Assessment of Co-Sensitization between Pollen and Food Allergen Sources among Bengali Population, West Bengal, India.

INTRODUCTION: Secondary food allergies due to cross-reactivity between pollen and food allergens are a significant health burden in India. Prevalence of cross-reactivity varies by region, and particularly in West Bengal, it remains unexplored. The present study investigated sensitivities of pollen-related food allergy (PFA) patients of West Bengal by empirically determining co-sensitization patterns. METHODS: The present study retrospectively analysed 1,310 pollen-allergic (PA) patients from the Allergy and Asthma Research Centre, West Bengal. A questionnaire survey was performed to record patients' demographic and clinical features and categorized into seasonal and perennial ones. All patients were subjected to the skin prick test and specific IgE for evaluation of sensitivity against 16 pollen and 16 food allergens. Co-relation and principal component analysis (PCA) was performed to determine co-sensitivity. RESULTS: Seasonal allergic patients were comparatively higher than perennial ones. PFA patients were mostly sensitive to eggplant (n = 387), while Azadirachta indica (n = 341) was predominant sensitizer among pollen allergen sources. Cynodon dactylon showed maximum significant positive correlation with banana, orange, peanut, pineapple, cucumber, eggplant, potato, tomato, and wheat. In the seasonal group, Cynodon dactylon-specific IgE in PFA patients (median = 4.60 kU/L) was significantly higher from that of PA ones (median = 3.44 kU/L). Among 32 allergens tested, 27 were placed in first two dimensions of the PCA biplot. CONCLUSION: The present study established that co-sensitivity between pollen and food allergen sources were predominant in allergic patients of West Bengal. The co-sensitization patterns among unrelated allergen sources may be due to possible expression of biologic cross-reactivity to similar allergens.

Risk assessment of pollen allergy in urban environments.

According to WHO, by 2050, at least one person out of two will suffer from an allergy disorder resulting from the accelerating air pollution associated with toxic gas emissions and climate change. Airborne pollen, and associated allergies, are major public health topics during the pollination season, and their effects are further strengthened due to climate change. Therefore, assessing the airborne pollen allergy risk is essential for improving public health. This study presents a new computational fluid dynamics methodology for risk assessment of local airborne pollen transport in an urban environment. Specifically, we investigate the local airborne pollen transport from trees on a university campus in the north of France. We produce risk assessment maps for pollen allergy for five consecutive days during the pollination season. The proposed methodology could be extended to larger built-up areas for different weather conditions. The risk assessment maps may also be integrated with smart devices, thus leading to decision-aid tools to better guide and protect the public against airborne pollen allergy.

Tourist risk assessment of pollen allergy in tourism attractions: A case study in the Summer Palace, Beijing, China.

Pollen allergy has already been an increasingly prominent ecosystem disservice in tourism attractions. However, few studies have assessed the tourist risk of pollen allergy through integrating multidisciplinary knowledge of ecology, medicine, phenology, and risk management. Basing on the conceptual framework of risk assessment proposed by UNISDR, we first established an index system of pollen-allergy risk for tourists in attractions and outlined assessment methods 18 available indexes were put forward to cover three aspects: hazard of plant allergen, tourist vulnerability, and resilience of assessment units. Subsequently, taking the Summer Palace as the case study area, we conducted a tourist risk assessment of pollen allergy. Values of nine available indexes were obtained via ecological investigation, phenological observation, and data mining of visitors' logs on Sina Weibo. Risk levels of spring pollen allergy for tourists in different assessment units were revealed by combining the green zone allergenicity index model and three-dimensional risk assessment matrix. The results showed that: (1) There were seven primary pollen-allergenic plants in the Summer Palace, including Platycladus orientalis, Sabina chinensis, Salix babylonica, Pinus tabulaeformis, Populus tomentosa Carr, Morus alba L. and Fraxinus chinesis, among which Platycladus orientalis and Salix babylonica were the highest allergenic. (2) Among 18 spots, tourists faced the highest risk level of pollen allergy in spring at three spots, namely the Hall of Serenity, Hall of Benevolence and Longevity, and Gallery of Literary and Prosperity. (3) The two routes of the Long Corridor and Longevity Hill scored high on the risk level. (4) Among four areas, risk levels of the Front-hill and Rear-hill areas were high. Given the increasing spatial-temporal uncertainty of pollen allergy and tourist behaviors under global warming and urbanization, the related monitoring should be strengthened in the future. Furthermore, the dynamic and improved assessment of pollen-allergy risk should be institutionalized and be integrated into the evaluation of tourism experience quality. Tourism administration should make full use of relevant assessment results and conduct more effective risk communication.

Biological weed control to relieve millions from Ambrosia allergies in Europe.

