A real-life ImmunoCAT study: impact of molecular diagnosis through ImmunoCAPTM ISAC 112 on immunotherapy prescription in pollen-polysensitized patients in Catalonia, Spain.

BACKGROUND: Molecular diagnosis in allergology helps to identify multiple allergenic molecules simultaneously. The use of purified and/or recombinant allergens increases the accuracy of individual sensitization profiles in allergic patients. OBJECTIVE: To assess the impact of molecular diagnosis through the ImmunoCAPTM ISAC 112 microarray on etiological diagnosis and specific immunotherapy (SIT) prescription. This was compared to the use of conventional diagnoses in pediatric, adolescent, and young adult patients with rhinitis or rhinoconjunctivitis and/or allergic asthma, sensitized to three or more pollen allergens of different botanical species. METHODS: A multicenter, prospective, observational study was conducted in patients aged 3-25 years who received care at the Allergology service of 14 hospitals in Catalonia from 2017 to 2020. Allergology diagnosis was established based on the patient's clinical assessment and the results of the skin prick test and specific immunoglobulin E assays. Subsequently, molecular diagnosis was conducted using ImmunoCAPTM ISAC® 112 to recombinant and/or purified allergen components. RESULTS: A total of 109 patients were included; 35 (32.1%) were pediatric patients and 74 (67.9%) were adolescents or young adults (mean age: 18 years), with 58.0% being females. A change of 51.0% was observed in SIT prescription following molecular etiological diagnosis by means of a multi-parameter microarray. CONCLUSIONS: Molecular diagnosis by means of multi-parameter tests increases the accuracy of etiological diagnosis and helps to define an accurate composition of SIT.

Logistic regression models for predicting daily airborne Alternaria and Cladosporium concentration levels in Catalonia (NE Spain).

Alternaria and Cladosporium are the most common airborne fungal spores responsible for health problems, as well as for crop pathologies. The study of their behavior in the air is a necessary step for establishing control and prevention measures. The aim of this paper is to develop a logistic regression model for predicting the daily concentrations of airborne Alternaria and Cladosporium fungal spores from meteorological variables. To perform the logistic regression analysis, the concentration levels are binarized using concentration thresholds. The fungal spore data have been obtained at eight aerobiological monitoring stations of the Aerobiological Network of Catalonia (NE Spain). The meteorological data used were the maximum and minimum daily temperatures and daily rainfall provided by the meteorological services. The relationship between the meteorological variables and the fungal spore levels has been modeled by means of logistic regression equations, using data from the period 1995-2012. Values from years 2013-2014 were used for validation. In the case of Alternaria, three equations for predicting the presence and the exceedance of the thresholds 10 and 30 spores/m3 have been established. For Cladosporium, four equations for the thresholds 200, 500, 1000, and 1500 spores/m3 have been established. The temperature and cumulative rainfall in the last 3 days showed a positive correlation with airborne fungal spore levels, while the rain on the same day had a negative correlation. Sensitivity and specificity were calculated to measure the predictive power of the model, showing a reasonable percentage of correct predictions (ranging from 48 to 99%). The simple equations proposed allow us to forecast the levels of fungal spores that will be in the air the next day, using only the maximum and minimum temperatures and rainfall values provided by weather forecasting services.

The Moran effect and environmental vetoes: phenological synchrony and drought drive seed production in a Mediterranean oak.

Masting is the highly variable production of synchronized seed crops, and is a common reproductive strategy in plants. Weather has long been recognized as centrally involved in driving seed production in masting plants. However, the theory behind mechanisms connecting weather and seeding variation has only recently been developed, and still lacks empirical evaluation. We used 12-year long seed production data for 255 holm oaks (Quercus ilex), as well as airborne pollen and meteorological data, and tested whether masting is driven by environmental constraints: phenological synchrony and associated pollination efficiency, and drought-related acorn abscission. We found that warm springs resulted in short pollen seasons, and length of the pollen seasons was negatively related to acorn production, supporting the phenological synchrony hypothesis. Furthermore, the relationship between phenological synchrony and acorn production was modulated by spring drought, and effects of environmental vetoes on seed production were dependent on last year's environmental constraint, implying passive resource storage. Both vetoes affected among-tree synchrony in seed production. Finally, precipitation preceding acorn maturation was positively related to seed production, mitigating apparent resource depletion following high crop production in the previous year. These results provide new insights into mechanisms beyond widely reported weather and seed production correlations.

