Levels of IgE sensitization drive symptom thresholds in allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to 1 or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated with clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known. OBJECTIVE: To evaluate phenotypical differences between monosensitized and polysensitized patients with AR and to quantify their symptomatic variability. METHODS: A total of 565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. Of those, 155 were monosensitized and 410 were polysensitized. Interactions between sensitization levels and the reporting of different symptoms of AR and co-morbidities, disease duration, and impact were assessed. Furthermore, patients were stratified into monosensitized, oligosensitized, and polysensitized to assess whether the effect of sensitization on the phenotype was ranked. RESULTS: Polysensitized patients reported itchy eyes significantly more often (P = .001) and had a higher number of ocular (P = .005), itch-related (P = .036), and total symptoms (P = .007) than monosensitized patients. In addition, polysensitized adults and children more often reported wheeze (P = .015) and throat-clearing (P = .04), respectively. Polysensitization was associated with more burdensome AR based on a visual analog scale (P = .005). Increased sensitization level was reflected in more itchy eyes, a higher number of ocular, itch-related, and total number of symptoms, and disease burden. CONCLUSION: With an increasing number of sensitizations, patients with AR experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

Three-year pollen and fungi calendar in a Mediterranean region of the Northeast Greece.

INTRODUCTION AND OBJECTIVES: Pollen calendars have been proved clinically important in allergic disease management, as differences in airborne allergens exist not only between different countries but also between regions of the same country as well. This study aims to provide new data regarding the atmospheric pollen and fungi content of a Mediterranean region (Western Thrace/North-East Greece) and discuss seasonal trends, differences in pollen grains and fungi spores' circulation over the years, and correlations with climate parameters. MATERIAL AND METHODS: A 7-day continuously running volumetric trap was used to collect circulating pollen grains and fungi spores. Pollen taxa and fungi were characterized by standard protocols and counted as grains /m3 and average total grains and spores. The primary allergenic pollen season was discovered, and their 10-day averages were measured over time. Correlations with temperature, rain, and humidity were assessed by single linear regression analysis. RESULTS: Pollen grains from nine pollen families were identified, including five arboreal, two nonarboreal taxa, and spores from two fungi species. The three most prevalent taxa were Oleaceae, Poaceae, Pinaceae, and Cladosporium in the fungi. Peak pollen concentrations were detected during April and May, with daily averages exceeding 170 grains/m3. Poaceae presented the longest pollen season of 342 days and Oleaceae the shortest, extending to only 110 days, during the 3years. Cladosporium was the fungus with the highest spore concentration (180,129.9 spores) compared with Alternaria (28,026.1 spores). Correlations with meteorological parameters showed variable associations among different taxa, with rainfall and relative humidity being the most significant determinants. CONCLUSION: In this study, the pollenic and fungal spectrum of a Mediterranean region and information that can be proved clinically significant for the appropriate diagnostic and therapeutic approach of allergic patients was presented.

New concepts in pediatric rhinitis.

Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.

Lasers in endoscopic middle ear surgery: where do we stand today?

OBJECTIVE: To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery. METHODS: Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded. RESULTS: Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with minimal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications. CONCLUSION: Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue.