Invasive alien species (IAS) can substantially affect ecosystem services and human well-being. However, quantitative assessments of their impact on human health are rare and the benefits of implementing IAS management likely to be underestimated. Here we report the effects of the allergenic plant Ambrosia artemisiifolia on public health in Europe and the potential impact of the accidentally introduced leaf beetle Ophraella communa on the number of patients and healthcare costs. We find that, prior to the establishment of O. communa, some 13.5 million persons suffered from Ambrosia-induced allergies in Europe, causing costs of Euro 7.4 billion annually. Our projections reveal that biological control of A. artemisiifolia will reduce the number of patients by approximately 2.3 million and the health costs by Euro 1.1 billion per year. Our conservative calculations indicate that the currently discussed economic costs of IAS underestimate the real costs and thus also the benefits from biological control.

Data-driven questionnaire-based cluster analysis of asthma in Swedish adults.

The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.

[Subjective, physical and mental health of children and adolescents in Thuringia : Representative results of the Thuringia state module in KiGGS wave 1]. / Subjektive, körperliche und psychische Gesundheit von Kindern und Jugendlichen in Thüringen : Repräsentative Ergebnisse des Ländermoduls Thüringen in KiGGS Welle 1.

Children and adolescents from Thuringia have higher health care needs compared with peers in Germany overall. It was investigated whether this is due to a higher disease process. The data basis was the Thuringia state module (2010-2012; n = 4884; 0-17 years), which was conducted in KiGGS wave 1 (2009-2012). The health situation of children and adolescents is described in terms of various indicators of subjective, physical, and mental health. Prevalences with 95% confidence intervals were reported, and with logistic regressions, the significance of the group differences was examined. Whether children and adolescents in Thuringia and Germany overall differ in the examined health indicators, was tested with chi-square tests and the p values are corrected according to Bonferroni. With 93.8%, the majority of children and adolescents in Thuringia had very good or good subjective health. One-fifth of children and adolescents (20.4%) had a chronic illness or a long-standing health condition. Hay fever (13.6%) and atopic dermatitis (17.6%) were the most common medically diagnosed chronic diseases. In addition, one-fifth of children and adolescents (20.6%) had symptoms of mental health problems; a medical ADHD diagnosis was found in 5.6% of children and adolescents in Thuringia. Compared with peers from Germany overall, there were only a few differences in the incidence of disease. According to these results, the higher degree of care provided to Thuringian girls and boys cannot be attributed to a higher incidence of disease. Other factors such as greater parental willingness of utilization or a better supply structure must be taken into account.

Findings from an Online Survey Assessing the Burden and Management of Seasonal Allergic Rhinoconjunctivitis in US Patients.

BACKGROUND: Seasonal allergic rhinoconjunctivitis (SARC) affects ≥16% of the US population annually. Telephone and in-office surveys have demonstrated negative effects of allergic rhinitis (AR) symptoms on sleep, daily activities, productivity, concentration, and emotions. OBJECTIVE: The objective of this study was to assess the patient-perceived burden of SARC in relation to newer treatments, increased access to treatments, and changing management protocols. METHODS: An online survey of symptom experience, impact on daily life, and management was conducted in US respondents who suffer (or whose child suffers) from SARC symptoms. RESULTS: A total of 1001 surveys were completed: 500 adults (≥18 years old) and 501 children (12-17 years old, documented by their parents). Similar to earlier AR surveys, SARC symptoms negatively affected the patient's (and family's) quality of life, and were most severe in the spring. Before being treated, >50% of respondents reported daily symptoms during their season; 75% to 80% considered their symptoms moderate to severe. Patients saw a variety of health care professionals (including pharmacists) and used over-the-counter and prescription medications for symptoms. Those using prescription medications were generally more satisfied with treatment and less likely to switch or discontinue treatment. Nasal and/or ocular symptoms drove adherence, seeing a health care professional, and reviewing and/or changing treatment. CONCLUSIONS: The majority of patients with SARC report moderate-to-severe symptoms that significantly impair their quality of life. However, patients appear to be taking more responsibility for their (child's) condition, and patient expectations for therapy are increasingly being met. Continued efforts will be needed to examine the contribution of better information and/or increased access to and availability of medications to control the disease.

Health care resource use and associated costs among patients with seasonal versus perennial allergic rhinitis.

