Beclomethasone dipropionate aerosol in allergic rhinitis.

Treatment with beclomethasone dipropionate aerosol (BDA), 50 mug four times daily in each nostril, was compared with placebo therapy in a double-blind non-crossover trial of 30 matched patients with allergic rhinitis induced by ragweed pollen. The trial was started at the beginning of the ragweed season and continued for 42 days. Response to treatment was assessed from information on daily diary cards, weekly objective measurements of nasal patency and measurement of total eosinophil count (TEC) before treatment and at week 4. Patients in the BDA group had significantly less (P less than 0.05) sneezing, rhinorrhea and nasal stuffiness at 36 days, cough at 10 days and antihistamine consumption at 17 days. There was no significant difference between the groups in eye symptoms, nasal airway inspiratory resistance, maximum inspiratory nasal flow or TEC. Overall comparison with previous pollen seasons by the patients indicated moderate to great improvement in 86% of the BDA group and in 13% of the placebo group (P less than 0.01). Minor side effects were noted by two patients in each group.     

Randomised double blind controlled clinical trial of intranasal budesonide in treatment of hay fever.

The effectiveness of budesonide, a new non-halogenated glucocorticoid administered by nasal inhaler, was evaluated in a double blind comparison with placebo in patients presenting with hay fever. Patients were supplied with antihistamine tablets and eye drops for use when they considered that their symptoms were inadequately controlled by their inhaler. Patients recorded the severity of their symptoms in a daily diary card and visited their general practitioner for assessment weekly for four weeks. All nasal symptoms of hay fever were appreciably reduced in the group taking budesonide and, although their eye symptoms were more severe than in the group taking placebo, they did not use appreciably more eye drops than the latter. The placebo group used appreciably more antihistamine tablets than those in the budesonide group. No patients were withdrawn from the budesonide group because of treatment failure or unacceptable side effects. The results suggest that budesonide is an acceptable and effective treatment for the nasal symptoms of hay fever.     

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.     

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.     

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.     

Topical levocabastine-a review of therapeutic efficacy compared with topical sodium cromoglycate and oral terfenadine on days with high pollen counts

Levocabastine is a new H(1)-receptor antagonist specifically developed for the topical treatment of seasonal allergic rhinoconjunctivitis. Clinical experience to date clearly demonstrates that levocabastine eye drops and nasal spray are effective and well tolerated for the treatment of this allergic disorder. Analysis of data from a number of comparative trials reveals that topical levocabastine is at least as effective as sodium cromoglycate and the oral antihistamine terfenadine, even on days with high pollen counts (>/= 50 pollen particles/m(3) ) when symptoms are severe. Coupled with a rapid onset of action and twice daily dosing, these findings make topical levocabastine an attractive alternative to other therapeutic approaches as a first-line therapy for the treatment, of this common condition.     

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.     

Quantitative dynamics of Ambrosia pollen grains in Bulgaria

The aerobiological study of the Ambrosia pollen in Sofia, Bulgaria began in 1991. The quantitative dynamics of Ambrosia pollen grains during the last seven years was determined by Chebishev's method of parabolic interpolation with orthogonal polynoms. Thesensitization to ragweed pollen was investigated in random groups of patients with clinical manifestation of hay fever.This investigation proves the previouslyobserved tendency of an increase in thespreading of Ambrosia pollen in Bulgaria.     

Concentration of IgE in children during ragweed pollination season

Genetic and environmental factors are responsible for running allergic diseases. The aim of this study was to compare the values of total- (t-IgE) and allergen-specific IgE (s-IgE) to Ambrosia artemisiifolia L. (Amb a) in children with sensitization to Amb a during ragweed pollination season, who experienced seasonal symptoms of allergic rhinitis (rhinorrhea, post-nasal drip, nasal congestion, itching, sneezing) and asthma (coughing, especially at night, wheezing, shortness of breath, chest tightness). Ragweed pollen grains were collected in Virovitica (rural area) and Zagreb (urban area)—cities with the same geographical width and elevation—during ragweed pollination seasons (July–October in 2006 and 2007), and their count was estimated. Concentration of t-IgE and s-IgE in pollination season was determined in serum of children with symptoms of allergic diseases. The total count of ragweed pollen grains (PG) differed significantly between Virovitica and Zagreb in both years, 2006. and 2007. In Virovitica it was significantly greater than in Zagreb. There was no statistically significant seasonal difference in both, t-IgE and s-IgE, respectively. No correlation was found between pollen grain count and the concentration of IgE’s. To clarify the induction of IgE synthesis in children with sensitization to Amb a, further studies are needed.     

