Development and validation of a 5-day-ahead hay fever forecast for patients with grass-pollen-induced allergic rhinitis

One-third of the Dutch population suffers from allergic rhinitis, including hay fever. In this study, a 5-day-ahead hay fever forecast was developed and validated for grass pollen allergic patients in the Netherlands. Using multiple regression analysis, a two-step pollen and hay fever symptom prediction model was developed using actual and forecasted weather parameters, grass pollen data and patient symptom diaries. Therefore, 80 patients with a grass pollen allergy rated the severity of their hay fever symptoms during the grass pollen season in 2007 and 2008. First, a grass pollen forecast model was developed using the following predictors: (1) daily means of grass pollen counts of the previous 10 years; (2) grass pollen counts of the previous 2-week period of the current year; and (3) maximum, minimum and mean temperature (R ²?=?0.76). The second modeling step concerned the forecasting of hay fever symptom severity and included the following predictors: (1) forecasted grass pollen counts; (2) day number of the year; (3) moving average of the grass pollen counts of the previous 2 week-periods; and (4) maximum and mean temperatures (R ²?=?0.81). Since the daily hay fever forecast is reported in three categories (low-, medium- and high symptom risk), we assessed the agreement between the observed and the 1- to 5-day-ahead predicted risk categories by kappa, which ranged from 65 % to 77 %. These results indicate that a model based on forecasted temperature and grass pollen counts performs well in predicting symptoms of hay fever up to 5 days ahead.     

Incidence of allergic rhinitis in general practice, 1981-92.

OBJECTIVES--To determine the epidemiology of hay fever and to consider the role of pollution. DESIGN--Examination of data on weekly incidence of allergic rhinitis and hay fever by age, sex, region, and location. SETTING--Royal College of General Practitioners Weekly Returns Service. Practice data were based on registered populations of 220,000 in 1981, rising to 700,000 in 1992 from England and Wales. MAIN OUTCOME MEASURES--Numbers of new cases of hay fever and allergic rhinitis. Data on pollen counts for Darlington, Derby, and London. RESULTS--The incidence of allergic rhinitis fluctuated greatly from year to year but showed no trend. Peaks in hay fever coincided with peak pollen counts. No important differences were found between urban and rural locations or different parts of the country with respect to both size and timing of the peaks. Incidence was highest in children (5-14 years). CONCLUSIONS--The similarity of the results throughout England and Wales does not support an important role for local pollutants in hay fever. However, the possibility that levels of pollutants are high enough to act as an adjuvant in hay fever across the whole study area has not been excluded.     

Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts.

OBJECTIVE: To investigate whether changes in certain perinatal and social factors explain the increased prevalence of hay fever and eczema among British adolescents between 1974 and 1986. DESIGN: Two prospective birth cohort studies. SETTING: England, Wales, and Scotland. SUBJECTS: 11,195 children born 3-9 March 1958 and 9387 born 5-11 April 1970. MAIN OUTCOME MEASURES: Parental reports of eczematous rashes and of hay fever or allergic rhinitis in the previous 12 months at age 16. RESULTS: The prevalence of the conditions over the 12 month period increased between 1974 and 1986 from 3.1% to 6.4% (prevalence ratio 2.04 (95% confidence interval 1.79 to 2.32)) for eczema and from 12.0% to 23.3% (prevalence ratio 1.93 (1.82 to 2.06)) for hay fever. Both conditions were more commonly reported among children of higher birth order and those who were breast fed for longer than 1 month. Eczema was more commonly reported among girls and hay fever among boys. The prevalence of hay fever decreased sharply between social classes I and V, increased with maternal age up to the early 30s, and was lower in children whose mothers smoked during pregnancy. Neither condition varied significantly with birth weight. When adjusted for these factors, the relative odds of hay fever (1986 v 1974) increased from 2.23 (2.05 to 2.43) to 2.40 (2.19 to 2.63). Similarly, the relative odds of eczema rose from 2.02 (1.73 to 2.36) to 2.14 (1.81 to 2.52). CONCLUSIONS: Taken together, changes between cohorts in sex, birth weight, birth order, maternal age, breast feeding, maternal smoking during pregnancy, and father''s social class at birth did not seem to explain any of the observed rise in the prevalence of hay fever and eczema. However, correlates of these factors which have changed over time may still underlie recent increases in allergic disease.     

