Influencing factors on the safety and effectiveness of venom immunotherapy.

BACKGROUND AND OBJECTIVE: The safety profile of venom immunotherapy (VIT) is a relevant issue and considerable differences in safety and efficacy of VIT have been reported. The primary aim of this study was to evaluate the safety of ACE inhibitors and beta-blockers during VIT, which has already been published. For a second analysis, data concerning premedication and venom preparations in relation to systemic adverse events (AE) during the up-dosing phase and the first year of the maintenance phase were evaluated as well as the outcome of field stings and sting challenges. METHODS: The study was conducted as an open, prospective, observational, multicenter study. In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. RESULTS: Premedication with oral antihistamines was taken by 52.1% of patients during the up-dosing and 19.7% of patients during the maintenance phase. Taking antihistamines had no effect on the frequency of systemic AE (p=0.11) but large local reactions (LLR) were less frequently seen (OR: 0.74; 95% CI: 0.58-0.96; p=0.02). Aqueous preparations were preferentially used for up-dosing (73.0%) and depot preparations for the maintenance phase (64.5%). The type of venom preparation neither had an influence on the frequency of systemic AE nor on the effectiveness of VIT (p=0.26 and p=0.80, respectively), while LLR were less frequently seen when depot preparations were used (p<0.001). CONCLUSION: Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLR but not systemic AE. All venom preparations used were equally effective and did not differ in the frequency of systemic AE.

Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry.

BACKGROUND: Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE: To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS: Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS: We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION: Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.

First European data from the network of severe allergic reactions (NORA).

BACKGROUND: Occurrence, elicitors and treatment of severe allergic reactions are recognized and reported differently between countries. We aimed to collect standardized data throughout Europe on anaphylaxis referred for diagnosis and counselling. METHODS: Tertiary allergy, dermatology and paediatric units in 10 European countries took part in this pilot phase of the first European Anaphylaxis Registry, from June 2011 to March 2014. An online questionnaire was used to collect data on severe allergic reactions based on the medical history and diagnostics. RESULTS: Fifty-nine centres reported 3333 cases of anaphylaxis, with 26.7% below 18 years of age. Allergic reactions were mainly caused by food (children and adults 64.9% and 20.2%, respectively) and insect venom (20.2% and 48.2%) and less often by drugs (4.8% and 22.4%). Most reactions occurred within 30 min of exposure (80.5%); a delay of 4+ hours was mainly seen in drug anaphylaxis (6.7%). Symptom patterns differed by elicitor, with the skin being affected most often (84.1%). A previous, usually milder reaction to the same allergen was reported by 34.2%. The mainstay of first-line treatment by professionals included corticoids (60.4%) and antihistamines (52.8%). Only 13.7% of lay- or self-treated reactions to food and 27.6% of insect anaphylaxis received on-site adrenaline. CONCLUSION: This pilot phase of a pan-European registry for severe allergic reactions provides for the first time data on anaphylaxis throughout Europe, demonstrates its potential functionality and allows a comparison of symptom patterns, elicitors and treatment habits between referral centres and countries.

Cigarette smoking among students and the influence of legal regulations on passive smoking.

Research suggests that reducing the degree of nicotine addiction in the population cannot be achieved only by prevention programs. Legislative measures are necessary to be taken by the state. The aim of this study was to assess the degree of tobacco abuse in three groups of students. It also assesses the influence of ban on smoking in public places on passive contact of students with tobacco. A customized survey made up of open and closed questions was conducted among 102 students of electrical faculty, 109 medical students, and 71 students of animal husbandry faculty. The results showed that significantly more women from the electrical faculty smoked. Among the students of animal husbandry, men smoke significantly more cigarettes than women. Women studying animal husbandry start smoking significantly earlier (by about 2 years) than women from other faculties. They are also significantly less likely to smoke cigarettes at school and at home. According to the study, the Polish law to ban smoking in public places, in force since the 15th of November 2010, did not make students quit smoking, although the rate of smoking students decreased. Students did not observe restrictions on smoking in their environment. The study indicates a positive influence of the anti-nicotine legislation on passive smoking, just after 3 months from its introduction.

ß2-adrenergic receptor gene polymorphism and response to bronchodilating treatment evaluated by spirometry.

ß2-adrenergic receptors re abundantly expressed in airways, which explains the role of ß2 agonists, the strongest bronchodilators, in treatment of bronchial constriction. There may be a relation between ß2ADR gene polymorphism and the response to treatment with ß2 agonists. In the present study we attempted to study these relationship in vivo, estimating spirometric values before and after the use of salbutamol in reference to variant of ß2ADR gene polymorphisms. The study involved 148 healthy male volunteers. After the examination of the gene polymorphism of the ß2-adrenergic receptor (ß2-ADR) at nucleotide positions 46 and 79 (g.46 and g.79) we performed spirometry testing in all subjects. The pulmonary function was checked twice a day; before and 15 min after the administration of salbutamol. All subjects had normal basic values of spirometry. The use of salbutamol significantly increased spirometric values in all groups determined by ß2ADR gene polymorphisms. Analysis of the spirometric values in individual groups showed a significant increase only in peak expiratory flow (g.46AA and g.79CC). The results of this study give an insight into a possibly important mechanism of the response to treatment with ß2-agonists.