Assessing allergenicity in urban parks: A nature-based solution to reduce the impact on public health.

Urban parks play a key role in the provision of ecosystem services, actively participating in improving the quality of life and welfare of local residents. This paper reports on the application of an index designed to quantify the allergenicity of urban parks in a number of Spanish cities. The index, which records biological and biometric parameters for the tree species growing there, classifies parks in terms of the risk they pose for allergy sufferers, graded as null, low, moderate or high. In this initial phase, the index was applied to 26 green areas in 24 Spanish cities; green areas varied in type (urban park, historical or modern garden, boulevard, square or urban forest), size 1-100 ha), geographical location, species richness, number of trees and tree density (number of trees / ha.). The data obtained were used to calculate the percentage of allergenic species in each park, which varied between 17-67%; density ranged from 100 to 300 trees/ha. The index values recorded ranged from a minimum of .07 to a maximum of .87; a significant correlation was found between index value and both number of trees and tree density. Taking an index value of .30 as the threshold considered sufficient to trigger allergy symptoms in the sensitive population, 12 of the parks studied may be regarded as unhealthy at any time of the year. Corrective measures to mitigate the impact of pollen emissions include the implementation of nature-based solutions at various levels: planning and design, handling and management, and strengthening of urban green-infrastructure elements. The index proved to be a useful tool for environmental analysis, and complies with the principles of portability and scalability central to current and horizon scientific research.

A statistical approach to bioclimatic trend detection in the airborne pollen records of Catalonia (NE Spain).

Airborne pollen records are a suitable indicator for the study of climate change. The present work focuses on the role of annual pollen indices for the detection of bioclimatic trends through the analysis of the aerobiological spectra of 11 taxa of great biogeographical relevance in Catalonia over an 18-year period (1994-2011), by means of different parametric and non-parametric statistical methods. Among others, two non-parametric rank-based statistical tests were performed for detecting monotonic trends in time series data of the selected airborne pollen types and we have observed that they have similar power in detecting trends. Except for those cases in which the pollen data can be well-modeled by a normal distribution, it is better to apply non-parametric statistical methods to aerobiological studies. Our results provide a reliable representation of the pollen trends in the region and suggest that greater pollen quantities are being liberated to the atmosphere in the last years, specially by Mediterranean taxa such as Pinus, Total Quercus and Evergreen Quercus, although the trends may differ geographically. Longer aerobiological monitoring periods are required to corroborate these results and survey the increasing levels of certain pollen types that could exert an impact in terms of public health.

Projections of the start of the airborne pollen season in Barcelona (NE Iberian Peninsula) over the 21st century.

The effects of global warming are numerous and recent studies reveal that they can affect the timing of pollination. Temperature is the meteorological variable that presents a clearer relationship with the start of the pollination season of most of the observed airborne pollen taxa. In Catalonia, in the last fifty years, the average annual air temperature has increased by +0.23 °C/decade, and the local warming has been slightly higher than the one on a global scale. Projections point to an increase in temperature in the coming decades, which would be more marked towards the middle of the century. To analyse the effect of the increase in temperature due to global warming on the starting date of pollen season in Barcelona, a forecasting model has been applied to a set of projected future temperatures estimated by the European RESCCUE project. This model, largely used in the literature, is based on determining the thermal needs of the plant for the pollen season to begin. The model calibration to obtain the initial parameters has been made by using 20 years of pollen data (2000-2019), and the model effectiveness has subsequently been tested through an internal evaluation over the period of the calibration and an external evaluation on 4 years not included in the calibration (2020-2023). The mean bias error in the internal calibration ranged between -0.4 and - 0.6 days, and between +0.5 and - 8.3 in the external one, depending on the taxon. The results of the application of the model to the temperature projections over the 21st century point to a progressive advancement in the pollination dates of several pollen types abundant in the city, allergenic most of them. These advances ranged, at the end of the century, between 15 and 27 days, depending on the climate model, for the scenario of the highest concentrations (RCP8.5) and between 7 and 12 days for the emissions stabilization scenario (RCP4.5).

