New Developments in Climate Change, Air Pollution, Pollen Allergy, and Interaction with SARS-CoV-2

In recent years, the environmental impacts of climate change have become increasingly evident. Extreme meteorological events are influenced by climate change, which also alter the magnitude and pattern of precipitations and winds. Climate change can have a particularly negative impact on respiratory health, which can lead to the emergence of asthma and allergic respiratory illnesses. Pollen is one of the main components of the atmospheric bioaerosol and is able to induce allergic symptoms in certain subjects. Climate change affects the onset, length, and severity of the pollen season, with effects on pollen allergy. Higher levels of carbon dioxide (CO2) can lead to enhanced photosynthesis and a higher pollen production in plants. Pollen grains can also interact with air pollutants and be affected by thunderstorms and other extreme events, exacerbating the insurgence of respiratory diseases such as allergic rhinitis and asthma. The consequences of climate change might also favor the spreading of pandemics, such as the COVID-19 one.

Effects of allergen extract exchange in children and adolescents receiving house dust mite allergen immunotherapy during the Covid-19 pandemic: Real-life data

Background: In our country, allergen extracts (AEs) for house-dust mite (HDM) allergen immunotherapy (AIT), were provided by two companies which are Novohelisen Depot and Alutard SQ. During the Covid-19 pandemics, Novohelisen DepotHDM allergens could not be imported due to the unforeseen reasons. In order to ensure the continuity of AIT, consent obtained patients were treated with the AE of the other company. In this study, it was aimed to determine the frequencies of local and systemic side effects (SEs), clinical response, and the effect of AE change on these parameters during the Covid-19 pandemics. Method(s): 59 patients aged >= 5 years, followed up with the diagnosis of allergic rhinoconjunctivitis (ARC) and/or allergic asthma, and clinically related HDM allergy were included in the study. Demographic data of the patients and SEs during the treatment were recorded from the onset of subcutaneous AIT (SCIT) until September 2021. A transition protocol was created in order to maintain maximum effectiveness and minimize potential SEs of AIT after AE switching. After thetransition protocol, the frequency of SEs, and symptoms and medication scores were recorded during each AIT visit. Result(s): Of 59 patients, 38 (64.4%) were male, 27 (45.7%) had ARC and 32 (54.2%) had both allergic asthma and ARC. Age at the onset of AIT was 12 (6-17) years, and duration of the treatment was 30 (8-48) months. In this study 29 patients received Alutard-SQ (group 1) and 30 patients, Novohelisen-Depot (group 2). 19 patients in group 2 switched to AE of Alutard SQ. During the treatment period, 1209 Novohelisen Depot and 1504 Alutard SQ injections were administered and a total of 140 (5.2%) local reactions (LRs), 50 (1.8%) large local reactions (LLRs), and 7 (0.25%) systemic reactions (SRs) were observed. In group 2, 61 (8.3%) LRs and 1 (0.13%) SR were observed before switching, 5 (1.4%) LRs and neither LLR nor SR were observed after switching. Adherence to SCIT has been increased from 49.1% to 79.6% and the decrease in symptom and medication scores in the pre-transition period continued after switching. Conclusion(s): During the Covid-19 pandemics, HDM AEs transition protocol was safe in terms of local and systemic side effects, and AIT was effective.

