RELATIONSHIP OF ALLERGIC DISEASES, POLLEN EXPOSURE AND COVID-19 IN GEORGIA.

Allergic diseases have been recognized as one of the global health issues and affect about a third of the worldwide population. COVID-19 pandemic has raised concerns about the risk of infection and the severity of COVID-19 infection in patients with asthma and allergic rhinitis. The aim of our study was to define the relationships between pollen exposures and SARS-CoV-2 infection rates in Georgia, as well as to characterize the Covid-19 autoimmune and antiviral responses in Georgian allergic patients with different sensitization patterns. Data on daily COVID-19 positivity rates, case fatality rates, and pollen concentrations from February 2020 to November 2022 were collected in Tbilisi, Kutaisi, and Batumi. Diagnostic parameters, including total IgE, specific IgE, eosinophil counts, anti-nuclear antibodies, and Covid-19 antibodies, were assessed in 181 atopic patients and 24 healthy controls with confirmed SARS-CoV-2 infection. Laboratory findings revealed significant variations in eosinophil counts and total IgE levels among the groups. ANA positivity did not exhibit substantial differences between atopic patients and healthy controls. Individuals with indoor allergies displayed lower SARS-CoV-2-specific antibody levels, potentially explained by variations in adaptive immune responses. There was no correlation between pollen concentration and COVID-19 epidemiological characteristics, indicating that pollen had no effect on virus epidemiology.

The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the Republic of Georgia.

OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.

CYPRESS POLLEN SESITIZATION IN GEORGIA: CLINICAL AND MOLECULAR CHARACTERISTICS.

Cypress pollen allergy is a widely distributed, highly prevalent and severe winter pollinosis that may be caused by several Cupresaceae species around the Mediterranean basin, in North America and Asia. Exposure to cypress pollen has increased steadily over the last few decades and the prevalence of allergy to cypress pollen has also dramatically increased from 0.6% to 9.8% in the general population and from 9% to 35% in allergic patients, probably because of the allergen load has become more intense. The objective of the study was to evaluate cypress pollen allergy in Georgia and describe clinical characteristics and the molecular profile of sensitization. Patients attended to allergy clinic with suspected cypress pollen allergy (n=492) were included in the study. Diagnostic workup was performed according to local guidelines, specific IgE antibody against cypress allergen was performed using ImmunoCAP and ISAC assay platform. The airborne pollen monitoring was performed with a Burkard Seven Day Volumetric Spore-trap (Burkard Manufacturing Co Ltd, UK) during the seasons of 2019-2020, following the recommendations of European Aerobiology Society. 37.2% of studied cases were positive to cypress diagnostic test. From cypress positive 183 patients only 17 patients (9.2%) had no symptoms during the cypress season. The most frequent symptoms were sneezing and ocular itching (82.9% of patients for both symptoms), rhinorrhea was reported in 77.7% of cases and dry cough and shortness of breath - only in 22.3% (each symptoms). More than half of frequent symptoms were reported as severe. The cypress positive patients were mostly co-sensitized to plant allergen components: grasses (nCyn d1- 61.5% of ISAC positive cases, rPhl p 1 -72.5%, rPhl p 5 - 46.8%), trees (rBet v 1 - 27.5%, nCry j 1 - 78.9%, nPla a 2 - 32.1%) and weeds (nAmb a 1 - 48.6%, nArt v 1 - 20.2%). Our data show that in Georgia, the prevalence of sensitization to cypress pollen in patients attending the allergy clinic is high (every third patient). The clinical symptoms predominantly associated with allergic rhinitis and atopic conjunctivitis, in most cases which are expressing by acute sneezing and ocular itching during the pollen season and all patients are poly-sensitized. This was the first study to give a detailed description of the clinical characteristics of cypress pollen allergic patients in Georgia.

The burden and epidemiology of hepatitis B and hepatitis D in Georgia: findings from the national seroprevalence survey.

