[Component-resolved diagnosis of tree pollen allergen: identify key allergens to develop treatment plans].

With the increasing global prevalence of tree pollen allergies, there has been a significant impact on the quality of life for populations. In North and Central China, birch pollen, cypress pollen, and plane tree pollen are the most common allergens for springtime pollen allergy sufferers. The distribution of plants and patterns of pollen transmission in different geographical areas result in varying pollen exposure outcomes, further complicating the challenges in diagnosis and individualized treatment. This article delves into the research progress and clinical application of tree pollen allergies based on the "Molecular Allergology User's Guide 2.0 (MAUG 2.0) " published by the European Academy of Allergy and Clinical Immunology (EAACI). It discusses major allergen families and component proteins of tree pollen such as PR-10 proteins, profilins, polcalcins, as well as cross-reactive components that may cause pollen-food allergy syndrome. Allergen component diagnostics can distinguish true allergy sufferers from those with multiple allergen reactions, enabling more targeted selection of allergens for specific immunotherapy, thus enhancing treatment effectiveness. Bet v 1 and Cup a 1, for instance, are specific indicators for immunotherapy in birch and cypress allergy patients. Overall, this article provides cutting-edge information for professionals in the field of tree pollen allergies, offering in-depth exploration of tree pollen allergen component proteins, clinical manifestations, and treatment-related research, aiding in better understanding and addressing the challenges of tree pollen allergies.

Mutational spectra induced by flavonoid extracts from pepper tree (Schinus terebinthifolius, Raddi) stem bark.

Flavonoids are a diverse family of plant compounds that are involved in pigmentation, protection, and endogenous regulation. Flavonoids also have medicinal applications, suggesting that they may exert chemoprotective effects. However, some studies have shown, that some plant flavonoids have oxidative and toxic effects, including those produced by Schinus terebinthifolius. In Brazil, extracts of this plant are widely used for medical purposes. In this study, we analyzed the mutagenic potential of two flavonoid-enriched fractions from Brazilian pepper tree stem bark using Escherichia coli CC strains deficient and proficient in enzymes involved in the DNA repair of oxidative lesions. The highest mutagenic response was detected in the CC104mutMmutY strain but CC104mutY showed a higher mutation frequency than CC104mutM. The spectrum of mutations induced in plasmid DNA is composed of mutations typically caused by oxidative lesions. However, a new type of lesion must be occurred to explain the cytotoxicity, higher mutation rates in the CC104mutY strain, and the rare A:T → T:A and G:C → C:G transversions found in this work.

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.

Food-dependent, exercise-induced anaphylaxis in a patient allergic to peach.

Determining the single factor that triggered anaphylactic shock can be challenging. We present an interesting case of a 25-year-old female patient with recurrent anaphylactic reactions developing after eating various foods, particularly in presence of co-factors of allergic reactions. Symptoms occurred after consumption of various kinds of foods - peach, pancakes with cottage cheese and fruit, a meal from a Chinese restaurant - all eaten on other occasions without symptoms. During diagnosis, skin prick tests were negative for all tested allergen extracts (both inhalatory and food) from Allergopharma. Prick by prick tests were positive for the peach - wheal diameter - 6 mm, nectarine - 4 mm (histamine 4 mm, negative control 0 mm). Increased levels of asIgE were found for allergens of peach (0.55 kU/L).Open challenge test with one mid-size peach combined with the physical exercise challenge test was positive. ImmunoCAP ISAC test indicated increased levels of IgE specific for the lipid transfer protein (LTP) for walnut (nJug r 3), peach (Pru p 3), wheat (rTri a 14) and plane tree (rPla a 3). The patient was diagnosed with food-dependent, exercise-induced anaphylaxis associated with an allergy to lipid transport proteins (LTPs).

Outdoor pollen is a trigger of child and adolescent asthma emergency department presentations: A systematic review and meta-analysis.

