Controle ambiental: prevenção e manejo das doenças atópicas / Environmental control: prevention and management of atopic diseases

A asma é uma das doenças crônicas mais prevalentes no mundo, sendo que 50% a 80% dos pacientes apresentam o fenótipo alérgico. A asma resulta da interação entre predisposição genética e exposição ambiental. Os aeroalérgenos perenes, especialmente os ácaros da poeira doméstica, são considerados um dos responsáveis pelo aumento da prevalência da asma em todo mundo. O controle ambiental é uma das medidas necessárias para o tratamento e controle da asma.

Asthma is one of the most prevalent chronic diseases worldwide, and 50 to 80% of affected patients have the allergic phenotype. Asthma results from the interaction between genetic predisposition and environmental exposure. Perennial aeroallergens, especially household dust mites, are considered one of the reasons for the increase in the prevalence of asthma worldwide. Environmental control is a necessary measure to treat and control asthma.

La atención del cáncer en el Ecuador: pasado, presente y futuro / Cancer care in Ecuador: past, present and future

Contexto: El Ecuador tiene un sistema nacional de salud caracterizado por una amplia fragmentación institucional, por segmentación poblacional y del financiamiento. Esto determina una distribución inequitativa de recursos y servicios para el control del cáncer. SOLCA es una organización privada que desde 1951, ofrece al país atención especializada en cáncer. Por otra parte, la incorporación de los servicios de oncología en los hospitales públicos del MSP es relativamente reciente. Discusión: la nueva Estrategia Nacional para la Atención Integral del Cáncer en Ecuador incluye líneas de acción dirigidas a la prevención, detección temprana, diagnóstico, tratamiento, rehabilitación y cuidados paliativos, promoviendo la acción social e intersectorial e incidiendo en la educación de la población. Además, se espera que esta estrategia disminuya la carga socioeconómica, promueva la calidad de vida y reduzca la inequidad en el acceso a los servicios de salud; sin embargo, su adecuada implementación requerirá de la participación y los esfuerzos de todos los sectores involucrados, incluyendo las organizaciones civiles. Conclusión: el control y atención integral del cáncer en Ecuador debe ser una prioridad nacional por lo cual, las decisiones y acciones futuras, deberán basarse en una responsabilidad compartida entre los diferentes actores, en el marco de una verdadera conciencia social y en la aplicación del derecho constitucional a la salud. (AU)

Context: Ecuador has a national health system characterized by a wide institutional fragmentation, by population segmentation and financing. This determines an inequitable distribution of re-sources and healthcare services for cancer control. The Society for the Fight against Cancer (SOLCA) is a private organization that, since 1951, offers specialized cancer care in the country. On the other hand, the incorporation of oncology services in public hospitals of the MSP is relatively recent. Discussion: dthe new National Strategy for Comprehensive Cancer Care in Ecuador includes lines of action aimed at prevention, early detection, diagnosis, treatment, rehabilitation and palliative care, promoting social and intersectoral action, and influencing the education of the population. In addition, this strategy is expected to reduce the socioeconomic burden, promote quality of life and reduce inequity in access to health services. However, its proper implementation will re-quire the participation and efforts of all the sectors involved, including civil organizations. Conclusion: the control and comprehensive care of cancer in Ecuador should be a national priority There-fore, decisions and future actions should be based on a shared responsibility among the differ-ent actors, within the framework of a true social conscience and in the application of constitu-tional right to health. (AU)

The potential of synthetic biology for improving environmental quality and human health in developing countries / Biología Sintética: un nuevo potencial para mejorar la calidad ambiental y la salud humana en países en desarrollo

ABSTRACT Environmental quality is a major factor in global health that mainly affects the poorest populations. Vector- borne diseases, climate change, pollution and unintentional poisonings are recognized as the primary causes of environmental diseases burden in developing countries. The development and implementation of new technologies to reduce the impact of these risk factors on health in developing countries is a priority in the current research. In this regard, synthetic biology, a nearly new research area, has initiated a big revolution through the de novo design or rewiring of biological components, organisms, and functions with the aim to reduce the adverse effects of environmental risk factors on human health. Despite synthetic biology is well recognized for being a multidisciplinary area where biotechnologist, biologist, physicists, mathematicians and engineers play together, its integration with public health and other social sciences seems to be of relevance to apply these technologies into a practical context. In this review, we discuss the major advances in synthetic biology with potential to improve environmental quality and human health in developing countries.