Aspergillus Conidia and Allergens in Outdoor Environment: A Health Hazard?

Aspergillus is a genus of saprophytic fungus widely distributed in the environment and associated with soil, decaying vegetation, or seeds. However, some species, such as A. fumigatus, are considered opportunistic pathogens in humans. Their conidia (asexual spores) and mycelia are associated with clinical diseases known as invasive aspergillosis (IA), mainly related to the respiratory tract, such as allergic asthma, allergic bronchopulmonary aspergillosis (ABPA), or hypersensitivity. However, they can also disseminate to other organs, particularly the central nervous system. Due to the dispersal mechanism of the conidia through the air, airborne fungal particle measurement should be used to prevent and control this mold. This study aims to measure the outdoor airborne concentration of Aspergillus conidia and the Asp f 1 allergen concentration in Bellaterra (Barcelona, Spain) during 2021 and 2022, and to compare their dynamics to improve the understanding of the biology of this genus and contribute to a better diagnosis, prevention, and therapeutic measures in the face of possible health problems. The results show that both particles were airborne nearly all year round, but their concentrations showed no correlation. Due to Asp f 1 not being present in the conidia itself but being detectable during their germination and in hyphal fragments, we report the relevance of the aero-immunological analysis as a methodology to detect the potential pathogenic hazard of this fungus.

Influence of synoptic meteorology on airborne allergenic pollen and spores in an urban environment in Northeastern Iberian Peninsula.

The influence of the most frequent patterns of synoptic circulation on the dynamics of airborne pollen/spores recorded at the Barcelona Aerobiological Station (BCN) was analysed. Six pollen types (Platanus, Cupressaceae, Olea, Poaceae, Urticaceae and Amaranthaceae), and one fungal spore (Alternaria) were selected for their high allergenic effect in sensitive people. Six synoptic meteorological patterns were identified through cluster analysis of sea level pressure fields as the main responsible of the weather conditions in the Iberian Peninsula. The local meteorological conditions in Barcelona associated with each one of the synoptic types were also stablished. Different statistical methods were applied to analyse possible relationships between concentrations and timing of the recorded aerobiological particles and specific synoptic types. The study, focused in the 19-year period 2001-2019, shows that one of the scenarios, frequent in winter and linked to high stability and air-mass blockage, registered the highest mean and median values for Platanus and Cupressaceae, but it was not very relevant for the other taxa. It was also this scenario that turned out to be the most influent on the pollination timing showing a significant influence on the start occurrence of Urticaceae flowering and on the peak date of Platanus. On the other hand, the most frequent synoptic type in the period, relevant in spring and summer, was linked to sporadic episodes of levels considered to be of high risk of allergy to Platanus, Poaceae, and Urticaceae pollen, and Alternaria fungal spore. This synoptic pattern, characterized by the presence of the Azores anticyclone and the Atlantic low located in the north of the United Kingdom, was associated with high temperatures, low relative humidity and moderate winds from the NW in Barcelona. The identification of an interaction between synoptic meteorology and pollen/spore dynamics will allow better abatement measures, reducing adverse health effects on sensitive population.

Airborne Alt a 1 Dynamic and Its Relationship with the Airborne Dynamics of Alternaria Conidia and Pleosporales Spores.

Fungal spores are universal atmospheric components associated to allergic reactions. Alternaria (Ascomycota) is considered the most allergenic spore taxa. Alt a 1 is the major allergen of Alternaria and is present also in other Pleosporales. In this study, standard Hirst-based sampling and analyzing methods for measuring spore daily concentrations of Alternaria, Curvularia, Drechslera-Helminthosporium, Epicoccum, Leptosphaeria, Pithomyces, Pleospora and Stemphylium (all included in the taxon Pleosporales) have been used as well as two high-volume samplers, Burkard Cyclone (2017) and MCV CAV-A/mb (2019-2020), and ELISA kits for measuring the allergen. The detection and quantification of Alt a 1 was only possible in the samples from the MCV sampler. Although Alt a 1 was better correlated with Alternaria spores than with Pleosporales spores, the three of them showed high correlations. It is shown that there is a high and significant correlation of Alt a 1 with temperature, a negative correlation with relative humidity and no correlation with precipitation. The aerobiological monitoring of these three elements ensures the best information for understanding the affectation to allergy sufferers, but, if this is not possible, as a minimum public health service aimed at the detection, treatment and prevention of allergies, the study of the airborne Alternaria spores should be ensured.