BACKGROUND: In the context of increased asthma exacerbations associated with climatic changes such as thunderstorm asthma, interest in establishing the link between pollen exposure and asthma hospital admissions has intensified. Here, we systematically reviewed and performed a meta-analysis of studies on pollen and emergency department (ED) attendance. METHODS: A search for studies with appropriate search strategy in MEDLINE, EMBASE, Web of Science and CINAHL was conducted. Each study was assessed for quality and risk of bias. The available evidence was summarized both qualitatively and meta-analysed using random-effects models when moderate heterogeneity was observed. RESULTS: Fourteen studies were included. The pollen taxa investigated differed between studies, allowing meta-analysis only of the effect of grass pollen. A statistically significant increase in the percentage change in the mean number of asthma ED presentations (MPC) (pooled results from 3 studies) was observed for an increase in 10 grass pollen grains per cubic metre of exposure 1.88% (95% CI = 0.94%, 2.82%). Time series studies showed positive correlations between pollen concentrations and ED presentations. Age-stratified studies found strongest associations in children aged 5-17 years old. CONCLUSION: Exposure to ambient grass pollen is an important trigger for childhood asthma exacerbations requiring ED attendance. As pollen exposure is increasingly a problem especially in relation to thunderstorm asthma, studies with uniform measures of pollen and similar analytical methods are necessary to fully understand its impact on human health.

Temporal Association Between Nonfatal Self-Directed Violence and Tree and Grass Pollen Counts.

OBJECTIVES: Prior research suggests a possible association between pollen and suicide. No studies have examined the relationship between pollen and attempted suicide. This study examines the temporal association between airborne pollen counts and nonfatal suicidal and nonsuicidal self-directed violence (SDV) requiring an emergency department visit. METHODS: Data on daily emergency department visits due to nonfatal SDV as identified by ICD-9 diagnosis criteria were extracted from emergency department medical records of Parkland Memorial Hospital in Dallas, Texas, between January 2000 and December 2003. Concurrent daily airborne tree, grass, and ragweed pollen data from the city of Dallas were extracted from the National Allergy Bureau online database. The data were analyzed using the time series method of generalized autoregressive conditional heteroskedasticity. RESULTS: There were statistically significant and positive temporal associations between tree pollen counts and the number of nonfatal SDV events among women (P = .04) and between grass pollen counts and number of nonfatal SDV events among both men (P = .03) and women (P < .0001). There was no significant temporal association found between ragweed pollen counts and number of nonfatal SDV events. CONCLUSIONS: The study findings suggest that an increase in nonfatal SDV is associated with changes in tree and grass pollen counts. This is the first study that has examined an association between seasonal variation in tree and grass pollen levels and nonfatal SDV event data. The study also used a narrowly defined geographic area and temporal window. The findings suggest that pollen count may be a factor influencing seasonal patterns in suicidal behavior.

Tree pollen allergens-an update from a molecular perspective.

It is estimated that pollen allergies affect approximately 40% of allergic individuals. In general, tree pollen allergies are mainly elicited by allergenic trees belonging to the orders Fagales, Lamiales, Proteales, and Pinales. Over 25 years ago, the gene encoding the major birch pollen allergen Bet v 1 was the first such gene to be cloned and its product characterized. Since that time, 53 tree pollen allergens have been identified and acknowledged by the WHO/IUIS allergen nomenclature subcommittee. Molecule-based profiling of allergic sensitization has helped to elucidate the immunological connections of allergen cross-reactivity, whereas advances in biochemistry have revealed structural and functional aspects of allergenic proteins. In this review, we provide a comprehensive overview of the present knowledge of the molecular aspects of tree pollen allergens. We analyze the geographic distribution of allergenic trees, discuss factors pivotal for allergic sensitization, and describe the role of tree pollen panallergens. Novel allergenic tree species as well as tree pollen allergens are continually being identified, making research in this field highly competitive and instrumental for clinical applications.

