Effect of pulmonary rehabilitation in an allergen safe outdoor environment on children and adolescents with mild to moderate persistent allergic asthma.

BACKGROUND: Environmental interactions are very complex in childhood asthma, and we hypothesized that even a short-term exposure to an allergy safe outdoor environment (AllSOE) combined with pulmonary rehabilitation program (PRP) could exert significant beneficial effects. Our aim was to test the effects of 2-week PRP provided in an AllSOE in children with mild to moderate asthma. METHODS: 110 children (aged 7.5-17 years, 46% girls), with partially or totally controlled asthma, attended the PRP at the Island of Losinj (Croatia) supervised by a multidisciplinary team (pediatric pulmonologist, sports medicine specialist, physiotherapist and kinesiologist). Each child had an adjusted intensity of physical activity with at least 2 h of exercise per day. Body height and weight, spirometry, fraction of exhaled nitric oxide (FeNO), running distance during free running test (FRT) and the decline in lung function after FRT (exercise-induced bronchoconstriction- EIB) were measured at baseline and after PRP. RESULTS: A significant improvement in running distance (from 903 ± 272 m to 968 ± 289 m; p < 0.001), a decrease of FeNO (from 37 ± 32 ppb to 25 ± 17 ppb; p < 0.001) were determined after PRP. There were no significant changes in lung function and EIB, except EIB in the fourth quartile (significant EIB at baseline) where EIB significantly decreased (p < 0.001) after PRP. CONCLUSION: Two weeks of PRP in an AllSOE significantly improved exercise capacity and reduced airway inflammation and airway hyperreactivity showing that even a short-term PRP within a proper environment could be effective and affordable management strategy for children and adolescents with mild to moderate asthma.

Eight weeks of omeprazole 20 mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial.

OBJECTIVES: Gastroesophageal reflux recommended treatment (dose and duration) with proton-pump inhibitor (PPI) compared to placebo significantly reduces the signs and symptoms of laryngopharyngeal reflux (LPR) and comorbid chronic rhinosinusitis (CRS). DESIGN: Double-blind randomised placebo-controlled trial. SETTING: Eight weeks of treatment with omeprazole 20 mg once daily (OD). PARTICIPANTS: Sixty patients (28 women, aged 19-87 years) with diagnosed LPR and comorbid CRS. MAIN OUTCOME MEASURES: Significant reduction in signs and symptoms (reflux symptom index (RSI) score as subjective, and reflux finding score (RFS) as objective measure) of LPR after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo. Secondary objectives were significant reduction in signs and symptoms of comorbid CRS after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo and the association of the severity of signs and symptoms of LPR with the ones of CRS. RESULTS: RSI and RFS decreased significantly more in the active treatment group after 8 weeks compared to placebo (P < .001 for both). CRS and endoscopy scoring decreased both significantly more in the active group after 8 weeks compared to placebo (P < .001 for both). CRS scoring significantly correlated with RSI (R = 0.312, P = .015) but not with RFS (R = 0.199, P = .127). CONCLUSIONS: The results of our trial suggest that omeprazole 20 mg OD for 8 weeks was effective in reducing signs and symptoms of both LPR and CRS, although in most patients still present at the end of the trial.

Diagnostic value of a pattern of exhaled breath condensate biomarkers in asthmatic children.

BACKGROUND: Diagnosing asthma in children is a challenge and using a single biomarker from exhaled breath condensate (EBC) showed the lack of improvement in it. OBJECTIVE: The aim of this study was to assess the diagnostic potential of a pattern of simple chemical biomarkers from EBC in diagnosing asthma in children in a real-life setting, its association with lung function and gastroesophageal reflux disease (GERD). METHODS: In 75 consecutive children aged 5-7 years with asthma-like symptoms the following tests were performed: skin prick tests, spirometry, impulse oscillometry (IOS), exhaled NO (FENO), 24-hour oesophageal pH monitoring and EBC collection with subsequent analysis of pH, carbon dioxide tension, oxygen tension, and concentrations of magnesium, calcium, iron and urates. RESULTS: No significant differences were found for individual EBC biomarkers between asthmatics and non-asthmatics (p>0.05 for all). A pattern of six EBC biomarkers showed a statistically significant (p=0.046) predictive model for asthma (AUC=0.698, PPV=84.2%, NPV=38.9%). None to moderate association (R2 up to 0.43) between EBC biomarkers and lung function measures and FENO was found, with IOS parameters showing the best association with EBC biomarkers. A significantly higher EBC Fe was found in children with asthma and GERD compared to asthmatics without GERD (p=0.049). CONCLUSIONS: An approach that involves a pattern of EBC biomarkers had a better diagnostic accuracy for asthma in children in real-life settings compared to a single one. Poor to moderate association of EBC biomarkers with lung function suggests a complementary value of EBC analysis for asthma diagnosis in children.