Aerobiological modelling II: A review of long-range transport models.

The long-range atmospheric transport models of pollen and fungal spores require four modules for their development: (i) Meteorological module: which contain the meteorological model, and it can be coupled to transport model with the same output configuration (spatio-temporal resolution), or uncoupled does not necessarily have the same output parameters. (ii) Emission module: settles the mass fluxes of bioaerosol, it can be done with a complex parameterization integrating phenological models and meteorological factors or by a simple emission factor. (iii) Sources of emission module, specifically refers to forestry/agronomy maps or, in the case of herbs and fungi, to potential geographical areas of emission. Obtaining the highest possible resolution in these maps allows establishing greater reliability in the modelling. (iv) Atmospheric transport module, with its respective established output parameters. The review and subsequent analysis presented in this article, were performed on published electronic scientific articles from 1998 to 2016. Of a total of 101 models applied found in 64 articles, 33 % performed forward modelling (using 15 different models) and 67 % made backward modelling (with three different models). The 88 % of the cases were applied to pollen (13 taxa) and 12 % to fungal spores (3 taxa). Regarding the emission module, 22 % used parametrization (four different parameters) and 10 % emission factors. The most used transport model was HYSPLIT (59 %: 56 % backward and 3 % forward) following by SILAM 10 % (all forward). Main conclusions were that the models of long-range transport of pollen and fungal spores had high technical-scientific requirements to development and that the major limitations were the establishment of the flow and the source of the emission.

Environmental heterogeneity in human health studies. A compositional methodology for Land Use and Land cover data.

The use of Land use and Land cover (LULC) data is gradually becoming more widely spread in studies relating the environment to human health. However, little research has acknowledged the compositional nature of these data. The goal of the present study is to explore, for the first time, the independent effect of eight LULC categories (agricultural land, bare land, coniferous forest, broad-leaved forest, sclerophyll forest, grassland and shrubs, urban areas, and waterbodies) on three selected common health conditions: type 2 diabetes mellitus (T2DM), asthma and anxiety, using a compositional methodological approach and leveraging observational health data of Catalonia (Spain) at area level. We fixed the risk exposure scenario using three covariates (socioeconomic status, age group, and sex). Then, we assessed the independent effect of the eight LULC categories on each health condition. Our results show that each LULC category has a distinctive effect on the three health conditions and that the three covariates clearly modify this effect. This compositional approach has yielded plausible results supported by the existing literature, highlighting the relevance of environmental heterogeneity in health studies. In this sense, we argue that different types of environment possess exclusive biotic and abiotic elements affecting distinctively on human health. We believe our contribution might help researchers approach the environment in a more multidimensional manner integrating environmental heterogeneity in the analysis.

Concentrations of nitrogen compounds are related to severe rhinovirus infection in infants. A time-series analysis from the reference area of a pediatric university hospital in Barcelona.

BACKGROUND: There is scarce information focused on the effect of weather conditions and air pollution on specific acute viral respiratory infections, such as rhinovirus (RV), with a wide clinical spectrum of severity. OBJECTIVE: The aim of this study was to analyze the association between episodes of severe respiratory tract infection by RV and air pollutant concentrations (NOx and SO2 ) in the reference area of a pediatric university hospital. METHODS: An analysis of temporal series of daily values of NOx and SO2 , weather variables, circulating pollen and mold spores, and daily number of admissions in the pediatric intensive care unit (PICU) with severe respiratory RV infection (RVi) in children between 6 months and 18 years was performed. Lagged variables for 0-5 days were considered. The study spanned from 2010 to 2018. Patients with comorbidities were excluded. RESULTS: One hundred and fifty patients were admitted to the PICU. Median age was 19 months old (interquartile range [IQR]: 11-47). No relationship between RV-PICU admissions and temperature, relative humidity, cumulative rainfall, or wind speed was found. Several logistic regression models with one pollutant and two pollutants were constructed but the best model was that which included average daily NOx concentrations. Average daily NOx concentrations were related with the presence of PICU admissions 3 days later (odds ratio per IQR-unit increase: 1.64, 95% confidence interval: 1.20-2.25)). CONCLUSIONS: This study has shown a positive correlation between NOx concentrations at Lag 3 and children's PICU admissions with severe RV respiratory infection. Air pollutant data should be taken into consideration when we try to understand the severity of RVis.