RESUMEN La calidad ambiental es reconocida como uno de los factores con mayor impacto sobre la salud humana principalmente en los países en vías de desarrollo. Las enfermedades transmitidas por vectores, el cambio climático, la contaminación y las intoxicaciones no intencionales han sido reportados como las principales causas de enfermedades ambientales en estos países. El desarrollo y la implementación de nuevas tecnologías encaminadas a reducir el impacto de estos factores ambientales en la salud es una prioridad de la investigación actual. En ese sentido, la biología sintética ha iniciado una gran revolución al permitir el diseño de novo y el mejoramiento de diversos componentes biológicos, organismos y funciones biológicas que tienen el potencial de reducir los efectos adversos de estos factores en la salud humana de una manera más eficiente y económica. A pesar de que la biología sintética es reconocida como un área multidisciplinaria donde biotecnólogos, biólogos, físicos, matemáticos e ingenieros unen sus esfuerzos, su integración con el área de la salud pública y las ciencias sociales es muy importante para llevar estas tecnologías a la práctica. En esta revisión, nosotros discutimos los más importantes avances en biología sintética y su potencial para mejorar la calidad ambiental y la salud humana en países en vías de desarrollo.

Indoor air quality monitoring of communities surrounding a coal-fired power plant in Pagbilao, Quezon

OBJECTIVES: The study evaluated the quality of indoor air in households surrounding a coal-fired power plant in Pagbilao, Quezon and its impact to the residents in these communities.  METHODS: The researchers used a quantitative approach and gathered both primary and secondary data from the Province of Quezon, Municipalities of Pagbilao and Padre Burgos and 12 other barangays from January to June 2008. A household survey was conducted to obtain the health and socio-demographic characteristics of the respondents. Likewise, indoor air quality surveys, respiratory health profiling and pulmonary function tests were done. Indoor air quality monitoring measured eight hour levels of particulate matter -10 (PM10) in "near" and "far" barangays and sulfur dioxide (SO2) and nitrogen dioxide (NO2) in two primary impact barangays as indicated in the environmental impact assessment of the power plant.RESULTS AND CONCLUSION: Results showed that there is no significant difference (p=

Is dry eye an environmental disease? / O olho seco é uma doença relacionada a exposição ambiental?

Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/ or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED.

Diversos estudos têm demostrado que o contato ocular com poluentes ambientais afeta a composição do filme lacrimal e de estruturas da superfície ocular. Tais efeitos são mediados pela ligação de agentes ambientais com receptores na superfície ocular, levando a ativação de mediadores pró inflamatórios. Esta revisão propõe uma avaliação das evidências publicadas, que associam fatores ambientais as doenças de superfície ocular e ao olho seco. O leitor compreenderá que é possível inferir olho seco ambiental como uma entidade singular dentro do contexto da doença olho seco, diretamente causado pela exposição a poluentes e/ou condições climáticas adversas. Serão descritos os indicadores e achados clínicos, assim como o diagnóstico diferencial das fases aguda e crônica. A avaliação de relatos clínicos e observações epidemiológicas demonstra uma forte associação entre olho seco e fatores ambientais. O conhecimento sobre parâmetros internacionais e ferramentas de monitorização das condições ambientais no mundo, permite identificar localidades e populações mais suceptívies ao olho seco ambiental e pode auxiliar na identificação de indivíduos acometidos e grupos predispostos. E desta forma, melhorar o entendimento e tratamento dessa condição, diminuir os fatores associados, sua frequência e progressão.