Changes to airborne pollen counts across Europe

A progressive global increase in the burden of allergic diseases has affected the industrialized world over the last half century and has been reported in the literature. The clinical evidence reveals a general increase in both incidence and prevalence of respiratory diseases, such as allergic rhinitis (common hay fever) and asthma. Such phenomena may be related not only to air pollution and changes in lifestyle, but also to an actual increase in airborne quantities of allergenic pollen. Experimental enhancements of carbon dioxide (CO[Formula: see text]) have demonstrated changes in pollen amount and allergenicity, but this has rarely been shown in the wider environment. The present analysis of a continental-scale pollen data set reveals an increasing trend in the yearly amount of airborne pollen for many taxa in Europe, which is more pronounced in urban than semi-rural/rural areas. Climate change may contribute to these changes, however increased temperatures do not appear to be a major influencing factor. Instead, we suggest the anthropogenic rise of atmospheric CO[Formula: see text] levels may be influential.     

Study of airborne pollen composition and allergen spectrum of hay fever patients in South Hungary (1990–1999)

On the basis of their 10-year-longaeropalynological and allergological studies,the authors examined the changes in theallergen spectrum of hay fever patients inconnection with the seasonality of the symptomsand pollen count of this period of 10 years.The results of skin prick tests (SPT) and casehistories of patients examined in 1990/91 and1998/99 were compared. Pollen counting wasperformed with a Hirst-type pollen trap. By theend of the observed period, the ratio ofseverely polysensitized patients (4 or morepositive skin prick tests) increasedsignificantly according to the significantlyincreased amount of positive skin prick teststo trees, rye and plantain. As the seasonalityof the patients' symptoms did not change duringthis period, this increase in skin prick testpositivity means latent allergy. However, in afew years time, it may become manifest allergycausing symptoms in the early springtime.According to the results of pollen counting,the atmospheric pollen pollution of the regionwas markedly high during the possiblesensitization period of these patients.     

Seasonal distribution of pollen in the atmosphere of melbourne: an airborne pollen calendar

Environmental monitoring of pollen grains in the atmosphere of Melbourne has been achieved using Burkard volumetric traps. Twenty-two families of flowering plants and confiers were identified in the pollen counts. About 62% of these pollen grains belonged to trees, 20% to grasses and 9% to herbs and weedy plants. During spring and summer, the atmosphere contained about 70% of the total annual pollen count. Tree pollen, predominantly elm and cypress, occurred abundantly in late winter and spring, with grass pollen predominantly in spring and early summer. These three types of pollen grains occurred in significant amounts, together accounting for more than 60% of the total annual catch. A seasonal incidence chart (pollen calendar) for Melbourne based on 2 years observation has been constructed. This pollen calendar is useful in identifying sources of allergies against particular seasonal airborne pollen types. Comparison of the time of occurrence of a particular pollen type using the pollen calendar and the time of allergic symptoms, can lead to accurate diagnosis and preventive measures being taken. This study has confirmed that grass pollen is the major source of allergenic pollen in the external environment triggering hay fever and allergic asthma in spring and early summer in Melbourne, Australia.     