Impact of meteorological variation on hospital visits of patients with tree pollen allergy.

BACKGROUND: Climate change could affect allergic diseases, especially due to pollen. However, there has been no epidemiologic study to demonstrate the relationship between meteorological factors, pollen, and allergic patients. We aimed to investigate the association between meteorological variations and hospital visits of patients with tree pollen allergy. METHODS: The study subjects were adult patients who received skin prick tests between April and July from 1999 to 2008. We reviewed the medical records for the test results of 4,715 patients. Patients with tree pollen allergy were defined as those sensitized to more than 1 of 12 tree pollen allergens. We used monthly means of airborne tree pollen counts and meteorological factors: maximum/average/minimum temperature, relative humidity, and precipitation. We analyzed the correlations between meteorological variations, tree pollen counts, and the patient numbers. Multivariable logistic regression analyses were used to investigate the associations between meteorological factors and hospital visits of patients. RESULTS: The minimum temperature in March was significantly and positively correlated with tree pollen counts in March/April and patient numbers from April through July. Pollen counts in March/April were also correlated with patient numbers from April through July. After adjusting for confounders, including air pollutants, there was a positive association between the minimum temperature in March and hospital visits of patients with tree pollen allergy from April to July(odds ratio, 1.14; 95% CI 1.03 to 1.25). CONCLUSIONS: Higher temperatures could increase tree pollen counts, affecting the symptoms of patients with tree pollen allergy, thereby increasing the number of patients visiting hospitals.

Intradiurnal variations of allergenic tree pollen in the atmosphere of Toledo (central Spain).

To study the impact of inhaling airborne pollen on health, it is important to know not only their average daily concentrations but also the intradiurnal behaviour of these biological particles. This study reports the bi-hourly distribution of the arboreal airborne pollen types more abundant in the atmosphere of Toledo (central Spain), many of them triggering important allergic processes in Toledo citizens and tourist visitors. Knowledge of bi-hourly pattern atmospheric variation pollen may help pollinosis patients to adopt preventive measures and plan their outdoor activities accordingly. Intradiurnal variation has been studied for the arboreal pollen types: Cupressaceae, Fraxinus, Olea, Platanus, Populus, Quercus and Ulmus, during the period 2005-2008. The main hourly pollen concentrations were observed during sunlight hours and the maximum pollen values obtained at midday and in the afternoon, except for pollen types Quercus and Platanus, whose maximum pollen concentrations were obtained during the night. The statistical analyses performed to compare pollen concentration and main hourly meteorological variables proved to be significant for most of the taxa. The results show a significant and positive effect of temperature, solar radiation and wind speed on the daily variability undergone by atmospheric pollen. Relative humidity influenced in a negative way on the intradiurnal variation of pollen in the atmosphere of Toledo.

Clinical efficacy and safety of sublingual immunotherapy with tree pollen extract in children.

BACKGROUND: Subcutaneous immunotherapy has been the principal approach of immunotherapy in the treatment of allergic diseases. Several clinical studies with birch, alder or hazel pollen extract conducted as subcutaneous immunotherapy have been published suggesting a well-tolerated and clinically effective treatment. Only a few clinical studies of sublingual immunotherapy (SLIT) with these allergens have been published. This study investigated the clinical efficacy, safety and dose-response relationship of SLIT in children suffering from rhinoconjunctivitis with/without asthma. METHODS: Eighty-eight children (5-15 years) with a history of tree pollen-induced allergic rhinoconjunctivitis with/without seasonal asthma for >or=2 years were included. Allergy to tree pollen was confirmed by positive skin-prick test, positive specific IgE and positive conjunctival provocation test. The extract used was a glycerinated mixture of Betula verrucosa, Corylus avellana and Alnus glutinosa 100,000 SQ-U/ml. Children were randomized into three groups receiving SLIT 5 days a week for up to 18 months; dose group 1: accumulated weekly dose of 24,000 SQ-U; dose group 2: accumulated weekly dose of 200,000 SQ-U; and placebo. RESULTS: In the birch pollen season, dose group 2 showed a significant reduction of symptom (P = 0.01) and medication scores (P = 0.04) compared with placebo. Dose group 1 showed a significant reduction of symptom scores (P = 0.03). There were no statistical differences between dose groups 1 and 2. All children tolerated the treatment well. CONCLUSION: SLIT with tree pollen extract provided dose-dependent benefits in tree pollen-allergic children in terms of significantly reduced symptoms and medication use. The treatment was well tolerated.

