not had a proper diagnosis made despite reporting clinical symptoms. CONCLUSIONS: In Poland asthma is a common and frequently underdiagnosed disease in the elderly.

The position paper of the Polish Society of Allergology on climate changes, natural disasters and allergy and asthma.

The observed global climate change is an indisputable cause of the increased frequency of extreme weather events and related natural disasters. This phenomenon is observed all over the world including Poland. Moreover, Polish citizens as tourists are also exposed to climate phenomena that do not occur in our climate zone. Extreme weather events and related disasters can have a significant impact on people with allergic diseases, including asthma. These effects may be associated with the exposure to air pollution, allergens, and specific microclimate conditions. Under the auspices of the Polish Society of Allergology, experts in the field of environmental allergy prepared a statement on climate changes, natural disasters and allergy and asthma to reduce the risk of adverse health events provoked by climate and weather factors. The guidelines contain the description of the factors related to climate changes and natural disasters affecting the course of allergic diseases, the specific microclimate conditions and the recommendations of the Polish Society of Allergology for vulnerable population, patients suffering from asthma and allergy diseases, allergologists and authorities in the event of climate and weather hazards.

Work-related symptoms among workers exposed to black tea dust.

BACKGROUND: Tea may be classified as unfermented green, semi-ferinented oolong and fermented black. All of these types are derived from Camellia sinensis, the Tea Plant, which contains the low molecular weight (LMW) agent Epigallocatechin gallate (EGCg), probably responsible for allergic reactions. The aim of our study was to asses the work-related allergic symptoms and IgE-mediated sensitivity among black tea packers. MATERIAL AND METHODS: Study groups comprised 26 black tea packers (group 1) and 20 office workers (group 2). A questionnaire, skin prick tests (SPTs) to common allergens and black tea, evaluation of specific IgE (asIgF) to Camellia sinensis and moulds, pre- and post-work-shift spirometry were performed. RESULTS: At least I symptom suggesting allergic disease was reported by 85% of the tea packers and 60% of the office workers. The most frequent positive results of SPTs were obtained with moulds (8%). A small decline in FE%1 (forced expiratory volume in I s) after the work shift was observed among tea packers sensitized to moulds. CONCLUSIONS: Although specific sensitization to black tea was not observed in our study groups, cough and skin symptoms were significantly more frequently among the tea packers than in office workers. The irritant impact on the airways and the skin of tea dust and/or sensitization to moulds contaminating tea leaves are being suspected.

Effect of an Intranasal Corticosteroid on Quality of Life and Local Microbiome in Young Children With Chronic Rhinosinusitis: A Randomized Clinical Trial.

Importance: Intranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented. Objective: To assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS. Design, Setting, and Participants: This open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022. Interventions: Patients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nasal nebulizer once a day for 12 weeks (control group). Main Outcomes and Measures: Measures taken both before and after treatment included the Sinus and Nasal Quality of Life Survey (SN-5), a nasopharynx swab for microbiome analysis by next-generation sequencing methods, and nasal mucosa sampling for occurrence of innate lymphoid cells (ILCs). Results: Of the 66 children enrolled, 63 completed the study. The mean (SD) age of the cohort was 6.1 (1.3) years; 38 participants (60.3%) were male and 25 (39.7%) were female. The clinical improvement reflected by reduction in SN-5 score was significantly higher in the INC group compared with the control group (INC group score before and after treatment, 3.6 and 3.1, respectively; control group score before and after treatment, 3.4 and 3.8, respectively; mean between-group difference, -0.58; 95% CI, -1.31 to -0.19; P = .009). The INC group had a greater increase in nasopharyngeal microbiome richness and larger decrease in nasal ILC3 abundance compared with the control group. A significant interaction was observed between change in microbiome richness and the INC intervention on the prediction of significant clinical improvement (odds ratio, 1.09; 95% CI, 1.01-1.19; P = .03). Conclusions and Relevance: This randomized clinical trial demonstrated that treatment with an INC improved the quality of life of children with CRS and had a significant effect on increasing sinonasal biodiversity. Although further investigation is needed of the long-term efficacy and safety of INCs, these data may reinforce the recommendation of using INCs as a first-line treatment of CRS in children. Trial Registration: ClinicalTrials.gov Identifier: NCT03011632.

Contact allergy to metals in adolescents: nickel release from metal accessories 7 years after the implementation of the EU Nickel Directive in Poland.