Custo das doencas atribuiveis a fatores ambientais na cidade de Manaus, Amazonas, Brasil / Cost of illness attributable to environmental factors in the city of Manaus, state of Amazonas, Brazil

O presente estudo estimou o custo das doenças atribuíveis a fatores ambientais na cidade de Manaus, entre os anos de 1998 a 2009. As causas de internação hospitalar foram agrupadas com base nos estudos de Carga Global de Doença e da Análise Comparativa de Risco da Organização Mundial da Saúde. O valor foi estimado por meio da soma dos (i) gastos hospitalares com tratamento das doenças atribuíveis a fatores ambientais com os (ii) valores dos dias de trabalho perdidos resultante da permanência em leito hospitalar, estimados a partir da remuneração média dos trabalhadores de Manaus. Os dados ainda foram calibrados levando-se em consideração a cobertura da população com plano de saúde privado. O custo das doenças, considerando os valores corrigidos pelo Índice Geral de Preços do Mercado para o ano de 2009, foi estimado em R$ 286.852.666,97, dos quais as doenças cardiovasculares, as infecções respiratórias das vias aéreas inferiores e as doenças diarreicas são responsáveis por 78,6%. Das frações atribuíveis a fatores ambientais, as doenças cardiovasculares respondem por 16% (IC: 7-23%), as infecções respiratórias das vias aéreas inferiores por 41% (IC: 32-47%), e as diarreias por 94% (IC: 84-98%) da carga global das doenças.

The study estimated the cost of illness attributable to environmental factors in the city of Manaus between the years 1998 to 2009. The causes of hospitalization were grouped based on studies of the Global Burden of Disease and Comparative Risk Assessment of the World Health Organization. The value was estimated by the sum of (i) hospital spending on treatment of diseases directly attributable to environmental factors, and (ii) the costs of lost workdays resulting from the stay in hospital estimated on the basis of the average earnings of Manaus workers. The data were further calibrated taking into account the coverage of the population with private health insurance. The cost of illness, considering the values corrected by the General Market Price Index for the year 2009 was estimated at R$ 286,852,666.97, of which cardiovascular disease, respiratory infections of the lower airways and diarrheal diseases are responsible for 78.6% of these values. Of the fractions attributable to environmental factors, cardiovascular diseases account for 16% (CI: 7-23%), respiratory infections and respiratory infections of the lower airways for 41% (CI: 32-47%), and diarrhea for 94% (CI: 84-98%) of the global burden of disease.

Deterioro de la calidad ambiental y la salud en el Perú actual / Deterioration of environmental quality and health in Peru today

Los problemas ambientales en el Per están afectando de manera creciente a la salud y la productividad de la población nacional, especialmente a la que vive en condiciones de pobreza, y amenaza el bienestar de las generaciones futuras. El objetivo de este artículo es llamar la atención de la comunidad académica, vinculada con la Salud Pública, sobre la importancia de su participación responsable en el análisis y debate sobre las respuestas sociales a tales problemas. Para ello, se presentan los resultados de los principales estudios realizados sobre el diagnóstico ambiental en el Perú y los desafíos ambientales que la sociedad nacional tiene que enfrentar en el siglo XXI, así como las nuevas intenciones gubernamentales que sobre el tema se han formalizado en la Política Nacional del Ambiente (2009) y en el Plan Nacional de Acción Ambiental 2011-2021. Finalmente, se comenta que si bien en la última á cada, la normatividad sobre la cuestión ambiental ha tenido avances en el país – particularmente después de la Conferencia de Río de Janeiro sobre Medio Ambiente y Desarrollo (1992) –, los mismos se han mostrado insuficientes para enfrentar de manera apropiada y efectiva a los problemas ambientales existentes. Una de las razones de tal insuficiencia es que en el país aún no se cuenta con la voluntad política y las capacidades necesarias para poner en marcha políticas de desarrollo sostenible realmente efectivas, aun cuando ‚éstas se encuentren formalizadas jur¡dicamente. Insuficiencia aparentemente contradictoria en un Estado de Derecho, pero que es legitimada en el discurso oficial cotidiano, en un contexto donde esas políticas ambientales – al igual que las sociales – están subordinadas a políticas económicas orientadas por un estilo de desarrollo de libre comercio, dominante en un mundo en proceso de globalización, que impone patrones de producción y consumo que ejercen presiones excesivas sobre los recursos naturales.