Gender differences in cadmium and cotinine levels in prepubertal children.

Susceptibility to environmental stressors has been described for fetal and early childhood development. However, the possible susceptibility of the prepubertal period, characterized by the orchestration of the organism towards sexual maturation and adulthood has been poorly investigated and exposure data are scarce. In the current study levels of cadmium (Cd), cotinine and creatinine in urine were analyzed in a subsample 216 children from 12 European countries within the DEMOCOPHES project. The children were divided into six age-sex groups: boys (6-8 years, 9-10 years and 11 years old), and girls (6-7 years, 8-9 years, 10-11 years). The number of subjects per group was between 23 and 53. The cut off values were set at 0.1 µg/L for Cd, and 0.8 µg/L for cotinine defined according to the highest limit of quantification. The levels of Cd and cotinine were adjusted for creatinine level. In the total subsample group, the median level of Cd was 0.180 µg/L (range 0.10-0.69 µg/L), and for cotinine the median wet weight value was 1.50 µg/L (range 0.80-39.91 µg/L). There was no significant difference in creatinine and cotinine levels between genders and age groups. There was a significant correlation between levels of cadmium and creatinine in all children of both genders. This shows that even at such low levels the possible effect of cadmium on kidney function was present and measurable. An increase in Cd levels was evident with age. Cadmium levels were significantly different between 6-7 year old girls, 11 year old boys and 10-11 year old girls. As there was a balanced distribution in the number of subjects from countries included in the study, bias due to data clustering was not probable. The impact of low Cd levels on kidney function and gender differences in Cd levels needs further investigation.

Prevalence of and risk factors for the development of atopic dermatitis in schoolchildren aged 12-14 in northwest Croatia.

BACKGROUND: Atopic dermatitis is a common allergic disorder. A multifactorial background for atopic dermatitis has been suggested, with genetic as well as environmental factors influencing disease development. Our aim was to estimate the prevalence rate and associated factors for atopic dermatitis in northern Croatia using the methods of the internationally standardised ISAAC protocol. METHODS: The study was undertaken among 12-14-year-old schoolchildren. Data were collected using standardised ISAAC written questionnaire Phase One and some selected questions from the ISAAC supplementary questionnaire completed by parents. RESULTS: A total of 2887 children participated in the study. Estimated lifetime (ever) prevalence rate of atopic dermatitis symptoms was 7.55% and estimated 12-month prevalence rate was 5.75%. The factors found to be associated to the symptoms of atopic dermatitis ever were: positive family atopy, female gender, sleeping on feather pillow and contact with pets after age of seven, and to the symptoms in the past 12 months were: positive family atopy, female gender, sleeping on feather pillow, parasite infestation, and contact with pets in the first year of life. CONCLUSIONS: The results of our study show that northern Croatia is a region with moderate prevalence rates of atopic dermatitis. Following risk factors were family atopy, female gender and sleeping on feather pillow. Because of controversial results of previous studies conducted on the same topic further investigations should be made.

Markers of systemic and lung inflammation in childhood asthma.

AIM: To compare different biomarkers of inflammation in children with controlled and uncontrolled asthma and to investigate their relationship with other clinical indices of asthma control (symptoms, lung function, serum IgE, and prn beta-agonist use). MATERIALS AND METHODS: A total of 62 consecutive asthmatic children (age 11 +/- 3.3 years, 32 girls) with controlled ([C], n = 19) and uncontrolled asthma ([NC], n = 43) were studied. Measured lung function and inflammatory biomarkers included: spirometry, exhaled NO (F(E)NO), high-sensitivity C-reactive protein (hs-CRP), peripheral blood white blood cells (WBC) counts, and differentials. RESULTS: Hs-CRP was significantly higher in uncontrolled than in controlled asthma (hs-CRP, median [IQR], mg/L; 0.56 [0.60] vs 0.25 [0.34], p = 0.008). Discriminant analysis (backward stepwise) depicted hs-CRP and lymphocytes (as Z-score for absolute count) as significant discriminative factors for asthma control (F = 8.319, p = 0.0007) with 82.3% diagnostic accuracy. Divided into quartiles hs-CRP showed the significant inverse association with F(E)NO (F = 7.359, p = 0.003, ANOVA) with no significant difference for asthma control (F = 1.032, p = 0.386). Post-hoc analysis revealed that F(E)NO values were significantly lower in the third and the fourth quartile of hs-CRP in comparison to the first and the second one (p < 0.05 for all). CONCLUSION: In asthmatic children with uncontrolled asthma serum hs-CRP was increased compared to children with controlled asthma. Although F(E)NO values were also increased (insignificantly) and inversely correlated with hs-CRP they were probably reflecting different etiology underlying the loss of control. The role of peripheral blood biomarkers in asthmatics is still poorly investigated so new studies are required.