BACKGROUND: Contact allergy among adolescents is an important issue. OBJECTIVES: To assess the prevalence of contact allergy to metals in adolescents aged 15 years and nickel release from metal accessories that are in direct contact with the skin. METHODS: Three hundred and nine females and 219 males, all 15 years old, from randomly selected secondary schools were examined and patch tested with nickel sulfate, cobalt chloride, palladium chloride, and potassium dichromate. Three hundred and ninety-nine metal accessories were tested with the dimethylglyoxime (DMG) test. RESULTS: 'Metal dermatitis' was reported by 19.4% of females and 0.5% of males. Positive patch test reactions were found in 8.5% of the adolescents (12.9% in females; 2.3% in males), namely to: nickel (12.3% of females; 1.4% of males); palladium (5.2% of females; 0.5% of males); cobalt (3.2% of females; 1.4% of males); and chromium (1.3% of females; 0.9% of males). Allergic contact dermatitis caused by metals was diagnosed in 9.7% of females and in 0.5% of males. Of the metal items, 26.1% gave positive DMG test results: 10.0% of earrings, 11.4% of snaps, and 56.2% of belt buckles. CONCLUSIONS: Despite the implementation of the Nickel Directive in Poland, nickel still remains an important causal factor for allergic contact dermatitis. Numerous metal accessories do not comply with the Directive.

[Pathogenetic and clinical aspects of diisocyanate asthma]. / Wybrane patogenetyczne i kliniczne aspekty astmy wywolanej zawodowa ekspozycja na diizocyjaniany.

Diisocyanates are currently the most common cause of occupational asthma in industrialized countries, where its prevalence ranges from less than 5% to 15%. They are mainly used in the production of polyurethane foam, plastic packagings, laminates and polyurethane paints. The diagnosis of diisocyanate asthma is often problematic due to the lack of simple diagnostic or screening tests, uncertainty of underlying mechanisms, and a multitude of other potential occupational and environmental causes of asthma. At present, only a specific standardized challenge test with diisocyanates in concentrations not exceeding the adopted hygiene standards has been found to show a real diagnostic value. The diisocyanate-inducedsensitization, is associated with the recruitment of CD4 T lymphocytes to the lungs and the production of Th2-type cytokines, including IL-4, IL-5 and IL-13. However, clinical studies have suggested that an immunological response to diisocyanates may involve both Th1 and Th2 cells. The development of animal models has been instrumental in furthering the understanding of the pathogenesis of many diseases, including bronchial asthma. Murine models of diisocyanate-induced asthma have proved to be the most useful. Mouse models offer distinct advantages of a better-defined genome than that of guinea pigs or rats and the availability of antibody reagents and transgenic strains to investigate detailed mechanistic pathways. A better understanding of the immunopathogenesis of diisocyanate asthma will hopefully lead to early markers of sensitization and asthma, as well as to a profound comprehension of exposure and host risk factors, both of them should greatly facilitate the development of much-needed diagnostic and preventive strategies for diisocyanate asthma.

[Borreliosis in occupational medicine practice]. / Borelioza w praktyce lekarza medycyny pracy.

Lyme borreliosis is a multisystem infectious disease that can occur from bites by infected ticks. It can appear at persons exposed professionally for staying in tick feeding environment as well as persons staying in such an environment occasionally. For a few years the Lyme disease is taking the leading place amongst occupational diseases and first amongst infectious occupational diseases. Lyme disease is a major problem especially in wooded areas of Poland however it can occur throughout the country. The variety of clinical and serological pictures is creating everyday diagnostic problems. The aim of this publication is to collect, methodize and remind the medical knowledge about pathogenesis, symptoms, diagnostics, prevention and medical certification of this disease. Disease symptoms were specified to appearing in various organs and systems in order to clarify this difficult to diagnose disease. Diagnostics of Lyme disease was divided into standard and highly specialized, performed in special cases.

Diagnosing of bakers' respiratory allergy: is specific inhalation challenge test essential?

