Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis

ObjectivesTo compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever).DesignRandomised, double blind, parallel group comparison.SettingFour outpatient general medicine and allergy clinics in Switzerland and Germany.Participants131 patients were screened for seasonal allergic rhinitis and 125 patients were randomised (butterbur 61; cetirizine 64).InterventionsButterbur (carbon dioxide extract tablets, ZE 339) one tablet, four times daily, or cetirizine, one tablet in the evening, both given for two consecutive weeks.ResultsImprovement in SF-36 score was similar in the two treatment groups for all items tested hierarchically. Butterbur and cetirizine were also similarly effective with regard to global improvement scores on the clinical global impression scale (median score 3 in both groups). Both treatments were well tolerated. In the cetirizine group, two thirds (8/12) of reported adverse events were associated with sedative effects (drowsiness and fatigue) despite the drug being considered a non-sedating antihistamine.ConclusionsThe effects of butterbur are similar to those of cetirizine in patients with seasonal allergic rhinitis when evaluated blindly by patients and doctors. Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided.

What is already known on this topic

Seasonal allergic rhinitis (hay fever) is common in countries with temperate climates.Most patients have their symptoms treated for short periods, particularly during peaks in atmospheric pollen count

What this study adds

After two weeks, the effects of butterbur and cetirizine were comparable in patients with hay feverButterbur produced fewer sedating effects than cetirizineButterbur should be considered when the sedating effects of antihistamines must be avoided     

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.     

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.     

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.     

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.     

Quantitative DNA Analyses for Airborne Birch Pollen

Birch trees produce large amounts of highly allergenic pollen grains that are distributed by wind and impact human health by causing seasonal hay fever, pollen-related asthma, and other allergic diseases. Traditionally, pollen forecasts are based on conventional microscopic counting techniques that are labor-intensive and limited in the reliable identification of species. Molecular biological techniques provide an alternative approach that is less labor-intensive and enables identification of any species by its genetic fingerprint. A particularly promising method is quantitative Real-Time polymerase chain reaction (qPCR), which can be used to determine the number of DNA copies and thus pollen grains in air filter samples. During the birch pollination season in 2010 in Mainz, Germany, we collected air filter samples of fine (<3 μm) and coarse air particulate matter. These were analyzed by qPCR using two different primer pairs: one for a single-copy gene (BP8) and the other for a multi-copy gene (ITS). The BP8 gene was better suitable for reliable qPCR results, and the qPCR results obtained for coarse particulate matter were well correlated with the birch pollen forecasting results of the regional air quality model COSMO-ART. As expected due to the size of birch pollen grains (~23 μm), the concentration of DNA in fine particulate matter was lower than in the coarse particle fraction. For the ITS region the factor was 64, while for the single-copy gene BP8 only 51. The possible presence of so-called sub-pollen particles in the fine particle fraction is, however, interesting even in low concentrations. These particles are known to be highly allergenic, reach deep into airways and cause often severe health problems. In conclusion, the results of this exploratory study open up the possibility of predicting and quantifying the pollen concentration in the atmosphere more precisely in the future.     

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.     

植物类过敏性蛋白(变应原)研究进展

据相关资料最新统计表明,全球大约有25%的人口受到I型变态反应疾病的影响。植物中的花粉、汁液和果实可以分别作为吸入性、接触性和食入性过敏原影响过敏体质的人群。目前,惟一有效的办法是应用特异性变应原进行脱敏治疗(脱敏治疗)。而在应用天然变应原提取物进行传统免疫治疗过程中存在一定的危险性。通过基因工程的方法合成的修饰后的高纯度特异变应原在保持过敏性蛋白完整的免疫活性的同时可降低其本身的过敏原性。这种修饰后的过敏性蛋白的应用将使免疫治疗更趋于标准化操作同时避免应用天然过敏性蛋白天然提取物时的危险性,最终可达到提高治疗的效果的目的。目前,重组这种新的过敏性蛋白已经成为过敏性疾病研究的新的热点。     

Characterization of Rhinitis According to the Asthma Status in Adults Using an Unsupervised Approach in the EGEA Study

Background

The classification of rhinitis in adults is missing in epidemiological studies.

Objective

To identify phenotypes of adult rhinitis using an unsupervised approach (data-driven) compared with a classical hypothesis-driven approach.

Methods

983 adults of the French Epidemiological Study on the Genetics and Environment of Asthma (EGEA) were studied. Self-reported symptoms related to rhinitis such as nasal symptoms, hay fever, sinusitis, conjunctivitis, and sensitivities to different triggers (dust, animals, hay/flowers, cold air…) were used. Allergic sensitization was defined by at least one positive skin prick test to 12 aeroallergens. Mixture model was used to cluster participants, independently in those without (Asthma-, n = 582) and with asthma (Asthma+, n = 401).