Impact of COVID-19 on the course of allergic diseases in children

Background: to evaluate the impact of COVID-19 on the course of allergic diseases in children. Method(s): 32 children with allergic diseases who had a coronavirus infection or their parents were surveyed. The questionnaire consisted of questions about the severity of an allergic disease, the severity and complications of a SARS-CoV- 2 infection, the amount of therapy during infection and after infection. The age of patients is from 5 to 16 years (boys 62%, girls 38%). Result(s): Among the respondents were 53.1% (17 patients) with allergic rhinoconjunctivitis (AlRC), 34.3% (11) with atopic bronchial asthma (ABA), 9.5% (3) with atopic dermatitis (AtD) and 3.1% (1) with a history of acute spontaneous urticaria (OK). 71.9% of patients suffered COVID-19 in mild, 25% in moderate and 3.1% in severe forms. Complications: 11 patients were diagnosed pneumonia with lung damage of less than 25%, 1 case of acute urticaria. The analysis of the effect of COVID-19 on the course of allergic diseases was carried out among patients (25 people) who were in remission before infection: with AlRC -15, ABA -8, AtD-2 patients. Patients with AlRC against the background of COVID-19 disease in 40% cases had increase in symptoms, 33.3% noted a preservation of exacerbation after 1 month after the disease, 26.7% after 3 months. Patients with ABA had increase symptoms against the background of COVID-19 occurs in 37.5%, 25% of cases -1 month after the disease, 12.5% of cases after 3 months, Symptoms did not bother and after 6 months. 1 patient with AtD disease had an exacerbation of dermatitis during of COVID-19 and 1 month after infections. Patients who had an exacerbation of an allergic disease against the background of COVID-19, changed drug treatment on a step upper. Reducing the dose of the drugs and and the volume of drug therapy was possible only 3 months after the infection Conclusion(s): Children with allergic diseases have SARS-CoV- 2 occurs in a mild form in most cases. COVID-19 causes exacerbation of AlRC, ABA, AtD in more than 1/3 of patients. Acute urticaria was presented as a complication in one case. Exacerbation of allergopathology against the background of COVID 19 requires a transition to a step above drug therapy for 3 months. Control over the symptoms of allergic diseases is observed 3 to 6 months after the infection.

Vaccination against COVID-19 in patients with allergic diseases

Background: In the context of the COVID-19 pandemic it is very important to achieve collective immunity. Allergic reactions to vaccines are rare -up to 30 per 100 000, but 4-8 may have anaphylaxis. The aim of this study was to develop safe COVID-19 vaccination algorithm for patients with allergic diseases (AD). Method(s): Patients with the history of AD were invited for vacination to the Regional Allergy Center in Dnipro (Ukraine). Before vaccination all patients underwent: serum tryptase, whole blood count (WBC), D-dimer, blood biochemistry, electrocardiogram (ECG) and spirometry (for patients with asthma (A) only). 126 patients with AD 19-85 (53.2+/-1.5) years old (50, 39.68% men) were included into the study. 25.39% of them had seasonal allergic rhinitis (SAR);15.07% -A;10.32% -A+ SAR;35.71% -urticaria;11.11% -drug allergy;2.38% -history of anaphylaxis. Result(s): There were not any clinically significant changes found in WBC, blood biochemistry and ECG. At the same time in 4 patients (3.2%) high tryptase level was detected. Mastocytosis was diagnosed by sternal puncture in 3 of them. During 12 weeks they were treated by monoclonal antibodies and after that vaccinated with two doses of mRNA vaccine without adverse reactions. For 1 patient with high tryptase level and a history of 3 anaphylaxis with hospitalization vacination was postponed. 1 patient had elevated D-dimer (PTA was diagnosed by CT) -vaccination was temporarily delayed. In 10 patients uncontrolled A with FEV1 below 70% (36-65%) was found. After the correction of basic therapy, within 2 weeks vaccination was carried out. All patients were given a 4-fold dose of desloratadine 30 minutes before vaccination. Conclusion(s): 1. AD are not a contraindication for vacciantion against COVID-19. 2. Before vacciantion all patients with a history of AD should be examined by an allergist. 3. For patients with severe AD level of serum tryptase should be detected before vacciantion. 4. Patients with AD should be vaccinated in an allergy center with premedication of H1-blocker in a 4-fold dose.

Online public attention toward allergic rhinitis in Wuhan, China: Infodemiology study using Baidu index and meteorological data.

Background: With the popularization of the Internet and medical knowledge, more and more people are learning about allergic rhinitis (AR) on the Internet. Objective: This study aims to analyze the epidemiological characteristics and online public attention to AR in Wuhan, China, utilizing the most popular search engine in mainland China and meteorological data of Wuhan. Methods: To study the Internet attention and epidemiological characteristics of AR in Wuhan, the search volume (SV) of "Allergic Rhinitis" in Mandarin and AR-related search terms from 1 January 2014 through 31 December 2021 were recorded. For user interest, the search and demand data were collected and analyzed. Results: The yearly average Baidu SV of AR in both Wuhan and China increased year by year but began to decline gradually after the COVID-19 pandemic. Baidu SV of AR in Wuhan exhibited significant seasonal variation, with the first peak was from March to May and the second peak occurring between September and October. Correlation analysis revealed a moderate positive correlation between the monthly average SV of "Allergic Rhinitis" and "Mites" and "Mites + Pollen Allergy" in Wuhan, a weak positive correlation between the monthly average SV of "Allergic Rhinitis" and "Pollen Allergy," and a positive correlation between monthly SV of "Allergic Rhinitis" and the meteorological index of pollen allergy (MIPA). Conclusion: The attention given to the topic on the internet, as measured by the search volume, was reflective of the situation in Wuhan, China. It has the potential to predict the epidemiological characteristics of AR and help medical professionals more effectively plan seasonal AR health education.