Effects of aeroallergens on the lung function of primary school children at two contrasting sites in South-East England

It is well known that airborne pollen canaffect lung function and general well-being. This is particularly true for individualspredisposed to respiratory complications (forexample sufferers from hay fever and asthma). Globally, there is evidence that asthmaincidence is increasing in children over 2years of age, and, within the UK, thesouth-east of England has the highest incidencefor all ages in the population.Variations in lung function of school children(measured as peak expiratory volume) withassociated changes in airborne pollen andpollution loads at two contrasting sites (oneurban, the other rural) within the Medway Townsin south-east England were measured during thepollen season in 1998. Children of similar agesand social backgrounds participated in thestudies, and account was taken of children withknown respiratory problems. Pollen, pollutionand weather data were collected at each site.A picture has been obtained of how changes inlocal and regional aeroallergen levels, as wellas other environmental factors, effect publichealth in this region of England. Children atthe urban site produced consistently betteraverage lung function results, although morepollen was caught there. At the rural sitethere was generally no relationship betweenpollen counts and lung function. As expected,lung function was lower on anticyclonic dayswhen there was less mixing in the air. Thereis strong evidence that episodes of airpollution were more important in promotingreduced peak expiratory flows than specificaeroallergen levels alone. Whilst thisrequires further investigation, it confirmsthat attributing changes in lung functionsolely to pollen levels may sometimes bemisleading.     

Gramineae hay fever,and aerobiological and clinical investigation in Palermo; Sicily

Summary Epidemiological and aerobiological observations (1987;1989) have been carried out for three years in order to search the existing relationship between the Gramineae's daily pollen concentration in Palermo's atmosphere and the number of hay fever cases due to such pollen.The aerobiological data were obtained with a 2000 VPPS volumetric sampler. Clinical research was performed on 555 hay fever patients treated in our ambulatory over a three-year period (1987–1989).These data, elaborated by a seven day running mean method and correlated with epidemiological data, evidenced that three of the pollen families in our territory are clinically important: Urticaceae,Parietaria prevailing among them, Gramineae and Oleaceae,Olea europaea prevailing among them.The Gramineae are the second most important allergenic pollen (32,08% of all the pollinosis) whereas, as far as its concentration in the atmosphere is concerned; it ranks third followingParietaria and Oleaceae.     

Using meteorologic data to predict daily ragweed pollen levels

Pollen-related allergy is a common disease resulting in symptoms of hay fever and asthma. Control of symptoms depends (generally) on avoidance and pharmacological treatment. Both of these approaches could benefit from accurate predictions of pollen levels for future days. We have constructed a model that uses meteorological data to predict ragweed pollen levels based on air samples collected daily in Kalamazoo, MI from 1991 to 1994. Ragweed pollen counts were converted to pollen grains/m³ of air (24-h average). We used Poisson regression, which appropriately handles the heterogenous variance associated with pollen data. Using standard statistical model selection procedures, combined with biological considerations, we selected rainfall, wind speed, temperature, and the time measured from the start of the season as the most significant variables. Using our model, we propose a method that uses the weather forecast for the following day to predict the ragweed pollen level. This approach differs from most previous attempts because it uses Poisson regression and because this model needs to be fit iteratively each day. By updating the coefficients of the model based on the information to date, this method allows the fundamental shape of the pollen distribution curve to change from year to year. Application to the Kalamazoo data suggests that the method has good sensitivity and specificity for predicting high pollen days.     

Aerobiology of Urticaceae pollen in Trieste (NE Italy)

The aerobiological behaviour of Urticaceae in Trieste and the correlations with the meteorological parameters were examined. Airborne pollen was collected from 1990 to 1999 using a Hirst type spore trap (Burkard) and the data interpretation was performed according to the standard method adopted by the Italian Aeroallergen Network. The main pollen season of Urticaceae in Trieste goes from mid-April to mid-September. The highest values occur in May and June. Although different seasonal patterns are found every year, the main peak occurs on average at the beginning of May, followed by other decreasing peaks until September. Thecumulative counts vary greatly over the years, with a mean value of 18.315 p/m³. The maximum annual total pollen grains was registered in 1996 and the minimum in 1991. Spearman's correlation was used to establish the relationship between the daily pollen counts and the daily meteorological data both considering their original quantitative values and transformed values according to their day by day changes. Daily pollen concentrations present usually positive correlation with temperature, negative with rainfall and wind speed and no correlation with humidity. Better results were obtained with transformed values.     

