Co-occurrence of otitis media with effusion and another environment-dependent disease (selected allergic conditions).

Introduction: Otitis media eith effusion (OME) is an inflammatory condition of the middle ear that involves accumulation of sterile fluid or effusion in the tympanic cavity with the tympanic membrane intact. The pathophysiology of OME is undoubtedly multifactorial. Aim: To assess the co-occurrence of OME, allergic rhinitis, and asthma. Material and methods: The study involved a group of 18,617 subjects aged 6-7 years, 13-14 years, or 20-44 years. ECRHS and ISAAC questionnaires, validated and adopted for Polish conditions, were used in the study. Results: OME increases the risk of developing allergic rhinitis by nearly two-fold (OR = 2.07, 95% CI: 1.738-2.479 in 6-7-year-olds; OR = 1.61, 95% CI: 1.299-1.995 in 13-14-year-olds, and OR = 1.55, 95% CI: 1.262-1.83 in 20-44-year-olds). Protective factors against otitis media with effusion include the number of siblings (the more children in the family, the higher the risk of chronic OM; OR = 2.00, 95% CI: 1.15-1.346) and consumption of dairy products rich in lactic acid bacteria. Conclusions: OME significantly more often co-exists with other conditions, particularly allergic rhinitis.

Reactivity of nasal cavity mucosa in the nasal cow's milk allergen provocation test.

Introduction: The nasal allergen provocation test plays an important role in differential diagnostics of rhinitis. Due to its informative potential, the test is also becoming increasingly used in other areas of diagnostics, including the diagnostics of food allergies. Aim: To assess the reactivity of nasal mucosa to the cow's milk protein allergens (as being widely used in powdered form in the food industry). Material and methods: The study material consisted of a group of 31 healthy subjects not sensitized to environmental allergens including cow's milk protein allergens. The study method involved an incremental nasal provocation test with cow's milk protein evaluated using the visual analog scale and acoustic rhinometry. Results: A total of 29 out of 31 volunteers presented with a significant decrease in nasal patency (control solution: 1.112 ±0.161 vs. local allergen application 1.005 ±0.157; p < 0.004) as measured by acoustic rhinometry following the allergen dose of 12.5 µg. Slight changes in complaints were observed using the visual analog scale. Exposure to the widespread food allergens (including powdered cow's milk allergens) presents a potential risk of positive response in non-sensitized individuals. Conclusions: Further studies on dose standardization are necessary in the study area.

Differential diagnostics of food allergy as based on provocation tests and laboratory diagnostic assays.

Due to the scale of the phenomenon, food allergy constitute a significant health problem and significantly impair the quality of life of patients. Differential diagnostics, including skin tests, sIgE detection tests, basophil and mast cell activation tests as well as double-blind placebo-controlled food challenge tests, is the gold standard in the diagnosis of food allergy. Recently, increasing attention has been paid to the potential use of nasal provocation test in the diagnosis of food allergy. Allergen dose, protocol standardization, assessment of subjective complaints and objectivization of test results are important factors determining the applicability of provocation tests.

The normal ranges of selected acoustic rhinometry parameters depending on age and sex-component of standarization in nasal provocation test.

Introduction: Acoustic rhinometry is a non-invasive method of measuring intranasal spaces. As one of the objective techniques for nasal patency, it plays a critical role in evaluating the nasal allergen challenge.Aim: To establish the typical ranges of selected AR parameters for age and sex. Material and methods: The study was conducted in a group of 583 randomly selected subjects (329 females and 254 males). Acoustic rhinometry was done before and 15 min after a two-time application of 0.1% solution of the decongestant xylomethazoline. The evaluated AR parameters (the cross-sectional area 1 (CSA-1) at the level of the isthmus nasi and the distance between the external nares and the isthmus nasi (dCSA-1)) were measured separately for both nasal cavities. Another evaluated parameter was the mean CSA measured 3 cm beyond CSA-1 on the AR curve (CSA-3). Results: The site of the minimum CSA on the acoustic rhinometry curve in the study group was the second notch on the acoustic rhinometry curve (CSA-1), corresponding to the nasal isthmus. With increasing age of the subjects, we observed a systematic increase in nasal spaces. The difference between sexes reached statistical significance at the ages of 17 years and older. Conclusions: The evaluated males show larger nasal cavity volumes than females. The difference between the sexes reaches statistical significance at older ages.