OBJECTIVES: The burden of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections is unknown in Georgia. This analysis describes the prevalence of hepatitis B and coinfection with HDV and the demographic characteristics and risk factors for persons with HBV infection in Georgia. STUDY DESIGN: This is a cross-sectional seroprevalence study. METHODS: A cross-sectional, nationwide survey to assess hepatitis B prevalence among the general adult Georgian population (age ≥18 years) was conducted in 2015. Demographic and risk behavior data were collected. Blood specimens were screened for anti-hepatitis B core total antibody (anti-HBc). Anti-HBc-positive specimens were tested for hepatitis B surface antigen (HBsAg). HBsAg-positive specimens were tested for HBV and HDV nucleic acid. Nationally weighted prevalence estimates and adjusted odds ratios (aORs) for potential risk factors were determined for anti-HBc and HBsAg positivity. RESULTS: The national prevalence of anti-HBc and HBsAg positivity among adults were 25.9% and 2.9%, respectively. Persons aged ≥70 years had the highest anti-HBc positivity (32.7%), but the lowest HBsAg positivity prevalence (1.3%). Anti-HBc positivity was associated with injection drug use (aOR = 2.34; 95% confidence interval [CI] = 1.46-3.74), receipt of a blood transfusion (aOR = 1.68; 95% CI = 1.32-2.15), and sex with a commercial sex worker (aOR = 1.46; 95% CI = 1.06-2.01). HBsAg positivity was associated with receipt of a blood transfusion (aOR = 2.72; 95% CI = 1.54-4.80) and past incarceration (aOR = 2.72; 95% CI = 1.25-5.93). Among HBsAg-positive persons, 0.9% (95% CI = 0.0-2.0) were HDV coinfected. CONCLUSIONS: Georgia has an intermediate to high burden of hepatitis B, and the prevalence of HDV coinfection among HBV-infected persons is low. Existing infrastructure for hepatitis C elimination could be leveraged to promote hepatitis B elimination.

TEMPORAL TRENDS OF CERVICAL CANCER MORTALITY IN GEORGIA, 2011-2018.

Cervical cancer is the fifth most common cancer diagnosed in Georgia, after breast, thyroid, colorectal, and uteri cancers. During 2015-2018 cervical cancer incidence composed 17.9, 19.6, 15.0 and 14.3 per 100000 female population accordingly. The study aims to describe cervical cancer (CC) mortality in Georgia during the period of 2011 and 2018. Descriptive analysis was conducted using mortality data during the period of 2011-2018 from the National Statistics Office of Georgia. To estimate time trends of CC mortality study period was divided into two groups - 2011-2014 and 2015-2018 years. For data analysis, descriptive statistics was performed, in which the mortality rates, age-specific mortality rates per 100,000 female population and other statistical measurements - median, the first quartile (Q1), the third quartile (Q3), and interquartile range (IQR) of age at death from Cervical cancer were estimated. Statistical analysis was completed by using the programs of EpiInfo version 7 and Statistical Package of the Social Science (SPSS) version 23 for Windows. The statistical significance tests - p value, and 95% of Confidence Interval (95% CI) were used in order to estimate statistical reliability of the results. The number of annual deaths varied between 121 and 185 cases that composed variation of mortality rates from 6.1 to 9.5 per 100,000 women. According to the 95% of CI the difference between mortality rates according to calendar years is not statistically significant. Mean mortality rates for the periods 2011-2014 and 2015-2018 were 7.1(SD=0.7) and 8.7 (SD=0.5) accordingly and presented a slight increase. Taking into consideration that during 2005-2010 annual number of registered deaths from cervical cancer in Georgia was quite low and varied between 50 and 60, it is likely that this increase is related to the improvement in registration and is not a true increase. Therefore, the second period (2015-2018) of the study represents more real data, then the first (2011-2014). Cervical cancer mortality increases with age, which indicates that advanced age is a predictor factor. The age effects for almost all calendar years included in analysis (2011-2018) presented an increasing trend with age from 25 to 59, while a moderate decrease was shown within the age group from 60-64 to 65-69 and over 80 years of old. The median age of deaths from CC fluctuated inconsistently between 57 and 62 years; Interquartile range in different calendar years composed: 47-67, 52-72, and 52-67 years. Comparatively stable median age of deaths, indicates that, there is no tendency of cervical cancer early mortality reduction. The study revealed a slight increase in CC mortality, which could be related to the improvement of death registration.