Relation of indoor heating with asthma,allergic sensitisation,and bronchial responsiveness: survey of children in south Bavaria.

OBJECTIVE--To investigate the relation between different types of heating and the prevalence of atopic diseases, skin test reactivity, and bronchial hyperresponsiveness. DESIGN--Cross sectional survey among school-children aged 9-11 years. Skin prick tests, pulmonary function tests, and bronchial challenge in the children and self completion of a written questionnaire by the children''s parents. SUBJECTS--1958 children in a rural area in southern Bavaria, Germany. MAIN OUTCOME MEASURES--Prevalence of asthma, hay fever, and atopic dermatitis as determined by parents'' answers to a questionnaire; the atopic status of the child assessed by skin prick tests; and bronchial responsiveness to cold air challenge in the children. RESULTS--After possible confounders were controlled for, the risk of developing hay fever (odds ratio = 0.57; 95% confidence interval 0.34 to 0.98), atopy defined as at least one positive reaction to a panel of common aeroallergens (0.67; 0.49 to 0.93), sensitisation to pollen (0.60; 0.41 to 0.87), and of bronchial hyperresponsiveness (0.55; 0.34-0.90) was significantly lower in children living in homes where coal or wood was used for heating than in children living in homes with other heating systems. CONCLUSIONS--Factors directly or indirectly related to the heating system used in rural Bavarian homes decrease the susceptibility of children to becoming atopic and to developing bronchial hyperresponsiveness.     

Google Trends reflect allergic rhinitis symptoms related to birch and grass pollen seasons

Google Trends (GT) describes the variation of the relevant interest of internet searches toward medical conditions and related symptoms. Allergic rhinitis symptom levels result from the intensity of exposure to aeroallergens in combination with relevant medication use. We analyze data from Germany to examine the relationship between hay fever-related Google search terms, symptom levels, medication use, and pollen count levels. For doing so, we also employ the new definitions on pollen season and peak pollen period start and end as proposed by the European Academy of Allergy and Clinical Immunology in a recently published position paper. We extract GT data for a number of search terms related to allergic rhinitis for Germany. We use total nasal symptom and mediation scores as reported by patients via a patient hay fever diary in the Berlin and Brandenburg areas in Germany for 3 years (2014–2016), accompanied by pollen data. Then a Pearson and Spearman correlation analysis is performed between symptom data and GT data. A graphical analysis is conducted, and the identification of pollen season and peak pollen periods is done based on the EAACI criteria. The analysis reveals that GT data are highly correlated with symptom levels and follow peak pollen period start–end, concerning grass and birch pollen-induced allergic rhinitis symptoms. GT data can be used as a proxy for the identification of the onset and variation of nasal symptom and medication score for allergic rhinitis sufferers.     

Hay Fever in a Changing Climate: Linking an Internet-Based Diary with Environmental Data

Investigating the impact of climate change on human health requires the development of efficient tools that link patient symptoms with changing environmental variables. We developed an internet-based hay fever diary linked to simultaneously recorded pollen load and weather variables in Canberra, Australia over spring 2010. We recruited 42 hay fever sufferers to complete a simple online pollen diary daily over a period of 60 days. In conjunction, daily airborne pollen load was counted and meteorological data collected simultaneously. We focused on the relationships between temperature, rainfall, pollen count and rhinoconjunctivitis symptoms. Pollen load increased after a peak rainfall event until the end of the study. Compliance was high, averaging 79% of days per person. Nasal rhinoconjunctivitis symptoms increased in concert with increasing pollen load, and then remained high. Mucosal itching increased more gradually and strongly coincided with increased daily maximum temperature. Our study successfully demonstrated the feasibility of linking pollen load and climate variables to symptoms of rhinoconjunctivitis in the Australian community. However, a larger study would better explore the nature of associations between these variables. Similar online methods could be used to monitor a range of health responses to our changing environment.     

Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart.

OBJECTIVE--To estimate changes in the prevalence of respiratory symptoms and the reported diagnoses of asthma, eczema, and hay fever in primary school children in Aberdeen between 1964 and 1989. DESIGN--Determination of incidence prevalence and prevalence from survey data. SETTING--Aberdeen, Scotland. PARTICIPANTS--2743 primary school children (aged 8-13) from 1964 and 4003 [corrected] from 1989. MAIN OUTCOME MEASURES--Survey data on whether, according to the parent or guardian, the child wheezed or was troubled with shortness of breath; the number of episodes of breathlessness in the past year; and whether asthma, eczema, or hay fever had ever been diagnosed. RESULTS--Questionnaires were completed by the parents of 2510 children in 1964 and 3403 children in 1989. The prevalence of wheeze rose from 10.4% in 1964 to 19.8% in 1989, and the prevalence of episodes of shortness of breath increased from 5.4% to 10.0%. In both surveys wheeze and shortness of breath were more prevalent in boys than in girls. The reported diagnosis of asthma rose from 4.1% to 10.2%, hay fever from 3.2% to 11.9%, and eczema from 5.3% to 12%. The proportion of boys suffering from eczema rose from 47.7% to 60.0%. Hay fever showed a similar increase, from 49.4% to 60.1%, in boys over the 25 year period. Though the parents of a higher proportion of children with wheeze were aware of the diagnosis of asthma in 1989, because of the increased prevalence of wheeze the absolute number of parents of wheezy children who were not aware of a diagnosis of asthma increased from 7.4% to 9.6% of the population studied. CONCLUSION--The higher diagnosis rate for asthma is due not simply to changes in diagnostic fashion but reflects an increase over the past 25 years in the prevalence of respiratory symptoms, which in turn may reflect a more general change in the prevalence of atopy, the increase in which was particularly noticeable in boys. This increase explains some of the increase in hospital admission rates for children with asthma.     

Prevalence of asthma and hay fever in England and Wales.

The results concerned with the prevalence of asthma and hay fever in the large surveys of morbidity in general practice in 1970-1 and 1981-2 were compared. In data standardised for age the prevalence of asthma in men increased from 11.6 to 20.5 people consulting per 1000 population (p less than 0.001) and in women from 8.8 to 15.9 per 1000 population (p less than 0.001). Similar increases were also evident in data analysed from the 19 practices contributing to both surveys. The prevalence of asthma increased in each age group examined. Increases of similar magnitude were reported for hay fever--the prevalence in men increased from 10.8 to 19.8 people consulting per 1000 population (p less than 0.001) and in women from 10.3 to 19.7 per 1000 population (p less than 0.001) and occurred in all age groups. The prevalence of acute bronchitis was reduced significantly in the age group 5-14 and increased among the elderly. The prevalence of chronic bronchitis was reduced substantially in 1981-2. The reported increased prevalence of both asthma and hay fever represented a real increase and was not accounted for by changes in diagnostic preference. Only in the age group 5-14 was there any likelihood that some of the increased prevalence of asthma might have resulted from a reduction in the prevalence of acute bronchitis.     

Responses in the start of Betula (birch) pollen seasons to recent changes in spring temperatures across Europe