The environmental problems in Peru are increasingly affecting the health and productivity of the national population, especially those living in poverty, and threaten the welfare of future generations. The aim of this article is to draw attention of the academic community, linked to public health, about the importance of responsible participation in the analysis and debate on social responses to such problems. To do this, we present the results of major studies on the environmental assessment in Peru and environmental challenges that the national society has to face in the twenty-first century, and the new government intentions that have been formalized in the National Environmental Policy (2009) and the National Environmental Action Plan 2011-2021. Finally, it is said that while in the past decade, the regulations on environmental issues has made progress in the country (particularly after the Rio Conference on Environment and Development, 1992), they have proved to be insufficient in order to deal appropriately and effectively to environmental problems. One of the reasons for this failure is that the country still lacks policies and the skills to implement sustainable development policies really effective, even if they are legally formalized. Failure seemingly contradictory rule of law, but that is legitimized in the official daily, in a context where these environmental policies (as well as social) are subordinated to economic policies aimed at developing a style of free trade, dominant a world of globalization, which requires production and consumption patterns that exert excessive pressure on natural resources.

A procura de pontos de mutação na enfermagem: eles existem? / Looking for turning points in nursing: do they exist? / Buscando puntos de mutación en la enfermería: ¿ellos existen?

Nos últimos anos, é diária a veiculação de informações acerca de catástrofes ambientais e seus impactos ecológicos e sociais, o que torna relevante pesquisar a interface saúde e meio ambiente. O objetivo deste estudo foi discutir o estado da arte construído pela enfermagem na temática ambiental, na base de dados Medline, no período de 1997 a 2010. Trata-se de uma revisão sistemática qualitativa, processada em junho de 2010, e que resgatou 35 referências, sendo 16 delas analisadas. Construíram-se como categorias de análise: Riscos ambientais; Concepção de meio ambiente e ações de enfermagem; Meio ambiente como ambiente de trabalho da enfermagem; Interação indivíduo-meio ambiente e sua influência no processo saúde/doença; e A formação em enfermagem e sua relação com a questão ambiental. Concluiu-se que a produção na área é limitada, pontual, vinculada a entrevistas e reflexões, as quais funcionam como pontos de mutação; resta saber quantos são os sensibilizados.

Given the information about environmental disasters and their ecological and social impacts broadcast daily in recent years, it is important to research at the health-environment interface. This study aimed to discuss the state-of-the-art knowledge constructed by nursing on environmental issues in the Medline database from 1997 to 2010. This qualitative, systematic review, performed in June 2010, found 35 references, 16 of which were examined. The analytical categories constructed were: Environmental hazards; The conception of environment and nursing actions; Environment as nurses’ working environment; Interaction between individual and environment and its influence on health-disease processes; and Nursing training and its Relation to environmental issues. It was concluded that production in the field is limited, occasional, and connected with interviews and critical thinking, which function as “turning points”. It remains to know how many people are aware of them.

Actualmente, es diaria la vinculación de informaciones acerca de catástrofes ambientales y sus impactos ecológicos y sociales, lo que torna relevante investigar la interface salud y medio ambiente. Esa exploración bibliográfica pretende discutir el estado de la arte construido por la enfermería en la temática ambiental, en la base de datos Medline, en periodo de 1997 a 2010. Es una revisión sistemática cualitativa, procesada en junio de 2010, que rescató 35 referencias, siendo 16 de ellas analizadas. Las categorías de análisis: Riesgos ambientales; Concepción de medio ambiente y acciones de enfermería; Medio ambiente como ambiente de trabajo de enfermería; Interacción individuo-medio ambiente y su influencia en el proceso salud enfermedad; y La formación en enfermería y su relación con la cuestión ambiental. Se concluyó que la producción en esta área es limitada, puntual, vinculada a entrevistas y reflexiones, las cuales funcionan como puntos de mutación; falta saber cuantos son los sensibilizados.