Changes in the cross-sections of the nasal cavity assessed by acoustic rhinometry in the study population as a guideline for attempts to standardize nasal provocation tests.

Introduction: A specific difficulty in the standardization of nasal allergen challenge tests as measured by acoustic rhinometry is the lack of reference values measured according to dependent changes, for example height and weight/height- or weight-dependent changes. Human growth and development rates and other changes the human body undergoes throughout the lifetime depend closely on the environment, sex, and race. Aim: To assess selected anthropometric (body weight and height) and rhinometric (nasal cross-sectional areas) measurements concerning subject age and sex. Material and methods: The study was conducted in 633 subjects selected in multistage, stratified sampling (324 females and 309 males). Body weight and height were measured with a sliding weight scale and height measure. Nasal cavity cross-sectional areas were measured via acoustic rhinometry. Results: We observed parallel increases in the evaluated anthropometric measurements and nasal cavity cross-sectional areas both in males and females aged ≤ 14 years, with the two sexes starting to differ significantly in terms of those measurements over the age of 14 (p < 0.0001; p < 0.000001). The evaluated rhinometric measurements showed a greater correlation with height than with body weight. The time of the most diversified and dynamic changes in anthropomorphic measurements was the age of > 12 years: with boys demonstrating significantly higher mean values of height and body weight than girls. Conclusions: Height showed a better correlation with rhinometric measurements (cross-sectional area of the nasal cavity) in younger subjects (at their age of development) than in older ones.

Gold standard diagnostic algorithm for the differential diagnosis of local allergic rhinitis.

Local allergic rhinitis, defined as a localized allergic response of the nasal mucosa in the absence of systemic atopy, poses a considerable clinical issue due to its prevalence. The gold standard in local allergic rhinitis diagnostics is primarily the patient's history taking and nasal allergen provocation testing or, alternatively, the basophil activation test, described as "an allergic reaction in a test tube".

Nasal lavage fluid sIgE levels in differential diagnostics of allergic rhinitis.

Differential diagnosis plays a key role in diagnosing specific types of allergic rhinitis. The method involving allergen-specific immunoglobulin E (sIgE) detection in nasal lavage fluid, which has continually been the object of standardization efforts, is characterized by high specificity/sensitivity and plays a special role in diagnosing local allergic rhinitis. This article is a systematic review of the literature on the methodology, standardization, and use of sIgE detection in nasal lavage fluid in patients undergoing diagnostic tests for allergic rhinitis.

Optical rhinometry in assessing the nasal mucosa reaction during nasal allergen provocation testing.

Introduction: Optical rhinometry is a newly standardized technique for assessing nasal obstruction in nasal allergen provocation testing. It is one of the few techniques that accurately determine the beginning of an allergic reaction as it measures optical density, which is consistent with the degree of response. Aim: To evaluate the usefulness of optical rhinometry in nasal allergen provocation testing. Material and methods: The study population was a group of 45 subjects (25 diagnosed with an allergy to common environmental allergens and 20 controls). Nasal allergen provocation testing was conducted with the use of Dermatophagoides pteronyssinus and Dermatophagoides farina (5,000 SBU/ml). Results: The onset of the nasal mucosa allergen response in the form of nasal obstruction was observed at 10.40 min. The subsequent reaction developed rapidly, with only 53 s from the initial stage of nasal obstruction to complete obstruction (optical density 0.4552). Conclusions: Due to its informative potential, optical rhinometry is a valuable tool in assessing the nasal mucosal response to topical allergen application.

Asthma as a social problem requiring systemic solutions in Poland.