The diagnosis of occupational asthma (OA) and/or rhinitis needs to be confirmed by means of objective methods, because it is followed by important social and financial consequences. The aim of the study was to evaluate sensitivity and specificity of diagnostic methods as skin-prick tests (SPTs) to occupational allergens, evaluation of allergen-specific serum IgE, and nonspecific bronchial hyperreactivity with reference to a specific inhalation challenge test in diagnosing bakers' respiratory allergy due to wheat flour. The study group included 358 bakers suspected of having OA due to wheat flour. They underwent physical examination, SPTs to common and occupational allergens, allergen-specific IgE determination, spirometry, nonspecific bronchial challenge, and specific inhalation test. The sensitivity of SPTs to occupational allergens in recognition of baker's rhinitis was low (47.9%) unlike the estimation of allergen-specific IgE (76.4%), with relatively high specificity (77.4 and 68.3%, respectively). Bronchial hyperreactivity (PC(20) < 8 mg/mL) was the most sensitive method, whereas high degree of bronchial hyperreactivity (PC(20) < 1 mg/m(3)) alone or bronchial hyperreactivity (PC(20) < 8 mg/m(3)) combined with the skin reactivity to wheat flour was the most specific method of recognizing OA. Neither SPTs to occupational allergens nor evaluation of serum allergen-specific IgE alone or combined with nonspecific bronchial hyperreactivity are characterized by sufficient diagnostic accuracy to replace the specific inhalation challenge test. For the establishment of a definite diagnosis of baker's asthma, specific challenge testing with occupational allergens should be performed.

[Occupational allergy in transport workers--underestimated hazard]. / Alergia zawodowa wsród pracowników transportu--niedoceniane zagrozenie.

Transport workers, subjected to variable direct exposure to allergens in the workplace, are an occupational group at risk of developing occupational allergic diseases of the respiratory system as well as the skin. Their work environment is characterized by considerable diversity of both chemical and biological sensitizers. Sensitization occurs due to occupational exposure to allergens mainly by inhalation or direct skin contact. Therefore, it is necessary to be aware of the presence of strong allergens in the work environment to introduce appropriate preventive measures and to reduce the adverse health effects resulting from the exposure. This publication presents the most important allergens described as causal factors of occupational allergy among transport workers and the basic principles of diagnostics and medical certification of these diseases.

[Cleaners'asthma--etiology, diagnostics, prophylaxis and medical certification]. / Astma u osób zawodowo sprzatajacych--etiologia, diagnostyka, metody profilaktyki i orzecznictwo.

Asthma is the most common occupational allergic respiratory disease. The results of several current studies reveal also high risk of work-related asthma among cleaners. This kind of work may increase the risk of allergic as well as non-allergic asthma. However, the mechanism by which inflammation in respiratory airways is induced by cleaning chemicals is still unknown. This paper shows the results of numerous studies regarding exposure and respiratory symptoms among cleaning personnel. The increased risk of respiratory diseases among cleaners suggests the need to educate workers and to devise safety methods during multiuse cleaning both in occupational settings and in private households.

[Prophylactic care of apprentices occupationally exposed to allergens]. / Badania profilaktyczne uczniów narazonych na czynniki alergizujace drogi oddechowe.

An increase in the frequency of allergic diseases, including bronchial asthma, in the children population has been observed over several last decades. This trend is reflected in the increasing number of young workers who suffer from allergy and asthma. The problem determines a new challenge to physicians responsible for medical prophylactic care of this group of patients. Active occupational counseling should be performed especially by general practitioners and occupational medicine specialists in in cooperation with allergologists. Apprenticeship is a period of increased risk of work-related respiratory allergic diseases, particularly in the case of occupational exposure to high molecular weight agents. An adequate prophylactic care of apprentices exposed to aeroallergens at workplace may help to reduce work-related allergic health problems, mainly by supporting adolescents in choosing their jobs.

[Invasion by trichinae in the patient hospitalized with suspicion of occupational borreliosis: a case report]. / Zarazenie wlosniem kretym u pacjenta z podejrzeniem boreliozy zawodowej--opis przypadku.

Diagnosis of occupational infectious diseases gives rise to a number of problems in the practice of occupational medicine. Similar symptoms of many infections, including parasitic diseases, can limit the range of applied diagnostic and certification procedures only to diseases induced by pathogenic agents or exposures occurring in the occupational environment. In some cases this makes difficult or even impossible to explain a real cause of patients' complaints. We present a case report on the patient with suspected occupational borreliosis. Due to many diagnostic doubts during hospitalization, including long term presence of some clinical manifestations reported by the patient, which could occur in the course of borreliosis and also suggest earlier infection by trichinae, a wider span of specialist examinations was applied. Finally, the invasion of trichinae was diagnosed and later confirmed by serologic tests.

[Coexistence of two occupational infectious diseases in one patient--borreliosis and tick-borne encephalitis--a case report]. / Borelioza i kleszczowe zapalenie mózgu jako wspólistniejace choroby zawodowe--opis przypadku klinicznego.