Immunologic mechanisms of a short-course of Lolium perenne peptide immunotherapy: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: A 3-week short-course of adjuvant-free hydrolysates of Lolium perenne peptide (LPP) immunotherapy for rhinoconjunctivitis with or without asthma over 4 physician visits is safe, well tolerated, and effective. OBJECTIVE: We sought to investigate immunologic mechanisms of LPP immunotherapy in a subset of patients who participated in a phase III, multicenter, randomized, double-blind, placebo-controlled trial (clinical.govNCT02560948). METHODS: Participants were randomized to receive LPP (n = 21) or placebo (n = 11) for 3 weeks over 4 visits. Grass pollen-induced basophil, T-cell, and B-cell responses were evaluated before treatment (visit [V] 2), at the end of treatment (V6), and after the pollen season (V8). RESULTS: Combined symptom and rescue medication scores (CSMS) were lower during the peak pollen season (-35.1%, P = .03) and throughout the pollen season (-53.7%, P = .03) in the LPP-treated group compared with those in the placebo-treated group. Proportions of CD63+ and CD203cbrightCRTH2+ basophils were decreased following LPP treatment at V6 (10 ng/mL, P < .0001) and V8 (10 ng/mL, P < .001) compared to V2. No change in the placebo-treated group was observed. Blunting of seasonal increases in levels of grass pollen-specific IgE was observed in LPP-treated but not placebo-treated group. LPP immunotherapy, but not placebo, was associated with a reduction in proportions of IL-4+ TH2 (V6, P = .02), IL-4+ (V6, P = .003; V8, P = .004), and IL-21+ (V6, P = .003; V8, P = .002) follicular helper T cells. Induction of FoxP3+, follicular regulatory T, and IL-10+ regulatory B cells were observed at V6 (all P < .05) and V8 (all P < .05) in LPP-treated group. Induction of regulatory B cells was associated with allergen-neutralizing IgG4-blocking antibodies. CONCLUSION: For the first time, we demonstrate that the immunologic mechanisms of LPP immunotherapy are underscored by immune modulation in the T- and B-cell compartments, which is necessary for its effect.

Symptomatology Patterns in Children with Allergic Rhinitis.

BACKGROUND Although allergic rhinitis (AR) is recognized as a growing global health disease with considerable importance for patients' lives, especially among children and adolescents, there is a lack of population studies concerning symptomatology patterns of the disease. The present study aimed to explore symptoms prevalence among school-aged children, to detect any correlation between allergen sensitivities with symptomatology patterns, and, finally, to evaluate the association of the sensitivity grade score with symptoms severity or seasonality. MATERIAL AND METHODS This was a cross-sectional, observational study in a childhood population. The first stage included recruitment of children and parental-completed questionnaires. The second stage included skin-prick tests for the most common allergens. Severity of symptoms was self-evaluated using a scale that ranged from "0" (no symptoms), "1" (mild), and "2" (moderate-to-severe). AR was classified as seasonal (SAR) or perennial (PAR). RESULTS The most frequent symptoms were reported for nasal obstruction, sneezing, and rhinorrhea. All nasal symptoms were significantly more profound among children with HDM sensitivity. However, more symptoms, not only nasal, but also ocular and general ones, were detected among patients with grass pollen sensitivity. Patients with PAR reported more severe symptoms. SAR was associated with mild disease. Finally, the sensitivity grade score was significantly correlated with symptom severity. CONCLUSIONS Our results suggest that allergen sensitivity may be correlated with symptomatology patterns among children who have allergic rhinitis.

Aeroallergens in West Crete, Greece: A five year (2010-2014) aerobiological study.

The objective of the analytic observational study was to present air-pollen counting program results for a 5-year period. Airborne pollens and fungi collection, from both urban and sub-urban areas, were obtained using a special Burkard pollen trap installed on the roof of Chania General Hospital. Aeroallergen concentration measurement was made in a standardized way with fixation of the material collected and then counting using an optical microscope. Annual and total circulating pollen and fungi counts for the study period are presented. In the year 2014, the highest total annual count was recorded, while 2013 was the year with the lowest one. Months with the highest average concentrations were June for the years 2010 and 2011 (1291 and 1114.6 grains/m(3), respectively) and May for the consecutive 3 years 2012-2014 (1120, 890 and 1353.1 g/m(3), respectively). Peak periods for circulating aeroallergens were April-June. Trees pollen accounted for the majority of circulating aeroallergens (615.9 and 677.1 g/m(3) during peak periods in the years 2012 and 2014), while fungi accounted for the majority of circulating aeroallergens (818.5, 729.4, 890.7 spores/m(3)), during the peak periods in the years 2010, 2011 and 2013. Variability in peak airborne allergen periods could be partly explained by the differences in climatic conditions during the study period.