Introduction: Due to its physiopathology and chronic character, asthma constitutes a considerable burden to health care and public health. Aim: The main aim of this study was to determine and present the problems of patients diagnosed with asthma and to suggest solutions to meet the individual and public expectations. Material and methods: The study included 18,874 patients and was part of the System for the Prevention and Early Detection of Allergic Diseases in Poland. The study method was a questionnaire based on the European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC). Results: Nearly 90.1% of patients aged 6-7 years reported periodic difficulty in breathing, with over three episodes per week (3.6 in adults, 3.6 in women, 3.1 in men, 3.3 in urban residents, and 4.6 in rural residents) of reported asthma attacks interrupting patients' sleep. Recent asthma attacks were reported mainly by women living in urban areas. Conclusions: Health problems of asthma patients have a measurable impact on the need to introduce systemic solutions, to ultimately minimize the risk of complications for the individual as well as to minimize the social burden of chronic asthma in Poland.

Eosinophilic esophagitis: an interdisciplinary clinical problem.

Eosinophilic esophagitis is a newly described entity of increasing incidence. Previously thought to be a variation of gastroesophageal reflux disease, now it becomes well known among gastroenterologists, allergologists, paediatricians and pathologists. Aetiology of the disease is strongly correlated with atopic and allergic disorders but exact pathogenesis and cellular mechanisms of inflammatory process in the esophagus are still unknown. Diagnostic criteria have been described but diagnostic tools are still in the research and improvement phase. Clinical manifestation varies considerably between age groups, which causes a delay in the course of diagnosis due to improperly recognized symptoms. Since eosinophilic esophagitis is a chronic disease without a tendency to be self-limiting, delayed diagnosis may lead to complications associated with oesophageal tissue remodelling. Some forms of treatment are approved and of great therapeutical value, nevertheless clinical trials of new medications provide new possibilities. Therefore, many questions regarding eosinophilic esophagitis arise and are still unanswered.

Stimulation of an immune system by different types of allergens causes seasonal (late spring and summer) factors to increase probability of allergic rhinitis symptoms. The Epidemiology of Allergic Diseases in Poland (ECAP) survey: part two.

INTRODUCTION: Specific immunoglobulins E (sIgE) are important parameters to estimate severity of allergic diseases. AIM: To determine the relationship between the concentration of sIgE antibodies in serum and clinical outcome of allergic diseases. MATERIAL AND METHODS: The concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, Timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 9 regions (ECAP study). Positive results of sIgE (≥ 0.35 IU/ml) were correlated with answers in ECRHSII and ISAAC questionnaires. RESULTS: IgE antibodies are more frequently detected in respondents aged over 4 years when they had their first attack of asthma (cat dander p < 0.05, Timothy grass p < 0.05). IgE antibodies are less frequently detected in respondents aged over 29 years when they had the first allergic rhinitis symptoms as compared to respondents aged 0-19 years when they had the first allergic rhinitis symptoms (p < 0.05 to p < 0.001). Among respondents showing allergic rhinitis symptoms, IgE antibodies are more frequently detected in respondents showing those symptoms from May to August (p < 0.05 to p < 0.005). CONCLUSIONS: The first attack of asthma appears later mainly in patients whose immune systems are more strongly stimulated by allergens. Development of allergic rhinitis in patients aged over 29 years presumably needs weaker stimulation of their immune systems by allergens than in patients aged 0-19 years. Stimulation of an immune system by different types of allergens modifies its response in such a way that seasonal (late spring and summer) factors increase probability of allergic rhinitis symptoms.

The relationship between nasal polyps, bronchial asthma, allergic rhinitis, atopic dermatitis, and non-allergic rhinitis.