2020 ARIA CARE PATHWAYS FOR ALLERGIC RHINITIS - GEORGIA.

Allergic rhinitis is the most common chronic disease worldwide. Treatment guidelines have improved the knowledge on rhinitis and have had a significant impact on AR management. In 20 years, ARIA has considerably evolved from the first multi-morbidity guideline in respiratory diseases to the digital transformation of health and care. Allergic rhinitis in Georgia, Next-generation ARIA-GRADE guidelines and ARIA, 2020 care pathways for Allergen Immunotherapy have been discussed in this review.

PLANT AEROALLERGENS IN TWO MAJOR CITIES OF GEORGIA - TBILISI AND KUTAISI.

Pollen allergy is caused by a hypersensitivity reaction mainly of the respiratory tract and eye conjunctivae to pollen grains. The number of people allergic to plant aeroallergens has substantially increased in big cities and industrial areas. The monitoring of aerobiological parameters is of paramount importance for the characterization of allergenic risks. The aims of presented study were as follows: to profile the plant aeroallergens in two major cities of Georgia, to compare the character of pollination curves, to determine the dates of beginning of pollen seasons and their duration in particular cities. Two Burkard 7-day samplers were located in cities: Tbilisi, with climate transitional from humid subtropical to relatively mild continental and Kutaisi, with humid subtropical with a well-defined on-shore/monsoonal flow. Pollen counts were expressed as a daily mean value in number of pollen grains/spores per m3 of air. Data was obtained in 2016 year. The main tree pollen types for both centers were: Alnus (Alder), Betula (Birch), Carpinus (Hornbeam), Castanae (Chestnut), Corylus (Hazel), Cupressaceae (Cypress), Fagus (Beech), Fraxinus (Ash), Juglans (Walnut), Morus (Mulberry), Pinus (Pine), Platanus (Plane Tree), Quercus (Oak), Salix (Willow), Tilia (Lime), and Ulmus (Elm Tree). Comparison analysis had shown that the pollination season of the most trees began earlier in Kutaisi. As an example, the beginning of pollination was about 10-15 days earlier for Corylus and Alnus. The difference in pollen count of particular taxa was observed as well. It was much higher in Kutaisi for Corylus, Alnus and Cupressaceae and significantly higher in Tbilisi for Platanus and Pinus. Main grass pollen was Gramineae (Grasses): the pollination started a little bit earlier in Kutaisi, but the pollen count was generally higher in Tbilisi. The features of pollen seasonal distribution and amount were revealed also for the weeds (mainly Ambrosia (Ragweed) and Artemiasia (Mugwort)). The differences noted in pollen count between two major cities of Georgia may be due to a different composition of local flora and the influence of weather.

Trends in the prevalence of childhood asthma and allergy in Western part of Georgia.