Hyposmia: an underestimated and frequent adverse effect of chemotherapy.

OBJECTIVES: Optimal function of both the olfactory sensory neurons and the olfactory mucosa is a prerequisite for normal olfactory perception. Both the olfactory neurons and mucosa might be subjects to the neurotoxic and mucotoxic effects of chemotherapy. Despite the recognized importance of olfaction in nutrition and quality of life, the potential olfactory toxicity of chemotherapy regimens has not been adequately assessed. The aim of this study is to investigate whether mucotoxic and/or neurotoxic drugs compromise olfactory performance. PATIENTS AND METHODS: Forty-four consecutive patients completed the "Sniffin' Sticks" test, an objective quantitative/qualitative method to assess olfactory function, at diagnosis and immediately before the infusion of the last session of three to four chemotherapy cycles, according to the therapeutic protocol. The patients underwent therapy containing oxaliplatin and antimetabolites (5-FU or capecitabine; O+A group), taxanes and platinum analogues (cisplatin and carboplatin; T+P group), or taxanes and anthracyclines (doxorubicin or liposomal doxorubicin; T+A group). RESULTS: A significant decrease was noted for olfactory threshold (OT), olfactory discrimination (OD), olfactory identification (OI), and the composite threshold-discrimination-identification (TDI) score. A significant deterioration of all olfactory indices was found for each chemotherapy group. Pairwise comparisons revealed significant differences between the O+A and the T+P group regarding OT and TDI. TDI scores were significantly lower after chemotherapy in all age groups. Patients older than 50 years were found to be more susceptible to olfactory toxicity than younger patients. CONCLUSIONS: Patients who undergo chemotherapy experience significant compromise in their olfactory function. A grading system for olfactory toxicity is proposed.

Predictors of quality of life improvement in allergic rhinitis patients after sublingual immunotherapy.

OBJECTIVES: Sublingual immunotherapy (SLIT) has been described as a significant intervention in the treatment of allergic rhinitis (AR). However, factors that may predict treatment outcomes with respect to quality of life (QoL) results and mainly the role of olfactory function are still being underestimated. In this study, we investigated determinants that best predict treatment outcomes for QoL, exploring mainly the role of olfaction. METHODS: One hundred forty-five patients following SLIT, 45 placebo-controls, and 48 healthy subjects were studied. Olfactory function was objectively evaluated using "Sniffin' Sticks" test pre- and post-cessation of SLIT. Three categories of validated QoL questionnaires were filled out by all subjects: questionnaire specific for olfaction (Questionnaire of Olfactory Deficits), questionnaires for assessing psychology (Beck Depression Inventory, Zung Depression Scale, State & Trait Anxiety Inventory), general Short Form-36 health survey. RESULTS: Statistically significant improvement of olfactory function by 11.1% and of all QoL questionnaires results (all P<.001) was observed on final evaluation. Anosmia, asthma history, and the severity of symptoms-expressed by the Total Symptoms Score-were proven independent determinants of clinically significant improvement in patients' QoL. CONCLUSIONS: Several factors were found that may predict QoL outcomes in AR patients following SLIT.

Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery.

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

Benign paroxysmal positional vertigo secondary to vestibular neuritis.

The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.

The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis.

BACKGROUND: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. OBJECTIVE: To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). METHODOLOGY: Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years. RESULTS: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. CONCLUSION: Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

The effect of MemoVigor 2 on recent-onset idiopathic tinnitus: a randomized double-blind placebo-controlled clinical trial.

