Co-occurrence of otitis media with effusion and another environment-dependent disease (selected allergic conditions).

Introduction: Otitis media eith effusion (OME) is an inflammatory condition of the middle ear that involves accumulation of sterile fluid or effusion in the tympanic cavity with the tympanic membrane intact. The pathophysiology of OME is undoubtedly multifactorial. Aim: To assess the co-occurrence of OME, allergic rhinitis, and asthma. Material and methods: The study involved a group of 18,617 subjects aged 6-7 years, 13-14 years, or 20-44 years. ECRHS and ISAAC questionnaires, validated and adopted for Polish conditions, were used in the study. Results: OME increases the risk of developing allergic rhinitis by nearly two-fold (OR = 2.07, 95% CI: 1.738-2.479 in 6-7-year-olds; OR = 1.61, 95% CI: 1.299-1.995 in 13-14-year-olds, and OR = 1.55, 95% CI: 1.262-1.83 in 20-44-year-olds). Protective factors against otitis media with effusion include the number of siblings (the more children in the family, the higher the risk of chronic OM; OR = 2.00, 95% CI: 1.15-1.346) and consumption of dairy products rich in lactic acid bacteria. Conclusions: OME significantly more often co-exists with other conditions, particularly allergic rhinitis.

Why the role of mHealth in allergy diagnosis and treatment adherence cannot be overlooked.

BACKGROUND: Allergic diseases-rhinitis and asthma-are the most common chronic conditions affecting adults. Traditional approaches to allergy diagnosis and treatment do not meet the health needs of all patients. Treatment adherence remains a challenge for physicians. The ubiquity of Internet access paired with limited in-person contact with medical personnel in the course of the COVID-19 pandemic demonstrated the potential of mHealth in communicating health information. BODY: The abundance of new applications dedicated to various medical specialties encourages reflection on the informed use of such tools. The paper takes a closer look at the potential of mHealth and presents conclusions of selected studies focusing on the use of good apps. The strength weakness opportunities threats analysis was used to illustrate the strengths of the mHealth strategy, as well as its advantages, limitations and areas in need of further development. CONCLUSION: The strength of mHealth depends on the quality and quantity of the collected patient data, its reliable processing, as well as publication of outcomes and conclusions from analyses. Therefore, it is necessary to promote the use of validated applications among patients, physicians and medical staff.

Methodological Principles of Nasal Food Challenge.

Thanks to their valuable assessment possibilities (subjective complaints and changes in nasal patency during the examination), nasal provocation tests may serve as an alternative tool for oral food challenges in the future. However, this test requires successive attempts to regulate its methodology in order to develop a standardized lyophilisate form and determine the threshold dose for a positive result. The study objective was to present the methodological foundation for nasal food allergen provocation tests induced by freeze-dried powdered chicken egg whites. A control group of 25 individuals with no history of allergy to chicken eggs or any other allergy was included in the study. Optical rhinometry and visual analog scales were used to assess the response of nasal mucosa to local allergen challenges. Minor variations in nasal flows, as measured by optical rhinometry, were observed in the provocation tests. The mean optical density measurements (as measured regardless of the allergen dose used) varied from positive to negative values and vice versa, e.g., amounting to 0.018 OD (standard deviation 0.095) at 15 min and -0.011 OD (standard deviation 0.090) at 30 min. No significant differences were observed concerning the perceived nasal discomfort using the visual analog scale. Due to the absence of nasal mucosal reactivity, nasal challenge is an excellent methodological tool for implementing food allergen tests.

Reactivity of nasal cavity mucosa in the nasal cow's milk allergen provocation test.