INTRODUCTION: Nasal polyps are frequently associated with bronchial asthma and rhinitis. The chronic nature of the symptoms, the high post-treatment recurrence rates, as well as various comorbidities, constitute key factors that significantly affect the quality of life of patients diagnosed with this condition. AIM: The purpose of the study was to estimate the prevalence of nasal polyps in the examined population and to assess the possible associative occurrence of nasal polyps (NP) with bronchial asthma (BA), allergic (AR) and non-allergic rhinitis (NAR), and atopic dermatitis (AD). MATERIAL AND METHODS: The ECRHS II and ISAAC questionnaires of the study group of 18,458 individuals, including 4,473 6-7-year-olds (24.2%), 4,675 13-14-year-olds (25.4%), and 9,310 20-44-year-olds (50.4%) were performed. RESULTS: The prevalence of nasal polyps in the examined group was 1.1%, reported by a total of 204 individuals. Nasal polyps were reported more frequently among urban residents (191 (1.1%)) than rural residents (13 (0.6%)). Our study demonstrated a correlation between the presence of nasal polyps and asthma, as well as allergic and non-allergic rhinitis The greatest risk factor for NP in the evaluated subpopulation with multiple allergic conditions was the co-existence of non-allergic rhinitis and atopic dermatitis (OR = 6.09; 95% CI: 3.4-10.93). CONCLUSIONS: Nasal polyps are relatively rare in the evaluated Polish population. Nonetheless, we believe their co-occurrence with non-allergic rhinitis, allergic rhinitis, bronchial asthma, and atopic dermatitis to be of significant importance, as it illustrates the phenomenon of multimorbidity of inflammatory conditions affecting the upper and lower respiratory tract.

The role of the nasal allergen provocation test in local allergic rhinitis cases: a preliminary report.

INTRODUCTION: The current state of knowledge is that allergic rhinitis can occur in two forms. One is allergic rhinitis as a manifestation of a systemic allergy with systemic atopy and positive results of skin prick tests or sIgE tests. The other is local allergic rhinitis (LAR) as a local allergic reaction affecting only the nasal mucosa without systemic atopy. AIM: To attempt to assess the usefulness of the nasal allergen provocation test for the purposes of differential diagnosis and the qualification of LAR patients for therapy. MATERIAL AND METHODS: The subjects in the study were a group of 6 adults diagnosed with LAR on the basis of their medical history and the results of nasal allergen provocation tests, with the allergens being house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae). The methods adopted in the study were a point-based rating scale as a measure of nasal/extranasal complaints and active anterior rhinomanometry. RESULTS: Significant differences (p < 0.05) were observed, using the subjective rating scale, in relation to registered nasal and extranasal complaints in the early phase of the allergic reaction. Similarly, the rhinomanometry method revealed significant differences in nasal resistance values before and after the administration of an allergen. CONCLUSIONS: The nasal allergen provocation test is the only testing tool that objectively measures the degree of the patient's allergic reactions and is useful in qualifying LAR patients for further therapy.

The use of nasal over-the-counter agents in the evaluated Polish population. The underrated role of the pharmacist in patient education on medical treatment in patients with allergic rhinitis.

INTRODUCTION: The goal of treatment in allergic rhinitis is a complete elimination of symptoms or achieving significant clinical improvement. The role of the pharmacist has been receiving particular attention in terms of the initial diagnosis and treatment of allergic rhinitis patients and their sufficiently early referral to a specialist in case of persistent symptoms. AIM: This study attempted to estimate the rates of nasal OTC use in patients diagnosed with allergic rhinitis. MATERIAL AND METHODS: Study population was 18,578 subjects (4,192 patients diagnosed with AR and 14,386 healthy controls): children aged 6-7 years, adolescents aged 13-14 years, and adults aged 20-44 years. We used translated and validated versions of ECRHS and ISAAC questionnaires. RESULTS: The rates of nasal decongestant use in the allergic rhinitis group were 60.4% in children, 50.7% in adolescents, and 43.0% in adults, with these figures significantly higher than in the control group (p < 0.05). The most common nasal agent was Oxymetazoline and Xylometazolini hydrochloridum 0.1%. CONCLUSIONS: Over a half of the evaluated allergic rhinitis patients used nasal decongestants, which poses a potential risk of uncontrolled side effects. There is an urgent need to introduce patient education on medical treatment.

Organizational model for the management of patients with chronic allergic conditions.