Background: Tinnitus is a common symptom associated with the conscious perception of sound in the absence of a corresponding external or internal sound source, which can severely impact quality of life. Because of the current limited understanding of the precise pathophysiological mechanism of idiopathic tinnitus, no curable treatment has been attained yet. A food supplement trading as MemoVigor 2, which contains a combination of therapeutic ingredients with mainly antioxidant activity, has been used in the treatment of tinnitus. The objective of our study was to evaluate the effectiveness of MemoVigor 2 in the treatment of recent-onset idiopathic tinnitus. Methods: In a prospective single-centre randomized, double-blind, placebo-controlled clinical trial we studied 204 patients with idiopathic tinnitus divided into two groups: 104 patients who received MemoVigor 2 and 100 patients treated with placebo. To evaluate changes in tinnitus we used (1) audiometry/tympanometry; (2) specific measures of tinnitus perception, including tinnitus pitch, loudness at tinnitus pitch, loudness at 1 kHz, minimum masking level, and residual inhibition; (3) questionnaires of tinnitus handicap inventory, mini tinnitus questionnaire and patients' global impression of change. All patients underwent this test battery at the beginning of the study and in a repeat post-3-month session. Results: All tinnitus measures, including pitch, loudness, minimum masking level and residual inhibition improved significantly in the intervention group. Most of these measures improved in the placebo group too, but in a lesser degree. All questionnaire scores diminished significantly in both groups, but the degree of decrease was greater in the intervention group. The participants' tinnitus outcome reported after treatment using the patients' global impression of change score differed significantly between the two groups, with greater improvement observed in the intervention group. Conclusion: We found that the use of MemoVigor 2 improved recent-onset tinnitus, as proved by a set of tests performed for its evaluation, including audiometric measures, specific measures of tinnitus perception and tinnitus questionnaires. Tinnitus in the placebo group improved too, but to a lesser degree. Clinical Trial Registration: isrctn.com, Identifier ISRCTN16025480.

Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy.

BACKGROUND: The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in treatment of chronic rhinosinusitis (CRS) with nasal polyps. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab, and mepolizumab in CRS treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why? METHODS: An extensive search in English literature was conducted in PubMed/Medline, Embase, Google Scholar, and Cochrane Database/Library. Eligibility criteria included papers with full text published in English, adult population studies, clearly described intervention protocol, and documented primary and secondary outcomes. RESULTS: The studies included numbered 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and indirect treatment comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations. CONCLUSIONS: Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question "which biologic agent is the most effective in CRS treatment?" Improved statistical methodology, head-to-head trials, and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.

Cancer Microenvironment Defines Tumor-Infiltrating Lymphocyte Density and Tertiary Lymphoid Structure Formation in Laryngeal Cancer.

BACKGROUND: The presence and activity of tumor-infiltrating lymphocytes (TILs) is a key parameter related to the antitumor immune response. A large number of studies reveal TIL density as a prognostic marker and predictor of response to radiotherapy, chemotherapy, and immunotherapy. METHODS: We examined the TIL and tertiary lymphoid structure TLS density in the invading front and inner tumor stroma, in a 33 squamous cell laryngeal carcinomas (LSCC) treated with laryngectomy. TIL and TLS densities were in parallel examined with markers of anaerobic metabolism, vascular density (VD), vascular survival ability (VSA), and histopathological parameters. RESULTS: TIL and TLS densities significantly decreased in inner tumor areas (p < 0.0001). TIL density in the invading tumor front was inversely related with lymph node involvement (p = 0.03), HIF1α expression (p = 0.008), vessel density (p = 0.02), and MIB1 (p = 0.006). TIL density in inner stroma was inversely linked to local invasion (marginal p = 0.05), tumor budding (TB) (p = 0.005), MIB1 (p = 0.02), and HIF1α expression (p = 0.02). Low-TLS density in the invading front and in inner tumor areas was related to high TB (p = 0.02 and 0.002, respectively), HIF1α (p = 0.003 and 0.01, respectively), and LDH5 expression (p = 0.003 and 0.007, respectively). CD4+, FOXP3+ TIL density, and FOXP3+/CD8+ ratio were directly associated with VSA (p = 0.008, 0.02, and 0.05, respectively). CONCLUSION: Poor immune response is related to hypoxic background and anaerobic metabolism, as well as increased invasive and metastatic ability. Regulatory TIL markers are linked with increased angiogenic potential. The prognostic, predictive, and therapy-guiding value of TILs in clinical practice demands thorough investigation.