Potential contribution of distant sources to airborne Betula pollen levels in Northeastern Iberian Peninsula.

Betula (birch) pollen is one of the most important causes of respiratory allergy in Northern and Central Europe. While birch trees are abundant in Central, Northern, and Eastern Europe, they are scarce in the Mediterranean territories, especially in the Iberian Peninsula (IP), where they grow only in the northern regions and as ornamental trees in urban areas. However, the airborne birch pollen patterns in Catalonia (Northeastern IP) show abrupt high concentrations in areas with usually low local influence. The intensity of the derived health problems can be increased by outbreaks due to long-range pollen transport. The present work evaluates the different potential contributions to Catalonia from the main source regions: Pyrenees, Cantabria, and the forests of France and Central Europe. To this end, we computed the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) back trajectories of air masses associated with the main Betula pollen peaks occurring simultaneously over different Catalan monitoring stations, and we studied their provenance over a 15-year period. The Vielha aerobiological station on the northern slopes of the Central Pyrenees was used to identify the dates of the pollen season in the Pyrenean region. In order to better understand the role of the Pyrenees, which is the nearest of the four birch forested regions, we classified the pollen peaks in the other Catalan stations into three groups based on the relationship between the peak and the pollen season in the Pyrenees. Our analysis of back-trajectory residence time, combined with the associated pollen concentration, reveals that two principal routes other than the Pyrenean forest sustain the northerly fluxes that enter Catalonia and carry significant concentrations of Betula pollen. This study has also allowed quantifying the differentiated contributions of the potential source regions. In addition, the Weather Research Forecast (WRF) mesoscale model has been used to study three specific episodes. Both models, HYSPLIT and WRF, complement each other and have allowed for better understanding of the main mechanisms governing the entry of birch pollen to the region.

Source areas and long-range transport of pollen from continental land to Tenerife (Canary Islands).

The Canary Islands, due to their geographical position, constitute an adequate site for the study of long-range pollen transport from the surrounding land masses. In this study, we analyzed airborne pollen counts at two sites: Santa Cruz de Tenerife (SCO), at sea level corresponding to the marine boundary layer (MBL), and Izaña at 2,367 m.a.s.l. corresponding to the free troposphere (FT), for the years 2006 and 2007. We used three approaches to describe pollen transport: (1) a classification of provenances with an ANOVA test to describe pollen count differences between sectors; (2) a study of special events of high pollen concentrations, taking into consideration the corresponding meteorological synoptic pattern responsible for transport and back trajectories; and (3) a source-receptor model applied to a selection of the pollen taxa to show pollen source areas. Our results indicate several extra-regional pollen transport episodes to Tenerife. The main provenances were: (1) the Mediterranean region, especially the southern Iberian Peninsula and Morocco, through the trade winds in the MBL. These episodes were characterized by the presence of pollen from trees (Casuarina, Olea, Quercus perennial and deciduous types) mixed with pollen from herbs (Artemisia, Chenopodiaceae/Amaranthaceae and Poaceae wild type). (2) The Saharan sector, through transport at the MBL level carrying pollen principally from herbs (Chenopodiaceae-Amaranthaceae, Cyperaceae and Poaceae wild type) and, in one case, Casuarina pollen, uplifted to the free troposphere. And (3) the Sahel, characterized by low pollen concentrations of Arecaceae, Chenopodiaceae-Amaranthaceae, Cyperaceae and Poaceae wild type in sporadic episodes. This research shows that sporadic events of long-range pollen transport need to be taken into consideration in Tenerife as possible responsible agents in respiratory allergy episodes. In particular, it is estimated that 89-97% of annual counts of the highly allergenous Olea originates from extra-regional sources in southern Iberia and northern Africa.