Introduction: The nasal allergen provocation test plays an important role in differential diagnostics of rhinitis. Due to its informative potential, the test is also becoming increasingly used in other areas of diagnostics, including the diagnostics of food allergies. Aim: To assess the reactivity of nasal mucosa to the cow's milk protein allergens (as being widely used in powdered form in the food industry). Material and methods: The study material consisted of a group of 31 healthy subjects not sensitized to environmental allergens including cow's milk protein allergens. The study method involved an incremental nasal provocation test with cow's milk protein evaluated using the visual analog scale and acoustic rhinometry. Results: A total of 29 out of 31 volunteers presented with a significant decrease in nasal patency (control solution: 1.112 ±0.161 vs. local allergen application 1.005 ±0.157; p < 0.004) as measured by acoustic rhinometry following the allergen dose of 12.5 µg. Slight changes in complaints were observed using the visual analog scale. Exposure to the widespread food allergens (including powdered cow's milk allergens) presents a potential risk of positive response in non-sensitized individuals. Conclusions: Further studies on dose standardization are necessary in the study area.

Evaluation of selected aspects of the hygiene hypothesis and their effect on the incidence of allergy.

OBJECTIVES: The development of allergic conditions is largely dependent on the interactions between genetic (individual genetic predisposition) and environmental factors (exposure to risk factors). The aim of this study was an attempt to assess the influence of selected elements of the hygiene theory in the development of allergic diseases such as allergic rhinitis and asthma. MATERIAL AND METHODS: The study group consisted of 5518 women and 3868 men. The method that was used was the European Community Respiratory Health Survey II and International Study of Asthma and Allergies in Childhood questionnaire validated and adapted to Central and Eastern European conditions. The project was conducted in 8 urban areas (Gdansk, Wroclaw, Poznan, Katowice, Kraków, Lublin, Bialystok, Warsaw) and 1 rural area (Krasnystaw county). This study had 2 stages; the first stage involved grouping the 22 500 respondents based on their questionnaire responses with the use of a Personal Digital Assistant (PDA); the second stage involved 7000 subjects, who underwent additional assessments: skin prick tests (birch, grasses/cereals, Dermatophagoides pteronyssinus and Dermatophagoides farinae, molds [set I: Botrytis cinerea, Cladosporium herbarum, Alternaria tenuis, Curvularia lunata, Fusarium moniliforme, Helminthosporium], molds [set II: Aspergillus fumigatus, Mucor mucedo, Penicillium notatum, Pullularia pullulans, Rhizopus nigricans, Serpula lacrymans], cat, dog, molds Cladosporium herbarum, Alternaria tenuis) and spirometry tests. RESULTS: The age at which children attend the nursery school is critical to the development of allergic diseases; in allergic rhinitis, the risk of an IgE-dependent reaction is 2 times higher in the second than in the first year of life (p = 0.00147, p < 0.05), while in asthma, having a large number of siblings increases the risk of developing obstructive disease by almost 6 times (p = 0.00316, p < 0.05).The age at which children attend the nursery school is critical to the development of allergic diseases; in allergic rhinitis, the risk of an IgE-dependent reaction is 2 times higher in the second than in the first year of life (p = 0.00147, p < 0.05), while in asthma, having a large number of siblings increases the risk of developing obstructive disease by almost 6 times (p = 0.00316, p < 0.05). CONCLUSIONS: The hygiene theory is particularly applicable and can explain the relationship of selected habits in the development of allergic diseases. Int J Occup Med Environ Health. 2023;36(1):69-83.

Optical rhinometry in assessing the nasal mucosa reaction during nasal allergen provocation testing.

Introduction: Optical rhinometry is a newly standardized technique for assessing nasal obstruction in nasal allergen provocation testing. It is one of the few techniques that accurately determine the beginning of an allergic reaction as it measures optical density, which is consistent with the degree of response. Aim: To evaluate the usefulness of optical rhinometry in nasal allergen provocation testing. Material and methods: The study population was a group of 45 subjects (25 diagnosed with an allergy to common environmental allergens and 20 controls). Nasal allergen provocation testing was conducted with the use of Dermatophagoides pteronyssinus and Dermatophagoides farina (5,000 SBU/ml). Results: The onset of the nasal mucosa allergen response in the form of nasal obstruction was observed at 10.40 min. The subsequent reaction developed rapidly, with only 53 s from the initial stage of nasal obstruction to complete obstruction (optical density 0.4552). Conclusions: Due to its informative potential, optical rhinometry is a valuable tool in assessing the nasal mucosal response to topical allergen application.