Internatinal time trend analyses, using the ISAAC (Phase Three) protocol, have yielded variable results and observed a rise in prevalence especially in areas where allergic diseases were previously less common. In 2003 and 2012, we performed cross-sectional studies in Kutaisi (western part of Georgia) schoolchildren aged 6-7 and 13-14 yr., using the validated ISAAC methodology, aiming to provide the prevalence trends of asthma and allergy in this population. Both cross-sectional studies were carried out in the same city, same season and used identical methodologies. In 2003, number of participants in 6-7 and 13-14 yrs old groups was 2666 and 2650 and in 2012 - 3039 and 2339 correspondently. Significant alteration in prevalence of asthma related symptoms was obtained in both age groups. The symptom of severe asthma had increased only in 13-14 year old adolescents and was not change in 6-7 year old group. There were significant increases (all to p < 0.001) in the symptoms of current sneezing (16.4% vs 8.7% and 28.4% vs 15.3% in 6-7 yr group and 13-14 yr group correspondently) and rhinoconjunctivitis (5.2% vs 2.9% and 9.6% vs 4.5% yr group and 13-14 yr group correspondently). Symptoms of current eczema (affecting flexural dermatitis) were increased in both age groups. The prevalence of asthma and allergies markedly increase among both age groups of schoolchildren in the western part of Georgia. The exact reasons for such trends remain to be explored.

Risk factors of asthma in Georgian schoolchildren.

All existing contemporary data are indicating a relatively low prevalence of asthma in Georgia. The aim of the study, which was undertaken as part of ISAAC Phase II, was to assess some potential risk factors of asthma among schoolchildren in Georgia. In this study the current wheezing was revealed in 9.2% of 9 to 11-year-old children. The presence of asthma symptoms was strongly associated with presence of symptoms of rhino-conjunctivitis (OR=8.60, 95% CI=4.82-15.33, p=0.000) and eczema (OR=5.30, 95% CI=2.80-10.04, p=0.000). The logistic regression analysis revealed that environmental factor such as dampness/moulds at home, in addition to family history of allergy, was significant risk factor for asthma in Georgia. Future epidemiological study of risk factors for asthma, at both the host and environmental level, is desirable in order to help detect strategies of allergen avoidance.

Illicit drugs use in Georgian students; pilot study rigorously following criteria of European School Project on Alcohol and Other Drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. This summary presents key results from the Alcohol Use in Georgian Students, pilot study rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD). The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. 22% of the surveyed students perceive cannabis to be easily available, and boys consider cannabis slightly more accessible than girls do, the gender difference is rather big (31% vs.13%). Amphetamines and ecstasy are not perceived to be as easily available as cannabis. On average, 33% of the boys and 8% of the girls have tried illicit drugs at least once during their lifetime (20% for all students). After cannabis, ecstasy is in second position, being mentioned by 7.5% of the students and the figure for amphetamines is about 2%. Lifetime use of crack was reported by fewer students (1.1%) and the rate for heroin was even lower (1%). Lifetime cocaine and heroine experiences were reported by 0.6% of the students on average. Just as few reported experience of GHB and anabolic steroids or drug use by intravenous administration. Since cannabis is the most frequently used illicit drug, it could be worthwhile to have a closer look at this substance. Use of cannabis in the past 12 months was reported by 17% of the boys and 3% of the girls (10% for all students) while use in the past 30 days was stated by 6.5% of the boys and 0.8% of the girls (3% mean). Using drugs is less problematic in Tbilisi adolescents but still needs urgent public health interventions. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study results show the importance of knowledge on these issues and therefore including the healthy lifestyle subject in school curricula. The need to repeat this exercise at regular intervals is important in order to be aware of newer trends and to serve as a basis for policy direction and change.