Results

Three clusters were identified in both groups: 1) Cluster A (55% in Asthma-, and 22% in Asthma+) mainly characterized by the absence of nasal symptoms, 2) Cluster B (23% in Asthma-, 36% in Asthma+) mainly characterized by nasal symptoms all over the year, sinusitis and a low prevalence of positive skin prick tests, and 3) Cluster C (22% in Asthma-, 42% in Asthma+) mainly characterized by a peak of nasal symptoms during spring, a high prevalence of positive skin prick tests and a high report of hay fever, allergic rhinitis and conjunctivitis. The highest rate of polysensitization (80%) was found in participants with comorbid asthma and allergic rhinitis.

Conclusion

This cluster analysis highlighted three clusters of rhinitis with similar characteristics than those known by clinicians but differing according to allergic sensitization, and this whatever the asthma status. These clusters could be easily rebuilt using a small number of variables.     

Sensitivity to mugwort pollen allergens (Artemisia vulgaris)

The author has found that 42% of patients with pollinosis had positive skin reactions with mugwort (Artemisia vulgaris) pollen allergens. The majority of tested patients (139 out of 187) were also allergic to grass pollens. However, hypersensitivity to mugwort pollen allergens was isolated and did not accompany grass pollen allergy. The symptoms of pollinosis appeared in this group later than in patients sensitive to grass pollen allergens only (over 21 years of age in 71%). Bronchial asthma was diagnosed in 40% of these patients and allergic skin reactions in 25%. Sensitivity to mugwort pollen allergens was accompanied by the sensitivity to pollen allergens of Graminae family of plants in 80% of cases. The author suggests that sensitivity to mugwort pollen allergens is the second most frequent cause of the pollinosis and is diagnosed too rarely. Failures of desensitization in patients sensitive to pollen allergens of Graminae family of plants may often result from coexisting sensitivity to mugwort pollen allergens as this sensitivity produces not only season but perennial clinical symptoms in nearly 50% of patients. The author discusses also botanical relations and cross-reactions in allergy to mugwort and ragweed pollen allergens.     

植物过敏性蛋白质及其生物学功能

在引起I型超敏反应的变应原中 ,植物的花粉、果实和汁液可以分别作为吸入性变应原 (inhalentallergen)、食入性变应原 (ingestentallergen)、接触性变应原 (contactentallergen)使过敏者患上鼻炎、哮喘、枯草热等疾病。而其中引起这些超敏反应的植物类蛋白质本身在植物体内亦行使着特定的生物学功能。对这些植物类过敏性蛋白质的研究不仅在植物学本身研究中具有一定意义 ,同时在变态反应性疾病的免疫治疗中亦具有重要的应用价值。目前 ,这类涉及植物学、免疫学和变态反应学的研究逐渐形成了一个新的交叉研究领域。     

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.     

The impact of pollen load on quality of life: a questionnaire-based study in Lithuania

Populations worldwide have been increasingly affected by allergic rhinitis associated with pollen allergens. Alterations in the geographical distribution of pollinating flora resulting from climatic changes and increased production of pollens caused by higher atmospheric CO₂, have changed the environment in which humans reside. This study, carried out in Lithuania, aimed to demonstrate how people with pollen allergy are affected by symptoms associated with changing pollen loads and to evaluate the resultant changes in human quality of life. This study assessed pollen loads in Lithuania during 2013–2014. Skin prick tests were carried out on 665 individuals aiming to evaluate sensitivity to pollen allergens. Self-reports on symptoms and their impact on quality of life were collected from each study subject. There were 24× to 42× differences in inter-annual peaks of Betula pollen concentrations, while differences of plant pollen concentrations of the other genus/families varied from 1.5 to 92 % on peak days. Positive reactions to pollen allergens were reported in 54 % of the study subjects; 90 % of these subjects had been continuously suffering from moderate-to-severe symptoms of allergic rhinitis. The most frequently reported symptoms were sneezing (99 %), runny nose (98 %) and stuffy nose (97 %). The dominant group of subjects reported symptoms during the entire period of vegetation (7 months). This study demonstrated that people with pollen allergies have attributed symptom-associated worsening of their quality of life to the typical periods of unavoidable exposure and have made only minimal changes in their lifestyle during the season of pollen load.     

