Efficacy and safety of birch pollen allergoid subcutaneous immunotherapy: A 2-year double-blind, placebo-controlled, randomized trial plus 1-year open-label extension.

BACKGROUND: Previous clinical trials with birch pollen subcutaneous immunotherapy have been conducted over a 1- to 2-year treatment period and involved mostly a single geographic location. OBJECTIVE: This study (EudraCT-Number: 2005-000025-35) intended to evaluate the effect of subcutaneous immunotherapy with high-dose hypoallergenic birch pollen allergoid in patients with confirmed moderate to severe seasonal allergic rhinitis/rhinoconjunctivitis over a 3-year course in 19 European centres. METHODS: Adults with confirmed birch pollen allergy (n = 253) were randomized to preseasonal placebo (n = 129) or active treatment (n = 124). Primary endpoint was change in Symptom Medication Score after 2 years treatment (2007). RESULTS: The change in Symptom Medication Score of active- vs placebo-treated patients for the Full Analysis Set (n = 227, 15.2% reduction, P = 0.0710) and Per-Protocol Set (n = 216, 16.7% reduction, P = 0.0523) showed a positive trend, although significance was not achieved. The primary endpoint, assessed in 2007, coincided with the lowest pollination during the study period. In a subgroup analysis of patients in the north-eastern region (n = 102), where birch is the major tree and consequently patients' exposure is higher, changes in Symptom Medication Score (32.7% reduction, P = 0.0034) and median number of well days (P = 0.0232) were highly significant in favour of the active group. During the open-label third year of treatment, the mean Symptom Medication Score of active-treated patients was further reduced despite an increased pollen count. Subcutaneous immunotherapy was well tolerated and consistent with the known safety profile. CONCLUSIONS AND CLINICAL RELEVANCE: Although the primary endpoint was not reached for the Full Analysis Set, a significant and clinically relevant effect on Symptom Medication Score was clearly demonstrated for the subgroup of patients in the north-eastern region of Europe, where birch is the predominant tree species. Proving efficacy of birch allergen subcutaneous immunotherapy is challenging due to the numerous factors influencing birch pollen allergen exposure in field studies.

[ARIA 2016 executive summary: Integrated care pathways for predictive medicine throughout the life cycle in Argentina]. / Resumen ejecutivo de ARIA 2016: vías integradas de atención para la medicina predictiva a lo largo del ciclo de vida en Argentina.

The ARIA initiative was started during a World Health Organization workshop in 1999. The initial goals were to propose a new classification for allergic rhinitis, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with stakeholders for world-wide use. ARIA is now focused on the implementation of emerging technologies for individualized and predictive medicine. MASK: MACVIA-Aria Sentinel Network uses mobile technology to develop care pathways that enable management by a multidisciplinary group or by patients themselves. An App for iOS and Android uses a visual analogue scale to assess symptom control and work productivity, as well as a clinical decision support system; it is associated with an interoperable tablet for health professionals. The escalation strategy uses recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of ARIA's new approach is to provide an active and healthy life to people affected by rhinitis, regardless of age, gender or socioeconomic status, in order to reduce social and health inequalities caused by the disease.