La prevalencia de geohelmintiasis se relaciona con las condiciones socioambientales / The prevalence of geohelminthiasis is related to socio-environmental conditions

Se realizó un estudio socioambiental y parasitológico en niños de áreas urbanas, periurbanas y rurales de las provincias de Buenos Aires y Misiones. Se completó una encuesta epidemiológica y se tomaron muestras fecales seriadas, las cuales se analizaron mediante técnicas de flotación y sedimentación. Del total de muestras fecales (1893), 5.5% fueron positivas en Buenos Aires y 25.6% en Misiones. El área periurbana de Misiones presentó la mayor prevalencia de parasitosis total (34.1%) y de biparasitados y poliparasitados (45.4%). Las especies más prevalentes fueron Strongyloides stercoralis (22.1%) en el sector periurbano y Ancylostomideos (21.6%) en el área rural de Misiones. Hymenolepis nana y Ascarislumbricoides mantuvieron bajas frecuencias en ambas provincias y Trichuris trichiura sólo se encontró en el periurbano de Buenos Aires. La prevalencia de geohelmintos aumentó con la edad (p < 0.05) y se asoció en el área periurbana de ambas provincias y rural de Misiones con las condiciones socioambientales: vivienda precaria, piso de tierra, eliminación de excretas en letrinas o a cielo abierto, sin recolección domiciliaria de residuos, madre sin actividad laboral, padres sin instrucción primaria (p < 0.05). Las características biogeográficas y las condiciones socioambientales de la provincia de Misiones favorecen la persistencia de las formas parasitarias en el ambiente.

Responsabilidade ambiental na visão de acadêmicos da área da saúde / Environmental responsibility in the view of students in the health field / Responsabilidad ambiental en la visión de estudiantes del área de la salud

O estudo objetivou compreender o que pensam acadêmicos da área da saúde sobre sua responsabilidade com o meio ambiente. Pesquisa descritiva, de abordagem qualitativa, realizada com 24 acadêmicos da área da saúde, de uma instituição de ensino superior do Rio Grande do Sul. Os dados foram coletados em 2010, por meio de entrevista semiestruturada, e analisados com base no referencial de análise de conteúdo. Os acadêmicos revelam que a sua responsabilidade com o meio ambiente abrange as dimensões pessoal e profissional. Acreditam que deve haver convergência entre educação em saúde e educação ambiental, sendo importante servir como exemplo, desenvolvendo ações de preservação ambiental. Depreende-se ser de fundamental importância a inserção dessa temática no contexto da formação profissional, a fim de buscar-se uma postura de responsabilidade socioambiental por parte dos futuros profissionais da saúde.

This study sought to understand what students in the health field think of their responsibility to the environment. A qualitative, descriptive study was conducted of 24 students in the health field at a higher education institution in Rio Grande do Sul. Data were collected in 2010 by semi-structured interview and were analyzed using content analysis as the frame of reference. The students revealed that their responsibility to the environment spans the personal and professional dimensions. They believe there should be convergence between health education and environmental education, and that it is important they serve as an example by engaging in environmental preservation actions. It follows inferred that it is of crucial importance to introduce this subject into professional training, in order to foster a posture of socio-environmental responsibility among future health professionals.

El estudio tuvo por objetivo comprender lo que piensan los estudiantes del área de la salud sobre su responsabilidade con el medio ambiente. Investigación descriptiva, de abordaje cualitativo, realizada con 24 estudiantes del área de la salud, de una institución de enseñanza superior de Rio Grande del Sur-Brasil. Los datos fueron recolectados en 2010, por medio de entrevista semiestructurada, y analizados con base en el referencial de análisis de contenido. Los estudiantes han demonstrado que su responsabilidad con el medio ambiente abarca las dimensiones personal y profisional. Creen que debe haber una convergencia entre educación en salud y educación ambiental, siendo importante servir como un ejemplo, desarrollando acciones de preservación ambiental. Se percibe de fundamental importancia la inserción de esa temática en el contexto de la formación profesional, con el fin de buscarse una postura de responsabilidad socioambiental por parte de los futuros profesionales de la salud.

