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.     

Nasal hyperreactivity and inflammation in allergic rhinitis

The history of allergic disease goes back to 1819, when Bostock described his own 'periodical affection of the eyes and chest', which he called 'summer catarrh'. Since they thought it was produced by the effluvium of new hay, this condition was also called hay fever. Later, in 1873, Blackley established that pollen played an important role in the causation of hay fever. Nowadays, the definition of allergy is 'An untoward physiologic event mediated by a variety of different immunologic reactions'. In this review, the term allergy will be restricted to the IgE-dependent reactions. The most important clinical manifestations of IgE-dependent reactions are allergic conjunctivitis, allergic rhinitis, allergic asthma and atopic dermatitis. However, this review will be restricted to allergic rhinitis. The histopathological features of allergic inflammation involve an increase in blood flow and vascular permeability, leading to plasma exudation and the formation of oedema. In addition, a cascade of events occurs which involves a variety of inflammatory cells. These inflammatory cells migrate under the influence of chemotactic agents to the site of injury and induce the process of repair. Several types of inflammatory cells have been implicated in the pathogenesis of allergic rhinitis. After specific or nonspecific stimuli, inflammatory mediators are generated from cells normally found in the nose, such as mast cells, antigen-presenting cells and epithelial cells (primary effector cells) and from cells recruited into the nose, such as basophils, eosinophils, lymphocytes, platelets and neutrophils (secondary effector cells). This review describes the identification of each of the inflammatory cells and their mediators which play a role in the perennial allergic processes in the nose of rhinitis patients.     

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.     

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.     

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.     

Allergenic airborne pollen monitoring of Vigo (NW Spain) in 1995–2001

Pollen data from the atmosphere of Vigo, NW Spain was collected using a Hirst type pollen trap over a seven-year period (1995–2001). A total of 56 different pollen types were identified, among which Urticaceae, Poaceae, Betula and Quercus represent the greatest risk for people suffering from allergic rhinitis (hay fever) or other allergic diseases. Although in the atmosphere of Vigo the presence of allergenic pollen is constant throughout the year, the months of March and April account for 40% of the annual total pollen count. Two main risk periods have been identified for asthma and allergies: (1) March – April, and (2) June – July, the latter is of greater importance due to high concentrations of Poaceae pollen. Correlation analysis with meteorological parameters demonstrates that rainfall, relative humidity, maximum temperature, sun hours and north-easterly winds are the main factors influencing the average daily pollen concentrations in the atmosphere.     

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.     

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.     

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     

Pollen generates nitric oxide and nitrite: a possible link to pollen-induced allergic responses

Reactive nitrogen species (RNS), such as nitric oxide (NO), are ubiquitous and diverse signalling molecules involved in a wide range of physiological and pathophysiological processes in both animals and plants. Nitrite, a metabolite of NO turnover, has also been recently characterised as an important mediator of fundamental physiological mechanisms in mammalian cells, and is a substrate for NO production in several plant cell signalling processes. A previous study demonstrated that during plant reproductive processes, intracellular NO is produced by pollen, and that such NO could be important in signalling interactions between pollen and stigma. The aim of this study was to establish whether pollen releases NO and nitrite, using a wide range of plant species. Using a fluorimetric assay in conjunction with electron paramagnetic resonance (EPR) spectroscopy, the present study demonstrated that all hydrating pollen examined released NO, although some appeared to have more activity than others. Additionally, gas phase ozone-based chemiluminescence data showed that nitrite is also released from hydrating pollen. Given that pollen has interactions with other cells, for example in allergenic rhinitis (hay fever) in humans, it suggests that NO might be involved in mediating the responses of both plant and animal cells to pollen. These findings may have important implications for future allergy research, as it is possible that pollen-derived NO and nitrite may impact on mammalian cells during pollen-induced allergic responses.     

Pollen Loads and Allergic Rhinitis in Darwin, Australia: A Potential Health Outcome of the Grass-Fire Cycle

Although the prevalence of asthma and allergic rhinitis has been increasing in tropical regions, little is known about the allergenicity of pollens from tropical plant families or the importance of ongoing environmental changes. We investigated associations between daily average pollen counts of several tropical plant families and sales of medications for the treatment of allergic rhinitis in Darwin, Australia—a tropical setting in which grass abundance has increased due to increased fire frequencies and the introduction of African pasture grasses. Daily pollen counts with detailed identification of plant species were undertaken in conjunction with a weekly survey of flowering plant species from April 2004 to November 2005. Five pharmacies provided daily sales data of selected medications commonly used to treat allergic rhinitis. We used generalized linear modeling to examine outcomes. All analyses accounted for the potential confounding effects of time trends, holidays, respiratory viral illnesses, meteorological conditions, and air pollution. The peak total pollen count was 94 grains/m³. Despite the low levels of Poaceae (grass) pollen (maximum daily count, 24 grains/m³), there was a clear association with daily sales of anti-allergic medications greatest at a lag of 1 day. Sales increased by 5% with an interquartile range rise (3 grain/m³) in Poaceae pollen (5.07%, 95%CI 1.04%, 9.25%). No associations were observed with pollen from other plant families. Although further testing is required, we suggest that an overlooked aspect of the “grass-fire cycle” that is degrading many tropical landscapes, could be an increase in the prevalence of allergic rhinitis.     