Alcohol use in Georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. In the article the results of the pilot study of Alcohol Use among Georgian Students, rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD) are presented. The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. The survey revealed that alcoholic beverages, especially beer and wine are considered easily available; 73% found beer and 70% wine easy to obtain. 90% of the surveyed students have tried alcohol at least once during their lifetime. 80% have done so in the last 12months and 40% in the past 30 days. Gender differences become apparent when frequency of use is considered: boys have used alcohol more often than girls. 7.5% of the students state that, they never drink alcohol at all. Wine and beer are the two most important types of beverage for the students. On average, 40% of students on the latest drinking day consumed wine and 38% - beer. Champagne and spirits consumed 29% and 22% of students, respectively. On average, half of the students have been intoxicated, at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up. 40% reported intoxication in the last 12 months and 12% in the past 30 days. Another way to measure drunkenness is to ask about a specific amount of alcohol consumed within a certain period of time. The students were asked if they had had five drinks or more on one occasion during the past month; this is referred to here as "heavy episodic drinking", 40% reported this; more boys than girls did so (45% versus 33%). More than half of the questioned students had consumed at least one glass of alcohol at the age of 13 or younger, and 25% had been drunk at that age. Having been intoxicated during the past 30 days, in turn, co-varies both with anticipating more positive consequences from drinking and with having experienced more negative personal consequences when drinking. Alcohol remains the number one problem. The fact that more than 90% of respondents have had drunk alcohol at least once and that more than 43% have had their last drink at home and more than 27% at friend's home, indicates the great reflection of the cultural acceptance of alcohol within Georgian society and within Georgian families. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study showed the importance of knowledge of alcohol use and the necessity including the healthy lifestyle subject in school curricula.

Tobacco use among georgian schoolchildren; pilot study following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. This summary presents key results from the Tobacco Use in Georgian Students, pilot study rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD). The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. On average, in our survey, about half of the surveyed students reported having tried smoking cigarettes at least once and 16% had used cigarettes during the past 30 days. 1.1% of all students had smoked at least a packet of cigarettes per day during the last 30 days. On average 60% of surveyed students replied that they find it fairly or very easy to get cigarettes if they want to. On average, 30% (10% - 9 years old or less) of the students said that they had been smoking cigarettes on a daily basis at the age of 13 or younger. The proportion of students who smoked on a daily basis at the age of 13 or younger is 4.3%. Adolescent's tobacco use is a great public health concern in Georgia. Smoking is quite prevalent among Georgian adult population which on one hand reflects their children's habits and on the other hand reflects not only their, but their families and broader community's health. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study results show the importance of knowledge on these issues and therefore including the healthy lifestyle subject in school curricula.

World Health Organization's HIV/AIDS policy and Georgia.

WHO takes the lead within the UN system in the global health sector response to HIV/AIDS. Recent estimates indicate that the health sector alone represents at least 55% of the resources required for the global response to HIV/AIDS. In order to better target much-needed interventions, the WHO HIV/AIDS Programme focuses on five strategic directions: Enable people to know their HIV status; Maximize the health sector's contribution to HIV prevention; Accelerate the scale-up of HIV treatment and care; Strengthen and expand health systems; Invest in strategic information to guide a more effective response. The European Region is now experiencing the fastest rate of growth of HIV prevalence in any region of the word with the evidence of increasing transmission of HIV in several countries. In WHO/EURO was developed 13 new or revised evidence-based protocols on HIV/AIDS prevention, treatment and care including co-infection with hepatitis B and hepatitis C, with TB, and a protocol on sexual and reproductive health for people living with HIV/AIDS. WHO assisted Georgia to elaborate and implement its first 1994-95 National Workplan on HIV/AIDS. WHO/EURO activities in Georgia consist: The advocacy and promotion of HIV/AIDS-related WHO policies, strategies, recommendations, distribution of WHO publications, press releases, and reports; The technical assistance to MoLHSA, UN Theme Group on HIV/AIDS, GFATM, major national and international stakeholders involved in HIV/AIDS field in promotion, development and implementation of evidence based norms and standards. By the support of WHO seven guidelines and treatment protocols have been prepared and adopted on different topics of HIV/AIDS in Georgian language; WHO participated in the preparation of "Country Response Plans for HIV/AIDS ", "UN joint response plans for HIV/AIDS", "TB/HIV national plan", applications for GFATM proposals, UNGASS reports etc.; Support in promotion, planning and caring out HIV/AIDS related events (World AIDS Day, AIDS Memorial Day, etc). By the financial support of WHO/EURO in 2007-2008 was carried out the HIV/Hepatitis coinfection epidemiological study as well as in 2006 the socio-economic study for HIV/AIDS in Georgia; In different fields of HIV/AIDS (epidemiology, surveillance, diagnostic and treatment) around 20 National and Regional conferences and workshops have been organized in Georgia and about 400 Georgian specialists passed the training courses for capacity building in and outside country.