Recently, infectious diseases have been found to be the most frequent among occupational diseases. Borreliosis, the most common among them, as well as tick-borne encephalitis is transmitted by ticks. Recognition of occupational etiology of such diseases is possible only when the relationship between the infection, occupational exposure and performed work is proved. A case report of a forest worker with borreliosis coexisting with tick-borne encephalitis is presented. Despite nonconcurrent recognition of both diseases it was highly possible that contagion took place at the same time or at a very short time interval. Despite high prevalence of tick-borne diseases, occupational etiology of these two infectious diseases in one patient is very rarely recognized.

[The real value of diagnostic methods in case of long time of cessation of occupational exposure to diisocyanates among patients diagnosed in the nofer institute of occupational medicine in Lodz]. / Rzeczywista wartosc metod diagnostycznych stosowanych w przypadku dluzszego czasu izolacji od narazenia na izocjaniany w srodowisku pracy u pacjentów zdiagnozowanych w instytucie medycyny pracy w Lodzi.

BACKGROUND: The aim of the study was to analyze the data obtained during the diagnostic process and their real values in the final diagnosis of patients exposed to diisocyanates amd suspected of occupational allergic disease of the respiratory system The patients have been hospitalized in the Nofer Institute of Occupational Medicine over recent 11 years. MATERIAL AND METHODS: In 1999-2009 we hospitalized 37 patients exposed to diisocyanates and suspected of occupational asthma. RESULTS: Test results of 37 patients were analyzed. The patients were divided into three groups of those with diagnosed occupational asthma, with diagnosed non-occupational asthma and those without any allergic airway disease. 40.0% of patients with occupational asthma, 64.3% of patients with non-occupational asthma and 15.4% of patients without any allergic disease were sensitized to at least one of common allergens. We did not find any specific IgE to diisocyanates. Specific challenge tests were performed in all the 37 subjects. We observed positive results of SIT with diisocyanates in 10 patients. CONCLUSIONS: Only specific challenge test with diisocyanates showed the real diagnostic value in case of a 7.5-year cessation of exposure. Determination of serum specific IgE to diisocyanates does not seem to be of clinical value in the diagnosis of diisocyanate-induced asthma in case of a 7.5 year cessation of exposure. Atopy is not the risk factor in diisocyanate-induced asthma.

[Health hazards associated with occupational exposure to birds]. / Zagrozenia zdrowotne zwiazane z zawodowa ekspozycja na ptaki.

The occupational group particularly exposed to contact with birds are zoo keepers, animal shop workers, individual bird's keepers and food industry workers. Work associated with contact with birds may contribute to the development of different symptoms and diseases, including allergic and contagious ones. This paper reviews the most common allergens occurring in the environment of bird's keepers, namely: feathers, egg proteins, allergens of plant origin, acarinae, allergens from latex and disinfectants. The most common health effects associated with occupational exposure to birds are also presented. Taking account of not fully understood pathogenesis of allergy to these allergens, complexity of occupational exposure and a possible coincidence of non-specific irritant effects of factors present in work environment, the diagnostic and certification procedures for occupational allergic diseases require highly specialized investigations. Objective and subjective medical examinations, taken medical history and physical examination also play a significant role in diagnostics of contagious diseases, whereas different laboratory tests are used in searching for their etiologic factors. The prevention of diseases associated with occupational exposure to birds comprises educational work, technical actions (hygiene prophylaxis) and medical prophylaxis.

[Cross-reactive carbohydrate determinants in diagnostics of occupational allergy]. / Krzyzowo reagujace determinanty weglowodanowe w diagnostyce alergii zawodowej.

In most cases diagnosis of immediate-type occupational allergy is very complex. Mainly it is caused by diversity of occupational allergens and lack of standardized diagnostic methods. The content of allergic proteins in commercially available skin prick test reagents differs between companies and in some the most important allergens are not named. Also the evaluation of serum specific IgE (asIgE) is characterized by different diagnostic accuracy. In some cases, false-positive results of asIgE detection are the consequence of cross-reaction to common environmental allergens. In those cases it is helpful to determine asIgE for cross-reacting carbohydrate determinants (CCDs) to exclude cross-hypersensitivity. The presented paper reviews the structure of carbohydrate determinants, their prevalence and possible impact on laboratory in vitro tests used in allergy diagnostics, as well as the methods of their identification. Possible applications of CCDs in occupational allergy diagnostics are also discussed.