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.

EVALUATION OF ANTINUCLEAR ANTIBODIES IN GEORGIAN ALLERGIC PATIENTS POLYSENSITIZED WITH CROSS REACTIVE ALLERGENS.

Western countries have been challenged with an "allergy epidemic" during the last three to four decades. Interestingly, there has been a parallel increase in the incidence rates of several autoimmune disorders.The aim of our study was to evaluate antinuclear antibodies (ANA) in Georgian allergic patientspolysensitized with cross reactive allergens, in order to establish connection between allergic and autoimmune diseases in our population. Two groups of patients were included in the study: patients with atopy (group 1, n=97) and without (group 2, n=42).ImmunoCAPPhadiatop and ISAC assay platforms were used for atopy screening and polysensitization patterns evaluation. Screening for ANAs was performed by IIFA (Indirect Immunofluorescence assay) on HEp-2 cells. In general 67(69.1%) allergic patients were sensitized to at least one of the cross reactive allergen. Among allergic patients 26 (26.8%) tested positive for the presence of auto-antibodies; for non-allergic patient this value was only 1(2.4%). 18(26.9%) patients sensitized to cross reactive allergens showed positive results for ANA testing and 8(26.7%) allergic patient without cross allergen sensitization were positive for ANA. The AC-2 was only one detected pattern among non-atopic individuals (1/2.4%) and the most frequent pattern in allergic patients (19/73%). In the ANA positive group of allergic patients the atopic dermatitis (13/50%) and asthma (6/23.1%) were most frequently diagnosed. The occurrence of antinuclear antibodies is more frequent in atopic patients and associate mostly with asthma and atopic dermatitis phenotypes of allergic diseases. The most frequent coexisting ANA pattern is dense fine speckled pattern (AC-2).The occurrence of ANA antibody in atopic patients and its role in allergy remains the subject for future research.

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.

ASSOCIATION BETWEEN URTICARIA AND INFECTIONS (REVIEW).

Urticaria is a common disease with 20% of prevalence and marked effects on quality of life. The burden of chronic urticaria for patients, their family and friends, the healthcare system and society is substantial. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear. The remission of annoying spontaneous chronic urticaria has been reported after successful treatment of persistent infections. Chronic viral infections including hepatitis B and C have been reported to be associated with CSU. More research is needed to make definitive recommendations regarding the role of infections and their management in case of urticaria and urticarial vasculitis. The routine screening of parasitic, bacterial or viral infections in CU is not recommended, however, testing a patient with urticaria for certain infections is a physician's choice based on the specific characteristics of the patient, such are clinical symptoms and laboratory results, dietary and cultural habits, country of origin and residency, traveling history.

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.

MODERN APPROACHES TO FRACTIONAL EXHALED NITRIC OXIDE AS A USEFUL BIOMARKER FOR ALLERGIC ASTHMA PHENOTYPING AND MANAGEMENT.

Asthma is a pathologically heterogeneous disease, consisting of several phenotypes. Different types of airway inflammation are the cornerstone feature of this condition. Fraction of nitric oxide in exhaled air (FENO) has been proposed as a noninvasive, specific biomarker for eosinophilic airway inflammation and has been shown to be elevated in patients with allergic asthma phenotype. More recent studies indicate that FeNO identifies T-helper cell type 2 (Th2)-mediated airway inflammation with a high predictive value for identifying inhaled corticosteroid (ICS) responsive airway inflammation. Taking into account the accumulated evidence,it is possible to consider, that FeNO testing has an important role in the assessment of patients with suspected asthma and in the management of established asthmadiagnosis. In conjunction with symptom scores and lung function tests, FeNO measurement could provide a more useful and effective approach for asthma in terms of: (1) detecting the presence of Th2-mediated airway inflammation, (2) determining the likelihood of ICS responsive (and lack of course), (3) monitoring of airway inflammation to determine risk for future impairment or loss of asthma control during reduction/cessation of ICS treatment, (4) unmasking (otherwise unsuspected) non-adherence to corticosteroid therapy and (5) in severe asthma cases tailoring treatment with biological drugs. However, more work is still needed to address outstanding questions about its exact role in guiding asthma management and better define the use of FENO in different clinical settings.