Asthma as a social problem requiring systemic solutions in Poland.

Introduction: Due to its physiopathology and chronic character, asthma constitutes a considerable burden to health care and public health. Aim: The main aim of this study was to determine and present the problems of patients diagnosed with asthma and to suggest solutions to meet the individual and public expectations. Material and methods: The study included 18,874 patients and was part of the System for the Prevention and Early Detection of Allergic Diseases in Poland. The study method was a questionnaire based on the European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC). Results: Nearly 90.1% of patients aged 6-7 years reported periodic difficulty in breathing, with over three episodes per week (3.6 in adults, 3.6 in women, 3.1 in men, 3.3 in urban residents, and 4.6 in rural residents) of reported asthma attacks interrupting patients' sleep. Recent asthma attacks were reported mainly by women living in urban areas. Conclusions: Health problems of asthma patients have a measurable impact on the need to introduce systemic solutions, to ultimately minimize the risk of complications for the individual as well as to minimize the social burden of chronic asthma in Poland.

Prevention of perennial allergic rhinitis in the conception of coordinated healthcare in Poland.

Introduction: The primary prevention is intended to prevent the development of diseases, secondary prevention aims to limit disease progression, and tertiary prevention involves reducing disease-associated symptoms. The purpose of this study was to assess the use of selected forms of secondary prevention by patients diagnosed with perennial allergic rhinitis. Moreover, this paper presents the ways in which the adopted organizational solutions could be utilized as part of coordinated healthcare to benefit patients with perennial allergies. Material and methods: The study population comprised 18,617 respondents, 4783 of whom (including patients allergic to Dermatophagoides pteronyssinus and Dermatophagoides farinae) were qualified to undergo a medical examination. The study used ECRHS and ISAAC questionnaires adapted for Europe. Results: Nearly 20% of patients diagnosed with chronic allergic rhinitis used preventive measures against house dust mites; this is in contrast with 13% in the control group (p = 1.358e-07). The secondary preventive measures most commonly used in the study group were, in descending order of frequency, mattress protectors and anti-dust-mite spray. Undertaking preventive measures was most common among study participants with higher education and residents of large cities. Conclusions: The proportion of patients diagnosed with a dust-mite allergy, who undertook preventive measures against perennial allergic rhinitis, was relatively low. Building, maintaining, and continual strengthening the doctors' relationship with chronic allergy patients may shift the nature of healthcare services more towards preventive measures, for the implementation of which the patient will be co-responsible under the coordinated healthcare system.

The Relationship between Searches for COVID-19 Vaccines and Dynamics of Vaccinated People in Poland: An Infodemiological Study.

BACKGROUND: Google Trends has turned out to be an appropriate tool for evaluating correlations and prognostic modelling regarding infectious diseases. The possibility of selecting a vaccine against COVID-19 has increased social interest in particular vaccines. The objective of this study was to show dependencies between the frequency of searches for COVID-19 vaccinations and the number of vaccinated people in Poland, along with epidemiological data. METHODS: Data were collected regarding Google searches for COVID-19 vaccines, the number of people in Poland vaccinated against COVID-19, the number of new cases, and the number of deaths due to COVID-19. Data were filtered from 27 December 2020 to 1 September 2021. RESULTS: The number of new vaccinations smoothed per million correlated most strongly with searches for the word 'Pfizer' in Google Trends (Kendall's tau = 0.46, p < 0.001). The number of new deaths correlated most strongly with the search phrase 'AstraZeneca' (Kendall's tau = 0.46, p < 0.001). The number of new cases per million correlated most strongly with searches for 'AstraZeneca' (Kendall's tau = 0.49, p < 0.001). The maximum daily number of searches ranged between 110 and 130. A significant interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of a considerable increase in the number of new cases and new deaths due to COVID-19. CONCLUSIONS: A significant increase in interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of gradually extended access to vaccinations, as well as a considerable increase in the number of new cases and new deaths due to COVID-19. The use of Google Trends with relevant keywords and a comparison with the course of the COVID-19 pandemic facilitates evaluation of the relationship between the frequency and types of searches for COVID-19 vaccines and epidemiological data.