Condiciones ambientales como factores de riesgo para la salud y su relación con enfermedades diarreicas e infecciones respiratorias agudas, en niños/as menores de 5 años que acuden al hospital de Quillacollo entre septiembre a noviembre del 2010 / Environmental conditions as risk factors for health and their relationship with diarrheal diseases and acute respiratory infections in children / as under 5 attending the hospital Quillacollo from September to November 2010

Las condiciones de vivienda y saneamiento básico son fundamentales para llevar una vida sana y de calidad; sin embargo, al no contar con los mismos o si éstos son utilizados de manera ineficiente, llega a ser dañino para la salud. El presente estudio relacionó estos factores de vivienda y saneamiento básico con la incidencia de dos enfermedades con más altas tasas de de morbi mortalidad en niños/as menores de 5 años, en el hospital de segundo nivel de Quillacollo, con un total de 98 menores de 5 años que asistieron a consulta externa por una de estas dos enfermedades.Un 73.6% de niños/as que tuvo diarrea y un 74.4% que tuvo tos, cuenta con servicios básicos adecuados como agua por cañería, recojo de basura a través de un carro basurero y alcantarillado, y un 26.4% que tuvo diarrea y un 25.6% que tuvo tos, cuentan con servicios alternativos como agua de pozo, disposición de basura a través de un contenedor y letrina sanitaria. Estos resultados llevaron a la elaboración de propuestas de educación para el mejoramiento de las condiciones de vivienda y saneamiento básico, tanto para el personal de salud y las autoridades del municipio, con el objetivo de sensibilizar a los mismos y lograr una mayor atención a la población, velando de esta manera por la salud, sobre todo la infantil

The influence of ambient air pollutants on outpatient visits for allergic disease and pollinosis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To assess the effects of ambient air pollutants on hospital outpatient visits for allergic disease and pollinosis.</p><p><b>METHODS</b>The monitoring data of daily air pollution (SO(2), NO(2) and PM(10)) in 8 national monitoring and controlling sites of Beijing air quality, airborne pollen in 4 monitoring sites of Beijing, and daily meteorological data, along with the daily numbers of outpatients visits for allergic disease and pollinosis at the Allergy Department of Beijing Shijitan Hospital from April to September in 2004 were collected. Associations between the levels of air pollutants and outpatient visits for allergic disease and pollinosis were estimated by time serial analysis using a generalized addictive model (GAM), considering lag effect and the influence of multipollutants.</p><p><b>RESULTS</b>During the study period, the average daily ambient concentrations of SO(2), NO(2) and PM(10) were (20.9 ± 12.9), (58.6 ± 13.6) and (126.8 ± 64.1) µg/m(3), respectively. The mean daily pollen count was (163.8 ± 209.0) grains/1000 mm(2), while the average daily numbers of doctor visits for allergic disease and pollinosis were (16.3 ± 5.3) and (3.5 ± 5.0), respectively. Time serial analysis showed that significant positive associations were found between levels of airborne pollen and doctor visits, with an excess risk (ER) of 2.44% (95%CI: 0.75% - 4.13%)for allergic disease and 6.58% (95%CI: 3.82% - 9.34%) for pollinosis per 100 grains/1000 mm(2) increase in pollen, in single-pollutant models. There were associations between ambient air pollutants (SO(2), NO(2), PM(10)) and doctor visits with lag effects. A 10 µg/m(3) increase in NO(2) was associated with a 3.14% (95%CI: 0.42% - 5.85%) increase in doctor visits for allergic disease at lag 6 d. For pollinosis, the highest ER was observed for 10 µg/m(3) increases in SO(2) at lag 1 d, NO(2) at lag 6 d, PM(10) at lag 3 d. However, this association was not statistically significant (RR (95%CI) were 1.0460 (0.9640 - 1.1280), 1.0325 (0.9633 - 1.1017), 1.0079 (0.9942 - 1.0217), respectively). The associations enhanced slightly in multi-pollutant models with an ER of 2.56% (95%CI: 0.80% - 4.31%) for allergic disease and 6.81% (95%CI: 3.91% - 9.71%) for pollinosis per 100 grains/1000 mm(2) of pollen.</p><p><b>CONCLUSIONS</b>Our results suggest that level of airborne pollen may have a stronger effect than ambient air pollutants on allergic disease and pollinosis.</p>