PATTERNS OF SENSITIZATION BY FOOD AND INHALANT COMPONENTS IN GEORGIAN PATIENTS.

Molecular-based allergy (MA) diagnostics is a novel approach used to map the allergen sensitization of a patient at a molecular level, using purified natural or recombinant allergen components instead of allergen extracts. The aim of our study was to: 1) investigate sensitization patterns to food and inhalant allergen components in different age groups of Georgian allergic patients 2) evaluate patient's potential risk of systemic reaction and manage dietary modifications. 3) Study food and inhalant components in different age groups in correlation with clinical manifestations of allergic disease. Allergic patient's sera samples were tested by ImmunoCap ISAC and specific IgE levels against 112 different allergen components were detected. The study population was comprising 81 allergic patients, included 26 adults (mean age 36.2±10.9) and 55 children (mean age 6.1±4.58). Results revealed that nGal d 1 (11.3%), nGal d 2 (10.1%) and nBos d 8 (10.1%) were more prevalent among food components. Cyn d 1 (35.4%), nCup a 1 (26.5%), n Amb a 1 (21.5%), rAlt a 1 (10.1%), rFel d1 (12.6%), rDer f 2 (26.50%), nDer p 2 (24%) were more prevalent among inhalant components. PR-10 reactivity was detected in 45%, Profilin - 43% and LTP - 29%. CRD food and inhalant pattern changes associated with age of children were correlating with the development of atopic march in Georgian population. Sensitization to most prevalent food components (Bos d 8 and Gal d 1) are predictors of allergy persistence in later life, in case of emergency individual action plan against anaphylaxis should be fulfilled.

SENSITIZATION PATTERN AND CLINICAL PECULARITIES OF FOOD ALLERGY IN GEORGIA.

The aim of our study was to investigate sensitization pattern to food allergens in different age groups of atopic patients in Georgia and reveal the associations between food sensitization and clinical manifestations of allergic disease reflecting the development of atopic march. 1000 patients (children-783, adult-217) with different clinical manifestations were involved in the study. Specific IgE antibodies to food mix, cow's milk, casein, egg, wheat, fish, nuts mixture and inhalant allergens were measured by using ImmunoCap (Phadia, Uppsala, Sweden). The prevalence of positive specific IgE to food mix was - 7.08%, cow's milk-4.61%, casein - 4.68%, hen's egg - 2.72%, fish mix - 0.77%, wheat -1.57% and to nuts mixture - 2.86%. The frequency of atopic dermatitis (p<0.0017), urticaria (p<0.0223) and anaphylactic shock (p<0.001) were significantly increased in patients with specific IgE to food mix. Allergic skin manifestations to ingested food were age-dependent, more frequent in children groups. Cow's milk and hen's egg are the commonest food allergens in the age group of <2 years. Sensitization to food mix, cow's milk, casein, hen's egg and wheat were predominated in male patients. Egg allergy was significantly associated with atopic dermatitis, fish allergy to bronchial asthma and severe milk allergy to anaphylactic shock. Present study is a first comprehensive investigation, providing unique data of the prevalence of food allergies in Georgian population. The results of this study are contributing to a better understanding of the disease, serving as a basis for the development of strategies for preventing and treating food allergies.

Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper.

The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.

Genetic variants associated with drugs-induced immediate hypersensitivity reactions: a PRISMA-compliant systematic review.