The partial contribution of specific airborne pollen to pollen induced allergy

The air that we inhale contains simultaneously a multiple array of allergenic pollen. It is well known that such allergens cause allergic reactions in some 15 of the population of the Western World. However little is known about the quantitative aspect of this phenomenon. What is the lowest concentration of pollen that might trigger allergic responses? As people are exposed to heterogeneous and variable environments, clarification of the partial contribution of each of the major airborne pollen allergens and determination of its role in invoking allergy are of prime importance. Objectives: (1) Assessment of a possible correlation between the concentration of airborne pollen and incidence of allergy. (2) Estimation of the lowest average concentrations for various species of airborne pollen that elicit allergic symptoms when exceeded. (3) Determination of the extent of the variations in manifestation of allergy symptoms that can be explained by fluctuations in the concentration of individual species of airborne pollen. Methods: The study was conducted during 14?months with a rural population in Israel. The participants completed a detailed questionnaire and were skin prick tested with the common airborne allergens. The appearance of clinical symptoms, i.e. nasal, bronchial, ocular or dermal, were reported daily by the patients. Concentrations of the airborne pollen and spores were monitored in the center of activity of the residents during one day every week, using three ‘Rotorod’ pollen traps. The pollen grains were identified by light microscopy. Results: The pollen spectrum was divided into time-blocks presenting the main pollination periods of the investigated species. The correlation between the concentration of airborne pollen of the relevant species and the clinical symptoms of the patients was determined for each time block. The correlation differed for different clinical symptoms and for different pollen allergens. Highest correlation with airborne pollen counts was found for patients with nasal and bronchial symptoms. The onset of the clinical symptoms by sensitive patients started, in each of the relevant groups, once the weekly average concentration of the airborne pollen crossed a threshold level. Under the limitations of the present study, this level was estimated to be 2–4 pollen m^?3 air for olive, 3–5 pollen m^?3 air for grasses, 4–5 pollen m^?3 air for Artemisia, 10–20 pollen m^?3 air for pecan and 50–60 pollen m^?3 air for cypress. Conclusions: Fluctuations in specific airborne pollen grains explained up to 2/3 of the variation in clinical allergy responses. Those were: 69 of the variation for cypress (March–April), 66 for the grasses (March–April), 49 for the pecan (May–June) and 62 for Artemisia (Autumn).     

Bronchial asthma in hay fever

The author diagnosed cough, emphysema and the symptoms characteristic for the bronchial asthma in 43% of patients with seasonal allergy (rhinitis, conjunctivitis) to pollens. Such symptoms were more frequent (51% of cases) in patients allergic to the grass pollens with coexisting hypersensitivity to Compositae family. Asthmatic symptoms in patients allergic only to grass pollens were seen in 38%. The author suggests that prolonged exposition in the inhalatory allergens (from two to four-five months) plays an important role in asthma onset in such patients. It rather delays than accelerates admittance to allergic clinics.     

The combination of airborne pollen and allergen quantification to reliably assess the real pollinosis risk in different bioclimatic areas

Exposure to allergens represents a key factor among the environmental determinants of asthma. The most common information available for pollinosis patients is the concentration of pollen grains in the bioaerosol and their temporal distribution. However, in recent years, discordance between pollen concentrations and allergic symptoms has been detected. The purpose of this research is to evaluate the relationship between pollen counts and the atmospheric aeroallergen concentrations in different Spanish bioclimatic areas. For the monitoring of allergen content in the air, a quantitative antigen–antibody technique combined with the Cyclone sampling methodology was used. The study was conducted during 2007 by considering some of the most common allergens that induce pollinosis in each area: Platanus and Urticaceae in Ourense and Cartagena, and Poaceae in Ourense and León. In Ourense, pollen counts and aeroallergen concentrations coincided for the three pollen types studied, and the pollen and allergen data associated with the meteorological factors were highly significant for the pollen counts. In Cartagena (for Platanus and Urticaceae) and León (for Poaceae), the low correlations between pollen counts and allergen concentrations obtained could be due to the specific bioclimatic conditions. In contrast, the higher allergen concentrations found in the atmosphere in Cartagena and León compared to Ourense could be related to the existing pollutant levels there, inducing a higher expression of plant pathogenesis-related proteins in the plants of polluted cities. The combination of pollen counts and allergen quantification must be assessed to reliably estimate exposure of allergic people to allergens in different bioclimatic areas.     

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.     

Trends in prevalence of allergic rhinitis and correlation with pollen counts in Switzerland

In recent decades, a large number of epidemiological studies investigating the change of prevalence of hay fever showed an increase in the occurrence of this disease. However, other studies carried out in the 1990s yielded contradictory results. Many environmental factors have been hypothesized to contribute to the increasing hay fever rate, including both indoor and ambient air pollution, reduced exposure to microbial stimulation and changes in diets. However, the observed increase has not convincingly been explained by any of these factors and there is limited evidence of changes in exposure to these risk factors over time. Additionally, recent studies show that no further increase in asthma, hay fever and atopic sensitisation in adolescents and adults has been observed during the 1990s and the beginning of the new century. As the pattern of pollen counts has changed over the years, partly due to the global warming but also as a consequence of a change in the use of land, the changing prevalence of hay fever might partly be driven by this different pollen exposure. Epidemiological data for hay fever in Switzerland are available from 1926 until 2000 (with large gaps between 1926 and 1958 and 1958 to 1986) whereas pollen data are available from 1969 until the present. This allows an investigation as to whether these data are correlated provided the same time spans are compared. It would also be feasible to correlate the pollen data with meteorological data which, however, is not the subject of our investigation. Our study focuses on analyzing time series of pollen counts and of pollen season lengths in order to identify their trends, and to ascertain whether there is a relationship between these trends and the changes in the hay fever prevalence. It is shown in this paper that the pollen exposure has been decreasing in Basel since the beginning of the 1990s whereas the rate of the hay fever prevalence in Switzerland remained approximately unchanged in this period but with a slight tendency to decrease. In Locarno, most of the pollen species also show a decreasing trend, while in Zurich, the development is somewhat different as the pollen counts of most of the pollen types have been increasing. It is interesting, however, that some of the pollen counts of this station (grass, stinging nettle, mugwort and ragweed) have been decreasing in the period 1982–2007.