Effect of standardized vs. local preoperative enteral feeding practice on the incidence of NEC in infants with duct dependent lesions: Protocol for a randomized control trial.

Background: Infants with duct dependent heart lesions often require invasive procedures during the neonatal or early infancy period. These patients remain a challenge for pediatric cardiologists, neonatologists, and intensive care unit personnel. A relevant portion of these infant suffer from respiratory, cardiac failure and may develop NEC, which leads to inadequate growth and nutrition, causing delayed or complicated cardiac surgery. Methods: This randomized control trial will recruit term infants diagnosed with a duct dependant lesion within the first 72 h of life. After obtaining written parental consent patients will be randomized to either the physician led enteral feeding or protocol-based feeding group. The intervention will continue up to 28 days of life or day of cardiosurgical treatment, whichever comes first. The primary outcomes include NEC and death related to NEC. Secondary outcomes include among others, number of interrupted feedings, growth velocity, daily protein and caloric intake, days to reach full enteral feeding and on mechanical ventilation. Discussion: Our study will be the first randomized control trial to evaluate if standard (as in healthy newborns) initiation and advancement of enteral feeding is safe, improves short term outcomes and does not increase the risk of NEC. If the studied feeding regime proves to be intact, swift implementation and advancement of enteral nutrition may become a recommendation. Trial registration: The study protocol has been approved by the local ethical board. It is registered at ClinicalTrials.gov NCT05117164.

The relationship between nasal polyps, bronchial asthma, allergic rhinitis, atopic dermatitis, and non-allergic rhinitis.

INTRODUCTION: Nasal polyps are frequently associated with bronchial asthma and rhinitis. The chronic nature of the symptoms, the high post-treatment recurrence rates, as well as various comorbidities, constitute key factors that significantly affect the quality of life of patients diagnosed with this condition. AIM: The purpose of the study was to estimate the prevalence of nasal polyps in the examined population and to assess the possible associative occurrence of nasal polyps (NP) with bronchial asthma (BA), allergic (AR) and non-allergic rhinitis (NAR), and atopic dermatitis (AD). MATERIAL AND METHODS: The ECRHS II and ISAAC questionnaires of the study group of 18,458 individuals, including 4,473 6-7-year-olds (24.2%), 4,675 13-14-year-olds (25.4%), and 9,310 20-44-year-olds (50.4%) were performed. RESULTS: The prevalence of nasal polyps in the examined group was 1.1%, reported by a total of 204 individuals. Nasal polyps were reported more frequently among urban residents (191 (1.1%)) than rural residents (13 (0.6%)). Our study demonstrated a correlation between the presence of nasal polyps and asthma, as well as allergic and non-allergic rhinitis The greatest risk factor for NP in the evaluated subpopulation with multiple allergic conditions was the co-existence of non-allergic rhinitis and atopic dermatitis (OR = 6.09; 95% CI: 3.4-10.93). CONCLUSIONS: Nasal polyps are relatively rare in the evaluated Polish population. Nonetheless, we believe their co-occurrence with non-allergic rhinitis, allergic rhinitis, bronchial asthma, and atopic dermatitis to be of significant importance, as it illustrates the phenomenon of multimorbidity of inflammatory conditions affecting the upper and lower respiratory tract.

The effect of infectious agents on the prevalence of allergies.