Drug hypersensitivity includes allergic (AR) and nonallergic reactions (NARs) influenced by genetic predisposition. We performed a systematic review of genetic predictors of IgE-mediated AR and NAR with MEDLINE and PubMed search engine between January 1966 and December 2014. Among 3110 citations, the search selected 53 studies, 42 of which remained eligible. These eligible studies have evaluated genetic determinants of immediate reactions (IR) to beta-lactams (n = 19), NAR against aspirin (n = 12) and other nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 8), and IR to biologics (n = 3). We reported two genomewide association studies and four case-control studies on candidate genes validated by replication. Genes involved in IR to beta-lactams belonged to HLA type 2 antigen processing, IgE production, atopy, and inflammation, including 4 genes validated by replications, HLA-DRA, ILR4, NOD2, and LGALS3. Genes involved in NAR to aspirin belonged to arachidonic acid pathway, membrane-spanning 4A gene family, histamine production pathway, and pro-inflammatory cytokines, while those involved in NAR to all NSAIDs belonged to arachidonic acid pathway and HLA antigen processing pathway. ALOX5 was a common predictor of studies on NAR to both aspirin and NSAIDs. Although these first conclusions could be drawn, this review highlights also the lack of reliable data and the need for replicating studies in contrasted populations, taking into account worldwide allele frequencies, gene-gene interactions, and contrasted situations of environmental exposure.

Prevalence of self-reported food allergy in different age groups of georgian population.

Epidemiological studies in high income countries suggested that a big proportion of the population in Europe and America report adverse reactions to food. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. The aim of our study was to report the prevalence of self-reported food allergy in the different age groups of Georgian population and to reveal the most common self-reported food allergens. ISAAC phase III study methodology and questionnaires were used for data collection. Questions about food allergy were added to the survey and involved questions about self-reported food allergy. 6-7 years old 6140 children (response rate-94,5%) and 13-14 years old 5373 adolescents (response rate-86,9%) from two locations of Georgia, Tbilisi and Kutaisi were surveyed. 500 randomly assessed adults from Tbilisi aged 18 years and older were added later (response rate-97,6%). Findings revealed that self-reported food allergy among 6-7 years old age group and 13-14 years old age were almost the same (15,7% and 15,9% correspondingly) and slightly lower in adult population - 13,9%. Study revealed, that hen's egg was the commonest implicated food for 6-7 years age group, hazel nut - for 13-14 years old age group followed by hen's egg. Walnut and hazel nut were most reported foods for adult population. The findings also revealed that food allergy is one of the most important risk factor for symptoms associated with asthma (OR-3,05; 95%CI 2.50-3.74), rhinoconjunctivitis (OR-2,85; 95%CI 2.24-3.64) and eczema (OR-5,42; 95%CI 4.08-7.18) in childhood. The data has provided the first epidemiological information related to food allergy among children and adults in Georgia. Results should serve as baseline information for food allergy screening, diagnosis and treatment. Our findings can also inform the public health officials on the disease burden and may offer some recommendations for minimizing the allergy-related risks.

Ige-mediated food allergy - current problems and future perspectives (review).

The incidence and prevalence of FA have changed over time, and many studies have indeed suggested a true rise in prevalence over the past 10-20 years. Recent studies showed that prevalence of self-reported food allergy is 17, 3%, versus challenged confirmed - 0.9%. The majority of allergic reactions to foods, particularly in children, are suggested to be caused primarily by eight foods, namely cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish. Clinical symptoms of FA include skin, gastrointestinal and systemic reaction anaphylaxis that might be life-threatening and cause fatal reaction. Diagnosis of food allergy is based on SPT, sIgE measurements, component resolved diagnostics (CRD) and double-blind placebo-controlled food challenge (DBPCFC) tests. The primary therapy for food allergy is strict avoidance of the causal foods. Patients should be provided an emergency action plan, including how to administer an epinephrine autoinjector. It is recommended that all infants be exclusively breast-fed, without maternal diet restriction of allergens, until 4 to 6 months of age. Recent studies have shown that oral immunotherapy (OIT) can induce desensitization and modulate allergen-specific immune responses. Further work to evaluate the long-term effectiveness and safety of this therapy is ongoing and needed before they are used in the main-stream care of children or adults with food allergy.

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.

A multi-centre study of candidate genes for wheeze and allergy: the International Study of Asthma and Allergies in Childhood Phase 2.