Airborne ragweed (Ambrosia artemisiifolia L.) pollen concentrations in Croatia, 2002–2004

The aim of this study was to determine the onset, length and end of the ragweed pollen season, taking into account diurnal, day-to-day, monthly and annual pollen variations, the effect of some meteorological parameters on atmospheric pollen concentrations and possible differences in the airborne pollen season and concentration due to sampling site. Airborne pollen was collected at three sites in central Croatia (Zagreb, Samobor and Ivanić Grad) during three pollen seasons (2002–2004). Seven-day Hirst-type volumetric pollen traps were used for pollen sampling. Ragweed pollen was the third most abundant pollen type to occur in the atmosphere of central Croatia. Total Ambrosia pollen concentration was the highest in the 2003 pollen season and the lowest in 2004 at all sampling sites. Maximum emissions were restricted to August and September. Intradiurnal periodicity showed a peak from 1000 to 1200 hours. The concentration of ragweed pollen during the pollen season was greatly influenced by temperature and precipitation: on rainy days accompanied by temperature decline, the air pollen concentration decreased abruptly. The results of this study are aimed at helping to alleviate the symptoms of allergic reactions in individuals with ragweed pollen hypersensitivity, thus improving their quality of life.     

Local Effect of Intranasal Beclomethasone Dipropionate Aerosol in Hay Fever

The effect of a daily dose of 400 μg beclomethasone dipropionate aerosol intranasally has been investigated in a double-blind cross-over trial in 29 patients with hay fever. The effect on the nasal symptoms was so pronounced in 25 patients that further symptomatic treatment was unnecessary. Beclomethasone dipropionate aerosol had, on the other hand, no direct effect on itching in the eyes, which is in accordance with the fact that biochemical investigations did not show any sign of suppression of the adrenal function. It is concluded that beclomethasone dipropionate aerosol intranasally is an effective and apparently harmless way of controlling the nasal symptoms in hay fever.     

Air and surface soil samples – two different pairs of shoes? Comparing the pollen spectrum on different days of the pollen season

The pollen spectra of air and surface soil samples from a rooftop (at 14 m) and from ground level (at 1.6 m) in the suburbs of Vienna (Austria) were compared. Two soil samples and two air samples were taken on four different days to account for possible differences: in winter when no pollination occurred (reference day), in spring during the main flowering of Betula (birch day), in spring/summer during the main flowering of Poaceae (grass day), and in autumn during the main flowering of Ambrosia (ragweed day). Thirty-five different pollen types were used to describe the pollen spectra. Frequencies of certain pollen types reflect a seasonal impact on both the surface soil and air samples and show a similarity between air and soil samples on most of the days. However, the seasonal impact is higher in the air samples and shows a high consistency for ground and rooftop level. Kendall’s tau correlation coefficients further substantiate the similarities of the samples especially for the pollen season days. Exceptions include the winter day when pollination was low and the air samples recorded nearly no pollen at all, and the ragweed day when Ambrosia pollen was abundant in three of four samples but not in the ground surface soil sample. Thus, (1) air and surface pollen samples record similar signals during the pollen season but not during the ragweed and winter season and (2) air and surface pollen samples show the impact of local vegetation also in pollen traps located at different heights.     

Development and pilot evaluation of a novel probiotic mixture for the management of seasonal allergic rhinitis

Microbial exposure may direct the immune system away from allergic-type responses, but until now probiotic interventions have had limited success in the prevention and treatment of allergic diseases. In this study, a novel probiotic mixture was specifically created based on preliminary in vitro investigations on pollen-induced immune responses. A mixture with Lactobacillus rhamnosus GR-1 and a novel fecal Bifidobacterium adolescentis isolate was formulated into a yogurt and tested for its effects in 36 subjects with allergic rhinitis over 2 pollen seasons in a double-blind, placebo-controlled trial. The new formulation was well tolerated, but did not have significant effects on the quality of life scores, use of antihistamines, or eosinophil cationic protein concentration in nasal lavage. However, at the end of the grass pollen season, serum IL-10 and IL-12 levels were increased in the probiotic group compared to the controls. During the ragweed season, the serum TGF-β levels were significantly higher in the probiotic group than in the controls. In conclusion, the novel probiotic formulation had potentially desirable effects on the cytokine profile of patients with allergic rhinitis, but provided few clinical benefits. The study highlights the challenges in designing efficient immunomodulatory probiotic therapies based upon in vitro findings.     

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.     

