Research needs in allergy: an EAACI position paper, in collaboration with EFA.

In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21st century.The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients' organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels.Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein.

Chronic disease in the elderly: a vital rationale for the revival of internal medicine.

The phenomenon of population aging has led to a significant rise in the chronic disease rate compared to other human pathologies. Elderly people are usually affected by > or =2 chronic diseases concomitantly, mainly cardiovascular, pulmonary, and central nervous system diseases, metabolic disturbances and cancer. Chronic comorbidities in elderly patients may worsen their clinical status, making both the diagnosis and treatment more difficult. Meanwhile, contemporary medicine is focused on its subspecialties, thus turning away from the tradition of great, academic-based, general internal medicine. Clinical practice is dominated by a specific approach to a single disease rather than a patient with comorbidities. Therefore, an accurate diagnosis, ensuring effective treatment in the case of a complex and ambiguous clinical picture, is based on an attempt to combine multiple expert consultations rather than make a holistic evaluation, so characteristic of traditional internal medicine. For that reason, pathophysiology and clinical picture of a chronic disease in the elderly requires the revival of internal medicine, which is also essential to the development of geriatrics.

[Cyclohaler's acceptance by asthma and COPD patients]. / Kryteria akceptacji cyclohalera przez chorych na astme i POChP.

INTRODUCTION: The patients' acceptance of the treatment scheme and their readiness to stick to the prescribed dosing is considered to be the most important condition on which successful treatment of asthma and COPD depends. With regard to this assumption, a study was designed whose aim was to find out how patients assess a particular powder inhaler, cyclohaler and to what degree they approve of its physical and technical features. MATERIAL AND METHODS: The study consisted in completing an anonymous questionnaire. The study group was recruited from asthmatic and COPD patients treated in outpatient units in Wroclaw and Lublin, Poland. 230 persons passed the recruitment stage, 220 completed the study. RESULTS: 96.4 and 94.5% of the patients ranked small size and low weight of the inhaler, respectively, as its most positive features, ranking the features higher than the device's colour (respectively p = 0.003 and p = 0.02). Other features, like dust protection and comfortable mouthpiece won almost equally high evaluation (respectively 97.3 and 98.2%). Most patients assessed these features as more important than discretion and easy handling and transportation (respectively p = 0.015 and p = 0.028). A high percentage of the study group praised the inhaler's technological efficacy. 94-96% at the least gave positive opinions about such features as: clear instruction, certainty of a dose's intake, the possibility of checking the amount of inhaled doses. CONCLUSION: The inhaler that was the object of the study enjoyed a high degree of acceptance mostly due to its features facilitating easy and efficient inhalation.

[The effect of desloratadine on use of rescue beta2-agonists and symptoms in patients suffering from seasonal allergic rhinitis and asthma]. / Wplyw desloratadyny na czestosc stosowania beta2-agonistów i objawy u chorych na sezonowy alergiczny niezyt blony sluzowej nosa i astme oskrzelowa.

Seasonal allergic rhinitis (SAR) and intermittent asthma are frequently comorbid and share some pathophysiological, clinical and epidemiological bases which has been confirmed by ARIA (Allergic Rhinitis and its Impact on Asthma) WHO position paper. Therapeutical consequences of H1 receptor antagonists treatment in patients with both SAR and asthma are not clear. The aim of this study was to evaluate the effect of desloratadine (5 mg daily) on rescue medication use, symptoms of SAR and asthma. One hundred and ninteen patients (59 men), mean age 29.64 +/- 8.34 years, suffering from SAR and asthma were recruited. After 14 days of screening during the pollen season desloratadine in an open manner was introduced. During the treatment phase mean beta2 agonist weekly demand decreased from 11.73 +/- 8.91 (screening) to 4.89 +/- 7.09 (p < 0.001, Wilcoxon test). Mean symptoms score decreased from 13.37 +/- 5.93 to 5.19 +/- 4.7 and from 5.69 +/- 3.83 to 2.09 +/- 2.45 for SAR and asthma respectively (p < 0.001). Eight mild adverse events were reported with the most frequent-sleepiness (6.9% of study group). Desloratadine in the dosis of 5 mg daily confirmed its efficacy and safety in the treatment of patients with SAR and asthma. Decrease of beta2-agonist use and reduction of diseases symptoms was documented in patients with seasonal allergic rhinitis and asthma.

[Epidemiology of allergic eye diseases]. / Epidemiologia alergicznych chorób oczu.

