[Incidence of malignant pleural mesothelioma in Split-Dalmatia County]. / Incidencija malignog mezotelioma poplucnice u podrucju Splitsko- dalmatinske zupanije u razdoblju od 2001. do 2005.

Between 2001 and 2005, 1150 patients with respiratory symptoms were admitted to our Pneumology Clinic whose workplace or residence could involve exposure to asbestos One hundred and twenty (10.4%) patients were confirmed a disease of the lung and/or pleura which could have been asbestos-related. A follow-up of these patients showed that 52 of 120 (43.3%) developed malignant pleural mesothelioma (MPM), but it was also found in 12 of 1030 (1.1%) patients without an asbestos-related disease. Of the 64 patients with MPM, 54 (84.3%) were men and 10 (15.6%) women. Fifty-two (81.2%) were professionally or residentially exposed to asbestos. The incidence ofmesothelioma for the Split-Dalmatia County between 2001 and 2005 was 13.8 per 100,000 inhabitants, while in the whole of Croatia it was 3.9. Mean annual incidence in the Split-Dalmatia County was 2.7 per 100,000 inhabitants, and in the whole of Croatia 0.8. This means that 22.7% of all patients with MPM in Croatia were from the Split-Dalmatia County (whose population is about 10.5% of Croatia's). This distribution of MPM may be related to the strong shipbuilding industry and other asbestos-related industries in this part of the country.

Allergic rhinitis and asthma in southern Croatia: impact of sensitization to Ambrosia elatior.

AIM: To identify pollen types in southern Croatia and investigate the impact of sensitization to Ambrosia elatior (A. elatior) on symptoms and treatment of patients with seasonal allergic rhinitis and/or asthma. METHODS: The study recruited 120 patients from Split-Dalmatian County with seasonal rhinitis and asthma symptoms and positive skin prick test to one or more common inhaled allergens. Patients with positive skin prick test and increased specific IgE to A. elatior (n=56) were included in the follow-up study during the A. elatior pollen season. Rhinitis and asthma symptoms were scored and drug treatment recorded using standardized questionnaires. Also, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and eosinophil count in peripheral blood were measured. Type and pollen concentration of A. elatior in the air over the nine-week pollen season were determined on the glass slides using the gravimetric method. The results were expressed as the proportion of A. elatior pollen in the total pollen. RESULTS: Fifty-six of 120 patients (46.7%) were sensitized to A. elatior. Its proportion in total pollen peaked to 12% in the first week of September. Forty-one patients who completed the follow-up study showed a significantly higher score of symptoms during this peak period than in the beginning of the pollen season for seasonal allergic rhinitis (median +/-interquartile range, 50+/-11 vs 7+/-4; P<.001) and for seasonal allergic asthma (12+/-2 vs 0+/-0; P<.001). CONCLUSION: A. elatior is an important cause of seasonal allergic rhinitis and asthma and must be included in the routine diagnostic procedures in southern Croatia.

Hypersensitivity to pollen allergens on the Adriatic coast.

This paper describes a study of air concentrations of pollens and a calendar of pollination around the town of Split on the Croatian Adriatic in 1994. High pollen concentrations of Parietaria officinalis dominated during the year (up to 20% from April to June) followed by the pollens of Pistacia lentiscus, Olea europaea, Pinus halepensis, Juniperus oxycedrus, Acacia baileyana, Artemisia vulgaris, Ambrosia elatior and Cistus monspeliensis. In 1994-95, skin prick tests using commercially available standard inhalation allergens and specially prepared pollen allergens were performed on 3,500 patients with allergic respiratory symptoms. About 30% were allergic to standard pollen allergens (mixed grass pollen, mixed tree pollen, Parietaria officinalis and Pittosporum tobira). Hypersensitivity to more than one allergen was found in 45% of patients, whereas 15% did not react to any of the standard allergens. Additional testing with newly prepared individual allergens (P. lentiscus, O. europaea, P. halepensis, A. baileyana, C. monspeliensis, A. vulgaris, A. elatior) revealed hypersensitivity in a number of patients, but 36% showed no reaction. This finding suggests that further studies of this kind are needed for additional identification, isolation, and characterisation of pollen allergens that are present in the Adriatic coast.

[Exposure and allergy to dust mites in general and working environment in Croatia]. / Izlozenost i alergija na prasinske grinje u opcem i radnom okolisu u Hrvatskoj.