Comparative effects of fexofenadine and montelukast on allergen-induced wheal and flare.

Comparisons of the efficacy, onset and duration of action of fexofenadine and montelukast are limited. This study evaluated the pharmacodynamic properties of these agents in an allergen-induced wheal-and-flare model. This randomized, placebo-controlled, crossover study was composed of three treatment periods and two visits on consecutive days for each period, with each period separated by a 14-day (+/-4) washout. At each treatment visit, subjects received a predose allergen skin-prick test followed by either a single dose of fexofenadine HCl 180 mg, montelukast sodium 10 mg, or placebo. Allergen skin-prick testing was performed at 20, 40, and 60 minutes, then hourly through 12 hours and at 23 hours and 24 hours postdose. Adults (n = 48) with positive skin-prick tests were included in the analysis. Significant flare inhibition occurred from 40 minutes through 24 hours postdose for fexofenadine versus placebo (p < 0.05), whereas montelukast did not reach statistical significance for flare inhibition at any time point compared with placebo. Significant wheal inhibition occurred from 60 minutes through 24 hours postdose for fexofenadine versus placebo (p = 0.0012); montelukast did not significantly suppress wheal versus placebo at any time point. Fexofenadine had greater suppression than montelukast for both wheal and flare from 40 minutes through 24 hours (p < .05). Maximum suppression of flare and wheal reached 79.0 and 72.3% for fexofenadine, and 7.3 and 9.6% for montelukast. Fexofenadine suppressed the allergen-induced wheal-and-flare response to a significantly greater extent, and had a significantly faster onset of action, compared with montelukast.

Pólenes alergénicos y polinosis en la ciudad de Burgos / Allergenic pollens and pollinosis in the city of Burgos

El objetivo de este estudio ha sido conocer cuáles son los pólenes que con más probabilidad producen polinosis en el área de la ciudad de Burgos. Método: Para ello se realizaron recuentos de pólenes con un colector Burkard, situado en la terraza del hospital General Yagüe. Se analizaron los taxones cuya media fuera superior al 1% del total de los años 1997, 1998 y del 2001 al 2004. Dentro de un estudio multicéntrico del Comité de Aerobiología de la SEAIC para el estudio de la polinosis, se seleccionaron 147 pacientes de ambos sexos, con clínica de rinitis, asma o ambas estacionales, residentes en nuestra área y con pruebas positivas frente a pólenes. Según el método de estudio se realizaron pruebas cutáneas por la técnica del prick con una batería de 25 pólenes. Resultados: Los pólenes alergénicos más frecuentemente encontrados en la atmósfera de Burgos fueron: cupresáceas (38,87%), especies de Quercus (14,51%), gramíneas (13,58%), especies de Pinus (10%), especies de Urtica (4,74%), especies de Platanus (3,49%), especies de Plantago (3,32%), Populus (2,26%), Olea (2,20%) y chenopoidaceas-amarantaceas (1,26%). Comparado con los pólenes anteriores, los resultados de las pruebas del prick en orden de prevalencia fue: gramíneas (91%), Plantago lanceolata (42,86%), Olea europaea (36,05%), Chenopodium album (26,53%), Urtica dioica (24,49%), Platanus hispanica (21,77%), Cupressus arizonica (19,05%) y Quercus ilex (18,37%). Como se observa en nuestros resultados, la sensibilización frente al polen de las gramíneas es la causa principal de polinosis en nuestro medio