La iniciativa ARIA (Rinitis Alérgica y su Impacto en el Asma) se inició durante un taller de la Organización Mundial de la Salud en 1999. Los objetivos iniciales fueron proponer una nueva clasificación de rinitis alérgica, promover el concepto de multimorbilidad en asma y rinitis y desarrollar guías con todas las partes interesadas para su en todos los países y poblaciones. ARIA, difundida e implementada en más de 70 naciones, ahora se centra en la implementación de tecnologías emergentes para la medicina individualizada y predictiva. MASK (MACVIA [Contre les Maladies Chroniques pour un Vieillissement Actif] Aria Sentinel Network) utiliza la tecnología móvil para desarrollar vías de atención que permitan el manejo de la rinitis y del asma por un grupo multidisciplinario o por los propios pacientes. Una aplicación (app) para iOS y Android está disponible en 20 países y 15 idiomas; utiliza una escala analógica visual para evaluar el control de los síntomas y la productividad del trabajo, así como un sistema de apoyo para las decisiones clínicas. Se asocia con una tabla interoperable (que permite intercambiar información) para médicos y otros profesionales de la salud. La estrategia de escalamiento utiliza las recomendaciones de la Asociación Europea de Innovación para el Envejecimiento Activo y Saludable. El objetivo del nuevo enfoque ARIA es proporcionar una vida activa y saludable a las personas afectadas por la rinitis, cualquiera que sea su edad, sexo o condición socioeconómica, con el fin de reducir las desigualdades sociales y de salud causadas por la enfermedad.

[ARIA 2016 executive summary: integrated care pathways for predictive medicine across the life cycle]. / ARIA 2016 yönetici özeti: Yasam döngüsü boyunca hastaliklari öngörmeye yönelik tip uygulamalari için bütünlestirilmis yaklasim yolaklari.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA- disseminated and implemented in over 70 countries globally- is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK (MACVIA (Contre les MAladies Chroniques pour un VIeillissement Actif)-ARIA Sentinel NetworK) uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multi-disciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Persons with allergy symptoms use alternative medicine more often.

INTRODUCTION: The aim of the study is to indicate the relation between the use of alternative medicine and the occurrence of allergic diseases in the Polish population of adults in the age of 20-44 years. Moreover the additional aim of the study is to define the relation between the sex, age and place of living and the use of alternative medicine. MATERIAL AND METHODS: The data from the project Epidemiology of Allergic Diseases in Poland (ECAP) has been used for analysis. This project was a continuation of the European Community Respiratory Health Survey II. The questions on alternative medicine were asked to the group of 4671 respondents in the age of 20-44 years. Additionally outpatient tests were performed in order to confirm the diagnosis of allergic diseases. RESULTS: The total of 22.2% of respondents that participated in the study have ever used alternative medicine (n = 4621). A statistically significant relation between the use of alternative medicine and declaration of allergic diseases and asthma symptoms has been demonstrated (p < 0.001). No statistically significant relation between the use of alternative medicine by persons diagnosed by a doctor with any form of asthma or seasonal allergic rhinitis (p > 0.05) has been demonstrated. CONCLUSIONS: The occurrence of allergic diseases and asthma influences the frequency of alternative medicine use. However the frequency of alternative medicine use does not depend on allergic disease or asthma being confirmed by a doctor.

The prevalence of sensitization to inhalant allergens in children with atopic dermatitis.

BACKGROUND: The role of sensitization to inhalant allergens in atopic dermatitis (AD) in children is uncertain. The aim of our study was to assess the relationship of AD symptoms with sensitization to aeroallergens in Polish children ages 6-7 and 13-14 years. MATERIAL AND METHOD: Epidemiology of Allergic Disorders in Poland is a randomized study with medical examination according to the ECRHS II and the International Study of Asthma and Allergies in Childhood standards in nine selected regions of Poland. We studied 6-7-year-old (n = 4510) and 13-14-year-old children (n = 4721). A total of 1583 children (25%) had a medical examination and a skin-prick test (SPT) with the 15 most common aeroallergens. RESULTS: AD was diagnosed in 235 children (8.9%) (8.7%, 6-7-year-old children; 9.0%, 13-14-year-old children; 8.6% boys and 9.1% girls). AD was more frequent in urban versus rural habitants (9.6% versus 3.7%; p < 0.05) and in participants with a positive atopy history versus those without atopy (9.4% versus 5.1%; p < 0.05). Positive SPT was found in 1165 children (43.9%) (38.5% boys, 49.5% girls) and 64.72% with AD versus 41.9% without AD (p < 0.05) and more common in the rural region versus urban setting among 6-7 year-olds (71.8% versus 35.0%; p < 0.05). The most frequent allergic reaction was Dermatophagoides pteronyssinus (13.5%), Dermatophagoides farina (11.7%), and grasses/crop plants (11.8%). The same pattern was seen in participants with and those without AD. Children with AD had more frequent positive SPT for all aeroallergens (p < 0.05). CONCLUSION: AD should be more frequent in children with a positive atopy history and in children who live in the city. Aeroallergens play an essential role in pathogenesis of eczema in children. House-dust mites and grass pollen proved to be the most common relevant aeroallergens.