The effect of temperature, relative humidity and rainfall on airborne ragweed pollen concentrations

Major weather parameters have long been known to alter airborne pollen and spore concentrations. The following study was conducted to study the effect of three of these parameters on airborne ragweed pollen concentrations.During the ragweed (RW) season for the years 1997 and 1998, 10 minute pollen collections were taken at least every 4 hours using an Allergenco MK-3 spore trap. Slides were fixed, and counted microscopically at 400X. During this same period, weather parameters were monitored by an Automated Weather Systems recording station located within a few meters of the collector.The ragweed season for this region begins in mid August and ends by mid October. Temperature patterns for the period demonstrated usual daily fluctuations with highs 13 to 35 °C and lows 8 to 24 °C. Relative humidity readings for the period varied between 25 and 100%. Highest RW values were seen after seasonal cooling in September. Daily rainfall for the period varied between 0 and 100 mm. Airborne RW always declined sharply after strong rainfall events (> 10 mm/day). Peak airborne RW concentrations were often associated with the passing of frontal boundaries and the change in wind direction and velocity that accompanies that passing.Factors influencing airborne RW concentrations are multiple and complex, but atmospheric forces have great influence. The passing of major weather fronts and the associated temperature drops, wind disturbances and rainfall are the major factors.     

Nasal Sensitization with Ragweed Pollen Induces Local-Allergic-Rhinitis-Like Symptoms in Mice

Recently, the concept of local allergic rhinitis (LAR) was established, namely rhinitis symptoms with local IgE production and negative serum antigen-specific IgE. However, the natural course of LAR development and the disease pathogenesis is poorly understood. This study investigated the pathophysiology of mice with allergic rhinitis that initially sensitized with ragweed pollen through the nasal route. Mice were nasally administrated ragweed pollen over consecutive days without prior systemic immunization of the allergen. Serial nasal sensitization of ragweed pollen induced an allergen-specific increase in sneezing, eosinophilic infiltration, and the production of local IgE by day 7, but serum antigen-specific IgE was not detected. Th2 cells accumulated in nose and cervical lymph nodes as early as day 3. These symptoms are characteristic of human LAR. Continual nasal exposure of ragweed pollen for 3 weeks resulted in the onset of classical AR with systemic atopy and adversely affected lung inflammation when the allergen was instilled into the lung. Fcer1a ^−/− mice were defective in sneezing but developed normal eosinophilic infiltration. Contrary, Rag2 ^−/− mice were defective in both sneezing and eosinophilic infiltration, suggesting that T cells play a central role in the pathogenesis of the disease. These observations demonstrate nasal allergen sensitization to non-atopic individuals can induce LAR. Because local Th2 cell accumulation is the first sign and Th2 cells have a central role in the disease, a T-cell-based approach may aid the diagnosis and treatment of LAR.     

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.     

Examination of seasonal difference in serum interleukin-17 and interleukin-5 concentrations in ragweed-sensitized children

Dysregulation of inflammatory mediators is characteristic for chronic inflammation in allergy. The aim was to determine the values of serum IL-17 and IL-5 in ragweed-sensitized children. The study included children analyzed during the ragweed pollen season compared to children analyzed out of season. Serum total IgE, specific IgE, and eosinophil cationic protein (ECP) were determined by fluoroimmunoassay while the concentrations of IL-5 and IL-17 were determined by flow cytometry. Patients evaluated during the pollen season, have higher values of total and specific IgE, eosinophil and neutrophil count than patients studied outside the pollen season. There was no statistically significant seasonal and out of season differences for the concentration of IL-17, IL-5, and ECP. Natural exposure to ragweed pollen allergen was not crucial for the induction of increased IL-17 and IL-5 synthesis, and factors other than allergen exposure should be investigated, especially in longitudinal studies of patients.     

Effects of Nasal Corticosteroids on Boosts of Systemic Allergen-Specific IgE Production Induced by Nasal Allergen Exposure

BackgroundAllergen exposure via the respiratory tract and in particular via the nasal mucosa boosts systemic allergen-specific IgE production. Intranasal corticosteroids (INCS) represent a first line treatment of allergic rhinitis but their effects on this boost of allergen-specific IgE production are unclear.AimHere we aimed to determine in a double-blind, placebo-controlled study whether therapeutic doses of an INCS preparation, i.e., nasal fluticasone propionate, have effects on boosts of allergen-specific IgE following nasal allergen exposure.MethodsSubjects (n = 48) suffering from grass and birch pollen allergy were treated with daily fluticasone propionate or placebo nasal spray for four weeks. After two weeks of treatment, subjects underwent nasal provocation with either birch pollen allergen Bet v 1 or grass pollen allergen Phl p 5. Bet v 1 and Phl p 5-specific IgE, IgG_1–4, IgM and IgA levels were measured in serum samples obtained at the time of provocation and one, two, four, six and eight weeks thereafter.ResultsNasal allergen provocation induced a median increase to 141.1% of serum IgE levels to allergens used for provocation but not to control allergens 4 weeks after provocation. There were no significant differences regarding the boosts of allergen-specific IgE between INCS- and placebo-treated subjects.ConclusionIn conclusion, the application of fluticasone propionate had no significant effects on the boosts of systemic allergen-specific IgE production following nasal allergen exposure.

Trial Registration

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