BACKGROUND: Health care resource use (HRU) and costs among patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) have not been widely studied. OBJECTIVE: To develop an algorithm to classify patients with SAR and patients with PAR, and to evaluate treatment patterns, HRU, and costs among these patients. METHODS: Patients with allergic rhinitis (AR) were identified retrospectively by using electronic medical records and administrative claims data, with an index date as the earlier of the date of AR diagnosis or allergy medication use. Patients with AR were followed-up from 12 months before the index date through 12 months after the index date (follow-up) and were classified as SAR or PAR based on medication patterns during follow-up. AR-related HRU, allergy immunotherapy administration, and costs per patient per year during follow-up were compared between patients with SAR and those with PAR, with analyses stratified by asthma diagnosis before the index date and by physician specialty (primary care physician versus specialist). RESULTS: Approximately 23% of patients with AR were classified as having PAR and 77% as having SAR. During follow-up, the patients with PAR had more allergy medication prescriptions versus the patients with SAR (8.0 versus 2.4 prescriptions), higher prescription medication costs ($1551 versus $313), higher allergy immunotherapy cost ($180 versus. $118), and higher total AR-related costs ($1944 versus $643); all with p < 0.001. Patients with asthma had higher costs than those without asthma. Patients seen by a specialist has higher costs than those treated by a primary care physician. CONCLUSION: Patients with PAR experienced more AR-related prescription drug use and higher health care costs than patients with SAR, with prescription drug costs being the main cost driver. Treatments that reduce the need for ongoing prescription medication use have the potential to be cost saving.

Comorbidities of asthma in U.S. children.

BACKGROUND: Few epidemiologic population-based data are available to describe the wide range of health conditions that affect children with asthma. We conducted this study to identify common comorbidities of asthma during childhood and compare the prevalences of selected comorbidities among children with and without asthma. METHODS: We analyzed weighted data from the 2012 National Health Interview Survey child sample, a sample of 10,954 U.S. children aged 3-17 years. Information about each child's health, including history of asthma and other health conditions, was provided by an adult proxy respondent. We conducted binomial regression to compare the prevalences of 41 selected health conditions among children with and without current asthma. RESULTS: An estimated 10.4% of children aged 3-17 years (n = 1202) were identified as having current asthma. Nearly all conditions considered were more common among children with than without asthma. Compared to children without asthma, children with asthma had higher prevalences of hay fever or respiratory allergies (prevalence difference [PD]: 30.5%; 95% CI: 26.6, 34.4), eczema or skin allergies (PD: 14.1%; 95% CI: 10.7, 17.5), sinusitis (PD: 11.3%; 95% CI: 8.4, 14.1), food or digestive allergies (PD: 10.4%; 95% CI: 7.7, 13.1), and difficulty with emotions, concentration, behavior, or getting along (PD: 7.9%; 95% CI: 4.7, 11.1). CONCLUSIONS: These results highlight the burden of comorbidities among children with asthma. Improved understanding of the impact of comorbidities among children with asthma may help develop best practices for the assessment, treatment, and control of coexisting health conditions.

[Adaptation to climate change-associated health risks as a task of environmental health protection. Analysis of a nationwide investigation by the Federal Environment Agency]. / Anpassung an die gesundheitlichen Risiken des Klimawandels als Aufgabe des umweltbezogenen Gesundheitsschutzes. Analyse einer bundesweiten Recherche und Erhebung des Umweltbundesamtes.

The German Strategy for Adaptation to Climate Change (DAS, 2008) identified 'human health' as an important sector with a need for adaptation. In line with the DAS, the Federal Environment Agency (UBA) and the Robert Koch Institute jointly elaborated guidelines for decision makers and stakeholders. Building on these, in 2013/2014, UBA has conducted a nationwide survey, collecting data on completed, ongoing and planned adaptation measures. UBA also analysed 32 adaptation strategies of the Federal States. Selected best practice examples of potential health-related prevention and adaptation measures concerning heat stress, UV radiation exposure and the spread of Ambrosia artemisiifolia are presented in this article. The data collection with more than 330 activities can be found on the website of the German National Environment and Health Action Plan (APUG; www.apug.de , in German only). In the course of this project, the APUG website was also significantly extended with comprehensive information and overviews on health risks of climate change, hence creating a central platform for this particular topic.

Intranasal corticosteroids: the role of patient preference and satisfaction.

Allergic rhinitis (AR) is a disease with a significant global burden, associated with many comorbidities and quality-of-life issues. Overwhelming evidence shows that intranasal corticosteroids are the most effective treatment for AR to control the disease, decrease comorbidities, and decrease costs. Poor adherence is a major barrier to achieving control of AR. This article addresses patient preferences and satisfaction regarding intranasal corticosteroids and factors leading to better adherence. We review and summarize the published literature. Factors affecting patient preference and, ultimately, adherence include a variety of sensory components such as odor, taste, comfort of delivery, delivery devices (aerosol versus aqueous) and patient cost. The intensity of adverse sensory attributes is negatively correlated with patient preference and the likelihood of adherence. Selection of an intranasal steroid (INS) with patient preference and satisfaction in mind can influence patient outcomes and cost. Providers need to assess each patient to determine which inhaled INS will lead to the best adherence, thereby improving outcomes in our patients and ultimately reducing the overall global burden of this disease.

Association between parental socioeconomic position and prevalence of asthma, atopic eczema and hay fever in children.