Mutations in FLG, the gene-coding profilaggrin/filaggrin, are associated with putative hay fever in patients with atopic dermatitis

Filaggrin plays a key role in the barrier function of the skin. Mutations in the gene encoding profilaggrin/filaggrin, FLG, are a predisposing factor for atopic dermatitis (AD). Thymus and activation-regulated chemokine/ C-C motif chemokine ligand 17 (TARC/CCL17) along with immunoglobulin (Ig) E, are considered reliable serum markers of Th2-dominant inflammation. We performed analyses of association between FLG mutation status and the serum levels of IgE, TARC, and history in patients with AD. This study was approved by the Ethics Review Committee of Nagoya University Graduate School of Medicine, Aichi, Japan. Twenty-eight patients (14 males, 14 females;age range 3–45 y) with AD, who visited the out-patient clinic of dermatology, Hirosaki University Hospital, were included. Of the 28 AD patients, 5 were carriers of 1 of 10 FLG mutations. Thus, the incidence rate was 17.9%. FLG mutations were associated with putative hay fever (odds ratio = 10 [95% CI 1.15–86.89]), however, were not associated with asthma (odds ratio = 5.5 [95% CI 0.28–107.16]). As for the aggravated COVID-19 patient, it was confirmed that a serum TARC level showed a low value. Although there is not the statistical significant difference between IgE, TARC, and FLG mutations, we found an association between FLG mutation positivity and putative hay fever in AD patients. Our study is limited by the small sample size, nevertheless, the findings show a significant association between FLG mutations and hay fever and provide evidence for the role of FLG mutations in the pathogenesis of hay fever.

Primary Vocal Cord Aspergillosis

Fungal infection of vocal cord in immunocompetent host is rare and may be missed as the lesion may mimic granulomatous disease, carcinoma, leukoplakia etc. Here we present a case of a healthy male patient. A 77 years old male patient presented to ENT specialist with complaints of hoarseness of voice for last 3 months. The patient was a non-smoker, not immunocompromised or taking immunosuppressive drugs. He was prone to seasonal bouts of cough & cold with sneezing. Video laryngoscopy showed inflamed tonsils and congested vallecula & epiglottis. Both vocal cords showed proliferative mass, white keratotic patch in anterior & middle third portion with restricted movement. Tissue samples from both vocal cords was sent for histopathology (HP). Slide examination revealed necrotic exudate containing broad based aseptate fungal hyphae and a provisional diagnosis of vocal cord fungal infection favoring Mucor mycosis was made. Patient was started on Itraconazole 100 mg twice daily along with treatment for patient's allergic condition. The slides and tissue sample obtained by direct laryngoscopy were sent to a different lab for reconfirmation. Further HP examination showed necrotic exudate and fibrin deposits with abundant fungal spores & hyphae. Grocott methenamine silver (GMS) stain & Periodic acid-Schiff (PAS) staining showed fungal spores and branching septate fungal hyphae confirming a diagnosis of vocal cord aspergillosis. His routine blood tests, serology, ECG reports were normal. RTPCR (Reverse Transcriptase Polymerase Chain Reaction) for SARS-CoV-2 was negative. After final diagnosis, patient was referred to pulmonologist to exclude pulmonary aspergillosis. Medication was changed to Voriconazole 200 mg twice daily along with antileukotrienes & antihistamines for his seasonal allergies. Patient was asked to follow up with CT chest to exclude pulmonary aspergillosis. The CT chest did not show any chest pathology. His voice was normal and other physical examinations were within normal limit. He was prescribed Voriconazole 200 mg twice daily for 3 months along with antihistamines, antileukotrienes, proton pump inhibitors & cough syrup. He was advised to come for follow up with liver function test after 4 weeks. Primary fungal infection of vocal cords is rare. Fungal infection is common in immunocompromised host but to detect such cases in healthy immunocompetent patient requires high level of suspicion and usually oral antifungal therapy for 3-4 weeks results in complete resolution of symptoms & lesion as per the current literature. (Figure Presented).