Epidemiology of allergic eye diseases has not been sufficiently studied so far. The first statistical studies regarded the coexistence of allergic conjunctivitis together with allergic rhinitis, as rhinoconjunctivitis. Only in the last 10 years eye allergy has been regarded as a separate epidemiological and clinical problem. According to Bonini, seasonal allergic conjunctivitis (SAC) accompanies pollinosis in 95.2%. Buckley's studies revealed symptoms of SAC in 21% of British population and Berdy reported a similar result in 20% of Americans. Weeke estimates that depending on geographical region and age of examined patients, allergic eye diseases occur in 5 to 22% of the population. Among them SAC and perennial allertgic conjunctivitis (PAC) account for up to 50%. A recent Italian study demonstrated an increase of the incidence of allergic eye diseases, which were found in 38% of the studied population, most frequently in young males. Eye allergy presented most frequently as rhinoconjunctivitis (SAC and PAC) (63.7%), and then as atopic keratoconjunctivitis (AKC) (21%) and vernal keratoconjunctivitis (VKC) (15.5%). It seems that the incidence of allergic eye diseases demonstrates a rising tendency, similarly as it has been found in recent years in the case of bronchial asthma, rhinitis or atopic dermatitis.

[Allergy to fungal antigens]. / Alergia na antygeny grzybów.

Fungi from human environment or growing in human body may cause allergic reactions. The most common allergens are microfungi (moulds) belonging to imperfect fungi: Alternaria, Cladosporium and sack-like forms: Aspergillus, Penicillium and yeasts. Fungal antigens may stimulate production of specific IgE in atopic individuals what, as a rule, worsens the clinical course of atopic diseases: allergic sinusitis, bronchial asthma or atopic dermatitis. Fungi may also cause IgE-independent allergic reactions: by production of IgE, immunological complexes and by stimulating cell hypersensitivity. Whether allergic bronchopulmonary aspergillosis (ABPA), allergic fungal sinusitis (AFS) or allergic dermatitis appears, depends on the immunological state of human organism and exposure to fungal antigens.

[Treatment of allergy to mould spores]. / Leczenie uczulen na zarodniki grzybów plesniowych.

The treatment of mould allergy is discussed in this article. The specific immunotherapy should be especially considered in this group of patients.

[Allergy to mould allergens as a risk factor for bronchial asthma in patients suffering from allergic rhinitis]. / Uczulenie na alergeny grzybów plesniowych jako czynnik ryzyka wystapienia astmy oskrzelowej u chorych z alergicznym niezytem nosa.

UNLABELLED: The ARIA study demonstrates the correlation between bronchial asthma (BA) and perennial rhinitis (PR) with mite or animal fur allergies. There are no reports concerning correlation between BA and PR with mould allergy. The authors of this study estimated the prevalence of BA in patients with PR, allergic to moulds in comparison with patients allergic to other aeroallergens. 460 patients suffering from PR were investigated: 102 were allergic to moulds (mono- or multisensitization type) and 358 were allergic to other allergens. The prevalence of BA in mould-sensitive and insensitive patients was 70.6% and 43.6%, respectively; it was significantly higher in the mould-sensitive group (p = 0.004) regardless of the type of mould hypersensitivity (mono- or multisensitization). The higher prevalence of BA in mould-sensitive patients was found to be valid only for adults. The adult PR patients with diagnosed BA were most frequently allergic to Alternaria (47.1%) and Cladosporium (30.8%). IN CONCLUSION: mould allergy may be a risk factor for BA development.

[Health threats for children in the modern building trade]. / Zagrozenia zdrowotne dzieci we wspólczesnym budownictwie mieszkaniowym.

Changes in building industry during last 30 years in search of economic technologies and building materials ended in creating airtight and energy-saving constructions with reduced ventilation. As a result, diminish exchange between internal and external air, leads to cumulation of various chemicals and organic substances in our houses. Concentrated oxidation products (CO2, CO, NO2, nicotine smoke), vaporizing substances (formaldehyde, NH3, aromatic hydrocarbons) might irritate mucouses, promote or intense respiratory tract infections, allergic diseases or bronchial asthma. Higher risk of atopic diseases and bronchial asthma also arises from proliferation of fungus, bacteria and mites in modern interiors, which are quite convenient for it. Buildings with microclimate, which is dangerous for human health, are termed "sick buildings". Diseases that develop under their influence are called BRI (building related illnesses). Children are most exposed on them, especially under municipal conditions, because they spend majority of their time at home.