AIM: To determine the prevalence of asthma, atopic eczema and hay fever among children in different age groups and examine the associations with parental socioeconomic position. METHODS: A cross-sectional health survey of four complete birth-cohorts in the municipality of Copenhagen was conducted. Children aged 11 and 15 years and parents of children aged 3 and 6 years completed questionnaires on symptoms and diseases. Data were linked to national registers on demographics and socioeconomic position measured as education, employment and income. In total, 9720 children/parents responded (50.5%). RESULTS: The prevalence of asthma and hay fever increased with increasing age; asthma: from 3.2% among children aged 3 years to 15.4% among children aged 15 years; hay fever: from 3.1% among children aged 3 years to 21.3% among children aged 15 years. The prevalence of atopic eczema did not vary with age and ranged between 15.5% and 17.8%. Odds Ratios for children of parents with the lowest vs. the highest educational level were 1.50 (95% CI = 1.17-1.91) for asthma; 1.68 (95% CI = 1.35-2.10) for hay fever; and 0.75 (95% CI = 0.64-0.89) for atopic eczema. Unemployment was significantly associated with a decreased risk of atopic eczema and eczema symptoms. There was no independent association between household income and any of the outcomes. CONCLUSIONS: The prevalence of asthma and hay fever, but not atopic eczema, increased with increasing age. Atopic eczema was associated with high parental educational level, whereas asthma and hay fever were associated with low educational level. No association with household income was found.

Importance of clinical epidemiology research in studies on respiratory diseases.

Evidence-based medicine (EBM) has generated great interest since the 1990s and many physicians worldwide have based their clinical practice on this idea. Its underlying concepts include a diverse array of findings from clinical epidemiological research. In western countries, many clinical databases of clinical epidemiology are in circulation. Clinical epidemiological research using these data in western countries constitutes the majority worldwide. However, because race, lifestyle, culture, etc., differ among western countries and Japan, it is difficult to apply the results of clinical epidemiological research obtained in Japan to western countries. Unfortunately, there is no large-scale database for respiratory diseases prevalent in Japan. Many specialists agree with the opinion that it is necessary to collect medical information specific to the Japanese population and analyze the clinical data. KiHAC (Kinki Hokuriku Airway Disease Conference) was established in September 2001 with the aim of generating evidence through clinical epidemiological research for airway diseases by targeting physicians practicing respiratory medicine, pediatrics, and otorhinolaryngology, primarily in the Kinki and Hokuriku regions located in the central to western parts of Japan. As a part of the KiHAC, clinical research societies will attempt to cooperate with each other to make joint research possible and to share and utilize information, in addition to further promoting clinical research in the field of respiratory medicine.

Incremental healthcare utilization and expenditures for allergic rhinitis in the United States.

OBJECTIVE: Determine incremental increases in healthcare expenditures and utilization associated with allergic rhinitis (AR). METHODS: Patients reporting a diagnosis of AR were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. AR patients were then compared to non-AR patients determining differences in healthcare utilization: office visits, emergency facility visits, and prescriptions filled, as well as differences in healthcare expenditures: total healthcare costs, office-based costs, prescription medication costs, and self-expenditures using demographically and comorbidity adjusted multivariate models. RESULTS: An estimated 17.8 ± 0.72 million adult patients reported AR in 2007 (7.9 ± 0.3% of the U.S. population). The additional incremental healthcare utilizations associated with AR relative to non-AR patients for office visits, emergency facility visits, and number of prescriptions filled were 3.25 ± 0.40, 0.01 ± 0.02, and 8.95 ± 0.80, respectively (P < .001, .787, and <.001, respectively). Similarly, additional healthcare expenditures associated with AR for total healthcare expenses, office-based visit expenditures, prescription expenditures, and self-expenditures were $1,492 ± 346, $461 ± 122, $876 ± 126, and $168 ± 25, respectively (all P < 0.001). CONCLUSIONS: AR is associated with substantial incremental increases in healthcare utilization and expenditures due to increases in office-based visits and prescription expenditures. As a commonly prevalent and costly disease, AR would be a prime target for guideline development and standardization of care.

Ciclesonide for the treatment of seasonal allergic rhinitis.

Allergic rhinitis is considered one of the most common afflictions of humans, affecting up to 30% of the world's population, and is increasing in incidence. Primary symptoms, comorbid conditions and complications of this disorder exact a significant toll, resulting in an enormous physical, social and economic impact on society. Single-season allergic rhinitis accounts for approximately 20% of cases of allergic rhinitis with another 40% having mixed seasonal-perennial presentations. Management of this disorder encompasses several treatment options, with intranasal corticosteroids recommended as first-line treatment in moderate-to-severe seasonal allergic rhinitis in current practice parameters. Ciclesonide is the most recently approved product in this category for the management of seasonal allergic rhinitis and is the subject of this article.