The effects of prior diseases on the change of taste and smell in the COVID-19 patients: Based onglobal consortium for chemosensory research (GCCR) study

Objectives: In this study, we propose to mine the GCCR database to capture the features of the prior diseases on the change of taste and smell in the COVID- 19 patients. Methods: The study information and detailed research plan are available on OSF individual homepage (https:// osf.io/ax3p5/). We used mixed linear regression models to test our hypothesis and the p-value of interaction will be concerned. Results: Overall, we got the final sample (n=26468), the final samples included 12438 participants, who were diagnosed with COVID-19. In the 12438 participants, the prior conditions were following: 1985 patients reported high blood pressure, 2046 patients reported obesity, 1368 patients reported they had lung disease (asthma/COPD), 1104 patients reported they had chronic sinus problems, 3562 patients reported they had seasonal allergies/hay fever. Multivariate regression analysis found that for patients with chronic sinusitis with COVID-19, the degree of smell and taste disorder is higher than that of patients with non-chronic sinusitis. Chronic sinusitis and COVID- 19 have an interactive effect on smell disorder (P<0.05), the status of state and other prior diseases will overestimate. The impact of COVID-19 on the degree of smell/taste loss, the recovery degree of smell/taste of patients with seasonal allergies/hay fever, were statistically significant in the three calibration models (P<0.05). Conclusion: COVID-19 participants who had more or more than one prior disease, those participants have worse smell/taste loss than those participants who had not the prior disease. This study may help us understand the possible involvement of comorbidities in COVID-19 patients who lose smell or taste and raise the concern of chemosensory dysfunction and commodity with COVID-19.

Hypersensitivity reactions to pfizer-biontech COVID-19 vaccine in the staff of Hospital Clínico San Carlos in Madrid, Spain

Background: The purpose of the study is to analyze the type of hypersensitivity reactions (HR) with Pfizer-BioNTech COVID-19 Vaccine (Comirnaty®) referred to our Allergy Department (AD), in order to asses vaccination with second dose safely. Method: Subjects with suspicion of HR after administration of first dose of Comirnaty® were referred to our AD from the Prevention and Occupational Risk Department responsible for the vaccination of hospital staff. Clinical history with special attention to atopic comorbidities and a detailed description of the HR after first dose of Comirnaty® was recorded. After providing signed informed consent, subjects underwent an allergy workup consisting of skin prick tests and intradermal tests (immediate and delayed readings) with polyethylene glycol (PEG) 4000 (1, 10 and 100 mg/ml), Polysorbate 80 (0.004 and 0.04 mg/dl), and Comirnaty® vaccine (as is). If skin tests proved negative, the second dose of Comirnaty® was administered under close supervision at our AD with an observation period of 60 minutes. Results: As of March 10, 2021, 6907 subjects had received the first dose of Comirnaty® and 5 were referred to our AD for evaluation. Mean age was 35 years, 4 were female and 1 male. Four patients had previous allergic history consisting of seasonal allergic rhinitis, contact dermatitis to nickel and thimerosal, and allergy to metamizole and mesalazine. After vaccination, two subjects had non-immediate reactions (NIR) that were generalized erythema within the first 48-96 h. Two subjects had immediate reactions (IR) 15 min after vaccination, consisting of generalized urticaria and erythema, and one was referred with a suspicion of immediate anaphylaxis but the reaction did not meet Brighton Anaphylaxis criteria. All subjects had negative skin tests with PEG-4000, Polysorbate 80 and Comirnaty®. The patient with the “suspicion of anaphylaxis” refused to receive the second dose. The remaining 4 subjects received the second dose of Comirnaty® with no reaction. Conclusion: The incidence of suggestive hypersensitivity reactions to Comirnaty® vaccine in our hospital staff was very low (0.07%). The administration of the second dose after a negative allergy workup seems safe, although the number of subjects treated is small.