INTRODUCTION: Allergic conditions present a serious problem for the Polish population. The most common form of allergy is allergic rhinitis. Due to its chronic nature and a complex pathophysiological mechanism the allergic rhinitis could be associated with others comorbidities. That is why it is a poses a considerable bio-psychosocial problem both for the affected individual patient and for the healthcare system. AIM: To identify organizational factors and analyse their effect on patients with chronic allergic conditions. MATERIAL AND METHODS: The study group comprised 9,370 respondents (including 1,967 patients with allergic rhinitis (AR), 372 patients with self-reported bronchial asthma (BA1), and 351 patients with physician-diagnosed bronchial asthma (BA2)) aged from 20 to 44 years, some of whom were additionally examined (skin pick tests) in an outpatient setting. The findings obtained in the outpatient subgroup (n = 4,783) were analysed in more detail. The study was based on translated and validated ECRHS and ISAAC questionnaires. RESULTS: Over a half of the evaluated patients with AR visited a specialist due to their symptoms. Some respondents neither visited their doctor regularly nor had regular check-ups, which undoubtedly affected their quality of life. CONCLUSIONS: The authors propose an organizational model incorporating the position of a healthcare educator (HE) as a coordinator in the process of managing chronic allergic conditions in adult patients within the Polish healthcare system. Adult patient education by the HE would include introducing the principles of secondary and tertiary prevention in order to improve the quality of life in patients with chronic allergic conditions.

The effect of selected risk factors, including the mode of delivery, on the development of allergic rhinitis and bronchial asthma.

INTRODUCTION: Cesarean section affects the process of colonization by bacteria transferred from the mother's skin and hospital bacteria, which in turn contributes to development of allergic conditions. AIM: To assess selected risk factors, including the mode of delivery, parity, and the role of genetic factors for the development of allergic rhinitis and bronchial asthma. MATERIAL AND METHODS: The study was conducted in 18,617 respondents aged 6-7, 13-14, and 20-44 years who completed the ECRHS II and ISSAC questionnaires. Thirty percent of the study population underwent complementary assessments in the form of skin-prick tests, serum IgE levels, lung function tests, and peak nasal inspiratory flow (PNIF). The study is a part of the Epidemiology of Allergic Disorders in Poland (ECAP) study conducted in 8 areas in Poland (Warsaw, Lublin, Bialystok, Gdansk, Poznan, Wroclaw, Katowice, Krakow, and two rural areas - Zamosc and Krasnystaw counties). RESULTS: Respondents diagnosed with allergic rhinitis were at a significantly higher risk of inheriting the allergic condition if their mother (OR = 2.17; 95% CI: 1.98-2.39, p = 2.00 × 10-16) or father (OR = 2.20; 95% CI: 1.96-2.47; p = 2.00 × 10-16) suffers from this allergy. Conversely, in the group diagnosed with bronchial asthma, the highest risk of an inherited allergy was observed in situations where maternal (OR = 2.00; 95% CI: 1.57-2.55; p = 1.69 × 10-5) or paternal (OR = 1.94; 95% CI: 1.42-2.66; p = 3.61 × 10-5) grandparent was affected. Moreover, the risk of developing allergic rhinitis depended on the mode of delivery: i.e. it was higher for a Cesarean section (OR = 1.20; 95% CI: 1.01-1.43; p = 0.04) than vaginal delivery (OR = 0.88; 95% CI: 0.78-0.99; p = 0.03). The higher the number of siblings, the lower the risk of allergic rhinitis. CONCLUSIONS: Allergy risk factors, especially those predisposing to allergic rhinitis, include not only genetic factors but also the mode of delivery: vaginal delivery or Cesarean section.

Optical rhinometry in nasal provocation testing.

INTRODUCTION: Optical rhinometry (ORM) is a technique that allows for direct continuous measurement of changes in blood flow (optical density) in nasal vessels, at the same time analyzing changes per unit of time in the evaluated variable: intravascular blood flow and oxygen saturation. AIM: To assess the extent to which ORM can be used as an objective measure of nasal mucosal edema following a nasal allergen provocation test in a group of patients with allergic rhinitis versus healthy controls. MATERIAL AND METHODS: The study group included 60 subjects: 30 patients diagnosed with an allergy to common environmental allergens (dust mites/grasses) and 30 healthy controls. The method used in the study was a nasal provocation test with an allergen, with a standard dose of a control solution and an allergen (5,000 SBU/ml) administered using a calibrated atomizer into both nostrils in room temperature. RESULTS: The mean delay to the onset of nasal mucosal response as measured by ORM was 3.15 min and the level of light extinction returned to baseline after 28.15 min (change in optical density 0.431). These objective changes in optical density strongly correlated with subjective perception measured via a visual analog scale. CONCLUSIONS: Optical rhinometry is a valuable tool for nasal allergen provocation testing.