The aim of the study was to know the main pollens with a higher probability of inducing pollinosis in the city of Burgos. Methods: For this purpose, pollen levels were measured by a Burkard collector situated in the terrace of the General Yagüe’s Hospital. Taxons with a mean above 1% of total during 1997, 1998 and 2001-2004 were analyzed. As part of a multicentric study from the SEAIC’s Aerobiology Committee for the study of pollinosis, 147 patients of both sexes with symptoms of seasonal rhinitis and/or asthma, resident in our area and with positive tests to pollens were selected. According to the study’s methodology, prick tests were performed with a panel of 25 pollens. Results: The allergenic pollens more prevalent in the atmosphere of Burgos were: cuppressus (38.87%), Quercus spp (14.51%), grasses (13.58%), Pinus spp (10%), Urtica spp (4.74%), Platanus spp (3.49%), Plantago spp (3.32%), Populus (2.26%), Olea (2.20%) y Chenopoidaceae- Amarantaceae (1.26%). Comparing with previous pollens, the results of prick tests were in order of prevalence: grass (91%), Plantago lanceolata (42.86%), Olea europaea (36.05%), Chenopodium album (26.53%), Urtica dioica (24.49%), Platanus hispanica (21.77%), Cupressus arizonica (19.05%) and Quercus ilex (18.37%). As we can infer from our results, sensitization to grass pollens constitutes the major cause of pollinosis en our area

Biology of tree pollen allergens.

More than 25% of the population suffer from type I allergy. Pollens from trees of the Fagales, Oleaceae, and Cupressaceae belong to the most potent and frequent allergen sources. During the past 15 years, the nature of the most important allergens has been identified by molecular biological techniques, and recombinant allergens equivalent to the natural allergens have been produced. These advances provide insight into the biological functions of important allergens and allow the development of novel forms of diagnosis and therapy. In this review, we focus on Fagales allergens to illustrate the impact of recombinant allergens on diagnosis and therapy. We discuss structural similarities as a molecular basis for cross-reactivities and develop diagnostic concepts by using species-specific marker allergens as well as highly cross-reactive allergens. The identification of the allergen recognition profiles of patients with recombinant allergens allows a more precise selection of patients for available forms of allergy treatment. Moreover, we describe novel recombinant allergen-based forms of specific immunotherapy.

Influence of outdoor aeroallergens on hospitalization for asthma in Canada.

BACKGROUND: The risk of hospitalization for asthma caused by outdoor aeroallergens is largely unknown. OBJECTIVE: The objective of this study was to determine the association between changes in outdoor aeroallergens and hospitalizations for asthma from the Pacific coast to the Atlantic coast of Canada. METHODS: A daily time series analysis was done to test the association between daily changes in aeroallergens and daily changes in hospitalizations for asthma during a 7-year period between 1993 and 2000 in 10 of the largest cities in Canada. Results were adjusted for long-term trends, day of the week, climate, and air pollution. RESULTS: A daily increase, equivalent to the mean value of each allergen, was associated with the following percentage increase in asthma hospitalizations: 3.3% (95% CI, 2.3 to 4.1) for basidiomycetes, 3.1% (95% CI, 2.8 to 5.7) for ascomycetes, 3.2% (95% CI, 1.6 to 4.8) for deuteromycetes, 3.0% (95% CI, 1.1 to 4.9) for weeds, 2.9% (95% CI, 0.9 to 5.0) for trees, and 2.0% (95% CI, 1.1 to 2.8) for grasses. After accounting for the independent effects of trees and ozone, the combination of the 2 was associated with an additional 0.22% increase in admissions averaged across cities (P <.05). CONCLUSION: These findings provide evidence for the hypothesis that aeroallergens are an important cause of severe asthma morbidity across Canada, and in some situations there might be a modest synergistic adverse effect of ozone and aeroallergens combined.