PURPOSE: The role of infectious agents in allergy development is ambivalent. On one hand, there are reports of an association between a previous infection (especially a viral respiratory tract infection) and developing hypersensitivity to inhaled allergens, which in turn may increase the risk of developing allergic reactions. On the other hand, there are reports emphasizing a protective effect of a number of infectious agents against allergy development. The aim the study was to find possible associations between a past infectious or parasitic disease and an allergic condition. MATERIAL AND METHODS: The study population was a group of 18,648 subjects. The study, which was a part of the project: 'Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland', was conducted in 9 selected regions of Poland and used the ECRHS and ISAAC questionnaires adapted for Europe. The following statistical tools were used: Pearson's chi-squared test, Fisher's exact test, and logistic regression. RESULTS: This research was an attempt to clear association between a history of measles or viral hepatitis and the likelihood of developing asthma, especially in males (χ2 = 5.29; p<0.05). Past parasitic disease showed a clear association with a suspected allergic rhinitis in various groups of patients (differing both in terms of sex and age). CONCLUSIONS: A history of some forms of either infectious or parasitic diseases has a measurable effect on the risk of developing allergies.

Prediction and Variable Selection in High-Dimensional Misspecified Binary Classification.

In this paper, we consider prediction and variable selection in the misspecified binary classification models under the high-dimensional scenario. We focus on two approaches to classification, which are computationally efficient, but lead to model misspecification. The first one is to apply penalized logistic regression to the classification data, which possibly do not follow the logistic model. The second method is even more radical: we just treat class labels of objects as they were numbers and apply penalized linear regression. In this paper, we investigate thoroughly these two approaches and provide conditions, which guarantee that they are successful in prediction and variable selection. Our results hold even if the number of predictors is much larger than the sample size. The paper is completed by the experimental results.

Sensitisation to airborne allergens as a risk factor for allergic rhinitis and asthma in the Polish population.

INTRODUCTION: The patterns of sensitisation to airborne allergens and their association with allergic diseases have been analysed in different geographical regions. AIM: To analyse the impact of sensitisation to airborne allergens on allergic rhinitis (AR) and asthma in different age groups of the Polish population. MATERIAL AND METHODS: Completed questionnaires of 18,617 subjects (53.8% females), collected within the ECAP, a cross-sectional multicentre study, were analysed. Three groups of respondents were included: 6-7-year-olds (24.2%), 13-14-year-olds (25.4%), 20-44-year-olds (50.4%). The clinical part (an anamnesis, physical examination, spirometry, skin prick tests and an assay of major airborne allergen-specific IgE) was attended by 25.7% of the respondents. RESULTS: The AR was most strongly related to sensitisation to Dermatophagoides pteronyssinus, with the highest odds ratios of 10 in two younger groups and of 16 for persistent AR in children. It was also the most important risk factor for allergic asthma, with odd ratios from 8.34 in children to 6.40 in adolescents. Sensitisation to grass pollen allergens was a major risk factor for both AR, with odds ratios from 9.16 in adults to 7.87 in adolescents, and asthma, with odds ratios from 6.16 in adolescents to 5.67 in adults. CONCLUSIONS: AR and asthma shared common risk factors, independently of age. Sensitisation to airborne allergens was significantly associated with asthma and, even more strongly, with AR, across all age groups. The AR was the strongest risk factor for allergic asthma in the youngest group. Persistent AR increased asthma risk more than intermittent AR in all age groups.

Prevalence of allergic rhinitis and asthma in Poland in relation to pollen counts.

INTRODUCTION: Despite the known role of pollen allergens in causing allergy symptoms in sensitized individuals, there are few publications investigating the relationship between pollen exposure in different regions and the prevalence of inhalant allergy. AIM: To assess the association between the prevalence of allergic rhinitis and asthma and the degree of exposure to pollen in various regions of Poland. MATERIAL AND METHODS: Completed questionnaires of 9,443 subjects living in four urban centres (Wroclaw, Katowice, Warsaw, Bialystok), collected within part of the ECAP project, were analyzed. Children aged 6-7 (n = 2,278), adolescents aged 13-14 (n = 2,418), and adults aged 20-44 (n = 4,747) constituted 24.2%, 25.6% and 50.3% of the respondents, respectively. The clinical part (including skin prick tests, an assay of Timothy grass-specific IgE), was attended by 24% of the respondents. Data from 6-year pollen monitoring served to characterize birch and grass pollen seasons. RESULTS: We found insignificant negative associations between the duration of birch pollen season and the prevalence of declared allergic rhinitis and asthma during the season across all age groups. There were insignificant inverse associations between the number of days with above-threshold and high grass pollen concentrations, total grass pollen count and the prevalence of declared allergic rhinitis and asthma during the season across all age groups. Associations noted in the clinical part were also non-significant; however, these trends were not uniform across the age groups. CONCLUSIONS: Our findings do not confirm the hypothesis of a positive association between pollen exposure and the prevalence of allergic rhinitis and asthma.