A shift in the timing of birch pollen seasons is important because it is well known to be a significant aeroallergen, especially in NW Europe where it is a notable cause of hay fever and pollen-related asthma. The research reported in this paper aims to investigate temporal patterns in the start dates of Betula (birch) pollen seasons at selected sites across Europe. In particular it investigates relationships between the changes in start dates and changes in spring temperatures over approximately the last 20 years. Daily birch pollen counts were used from Kevo, Turku, London, Brussels, Zurich and Vienna, for the core period from 1982 to 1999 and, in some cases, from 1970 to 2000. The sites represent a range of biogeographical situations from just within the Arctic Circle through to North West Maritime and Continental Europe. Pollen samples were taken with Hirst-type volumetric spore traps. Weather data were obtained from the sites nearest to the pollen traps. The timing of birch pollen seasons is known to depend mostly on a non-linear balance between the winter chilling required to break dormancy, and spring temperatures. Pollen start dates and monthly mean temperatures for January through to May were compiled to 5-year running means to examine trends. The start dates for the next 10 years were calculated from regression equations for each site, on the speculative basis that the current trends would continue. The analyses show regional contrasts. Kevo shows a marked trend towards cooler springs and later starts. If this continues the mean start date will become about 6 days later over the next 10 years. Turku exhibits cyclic patterns in start dates. A current trend towards earlier starts is expected to continue until 2007, followed by another fluctuation. London, Brussels, Zurich and Vienna show very similar patterns in the trends towards earlier start dates. If the trend continues the mean start dates at these sites will advance by about 6 days over the next 10 years. Following this work, amendments will be needed to pollen calendars and local predictive models. It will also be important to assess the implications of earlier seasons for allergy sufferers.     

Retrospective and predictive systems of information on airborne pollen concentrations in relation to hay fever

Summary In this survey, the most important aspects concerning information on airborne pollen concentrations in relation to hay fever are reported. Six of these aspects are briefly discussed. They are: target group, “spectivity”, subject exactness, routes, frequency. These aspects of information system can concern airborne pollen and/or pollinosis. The “Leiden” system has two flows of information: daily hay-fever forecast and weekly pollen bulletin.     

Numerical simulation of birch pollen dispersion with an operational weather forecast system

We included a parameterisation of the emissions of pollen grains into the comprehensive model system COSMO-ART. In addition, a detailed density distribution of birch trees within Switzerland was derived. Based on these new developments, we carried out numerical simulations of the dispersion of pollen grains for an episode that occurred in April 2006 over Switzerland and the adjacent regions. Since COSMO-ART is based on the operational forecast model of the German Weather Service, we are presenting a feasibility study of daily pollen forecast based on methods which have been developed during the last two decades for the treatment of anthropogenic aerosol. A comparison of the model results and very detailed pollen counts documents the current possibilities and the shortcomings of the method and gives hints for necessary improvements.     

Allergenic pollen and pollinosis in Warsaw

Summary Our study of fifty two hay fever patients included twenty six solely allergic to grass pollen and twenty six exhibiting allergy to various pollen species, such as hazel, birch, oak, poplar, andArtemisia. Their total and specific IgE response was evalutated by the immunoenzymatic method, while clinical reactivity was assessed by recording nasal and bronchial symptom scores between mid-March and mid-July. Simultaneously pollen counts were made. Polysensitized patients showed significantly higher levels of both total and specific IgE, which testifies to the enhanced quantitative and qualitative IgE. Multisensitized patients reacted earlier than patients sensitized to grass pollen only, which confirms that non-grass plants flowering only in the spring cause the priming effect on the nasal and bronchial mucosa. The early symptoms may be attributable to tree pollen sensitivity or may refletct higher grass pollen IgE levels in the polysensitized group. Characteristically, nasal symptoms preceded bronchial symptoms of several weeks.On comparing nasal washing from the polysensitized patients to washing from patients with grass pollen, we found much cytological material with the predominance of eosinophils.     

Airborne pollen survey of the warsaw area

Airborne and allergenic pollen types were identified in the area of Warsaw in the years 1983–1987. Over the same period of time, skin tests reactions were analysed in 400 hay fever patients. The aim of our study was to determine whether the most abundant pollen types at a given time did evoke hay fever symptoms in our allergy patients as confirmed by positive skin responses. In February, March and April 10.8% of patients showed allergy to deciduous tree pollen, while in May allergy to conifer pollen was confirmed in 2%. The most numerous group of patients demonstrating pollinosis due to grass and rye pollen attended the Clinic in June and July. In the autumn (September-October) symptoms due to weed pollens predominated in our patients.