Aerobiological modeling I: A review of predictive models.

The present work is the first of two reviews on applied modeling in the field of aerobiology. The aerobiological predictive models for pollen and fungal spores, usually defined as predictive statistical models, will, amongst other objectives, forecast airborne particles' concentration or dynamical behavior of the particles. These models can be classified into Observation Based Models (OBM), Phenological Based Models (PHM), or OTher Models (OTM). The aim of this review is to show, analyze and discuss the different predictive models used in pollen and spore aerobiological studies. The analysis was performed on published electronic scientific articles from 1998 to 2016 related to the type of model, the taxa and the modelled parameters. From a total of 503 studies, 55.5% used OBM (44.8% on pollen and 10.7% on fungal spores), 38.5% PHM (all on pollen) and 6% OTM (5.4% on pollen and 0.6% on fungal spores). OBM have been used with high frequency to forecast concentration. The most frequent model of OBM was linear regression (18.5% out of 503) on pollen and artificial neural networks (4.6%) on fungal spores. In the PHM, the principal use was to characterize the main pollen season (flowering season) based on the model of growth degree days. Finally, OTM have been used to estimate concentrations at unmonitored areas. Olea (14,5%) on pollen and Alternaria (4,8%) on fungal spores were the taxa most frequently modelled. Daily concentration was the most modelled parameter by OBM (25.2%) and season start day by PHM (35.6%). The PHM approaches include greater model diversity and use fewer independent variables than OBM. In addition, PHM show to be easier to apply than OBM; however, the wide range of criteria to define the parameters to use in PHM (e.g.: pollination start day) makes that each model is used with a lesser frequency than other models.

Neural networks for increased accuracy of allergenic pollen monitoring.

Monitoring of airborne pollen concentrations provides an important source of information for the globally increasing number of hay fever patients. Airborne pollen is traditionally counted under the microscope, but with the latest developments in image recognition methods, automating this process has become feasible. A challenge that persists, however, is that many pollen grains cannot be distinguished beyond the genus or family level using a microscope. Here, we assess the use of Convolutional Neural Networks (CNNs) to increase taxonomic accuracy for airborne pollen. As a case study we use the nettle family (Urticaceae), which contains two main genera (Urtica and Parietaria) common in European landscapes which pollen cannot be separated by trained specialists. While pollen from Urtica species has very low allergenic relevance, pollen from several species of Parietaria is severely allergenic. We collect pollen from both fresh as well as from herbarium specimens and use these without the often used acetolysis step to train the CNN model. The models show that unacetolyzed Urticaceae pollen grains can be distinguished with > 98% accuracy. We then apply our model on before unseen Urticaceae pollen collected from aerobiological samples and show that the genera can be confidently distinguished, despite the more challenging input images that are often overlain by debris. Our method can also be applied to other pollen families in the future and will thus help to make allergenic pollen monitoring more specific.

Cypress Pollinosis: from Tree to Clinic.