Multivariate analysis of preoperative and postoperative neutrophil-to-lymphocyte ratio as an indicator of head and neck squamous cell carcinoma outcome.

Recent publications have highlighted a greater utility of routine blood tests in patients with various cancers than previously assumed. It appears that the neutrophil-to-lymphocyte ratio (NLR) may be a good predictive biomarker for overall survival (OS) and disease-free survival (DFS). Preoperative and postoperative NLR data for patients with head and neck cancers have yet to be established. The aim of this study was to evaluate the preoperative and postoperative NLR in 182 patients with head and neck squamous cell carcinoma and to determine the association of NLR with OS and DFS. The statistical analysis of OS and DFS and their predictors was performed using Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression analysis, with factors including age, sex, alcohol and tobacco use, tumour location, treatment after surgery, and lymphocyte and neutrophil counts. Longer OS was significantly associated with not consuming alcohol, preoperative neutrophil and lymphocyte counts, preoperative NLR, and the difference between the preoperative and postoperative NLR (P=0.016). Longer DFS was significantly associated with not consuming alcohol, preoperative neutrophil and lymphocyte counts, postoperative NLR, and the difference between preoperative and postoperative NLR (P=0.028).

[Outdoor and indoor allergens and the respiratory tract]. / Alergeni vanjskih i unutarnjih prostora i disni sustav.

This paper gives an overview of common outdoor and indoor allergens which cause sensitisation of the respiratory tract and considers relevant biological and ecological hallmarks and symptoms of allergies. Grass, tree, and weed pollens as well as moulds (Cladosporium and Alternaria species) are a major source of allergens in the outdoor environment whereas mites (Pyroglyphidae, Acaridae, and Glycyphagidae), animals (pets, rodents, and insects), and moulds (Aspergillus, Penicillium, and Mucor species) are a major source in the indoor environment. The paper pays attention to the seasonal, geographical, and climatic influence on the concentration of allergen in the environment. The authors discuss differences between exposure to outdoor and indoor allergens, as well as the impact of pollutants on sensitisation of the respiratory tract. The paper proceeds with a short description of the primary prevention measures such as avoidance of the allergens and the secondary measures which are intended to prevent the occurrence or deterioration of respiratory symptoms in sensitised persons.

The changing pattern of poisoning with psychoactive drugs in Croatia.

The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985-1991 (period I) and 1992-1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.

Household chemicals--common cause of unintentional poisoning.

Of 4736 poisoning incidents registered in the Poison Control Centre in Zagreb from 1985 to 1999, household chemicals caused 23%. In the group of cleaning products, 11% of poisoning incidents were caused by corrosives, 9% by liquid detergents and 4% by hypochlorite. Organic solvents caused 18% of household chemical poisonings; among them gasoline and thinners were the most frequent. Cosmetics were responsible for 7% of poisoning incidents; the most frequent were hair shampoo, hydrogen peroxide, and acetone. In the group of other chemicals, the most common were ingestion of thermometer mercury and of silica gel, while poisonings with highly toxic antifreeze, mothballs, or liquid fertilisers were rare. Ingestion or other exposure to household chemicals often caused excessive concern and therapeutic measures. It is therefore advisable to consult a Poison Control Centre in order to get proper information about the composition of a chemical and toxicity of a product.

[Exercise-induced bronchospasm and its prevention]. / Bronhospazam izazvan tjelesnim opterecenjem i njegova prevencija.