Influence of body mass index on treatment of breathing-related sleep disorders.

BACKGROUND: Breathing-related sleep disorders cover several conditions (isolated snoring, UARS - upper airway resistance syndrome, obstructive sleep apnea, hypopnea, obesity hypoventilation syndrome) characterized by a variety of symptoms and complex etiology. The conditions can be successfully treated in most cases. Excessive body mass is a factor increasing the probability of the disorders. In most patients it is the only reason for breathing-related sleep disorders. However, it often coexists with various anatomical abnormalities in the upper airway, endocrinological diseases or genetic defects of the facial skeleton, and occurs more frequently in older people, especially men. Excessive body mass significantly affects the range and success of the treatment. OBJECTIVE: To analyze treatment outcome in patients treated at the otolaryngology unit for snoring and related diseases with submucosal tissue reduction within the nasal cavity, pharynx, and soft palate. MATERIAL AND METHODS: Patients were stratified into three study groups depending on the body mass index (BMI): normal, overweight, and obese. The BMI value was compared to the severity of breathing disorders during sleep, with the incidence of other systemic diseases (e.g., hypertension, diabetes), and with treatment outcome. RESULTS AND CONCLUSIONS: The analysis demonstrated a significant influence of body mass on snoring, particularly in complicated and severe types of breathing disorders, such obstructive sleep apnea or hypopnea, and the obesity hypoventilation syndrome. Corrective interventions carried out to eliminate anatomical abnormalities causing obstruction of upper airways provided the best therapeutic effects in patients with normal body mass.

Causes of respiratory ailments in pregnancy.

OBJECTIVE: During pregnancy, especially during its third trimester, most pregnant women reported respiratory discomfort (dyspnea), despite the absence of previously coexisting respiratory illnesses. The aim of this study was to determine the reason for this discomfort. MATERIAL AND METHODS: The study included 24 women examined before and after childbirth. Evaluation of respiratory complains was made on the basis of the respiratory questionnaire of St. George's Hospital. The data were correlated with the results of static and dynamic spirometric tests performed before and after childbirth. RESULTS: Pregnancy did not affect vital capacity (VC). Frequency of perceived symptoms correlated positively with IRV and the ratio IC/VC. A negative correlation was found between ERV and its derivative ERV/VC. There was no relationship between perceived discomfort and parameters of the flow-volume loop. CONCLUSIONS: The extent of perceived respiratory discomfort (dyspnea) during pregnancy was primarily associated with a reduction in expiratory reserve (ERV).

Changes of laryngeal parameters during intrauterine life.

OBJECTIVE: Increased care of fetal and neonatal airways has led to advances in neonatal medicine. The early diagnosis and treatment of respiratory diseases require a detailed knowledge of fetal airway anatomy and development. The aim of this study was to determine the anatomical development of the thyroid and cricoid cartilages and their structural variability during fetal life. MATERIAL AND METHODS: The study was performed on the thyroid and cricoid cartilages of 55 human fetal larynges of both sexes, between the ages of 13 and 27 weeks of intrauterine life. Numerous measurements of the thyroid and cricoid cartilages were performed. RESULTS: Correlations between the obtained results were calculated in relation to the crown-rump (C-R) length of human fetuses and to sex. The structural variability of the thyroid and cricoid cartilages of human male and female fetuses in subsequent weeks of intrauterine life was observed. In both genders a correlation between laryngeal size and fetal crown-rump length, regardless of sex, was found. The thyroid cartilage presents a sexual dimorphism. CONCLUSIONS: The results of this study can be useful in the analysis of prenatal examinations, and in planning the treatment of airway emergencies.

Snoring and sleep disorders in children with hypertrophy of lymphoid tissue in the throat.

Hypertrophy of lymphoid tissue within the throat in children leads to a number of respiratory problems and sleep disorders. The aim of this study was to evaluate the prevalence of the above-mentioned changes depending on the location of overgrown lymphoid tissue, BMI, and coexisting allergies. The study was based on a survey conducted in a group of 103 children aged 3-14 with a hypertrophy of lymphoid tissue requiring surgery. The questionnaire included questions about symptoms of sleep disordered breathing. In addition, BMI was calculated and the coexistence of other diseases in the group of examined children was taken into account. Pathological changes predominated in children aged 4-6. The incidence of snoring was the most common, observed in 87%, followed by apnea in 45% of the examined group. Co-occurrence of allergies was observed in 36% and excess of body weight in 21% of the children. Overweight was an essential factor that facilitated apneic sleep episodes accompanying lymphoid hyperplasia. Snoring and nasal obstruction were observed more often in allergic patients.