Cypress (Cupressus sp.pl) is a genus within the Cupressaceae family. This family covers all of the Earth's continents except for Antarctica, and it includes about 160 species. The most important taxa for allergic diseases belong to five different genera: Cupressus, Hesperocyparis, Juniperus, Cryptomeria, and Chamaecyparis. Cupressaceae species share a common pollen type that can even include the genus Taxus (Taxaceae) when this plant is also present. As Juniperus oxycedrus pollinates in October, Cupressus sempervirens in January and February, Hesperocyparis arizonica (prev. Cupressus arizonica) in February and March, and Juniperus communis in April, the symptomatic period is long-lasting. Due to global warming, the pollination period tends to last longer, and there is a trend for Cupressaceae bioclimate niches to migrate north. In Mediterranean areas, C. sempervirens (Italian cypress or Mediterranean cypress) is by far the most common pollinating species. It accounts for half of the total pollination level. The group 1 major allergens belong to the pectate-lyase family, and members share 70 to 97% sequence homology within the different Cupressaceae. Group 2 allergens correspond to the polygalacturonase protein family, while group 3, a minor allergen, belongs to the family of "thaumatin-like proteins," a pathogenesis-related protein 5. Group 4 allergens are Ca++-binding protein (4 EF-hands). Aside from these four groups, about 15 other allergens have been reported. Prominent among these is a basic low-molecular mass cross-reactive allergen that was identified recently, and which is suspected to be involved in pollen food syndromes which are common with peach and citrus. The prevalence of cypress allergy in the general population ranges from 0.6 to 3%, depending on the degree of exposure to the pollen. Depending on the geographic area and the studied population, 9 to 65% of outpatients consulting an allergist may have sensitization to cypress pollen. Repeated cross-sectional studies performed at different time intervals have demonstrated a threefold increase in the percentage of cypress allergy around the Mediterranean area. Risk factors include a genetic predisposition and/or a strong exposure to pollen, and the natural history of cypress allergy allows identification of a subgroup of patients as allergic rather than atopic. Concerning the clinical expression, rhinitis is the most prevalent symptom, while conjunctivitis is the most disabling. Pharmacological treatment of cypress allergies is not different from that of other seasonal allergies. Immunotherapy has been used, initially by subcutaneous injections, but currently mostly through the sublingual route. Although clinical trials have included only a limited number of patients, it has proven effective and safe. Avoidance can be implemented at the individual level, as well as at the community level, through the use of alternative plants, low-pollinating cypresses, or by trimming hedges before pollination.

Airborne Alternaria and Cladosporium fungal spores in Europe: Forecasting possibilities and relationships with meteorological parameters.

Airborne fungal spores are prevalent components of bioaerosols with a large impact on ecology, economy and health. Their major socioeconomic effects could be reduced by accurate and timely prediction of airborne spore concentrations. The main aim of this study was to create and evaluate models of Alternaria and Cladosporium spore concentrations based on data on a continental scale. Additional goals included assessment of the level of generalization of the models spatially and description of the main meteorological factors influencing fungal spore concentrations. Aerobiological monitoring was carried out at 18 sites in six countries across Europe over 3 to 21 years depending on site. Quantile random forest modelling was used to predict spore concentrations. Generalization of the Alternaria and Cladosporium models was tested using (i) one model for all the sites, (ii) models for groups of sites, and (iii) models for individual sites. The study revealed the possibility of reliable prediction of fungal spore levels using gridded meteorological data. The classification models also showed the capacity for providing larger scale predictions of fungal spore concentrations. Regression models were distinctly less accurate than classification models due to several factors, including measurement errors and distinct day-to-day changes of concentrations. Temperature and vapour pressure proved to be the most important variables in the regression and classification models of Alternaria and Cladosporium spore concentrations. Accurate and operational daily-scale predictive models of bioaerosol abundances contribute to the assessment and evaluation of relevant exposure and consequently more timely and efficient management of phytopathogenic and of human allergic diseases.

Estimated effects of air pollution and space-time-activity on cardiopulmonary outcomes in healthy adults: A repeated measures study.