A Rare Case of a Giant Sialolith Within Wharton's Duct.

Sialolithiasis is a common disease characterized by the formation of calculi within the salivary glands or their ducts. Although many cases of large stones located within the submandibular gland have previously been reported, the presence of a giant stone within Wharton's duct is extremely rare. We report the case of a patient who presented with an unusually large stone measuring about 6 cm in the greatest dimension located within Wharton's duct and causing local swelling and pain. The sialolith was successfully removed intraorally indicating that a minor procedure under local anesthesia can be a successful treatment modality even in the case of a giant sialolith.

The Clinical Significance of Pollen and Fungi Concentrations for Allergic Rhinitis: A Three-Year Study.

INTRODUCTION: The relationship between disease severity and exposure to allergens in allergic rhinitis (AR) patients is not fully clarified presently. We aimed to detect the correlation between airborne pollen and fungi concentrations in a Mediterranean region with symptom scores. METHODS: A total of 98 patients suffering from AR rated their symptoms at the time of exacerbation using the Total 5 Symptoms Score (T5SS) and the Visual Analogue Scale (VAS). Patients' quality of life (QoL) was estimated by using either disease-specific (Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ) or generic (Short-Form 36 (SF-36) and Beck Depression Inventory (BDI)) questionnaires. All patients' responses were correlated with aerobiological data. Skin prick tests (SPTs) were used to detect sensitivities to the most common registered pollen and fungi species. RESULTS: A significant positive correlation between total pollen and fungi counts and disease-specific questionnaires was found only for the RQLQ. Accordingly, a significant positive correlation was found between total pollen and fungi counts and T5SS (r = 0.655, p = 0.021), with breathing (r = 0.620, p = 0.032) and sneezing (r = 0.660, p = 0.020) being strongly affected. Moreover, a tendency toward a higher VAS score was found as total pollen and fungi counts increased (r = 0.523, p = 0.081). CONCLUSION: We found a significant correlation between patients' symptoms and pollen and fungal air concentrations. Our results emphasize the clinical significance of pollen and fungi maps in everyday clinical practice.

Clinical significance of Alternaria alternata sensitization in patients with allergic rhinitis.

PURPOSE: The aim of the study was to determine the epidemiologic profile of Alternaria alternata (AA)-sensitized patients with allergic rhinitis including coexistence of other atopic diseases, seasonal distribution of AA aeroallergens, age of onset of AA sensitization, and prevalence of sensitization to other allergens. MATERIALS AND METHODS: History, clinical examination, and skin prick tests were performed in 623 patients with allergic rhinitis from central Greece. Patients' age, cosensitization, place of living, seasonal distribution, and concomitant symptoms were the variables used to discriminate between AA-sensitized and non-AA-sensitized patients. Significant predictor variables for AA sensitization were determined. RESULTS: A alternata sensitization was associated with male sex, age younger than 18 years, living in new-built apartments in urban and semiurban areas by the sea, perennial distribution, and nonsmoking. A alternata-sensitized patients were affected more frequently by asthma than non-AA-sensitized patients. No significant differences were found in frequency of bronchitis, cough, conjunctivitis, urticaria, or eczema between patients sensitized or not to AA. Most (66.7%) of AA-sensitized patients were oligosensitized, 18.5% of patients were polysensitized, and 14.8% were monosensitized. Patients' age, cosensitization, place of living, and seasonal distribution were the significant predictor variables discriminating AA-sensitized from non-AA-sensitized patients. These variables correctly classified 79.7% of the patients. A alternata-sensitized patients were more frequently sensitized to grasses, cat epithelia, and flours-rye and less frequently sensitized to artemisia, Dermatophagoides pteronyssinus, D farinae, and chenopodium. CONCLUSIONS: Patients meeting the aforementioned epidemiologic criteria should be preferentially offered skin prick tests for AA sensitization.