Building age, type of indoor heating and the occurrence of allergic rhinitis and asthma.

INTRODUCTION: Structural materials and interior appliances are frequently mentioned as elements of modern buildings which may have an impact on the natural history of allergic diseases. AIM: We hypothesized that the building age, the type of the heating system and the use of various indoor appliances can influence the occurrence of allergic rhinitis (AR) and asthma. MATERIAL AND METHODS: The study group comprised 18,617 individuals. The tool used in the study was the European Community Respiratory Health Survey (ECRHS) and the International Study of Asthma and Allergies in Childhood (ISAAC) study questionnaire, adapted to European conditions (Middle and Eastern Europe) and used as part of the study called "Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland". RESULTS: Questionnaire results indicated that people living in homes built in the years 1971-1990 had higher rates of allergic rhinitis (OR = 1.15025), which was correlated with clinical findings of increased occurrence of seasonal allergic rhinitis (OR = 1.60543). The leading factor contributing to the intensification of AR symptoms was the central heating (OR = 1.45358). As opposed to AR, people living in buildings with central heating less often declared asthma (OR = 0.8407). A clinical examination confirmed that central heating reduced the symptoms of moderate asthma (OR = 0.3524). CONCLUSIONS: Increasing building age and certain indoor heating methods are important risk factors for the occurrence of allergic rhinitis and asthma.

The role of the nasal allergen provocation test in local allergic rhinitis cases: a preliminary report.

INTRODUCTION: The current state of knowledge is that allergic rhinitis can occur in two forms. One is allergic rhinitis as a manifestation of a systemic allergy with systemic atopy and positive results of skin prick tests or sIgE tests. The other is local allergic rhinitis (LAR) as a local allergic reaction affecting only the nasal mucosa without systemic atopy. AIM: To attempt to assess the usefulness of the nasal allergen provocation test for the purposes of differential diagnosis and the qualification of LAR patients for therapy. MATERIAL AND METHODS: The subjects in the study were a group of 6 adults diagnosed with LAR on the basis of their medical history and the results of nasal allergen provocation tests, with the allergens being house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae). The methods adopted in the study were a point-based rating scale as a measure of nasal/extranasal complaints and active anterior rhinomanometry. RESULTS: Significant differences (p < 0.05) were observed, using the subjective rating scale, in relation to registered nasal and extranasal complaints in the early phase of the allergic reaction. Similarly, the rhinomanometry method revealed significant differences in nasal resistance values before and after the administration of an allergen. CONCLUSIONS: The nasal allergen provocation test is the only testing tool that objectively measures the degree of the patient's allergic reactions and is useful in qualifying LAR patients for further therapy.

The use of nasal over-the-counter agents in the evaluated Polish population. The underrated role of the pharmacist in patient education on medical treatment in patients with allergic rhinitis.