BACKGROUND: Exposure to air pollution is known to affect both short and long-term outcomes of the cardiopulmonary system; however, findings on short-term outcomes have been inconsistent and often from isolated and long-term rather than coexisting and short-term exposures, and among susceptible/unhealthy rather than healthy populations. AIMS: We aimed to investigate separately the annual, daily and daily space-time-activity-weighted effect of ambient air pollution, as well as confounding or modification by other environmental (including noise) or space-time-activity (including total daily physical activity) exposures, on cardiopulmonary outcomes in healthy adults. METHODS: Participants (N=57: 54% female) had indicators of cardiopulmonary outcomes [blood pressure (BP), pulse (HR) and heart rate variability (HRV {SDNN}), and lung function (spirometry {FEV1, FVC, SUM})] measured on four different mornings (at least five days apart) in a clinical setting between 2011 and 2014. Spatiotemporal ESCAPE-LUR models were used to estimate daily and annual air pollution exposures (including PM10, PMCoarse, but not Ozone {derived from closest station}) at participant residential and occupational addresses. Participants' time-activity diaries indicated time spent at either address to allow daily space-time-activity-weighted estimates, and capture total daily physical activity (total-PA {as metabolic-equivalents-of-task, METs}), in the three days preceding health measurements. Multivariate-adjusted linear mixed-effects models (using either annual or daily estimates) were adjusted for possible environmental confounders or mediators including levels of ambient noise and greenness. Causal mediation analysis was also performed separately considering these factors as well as total-PA. All presented models are controlled by age, height, sex and season. RESULTS: An increase in 5µg/m3 of daily space-time-activity-weighted PMCoarse exposure was statistically significantly associated with a 4.1% reduction in total heart rate variability (SDNN; p=0.01), and remained robust after adjusting for suspected confounders [except for occupational-address noise (ß=-2.7, p=0.20)]. An increase in 10ppb of annual mean Ozone concentration at the residential address was statistically significantly associated with an increase in diastolic BP of 6.4mmHg (p<0.01), which lost statistical significance when substituted with daily space-time-activity-weighted estimates. As for pulmonary function, an increase in 10µg/m3 of annual mean PM10 concentration at the residential address was significantly associated with a 0.3% reduction in FVC (p<0.01) and a 0.5% reduction in SUM (p<0.04), for which again significance was lost when substituted for daily space-time-activity-weighted estimates These associations with pulmonary function remained robust after adjusting for suspected confounders, including annual Ozone, as well as total-PA and bioaerosol (pollen and fungal spore) levels (but not residential-neighborhood greenness {ß=-0.22, p=0.09; ß=-0.34, p=0.15, respectively}). Multilevel mediation analysis indicated that the proportion mediated as a direct effect on cardiopulmonary outcomes by suspected confounders (including total-PA, residential-neighborhood greenness, and occupational-address noise level) from primary exposures (including PM10, PMCoarse, and O3) was not statistically significant. CONCLUSION: Our findings suggest that increased daily space-time-activity-weighted PMCoarse exposure levels significantly adversely affect cardiac autonomic modulation (as reduced total HRV) among healthy adults. Additionally, increased annual levels at the residential address of Ozone and PM10 significantly increase diastolic blood pressure and reduce lung function, respectively, among healthy adults. These associations typically remained robust when adjusting for suspected confounders. Occupational-address noise and residential-neighborhood greenness levels, however, were seen as mediators of cardiovascular and pulmonary outcomes, respectively. Total daily physical activity was not seen as a mediator of any of the studied outcomes, which supports the promotion of active mobility within cities.

Building-integrated agriculture: A first assessment of aerobiological air quality in rooftop greenhouses (i-RTGs).

Building-integrated rooftop greenhouse (i-RTG) agriculture has intensified in recent years, due to the growing interest in the development of new agricultural spaces and in the promotion of food self-sufficiency in urban areas. This paper provides a first assessment of the indoor dynamics of bioaerosols in an i-RTG, with the aim of evaluating biological air quality in a tomato greenhouse near Barcelona. It evaluates the greenhouse workers' exposure to airborne pollen and fungal spores in order to prevent allergy problems associated with occupational tasks. Moreover, it evaluates whether the quality of the hot air accumulated in the i-RTG is adequate for recirculation to heat the building. Daily airborne pollen and fungal spore concentrations were measured simultaneously in the indoor and outdoor environments during the warm season. A total of 4,924pollengrains/m3 were observed in the i-RTG, with a peak of 334pollengrains/m3day, and a total of 295,038 fungal spores were observed, reaching a maximum concentration of 26,185spores/m3day. In general, the results showed that the most important source of pollen grains and fungal spores observed indoors was the outdoor environment. However, Solanaceae pollen and several fungal spore taxa, such as the allergenic Aspergillus/Penicillium, largely originated inside the greenhouses or were able to colonize the indoor environment under favourable growing conditions. Specific meteorological conditions and agricultural management tasks are related to the highest observed indoor concentrations of pollen grains and fungal spores. Therefore, preventive measures have been suggested in order to reduce or control the levels of bioaerosols indoors (to install a system to interrupt the recirculation of air to the building during critical periods or to implement appropriate air filters in ventilation air ducts). This first evaluation could help in making decisions to prevent the development of fungal diseases, specifically those due to Oidium and Torula.