COVID-19 lockdown: A real-life experiment of pollen avoidance for children affected by pollen allergy

Background: It is known that an increase in the risk of asthma exacerbations (AE) requiring emergency department (ED) presentation is demonstrated in children and adolescents exposed to outdoor pollen. On the other hand, COVID-19 lockdown represented a real-life experiment of pollen avoidance for children affected by pollen allergy. This study aims to test if pollen avoidance prevents asthma exacerbations in children affected by pollen allergy in an ED setting. Method: It is a retrospective study involving all children with a known diagnosis of pollen-allergy asthma who attended our ED for an AE in the town of Mantova and its provincies in the period March 09-May 03 of the years 2018, 2019 and 2020. This period was chosen because it coincided with the Italian COVID-19 lockdown in 2020. Results: In 2020, 4 (0.7%) children with a known diagnosis of pollen-allergy accessed the ED for an AE. On the other hand, pediatric access for this specific type of illness was a total of 20 (0.5%) and 12 (0.3%) in 2018 and 2019 in the same period. Specifically, the rate of hospitalization was 0 in 2020 versus 3 (15%) and 1 (8.3%) in 2018 and 2019, respectively. Regarding patients' ongoing treatment, 1 (25%) patient was under asthma maintenance therapy in 2020 versus 3 (15%) and 5 (41.6%) in 2018 and 2019, respectively. In addition: the male/female rate was 50% in 2020 versus 55% and 83.3% in 2018 and 2019, respectively. About median age (years), it was 14.7 in 2020 versus 9.5 and 6.8 in 2018 and 2019, respectively (tab. 1). Conclusion: The inevitable pollen avoidance during COVID-19 lockdown could prevent AE in children affected by pollen allergy. Anyway, further study should be performed to confirm this preliminary experience. (Table Presented).

A call for action: Understanding mental health impact of COVID-19 in the referred allergic population Lopera Hernandez G

Background: With the rise of the COVID-19 pandemic, feelings of fear and anxiety have increased across the world. Extended isolation has led to mental health implications requiring immediate efforts to address the impact of the pandemic, especially in individuals who present with respiratory allergies given that the symptoms are similar to those experienced in the COVID-19 virus (Gonzalez-Diaz et al., 2021). Method: A retrospective, 16 point questionnaire evaluating the mental health of adult patients with allergic rhinitis (AR) or allergic rhinoconjunctivitis (ARC) aged 18 to 30 years and 31 years to 70 years was conducted. The COVID-19 Impact on Mental Health Questionnaire (CIMhQ) focusing on mood behaviours was based on a 1-7 scoring system with 1 being not affected and 7 being extremely affected. Additionally, all patients were asked about interest in mental health support programs through professionals including TV live streams, applicable social media content, Zoom webinars, question and answer sessions, nutrition help along with positive COVID-19 stories and successes. Results: Data was collected from January-March 2021 in a community allergy clinic. Fifty-nine people aged 18-30 years (younger group) and thirty-seven people aged 31 to 70 (older group) answered the CIMhQ. Mean scores between both groups were compared with an analysis of variances (ANOVA) and a two-tailed t-test. A significant difference in mean CIMhQ scores was identified in the younger group (M= 78.12 ) versus the older group (M= 67.92), t (94) = 3.26, p = 0.0016. The younger group displayed higher mean CIMhQ scores. Twenty-seven percent of the younger group showed interest in receiving mental health support compared to 41% in the older group. Conclusion: The younger group showed higher levels of anxiety based on average CIMhQ results in comparison to the older group. Paradoxically, the older population was more willing to receive mental health support than the younger group. Awareness of the impact of mental health during a pandemic in referred patients for allergy assessments can help physicians direct appropriate counsel. (Table Presented).

Face masks suitable for preventing COVID-19 and pollen allergy. A study in the exposure chamber.

BACKGROUND: Since the outbreak of the coronavirus pandemic, the population in Germany has been asked to wear face masks in public areas. The masks are accepted by the public. People with a pollen allergy have an interest in knowing whether masks can also provide protection against pollen and thus prevent symptoms even without medication. METHOD: In order to evaluate the potential 'antipollen effect' of face masks, 14 adults with confirmed grass pollen-induced allergic rhinoconjunctivitis were exposed to grass pollen for a period of two hours following a standardised protocol. The test was conducted outside of the grass pollen season. The subjects wore either no mask, a medical mask or a FFP2 mask. RESULTS: Subjects wearing either mask were clearly able to avoid both nasal and conjunctival symptoms. There were no significant differences between the two masks in terms of effect. Mask wearing to prevent pollen exposure clearly supports overall well-being. CONCLUSION: Wearing a mask during pollen season can be recommended as an effective nondrug option for people with a pollen allergy. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s40629-021-00180-8) contains supplementary material, which is available to authorized users.