Seasonal non-allergic rhinoconjunctivitis

Several patients suffering from seasonal rhinitis imitating treepollen induced hay fever, but who have negative tests with pollen allergens, have been investigated. In a retrospective study, 86 such patients with seasonal non-allergic rhinitis (SNAR) were compared with two other groups of patients: patients with birch pollen hay fever (BP) and patients with vasomotor rhinitis (VR). It was found that SNAR and VR compared to BP started at a later age, was more common in females and less often combined with hypersensitivity against nuts, apples and stone fruits. Flowers and strong smells more often elicited symptoms in SNAR than in VR and BP. The seasonal symptoms started earlier among SNAR than among BP patients. Positive skin tests with common inhalant allergens were much more common in BP than in SNAR. It is concluded that SNAR has more characteristics in common with VR than with BP. A probable explanation of the disease is a non-specific hypersensitivity to non-allergenic substances occurring in out-door air in spring, possibly air pollutants bound to pollen grains.     

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.     

John Freeman,hay fever and the origins of clinical allergy in Britain, 1900–1950

In 1911, Drs John Freeman and Leonard Noon published an account of a novel treatment for hay fever. Their method of desensitisation consisted of injecting increasing doses of an extract of pollen subcutaneously until the hypersensitivity reaction was diminished or abolished. Over subsequent decades, desensitisation established itself as the cornerstone of clinical allergy in both England and the United States, at least until the advent of novel pharmaceutical agents in the 1950s and 1960s. Although British allergists such as Noon and Freeman were aware of conceptual developments within European immunology and pathology (such as the identification of anaphylaxis by Richet and Portier or von Pirquet’s coining of the term allergy), their approach to hay fever was driven by more immediate pragmatic, and indeed financial, considerations. Freeman’s immersion in the problems of hay fever and asthma and his pioneering use of allergen desensitisation or immunotherapy were shaped by his adherence to the convictions and bacteriological practices of his principal at St Mary’s Hospital, Almroth Wright, and by the drive to produce commercial vaccines which would help to subsidise the experimental and therapeutic work at St Mary’s. The aim of this paper is to explore early twentieth-century approaches to hay fever and other allergic diseases by tracing the intellectual and institutional origins of clinical allergy in Britain.     

Atmospheric Poaceae pollen frequencies and associations with meteorological parameters in Brisbane,Australia: a 5-year record, 1994–1999

Grass pollen is an important risk factor for allergic rhinitis and asthma in Australia and is the most prevalent pollen component of the aerospora of Brisbane, accounting for 71.6% of the annual airborne pollen load. A 5-year (June 1994–May 1999) monitoring program shows the grass pollen season to occur during the summer and autumn months (December–April), however the timing of onset and intensity of the season vary from year to year. During the pollen season, Poaceae counts exceeding 30 grains m^–3 were recorded on 244 days and coincided with maximum temperatures of 28.1 ± 2.0 °C. In this study, statistical associations between atmospheric grass pollen loads and several weather parameters, including maximum temperature, minimum temperature and precipitation, were investigated. Spearmans correlation analysis demonstrated that daily grass pollen counts were positively associated (P < 0.0001) with maximum and minimum temperature during each sampling year. Precipitation, although considered a less important daily factor (P < 0.05), was observed to remove pollen grains from the atmosphere during significant periods of rainfall. This study provides the first insight into the influence of meteorological variables, in particular temperature, on atmospheric Poaceae pollen counts in Brisbane. An awareness of these associations is critical for the prevention and management of allergy and asthma for atopic individuals within this region.     

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.     

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 Belgian Pollen Phone Service: Immediate and direct information to hay fever sufferers

The Belgian Pollen Phone Service gives continuous information about the pollen content of the air. A comparison of the number of incoming phone calls with the pollen content of the air revealed a surprisingly good correlation. This article underlines the success of this service. It confirms the high susceptibility of hay fever sufferers at the beginning of the season. It also highlights that pollinosis is not always limited to birch and grass pollen allergy and it demonstrates the necessity for the continuous determination of the pollen content of the air. Allergies to mugwort pollen seem to be less important. The Pollen Phone Service is a prompt way to provide allergic subjects with recent pollen information.     

The Belgian Pollen Phone Service: immediate and direct information to hay fever sufferers

The Belgian Pollen Phone Service gives continuous information about the pollen content of the air. A comparison of the number of incoming phone calls with the pollen content of the air revealed a surprisingly good correlation. This article underlines the success of this service. It confirms the high susceptibility of hay fever sufferers at the beginning of the season. It also highlights that pollinosis is not always limited to birch and grass pollen allergy and it demonstrates the necessity for the continuous determination of the pollen content of the air. Allergies to mugwort pollen seem to be less important. The Pollen Phone Service is a prompt way to provide allergic subjects with recent pollen information.     

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.