A Study of Airborne Pollen Grains and Fungal Spores in the Region of Epirus (Northwestern Greece).

INTRODUCTION: In the region of Epirus (Northwestern Greece) there are characteristic climatic and geographical conditions that facilitate the growth of typical vegetation with the production of allergic pollen. Aerobiological research into airborne pollen diversity and seasonal variation in pollen counts and fungi spores has become essential due to the growing incidence of allergic rhinitis, allergic asthma, and other pollen-related and spore-related allergic conditions. Furthermore, weather conditions and other factors like air pollution may affect the intensity, the onset, and the duration of the pollen season, and the impact on the patient's symptomatology. METHODS: The diversity of airborne pollen grains (grains/m3) and fungal spores (spores/m3) in the region of Epirus were measured volumetrically using Burgard trap for 13 months, from May 1, 2017 to May 31, 2018. RESULTS: Totally, 10 pollen families and two fungi were recognized. The six most common taxa were Cupressaceae, Pinaceae, Urticaceae, Poaceae, Betulaceae, and Compositeae. The fungi taxa were Cladosporium and Alternaria. Peak pollen centralization was recorded from May to September. Urticaceae had the longest pollen season while Oleaceae and Pinaceae had the shorter. Fungal spores were recorded during all the months of the year. Also, there was a correlation between meteorological parameters and most pollen taxa. CONCLUSION: The pollen and spore calendar shows the concentration of pollen grains and fungal spores in the region of Epirus. This knowledge is important for physicians and allergic patients as it could improve the management of the allergic respiratory disease.

Chronic pharyngitis is associated with severe acidic laryngopharyngeal reflux in patients with Reinke's edema.

OBJECTIVES: We evaluated the association between pathological acidic laryngopharyngeal reflux (LPR) events and chronic pharyngitis in patients with Reinke's edema. METHODS: We performed a prospective controlled study in 20 consecutive patients with Reinke's edema without pathological acidic LPR events (group A) and 40 consecutive patients with Reinke's edema with both clinical symptoms and 24-hour pH-metry suggesting acidic LPR (group B). The severity of acidic LPR was assessed by use of the Reflux Finding Score (RFS), the Reflux Symptom Index (RSI), and dual antimony probe 24-hour pH-metry. The patients were evaluated for the presence of chronic pharyngitis by clinical examination and biopsy specimens taken from the posterior pharyngeal wall. The Chi2 test was used to compare the groups for the presence of pharyngitis. In group B, the RSI, the RFS, and the total duration and number of acidic LPR events on 24-hour pH-metry were compared between patients with and without concomitant pharyngitis by use of the Mann-Whitney test. RESULTS: Five patients of group A and 20 patients of group B had chronic pharyngitis. Therefore, more patients with Reinke's edema and clinical signs of LPR tended to have chronic pharyngitis than did those with Reinke's edema and no clinical signs of LPR, but the difference was not statistically significant (p = 0.064; odds ratio, 3.0; 95% confidence interval, 0.9 to 9.8). Among group B patients, those with pharyngitis had significantly more acidic LPR events (p < 0.001) and a greater exposure time to gastric fluid (p = 0.008) than did those without pharyngitis. Their RFS and RSI did not differ significantly (p = 0.692 and p = 0.914, respectively). CONCLUSIONS: Only in the subgroup of patients with Reinke's edema and LPR was there a statistically significant correlation between the pH probe results and the incidence of clinical pharyngitis. Awareness should increase among physicians about addressing chronic pharyngitis in therapy for acidic LPR and/or Reinke's edema.