INTRODUCTION: The goal of treatment in allergic rhinitis is a complete elimination of symptoms or achieving significant clinical improvement. The role of the pharmacist has been receiving particular attention in terms of the initial diagnosis and treatment of allergic rhinitis patients and their sufficiently early referral to a specialist in case of persistent symptoms. AIM: This study attempted to estimate the rates of nasal OTC use in patients diagnosed with allergic rhinitis. MATERIAL AND METHODS: Study population was 18,578 subjects (4,192 patients diagnosed with AR and 14,386 healthy controls): children aged 6-7 years, adolescents aged 13-14 years, and adults aged 20-44 years. We used translated and validated versions of ECRHS and ISAAC questionnaires. RESULTS: The rates of nasal decongestant use in the allergic rhinitis group were 60.4% in children, 50.7% in adolescents, and 43.0% in adults, with these figures significantly higher than in the control group (p < 0.05). The most common nasal agent was Oxymetazoline and Xylometazolini hydrochloridum 0.1%. CONCLUSIONS: Over a half of the evaluated allergic rhinitis patients used nasal decongestants, which poses a potential risk of uncontrolled side effects. There is an urgent need to introduce patient education on medical treatment.

Organizational model for the management of patients with chronic allergic conditions.

INTRODUCTION: Allergic conditions present a serious problem for the Polish population. The most common form of allergy is allergic rhinitis. Due to its chronic nature and a complex pathophysiological mechanism the allergic rhinitis could be associated with others comorbidities. That is why it is a poses a considerable bio-psychosocial problem both for the affected individual patient and for the healthcare system. AIM: To identify organizational factors and analyse their effect on patients with chronic allergic conditions. MATERIAL AND METHODS: The study group comprised 9,370 respondents (including 1,967 patients with allergic rhinitis (AR), 372 patients with self-reported bronchial asthma (BA1), and 351 patients with physician-diagnosed bronchial asthma (BA2)) aged from 20 to 44 years, some of whom were additionally examined (skin pick tests) in an outpatient setting. The findings obtained in the outpatient subgroup (n = 4,783) were analysed in more detail. The study was based on translated and validated ECRHS and ISAAC questionnaires. RESULTS: Over a half of the evaluated patients with AR visited a specialist due to their symptoms. Some respondents neither visited their doctor regularly nor had regular check-ups, which undoubtedly affected their quality of life. CONCLUSIONS: The authors propose an organizational model incorporating the position of a healthcare educator (HE) as a coordinator in the process of managing chronic allergic conditions in adult patients within the Polish healthcare system. Adult patient education by the HE would include introducing the principles of secondary and tertiary prevention in order to improve the quality of life in patients with chronic allergic conditions.

Effect of indoor air quality on the natural history of asthma in an urban population in Poland.

Background: Indoor air pollution may have an impact on asthma. Objective: To evaluate the influence of indoor air pollution on the natural history of asthma. Methods: Data collection by using the European Community Respiratory Health Survey and International Study of Asthma and Allergies in Childhood standardized questionnaire (N = 18,617) and medical examinations (N = 4783) in selected Polish regions was used. Statistical analysis was performed by using the χ² test. A value of p < 0.05 was considered statistically significant. Results: Questionnaire results demonstrated that people who used the central heating system were less likely to declare the occurrence of asthma (odds ratio [OR] 0.84) and were corroborated with clinical findings of moderate asthma (OR 0.35). Symptomatic asthma occurred more frequently in people who used a solid-fuel heating device (OR 1.36) and electric heaters (OR 1.54). The use of cooking appliances with municipal natural gas (OR 1.77) and gas storage tanks (OR 2.03) was correlated with more frequent declarations of asthma. Symptomatic asthma was more common among people who smoked for at least 1 year (OR 2.26) and those who smoked over the course of the preceding month (OR 1.60). Passive exposure to tobacco smoke provided for a 1.5-fold increase in the incidence of symptomatic asthma (OR 1.53), regardless of the time of exposure. Conclusion: Both active and passive tobacco smoke exposure as well as the use of certain types of heating and cooking appliances have a significant impact on the incidence of asthma and the intensification of its symptoms in rooms with limited air exchange. Highlights of the study included the following: (1) central heating had an amelioratory effect on asthma, (2) heating technologies used at home had a significant impact on the incidence of asthma, and (3) devices used for cooking (municipal and cylinder gas stoves) played an important role in the intensification of asthma symptoms.