Exercise-induced bronchospasm (EIB) is a type of nonspecific bronchial hyperreactivity. It affects mostly children and younger adults with asthma (75%-95%) and allergic rhinitis (40%), but it is also found in 3-11% of the nonasthmatic and nonatopic younger population. Pathophysiology of this phenomenon is not clear and there are some attempts to explain it with hyperosmolality of bronchial epithelia, exchange of heat and water (reactive hyperemia) in airways and reflex vagal bronchospasm. Unrecognized and uncontrolled symptoms of EIB can lead patients to avoid general and occupational physical activities and sports. Diagnosis of EIB is focused on medical history and on pulmonary function testing after standardized exercise testing protocols on treadmill, cycle ergometer or by free running. Non-pharmacological and pharmacological prophylactic measures are the most important approach in the therapy of EIB. Inhalation of beta 2-agonists or cromolyns is the first choice in pharmacological prevention of EIB. With adequate therapy, symptoms of EIB can be controlled enough to maintain everyday as well as sports activities.

[Prevalence of atopy indicators in the adult population of the Zagreb region]. / Prevalencija pokazatelja atopije u odrasloj populaciji Zagrebacke zupanije.

In a sample of 583 subjects (303 men and 280 women) intradermal test with 13 inhalatory allergens, total serum IgE (PRIST Phadezym) determination and nonspecific bronchial reactivity measurement by histamin test, were performed. History data on respiratory symptoms was also taken. The following were evaluated: mean urtica diameter D+d/2 > 8 mm (KT+), value of IgE > 125 IU/ml, and bronchial hyperreactivity (BH), separately in symptomatic and asymptomatic subjects. In symptomatic smokers total IgE (G.M. IU/ml) was higher in women than in men (177.70:68.20-p < 0.01), and in asymptomatic smokers it was higher in men than in women (50.71:33.79-p < 0.01). A larger number of allergens discriminated skin reactivity between the symptomatic and asymptomatic women (grass, tree and weed pollen-p < 0.001; house dust-p < 0.05), than between the symptomatic and asymptomatic men (grass pollen-p < 0.001). The level of IgE < 125 and > 125 IU/ml discriminated significantly the prevalence of persons with KT+ in the group of symptomatic men (80%:27%-p < 0.001) but not in the group of symptomatic women (77%:67% N.S.). BH only partially coincides with KT+ and raised IgE (> 125 IU/ml) in symptomatic subjects (men 20%, women 23%) and in asymptomatic subjects only in men (8%).

[Sensitivity to latex and other rubber substances--an important occupational risk for health personnel (case report)]. / Senzibilizacija na lateks i druge sastojke gume--vazan profesionalni rizik zdravstvenih radnika (prikaz bolesnice).

Sensitization to latex and rubber additives has been acknowledged during the last 10 years as a major occupational health problem among health-care workers. In sensitized persons, respiratory and/or skin symptoms may be present. Pathophysiologic mechanisms of senzitisation involve allergic reactions types I and IV (Coombs and Gell). In this case report we described a female health-care worker with sensitization to latex and rubber additives simultaneously present on the skin and in the respiratory system, caused by wearing protective rubber gloves. The complex diagnostic procedure involved in determination of occupational allergic diseases is discussed.

Increased frequency of micronuclei in mononucleated lymphocytes and cytome analysis in healthy newborns as an early warning biomarkers of possible future health risks.

Impact of intrauterine development on health risks during adolescence and adulthood still needs to be investigated. The aim of study was to compare genome damage in newborns and mothers using the cytokinesis blocked micronucleus assay, nuclear division index (NDI), and centromere fluorescence in situ hybridization. The study was performed on 92 mothers and their newborns. Results showed that micronucleus frequency in binuclear T-lymphocytes (MNBN) in newborns was significantly lower than in mothers but higher in mononuclear T-lymphocytes (MNMONO). The NDI in the mothers was significantly higher than in the newborns. In newborns with <2500g birth weight, NDI was similar to the mothers'. Mothers have significantly more centromere negative micronuclei than newborns. A significantly higher NDI and MNBN was found in newborns with ≥2 MNMONO/1000 than in newborns with <2 MNMONO/1000. It is suggested that MOMN and NDI might be good candidates for biomarkers of health risks in newborns.

Telmisartan in daily clinical practice: factors affecting efficacy in treatment of primary arterial hypertension.