BACKGROUND: Common polymorphisms have been identified in genes suspected to play a role in asthma. We investigated their associations with wheeze and allergy in a case-control sample from Phase 2 of the International Study of Asthma and Allergies in Childhood. METHODS: We compared 1105 wheezing and 3137 non-wheezing children aged 8-12 years from 17 study centres in 13 countries. Genotyping of 55 candidate single nucleotide polymorphisms (SNPs) in 14 genes was performed using the Sequenom System. Logistic regression models were fitted separately for each centre and each SNP. A combined per allele odds ratio and measures of heterogeneity between centres were derived by random effects meta-analysis. RESULTS: Significant associations with wheeze in the past year were detected in only four genes (IL4R, TLR4, MS4A2, TLR9, P<0.05), with per allele odds ratios generally <1.3. Variants in IL4R and TLR4 were also related to allergen-specific IgE, while polymorphisms in FCER1B (MS4A2) and TLR9 were not. There were also highly significant associations (P<0.001) between SPINK5 variants and visible eczema (but not IgE levels) and between IL13 variants and total IgE. Heterogeneity of effects across centres was rare, despite differences in allele frequencies. CONCLUSIONS: Despite the biological plausibility of IgE-related mechanisms in asthma, very few of the tested candidates showed evidence of association with both wheeze and increased IgE levels. We were unable to confirm associations of the positional candidates DPP10 and PHF11 with wheeze, although our study had ample power to detect the expected associations of IL13 variants with IgE and SPINK5 variants with eczema.

IgE-mediated food hypersensitivity disorders.

Food allergy has become a serious health concern especially in developed countries in the past two decades. In general population approximately 4-6% of children and 1-3% of adults experience food allergy. The article reviews IgE-mediated food hypersensitivity disorders. Epidemiology, Mechanism, Clinical manifestations, Genetically modified crops (GMOs), Diagnosis, Prevention and Treatment of IgE-mediated food allergies are discussed. The investigations show that over 90% of IgE-mediated food allergies in childhood are caused by: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish and shellfish. Also the causes of food allergy are food additives, genetically modified crops. Risk factors for food-dependent exercise-induced anaphylaxis include asthma and previous allergic reactions to the causative food. Food allergy is one of the most common causes of systematic anaphylaxis and anaphylactoid reactions, with an annual incidence of four cases per million populations and estimated 500 deaths annually. In addition to gastrointestinal symptoms, individuals may experience urticaria, angioedema, atopic dermatitis, oral syndrome, asthma, rhinitis, conjunctivitis, hypotension, shock and cardiac arrhythmias, caused by the massive release of mediators from mast cells and basophiles. Diagnosis of food allergy is based on history, detailed dietary analysis, skin testing, measuring specific IgE in blood serum and challenge tests. Treatment and prevention includes: avoidance diet, application of auto-injectable epinephrine, H1 and H2 antihistamines, corticosteroids, antileukotrienes, prostaglandin synthetase inhibitors, cromolyn sodium, etc.

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.

[Study of the HLA and IgE systems in healthy persons and in patients with allergies of the respiratory tract]. / Issledovanie sistemy HLA i IgE u zdorovykh lits i bol'nykh allergozami dykhatel'nykh putei.

The purpose of the paper is to study the association of HLA-antigens and serum levels of IgE in healthy persons and patients with allergic diseases of the respiratory tracts in Georgian population. Research showed the association of the HLA-system and genes controlling serum levels of IgE. The association of comparatively low levels of IgE with antigens HLA-A11, B35, Cw4, and of a raised level with B7 and Cw2 antigens was established in healthy subjects. Healthy persons carrying antigen B7 and residents of the endemic zone of ragweed spreading formed a group at high risk of developing hyper-IgE response and ragweed pollinosis. Production of specific IgE antibodies was clearly correlated with certain HLA-antigens whereas the association of the HLA-system with total IgE levels was less marked and was revealed at comparatively low (less than 213.55 kU/l) or at significantly raised (over 433.41 kU/l) levels of total IgE. Development of hyper-IgE response (over 1000 kU/l) was associated with HLA-A3 (RR = 2.2; delta = 0.21).