Prevalence of asthma and allergies among adolescents in Georgia: comparison between two surveys.

Since healthcare costs for asthma and allergies are a heavy burden for a society, it is a general interest to know whether this temporal trend is still ongoing or whether a plateau has been reached over the last decade. We therefore aimed to follow the trends in the prevalence of asthma, allergic rhino-conjunctivitis, and atopic eczema in Georgian schoolchildren of 13-14 years of age between 1996 and 2003. Surveys were carried out according to the ISAAC methodology in Tbilisi and Kutaisi centres. The mean prevalence increased steadily for current wheezing from 3.6% to 5.6% (p=0.0001) and current rhino-conjunctivitis from 4.6% to 5.7% (p=0.008), while the prevalence of current atopic eczema has remained actually constant, 4.1% and 4.3%, respectively. The prevalence of allergic diseases showed diverging gender trends. The prevalence of rhino-conjunctivitis and eczema in girls has decreased, while in boys increased. The prevalence changes, particularly the increasing pattern, were more evident in Tbilisi vs. Kutaisi centre. The differences could be associated with so-called westernization processes in the capital of Georgia. The investigation of risk factors at regional level could be important in order to undertake preventive measures.

ISAAC I and III in Georgia: time trends in prevalence of asthma and allergies.

ISAAC I and III surveys were carried out in schoolchildren aged 6-7 years from two centres of Georgia to estimate time trends and geographic variations in the prevalence of asthma, rhino-conjunctivitis and atopic eczema symptoms. A standard core questionnaire was used following the ISAAC methodology and was completed by the schoolchildren's parents. The prevalence of symptoms of allergic diseases in Phase I and Phase III was compared. The average prevalence of "current wheezing" almost not changed over 7 years, however there was some heterogeneity across the centres, particularly in Tbilisi centre the prevalence of current wheezing increased by 2.6% and in Kutaisi (it decreased by 2.4%. The symptoms of current rhino-conjunctivitis slightly decreased, but not statistically significant. More significant reduction was observed for symptoms atopic eczema, which was revealed in both centres. The results indicate that the epidemiological features of asthma and allergies in Georgia are changing, although the causes are still uncertain. Different patterns of time trends between centres suggested that there may be local differences in risk factors.

Erythrocyte antigens as immunogenetic markers of respiratory atopic diseases in Georgians.

The aim of this study was to investigate the role of erythrocyte antigens of several systems (ABO, Rh, MNSs, P, Duffy, Kell) in the predisposition to and development of respiratory atopic disease (RAD) in the Georgian population. Two hundred and ninety-three patients with RAD, 83 patients with intrinsic bronchial asthma (IBA) and 215 healthy subjects were included. Associations between blood groups and RAD (atopic bronchial asthma [ABA] and pollinosis), the severity of the disease and the type of sensitization were established, involving the ABO, MNSs and Duffy systems. The groups at higher risk for the development of RAD were carriers of phenotypes O(I), MN, O(I)MN, MNFya(-), O(I)Fya(-) and O(I)MNFya(-). Resistance to RAD was associated with phenotypes A(II), AB(IV), N, Fya(+) and B(III)N. Markers for ABA and pollinosis were also revealed. Allergy to house dust allergen was associated with phenotype MN, whereas pollen sensitization was associated with the M group of MNSs. The risk for the development of severe ABA was higher in patients with B(III), M and B(III)M phenotypes. For the patients with groups O(I) and MN, a mild to moderate degree of severity of ABA was more characteristic. In healthy Georgians, erythrocyte polymorphism was not associated with immune status. In cases of house dust allergy, erythrocyte antigen P1 was associated with high levels of IgE. In patients with RAD higher B-lymphocyte counts were associated with O(I) and lower counts with A(II).