This paper gives a review of the most important impacts of exposure to dust mites in general and working environment on human health. The Institute for Medical Research and Occupational Health in Zagreb, Croatia, has been investigating the frequency and exposure levels of allergies to pyroglyphid and non-pyroglyphid mites in Croatia for the last 10 years. Investigations were performed in general urban and rural population from the inland and coastal Croatia, and several industrial inland populations occupationally exposed to organic dusts. Mite species and levels of pyroglyphid mites allergens (Der p 1, Der f 1) were established in house dust samples taken from the floors of bedrooms and living rooms and in several industrial dust samples. The frequency of allergies to pyroglyphid mites in general urban population of inland Croatia is about 20%, with significant general indoor exposure to these mites (median value for Der p 1: 0.85 microg/g of dust). General adult population of the coastal region had a significantly higher exposure to pyroglyphid mites (median value for Der p 1: 4.5 microg/g of dust), yet showed a significantly lower frequency of allergies to these mites (about 5%). New studies are necessary to investigate possible genetic and environmental factors involved in the mechanisms which protect coastal population from the development of mite allergy. Acarological and statistical analyses have shown that the high frequency of sensitisation to non-pyroglyphid mites found in the general and working populations of the inland region is not related to environmental exposure to these mites, but to the cross-reactivity between pyroglyphid and non-pyroglyphid mites and to false positive skin reactions in prick testing, particularly to T. putrescentiae. So far, results do not indicate that pyroglyphid mites are occupational allergens in paper-recycling, fish-processing and tobacco-processing.

Malignant and non-malignant asbestos-related pleural and lung disease: 10-year follow-up study.

AIM: To examine the presence of radiologically visible lung and pleural changes in patients who were exposed to the asbestos dust, and to correlate the progression of these changes with the duration and intensity of exposure and smoking. We also evaluated possible correlation between non-malignant asbestos-related pleural abnormalities and the occurrence of malignant pleural mesothelioma. METHODS: Among 7,300 patients who visited our department between 1991 and 2000 due to non-specific respiratory symptoms, we selected 2,420 with chest X-rays indicating the possible existence of non-malignant asbestos-related diseases. The selected group was followed-up for progression of radiological changes and the development of malignant pleural mesothelioma, and the changes were correlated with the intensity and duration of exposure to asbestos dust and smoking. RESULTS: Radiological changes characteristic for non-malignant asbestos-related pleural disease or lung asbestosis were identified in 340 (14%) out of 2,420 examined patients, of whom 77 (22.6%) developed malignant pleural mesothelioma, as compared with 13 patients out of 2,080 (0.6%) without radiological signs of asbestosis or pleural changes. Twenty-three (29.9%) patients who presented with a progression of pleural disease and lung asbestosis had a very significant incidence of malignant pleural mesothelioma (p<0.001). We also found that 55 (71.4%) patients with the highest asbestos exposure level (grade 3) developed malignant pleural mesothelioma more often (p=0.044). No correlation was found between malignant pleural mesothelioma development and duration of asbestos exposure (p=0.149) or smoking habit (p=0.617). Professionally exposed patients were at 3.3-times higher relative risk (95% confidence interval, 2.28-4.75) than those who were not exposed to develop malignant pleural mesothelioma. CONCLUSIONS: The risk of developing lung asbestosis increased with the level of exposure to asbestos dust and smoking. The risk of developing pleural disease correlated with the intensity and duration of exposure, but not with smoking. The patients with progressive pleural and parenchymal changes are at particularly high risk of developing malignant pleural mesothelioma and must be under special surveillance.

[Bronchial reactivity in patients with seasonal allergic rhinitis]. / Reaktivnost bronha u bolesnika sa sezonskim alergijskim rinitisom.

The allergic rhinitis (AR) is an important risk factor for the development of asthma. In significant number of patients with AR, the non-specific bronchial hyperresponsiveness (BHR) could be demonstrated. It has been anticipated that these patients were at the greater risk for asthma. This study was aimed to determine the frequency and intensity of BHR in patients with seasonal AR (SAR) due to Wall pellitory allergy. The patients who were sensitized solely to Parietaria officinalis (Wall pellitory) pollen allergen were recruited in the study, namely patients with SAR (n = 26), SAR with seasonal asthma (n = 23) as well as healthy volunteers (n = 10). In all subjects the clinical check-up, spirometry and bronchial challenge test with metacholine were performed before, during the peak, and after the peak of pollination of pellitory. Comparing to initial findings (23%), in patients with SAR the prevalence of BHR significantly increased during the peak of pollination (50%, p = 0.0039), and remained increased thereafter (43%, p = 0.0319). In patients with SAR and asthma prevalence and intensity of BHR was even higher with the similar seasonal variations. Comparing to initial findings (83%), the prevalence of BHR significantly increased during the peak of season (100%, p = 0.0001), and remained increased thereafter (87%, p = 0.061). In both groups of patients the intensity of BHR (median PC20) increased as well: 4.8, 2.05, and 2.45 mg/mL in patients with SAR, and 0.35, 0.16, and 0.20 mg/mL in patients with SAR and asthma. In healthy volunteers no significant BHR was observed. The results of the present study confirm significant prevalence of BHR in patients with SAR due to pellitory allergy. It is important to determine BHR in patients with SAR and without asthma because the appropriate pharmacotherapeutic and preventive measures (anti-inflammatory medication and specific immunotherapy) could prevent the development of asthma in these patients.