BACKGROUND: Telmisartan provides effective treatment of hypertension in a broad spectrum of patients. AIMS: To evaluate factors affecting the efficacy of telmisartan in daily clinical practice. SETTING AND DESIGN: Prospective practice-based 12-week uncontrolled cohort study. MATERIALS AND METHODS: Consecutive incident/prevalent outpatients with mild to moderate essential hypertension were started on telmisartan 40 mg/day with optional up-titration to 80 mg/day in order to achieve seated systolic (SSBP) and diastolic (SDBP) blood pressure < 140/90 mm Hg. Intent-to-treat (ITT, N=282) and per protocol (PP, N=275) efficacy assessment was based on SSBP/SDBP reduction and delivered doses. RESULTS: SSBP/SDBP decreased (165.2+/-13.1 / 98.3+/-6.7 mm Hg to 137.9+/-13.2 / 82.6+/-7.3 mm Hg), whilst telmisartan was up-titrated in 40.5% of patients during the study. Multivariate (practically identical ITT and PP) analysis indicated poorer response in obese vs. non-obese patients: lesser SDBP reduction (by around 2.2-2.3 mm Hg, P < 0.05) with higher odds of dose up-titration (odds ratio, OR around 1.90, P < 0.05); and better response in: a) patients started on telmisartan monotherapy than when added to a preexisting treatment: greater SSBP/SDBP reduction (by around 4.0 and 3.0 mm Hg, respectively, P < 0.05) with comparable odds of up-titration; b) diabetics vs. non-diabetics: greater SDBP reduction (by around 3.6-3.7 mm Hg, P < 0.05) with comparable odds of up-titration; c) men vs. women: slightly greater SDBP reduction (by around 1.2 mm Hg, 0.05 P < 0.1) with lower odds of up-titration (OR around 0.51, P < 0.05). CONCLUSION: Previous unsuccessful treatment, obesity, diabetes and gender should be considered in order to optimize the use of telmisartan for mild to moderate essential hypertension in daily clinical practice.

Diagnostic value of a pattern of exhaled breath condensate biomarkers in asthmatic children

BACKGROUND: Diagnosing asthma in children is a challenge and using a single biomarker from exhaled breath condensate (EBC) showed the lack of improvement in it. OBJECTIVE: The aim of this study was to assess the diagnostic potential of a pattern of simple chemical biomarkers from EBC in diagnosing asthma in children in a real-life setting, its association with lung function and gastroesophageal reflux disease (GERD). METHODS: In 75 consecutive children aged 5-7 years with asthma-like symptoms the following tests were performed: skin prick tests, spirometry, impulse oscillometry (IOS), exhaled NO (FENO), 24-hour oesophageal pH monitoring and EBC collection with subsequent analysis of pH, carbon dioxide tension, oxygen tension, and concentrations of magnesium, calcium, iron and urates. RESULTS: No significant differences were found for individual EBC biomarkers between asthmatics and non-asthmatics (p > 0.05 for all). A pattern of six EBC biomarkers showed a statistically significant (p = 0.046) predictive model for asthma (AUC = 0.698, PPV = 84.2%, NPV = 38.9%). None to moderate association (R2 up to 0.43) between EBC biomarkers and lung function measures and FENO was found, with IOS parameters showing the best association with EBC biomarkers. A significantly higher EBC Fe was found in children with asthma and GERD compared to asthmatics without GERD (p = 0.049). CONCLUSIONS: An approach that involves a pattern of EBC biomarkers had a better diagnostic accuracy for asthma in children in real-life settings compared to a single one. Poor to moderate association of EBC biomarkers with lung function suggests a complementary value of EBC analysis for asthma diagnosis in children

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[The role of nonspecific nasal reactivity in the evaluation of induced bronchial hyperreactivity]. / Uloga nespecificne nazalne reaktivnosti (NNR) u evaluaciji inducirane hiperreaktivnosti bronha (IHB).

The excitation of the irritant receptors in the upper respiratory tract may result in reflex bronchoconstriction. Does the raised reactivity of the nasal mucus membrane--the place of the first contact with respiratory irritants--play an important role in the expression of IBH? The level of NNR and the existence of relation between NNR and IBH have been assessed in 32 healthy subjects and 28 workers exposed to irritants with respiratory disorders. Nonspecific nasal provocation was performed by spraying of doubled concentrations of histamine solution in saline (0.03-16 mg/mL) in both nostrils in three minute intervals. The reaction was monitored by measurement of nasal peak inspiratory flow, nasal resistance, nasal forced expiratory volume in first second and nasal forced expiratory mid-flow. The level of NNR was expressed as provocation concentrations of histamine solution that produced significant change of all four measured parameters. Nonspecific bronchial provocation with histamine was performed by the modified method of Chai H. et al. The criterion for hyperreactivity was PC20FEV1 less than or equal to 8 mg/mL of histamine. There was statistically no significant correlation between NNR and IBH.

Lack of correlation between nonspecific nasal and bronchial reactivity in allergic rhinitis subjects.