Effect of the nasal cycle on congestive response during bilateral nasal allergen provocation.

BACKGROUND: Bilateral nasal allergen provocation usually produces more pronounced obstruction of one nasal passage. It was found that this could be related to the stage of the nasal cycle before the provocation. OBJECTIVE: To discover whether the stage of the nasal cycle is decisive for asymmetry in congestive response observed during bilateral allergen nasal provocation. methods. Two bilateral nasal allergen provocations were performed in a group of 26 pollen-sensitive volunteers. Acoustic rhinometry measurements were taken during the nasal cycle, and then after the provocation. A cross-sectional area at the level of the inferior turbinate (CSA-2) was measured. Consecutive challenges were performed in the opposite phase of the nasal cycle: the side which had been wide just before the first challenge, was narrow before the second provocation. RESULTS: Asymmetry in CSA-2 reduction between the nasal passages was observed in most cases. Significant difference was observed between mean CSA-2 reduction rate (reactivity) of the side that responded with greater congestion, and the opposite side. No significant difference was found in mean CSA-2 reduction rate between the side which was narrow, and the side which was wide before provocation. CONCLUSIONS: Asymmetry of congestive response during bilateral nasal allergen provocation is not dependent on the stage of the nasal cycle preceding the challenge.

[The influence of gastroesophageal reflux on the course and therapy of bronchial asthma]. / Wplyw refluksu zoladkowo-przelykowego na przebieg i leczenie astmy oskrzelowej.

The epidemiological and clinical data suggest the influence of gastroesophageal reflux disease (GER) on the course of bronchial asthma (BA). Pathogenetic relationships of both diseases are still not clear. The most possible theory seems to be micro-aspirations of refluxing digestive contents leading to the development of bronchial inflammation. It is increasingly improved the benefits of treatment for gastroesophageal reflux on asthma course. Apart from advices referring proper diet and resting with semirecumbent position, the most effective method of treatment seems to be appropriately high dose of proton pump inhibitors. It is seamed that in some cases an important role in development of GER could play hypotention produced in mediastinum in patients with exacerbated course of asthma. It is suggested to connect treatment of both illnesses to benefit in clinical course of GER and BA as well.

Correlation between conjunctival provocation test results and conjunctival symptoms in pollinosis - preliminary report.

The aim of the study was to investigate the correlation between the level of reactivity in conjunctival provocation test and conjunctival symptoms that develop during the pollination season in grass allergic patients. Conjunctival provocation test with grass pollen allergens was performed in 22 patients suffering from pollinosis. During grass pollination season all patients monitored their symptoms with Symptoms Score Cards. A parallel measurement of the level of grass pollen count was carried out on a daily basis by volumetric method. The mean grass pollen count which triggered the reaction in individual patients depended on the results of conjunctival provocation test. The lowest pollen count level was observed in cases of patients with positive conjunctival provocation test at low allergen extract concentration of 160 and 500 BU/ml, whereas the highest count in cases of 1,600 BU/ml. The difference between the results was found to be statistically significant. A threshold grass pollen concentration for conjunctival symptoms was established at the level of 22 grains/m (3). We conclude that the patients with pollinosis and high reactivity in conjunctival provocation test develop conjunctival symptoms earlier during grass pollination season than the patients who are characterised by lower reactivity during conjunctival provocation test.