Allergen Challenge Chamber: an innovative solution in allergic rhinitis diagnosis.

The Allergen Challenge Chamber (ACC) is definitely a serious challenge on the one hand and an innovative solution in allergic rhinitis diagnosis on the other. The gradual validation of the chamber (according to the test protocol) will allow for standardisation, which is a process undertaken by centres worldwide. The process of designing a consistent system that allows for creating conditions as those in the case of natural inhalation took into account all the aspects (technical specification) necessary to ensure appropriate inhalation.

Evaluation of selected aspects of the hygiene hypothesis and their effect on the incidence of allergy.

OBJECTIVES: The development of allergic conditions is largely dependent on the interactions between genetic (individual genetic predisposition) and environmental factors (exposure to risk factors). The aim of this study was an attempt to assess the influence of selected elements of the hygiene theory in the development of allergic diseases such as allergic rhinitis and asthma. MATERIAL AND METHODS: The study group consisted of 5518 women and 3868 men. The method that was used was the European Community Respiratory Health Survey II and International Study of Asthma and Allergies in Childhood questionnaire validated and adapted to Central and Eastern European conditions. The project was conducted in 8 urban areas (Gdansk, Wroclaw, Poznan, Katowice, Kraków, Lublin, Bialystok, Warsaw) and 1 rural area (Krasnystaw county). This study had 2 stages; the first stage involved grouping the 22 500 respondents based on their questionnaire responses with the use of a Personal Digital Assistant (PDA); the second stage involved 7000 subjects, who underwent additional assessments: skin prick tests (birch, grasses/cereals, Dermatophagoides pteronyssinus and Dermatophagoides farinae, molds [set I: Botrytis cinerea, Cladosporium herbarum, Alternaria tenuis, Curvularia lunata, Fusarium moniliforme, Helminthosporium], molds [set II: Aspergillus fumigatus, Mucor mucedo, Penicillium notatum, Pullularia pullulans, Rhizopus nigricans, Serpula lacrymans], cat, dog, molds Cladosporium herbarum, Alternaria tenuis) and spirometry tests. RESULTS: The age at which children attend the nursery school is critical to the development of allergic diseases; in allergic rhinitis, the risk of an IgE-dependent reaction is 2 times higher in the second than in the first year of life (p = 0.00147, p < 0.05), while in asthma, having a large number of siblings increases the risk of developing obstructive disease by almost 6 times (p = 0.00316, p < 0.05).The age at which children attend the nursery school is critical to the development of allergic diseases; in allergic rhinitis, the risk of an IgE-dependent reaction is 2 times higher in the second than in the first year of life (p = 0.00147, p < 0.05), while in asthma, having a large number of siblings increases the risk of developing obstructive disease by almost 6 times (p = 0.00316, p < 0.05). CONCLUSIONS: The hygiene theory is particularly applicable and can explain the relationship of selected habits in the development of allergic diseases. Int J Occup Med Environ Health. 2023;36(1):69-83.

Why the role of mHealth in allergy diagnosis and treatment adherence cannot be overlooked.

BACKGROUND: Allergic diseases-rhinitis and asthma-are the most common chronic conditions affecting adults. Traditional approaches to allergy diagnosis and treatment do not meet the health needs of all patients. Treatment adherence remains a challenge for physicians. The ubiquity of Internet access paired with limited in-person contact with medical personnel in the course of the COVID-19 pandemic demonstrated the potential of mHealth in communicating health information. BODY: The abundance of new applications dedicated to various medical specialties encourages reflection on the informed use of such tools. The paper takes a closer look at the potential of mHealth and presents conclusions of selected studies focusing on the use of good apps. The strength weakness opportunities threats analysis was used to illustrate the strengths of the mHealth strategy, as well as its advantages, limitations and areas in need of further development. CONCLUSION: The strength of mHealth depends on the quality and quantity of the collected patient data, its reliable processing, as well as publication of outcomes and conclusions from analyses. Therefore, it is necessary to promote the use of validated applications among patients, physicians and medical staff.