Local humoral immunity in patients with pollen allergy.

All classes of immunoglobulins and albumin have been studied in different phases of disease, both in blood and in the nasal secretions of 75 patients with pollen allergy. There were 20 healthy persons in the test group. Total correlational analysis was done to determine interdependence of the researched indexes. The percentage of local synthesis of immunoglobulins in the nasal secretion was calculated with the help of Donovan's formula. The results obtained allowed us to find out that the local origin was responsible for 74% of total IgE, 97% of IgA and 10% of IgG in the nasal secretion in patients with pollen allergy. While comparing the results of skin tests with RAST, both in blood and in the nasal secretion, a positive coincidence was found considering the results of skin tests and RAST in serum in 93.8% cases, and in the nasal secretion in 91% of the cases. Coincidence between negative skin tests and the results of RAST in serum was as high as 89% of the cases. In some cases with negative skin test, specific IgE to the corresponding pollen allergens was found in the nasal secretion. In most of the cases there was correlation between allergen specific IgE in blood and in the nasal secretion in the phase of remission (88% of cases) and in the phase of exacerbation (100%). Total and allergen specific IgE in the nasal secretion can be widely used to diagnose allergy "in vitro".

Comparative estimation of general and local humoral immunity indicators in connection with local immunotherapeutic treatment.

All classes of immunoglobulins in blood and in the nasal secretions of 75 patients were studied in different phases of disease. There were 20 healthy persons in the control group. Forty patients were treated by preseasonal local immunotherapy through the application of water-salt extracts of pollen allergens intranasally, with the help of drops and aerosol during 2 years. It was found that the patients had a high level of total IgE in the nasal secretion, both in the phase of remission and especially in the phase of exacerbation, though the concentration of IgE in the nasal secretion, on the whole, was several times lower than in serum. Quantification of the level of IgE in the nasal secretion can be recommended to diagnosis allergy, "in vitro". The level of sIgA in the nasal secretion of the patients with pollen allergy was lower in comparison with the test group of healthy persons, being most remarkable in the phase of exacerbation. Patients with pollen allergy had a heightened level of IgD in blood with a marked reliability in the exacerbation phase. IgD was not detected in the nasal secretion. Local immunotherapy was found to have a high effectiveness of 80% after one course of treatment, and nearly 95% success with two courses. Therefore, we consider that local immunotherapy should be widely used. With the background of the local immunotherapy there were changes in the concentration of immunoglobulins, mainly in the nasal secretion of the immunoglobulins. IgE in the nasal secretion was lowered to a great extent after two courses of treatment. sIgA after local immunotherapy had a tendency to increase considerably after two courses of treatment. The increase of sIgA level and the lowering of IgE in the nasal secretion can be considered as immunologic criteria of local immunotherapy effectiveness.

Seasonal variation of IgE synthesis in vitro by human peripheral blood mononuclear cells.

Seasonal variations in IgE antibody synthesis in vitro were studied in cultures of blood mononuclear cells (MNC) from 11 pollen allergic individuals. The IgE levels were significantly higher in two summer seasons than in the winter and spring between them. Net synthesis was confined to the summer in all but one of the patients. All the IgE in the cultures outside the pollen season represented preformed IgE which was present mainly (59%) in the monocyte fraction. Thus, preformed IgE seems to persist in monocytes at times when there is little de novo synthesis of IgE.

The determination of IgE synthesis in vitro. Methodological aspects.

Various methods to determine net synthesis of IgE in cell cultures and to differentiate this from preformed IgE have been evaluated. The most accurate values for net synthesis were obtained by adding the IgE levels in supernatants to the level of cell-bound acid extractable IgE at the end of the culture period and subtracting the IgE levels present in cultures subject to acid treatment on day 0.