A link between allergic rhinitis and asthma has long been suspected, allergic rhinitis being considered a precursor of asthma. The hypothesis is that if such a link exists, then nonspecific nasal and bronchial reactivity are already correlated in acute rhinitis patients. To test for this correlation, we compared nonspecific nasal and bronchial reactivity in two groups of rhinitis subjects: 37 rhinitis pollinosis patients tested during the pollen season and 35 rhinitis pollinosis patients tested outside the pollen season. We also assessed how smoking affects this link. In each subject, allergy, nonspecific nasal, and nonspecific bronchial reactivity were tested, and smoking was categorized. We found no correlation between nonspecific nasal and bronchial reactivity in the two nonasthmatic rhinitis groups. During active allergic inflammation (pollinosis season) no shift toward a stronger link between upper and lower airways can be found compared with the latent period (out of pollinosis season). Unexpectedly, among smokers we found a significant relationship between nonspecific nasal and bronchial reactivity. Thus, there is not yet sufficient evidence for a straightforward link between nasal and bronchial hyperreactivity in nonasthmatic pollinosis rhinitis subjects. The development of asthma seems to be crucial for this link.

Nonspecific nasal responsiveness in workers occupationally exposed to respiratory irritants.

The aim of the study was to establish the level of the nonspecific nasal responsiveness in a group of workers (N = 84) occupationally exposed to respiratory irritants, and to compare it with its level in healthy subjects (N = 60). Another goal was to study the effect of occupational exposure to irritants, smoking, and atopy on nonspecific nasal responsiveness. The modified method of nonspecific nasal provocation with histamine developed by van Wijk and Dieges (Clin Allerg 17:563-570, 1987) was used. The method was performed by spraying doubling concentrations of histamine (0.03-32 mg/mL), starting with saline, in a cumulative manner into each nostril. The reaction was measured by total nasal resistance ("opening" interruption technique). The result of the test was expressed as provocation concentration of histamine that caused > or = 75% rise of total nasal resistance compared to its value measured after saline. We found a significantly higher percentage of nasal hyperreactors and a significantly greater nonspecific nasal responsiveness among 65 exposed workers (chi 2 = 78.6; p < 0.001, t = -5.48; p < 0.001, respectively) than in the group of healthy subjects. A significantly (t = 4.25; p < 0.001) increased nonspecific nasal responsiveness was observed during exposure when compared to nonspecific nasal responsiveness assessed after 2 weeks out of exposure, when tested in 19 patients. Higher smoking rate as measured by smoking category (number of cigarettes multiplied with years of smoking) was associated with the lower levels of nonspecific nasal responsiveness. Also, we failed to confirm a relation between atopy and nonspecific nasal responsiveness in a group of workers exposed to irritants.

Differences in mite fauna between the continental and Mediterranean climates of Croatia: microscopy and Dustscreen test findings.

BACKGROUND: The aim of this study was to evaluate the difference between the mite fauna in the inland and coastal Croatia. METHODS: Ninety-nine floor house dust samples were collected: 28 from the coastal area, 31 from the inland rural and 40 from the inland urban area. Data on basic household characteristics were collected for 81 of 99 households. The mites were separated from the dust using the floatation method and then microscopically identified. The levels of Dermatophagoides pteronyssinus (Der p) 1, Dermatophagoides farinae (Der f) 1 and Der 2 were measured using the Dustscreen test. Ordinal descriptive statistics and nonparametric tests were used for data analysis, assuming statistical significance at P < 0.05. RESULTS: More than 70% of mites identified in all areas were pyroglyphids. Nonpyroglyphid mites accounted for 20-25% of all identified mites in the coastal areas (Blomia, Lepidoglyphus and Glycyphagus) and with 15% in the inland areas (Lepidoglyphus and Acarus). The highest Der p 1 median levels were found in the coastal area, with significantly lower levels in the inland rural and inland urban areas (4.5; 2; 0.85 microg/g of dust; P = 0.0001). The highest Der f 1 median levels were found in the inland urban area, with significantly lower levels in the inland rural and coastal areas (0.88; 0.75; 0 microg/g of dust; P = 0.0013). The levels of Der f 1 were significantly higher in samples taken from households with central heating than from those with traditional heating (1; 0.25 microg/g of dust; P < 0.01). CONCLUSIONS: Separate diagnostic dust mite lists for the coastal and inland areas because of climatic and dwelling differences required to be implemented. Compared with traditional heating, central heating significantly increases the risk of exposure to Der f 1 levels >2 microg/g of dust (odds ratio, 7.35; 95% confidence interval, 1.43-37.87; P = 0.01).