Dramatically decreased T cell responses but persistent IgE upon reduced pollen exposure.

Mugwort pollen allergy is frequent in parts of Europe. As mugwort pollen contains only one major allergen, Art v 1, which harbors only one T cell epitope, we employed mugwort pollen allergy as a model to study allergen-specific T cell responses. However, after 2004, we noticed a drastic decrease in the T cell responses to Art v 1 and eventually it became almost impossible to detect allergen-specific responses at the T cell level in mugwort-allergic individuals. To explain this observation, we retrospectively investigated the local exposure to mugwort pollen and its possible correlation to the frequency and reactivity of allergen-specific T cells. The total annual pollen indices dramatically dropped after 2004 and never reached previous levels again. Local sensitization to mugwort pollen and serum IgE antibodies specific for Art v 1 remained unchanged until 2015. Our mugwort pollen model shows that specific IgE-levels are maintained for extremely long time periods in spite of a long-term reduction of natural allergen exposure to levels that are too low to boost specific T cells.

The connection of pollen concentrations and crowd-sourced symptom data: new insights from daily and seasonal symptom load index data from 2013 to 2017 in Vienna.

BACKGROUND: Online pollen diaries and mobile applications nowadays allow easy and fast documentation of pollen allergy symptoms. Such crowd-sourced symptom data provides insights into the development and the onset of a pollen allergy. Hitherto studies of the symptom load index (SLI) showed a discrepancy between the SLI and the total pollen amount of a season, but did not analyze the daily data. METHODS: The Patient's Hayfever Diary (PHD) was used as data pool for symptom data. Symptom data of Vienna (Austria) was chosen as a large and local sample size within the study period of 2013 until 2017. The city was divided into three different areas based on equal population densities and different environmental factors. Correlation factors, regression lines, locally weighted smoothing (LOESS) curves and line plots were calculated to examine the data. RESULTS: Daily SLI and pollen concentration data correlates well and the progress of the SLI within a pollen season is mirrored by the pollen concentrations. The LOESS curves do not deviate much from the regression line and support the linearity of the symptom-pollen correlation on a daily basis. Seasonal SLI data does not follow the same pattern as the respective seasonal pollen indices. Results did not vary in the three areas within Vienna or when compared with the Eastern region of Austria showing no significant spatial variation of the SLI. DISCUSSION: Results indicate a linear relationship of the SLI and pollen concentrations/seasonal polllen index (SPIn) on a daily basis for both in general and throughout the season, but not on a seasonal basis. These findings clarify the frequent misinterpretation of the SLI as index that is tightly connected to pollen concentrations, but reflects as well the seasonal variation of the burden of pollen allergy sufferers. CONCLUSION: More than just the seasonal pollen index has to be considered when the SLI of a selected pollen season has to be explained. Cross-reactivity to other pollen types, allergen content and air pollution could play a considerable role. The similar behavior of the SLI in Vienna and a whole region indicate the feasibility of a possible symptom forecast in future and justifies the use of a single pollen monitoring station within a city of the size of Vienna.

Defining Pollen Seasons: Background and Recommendations.

PURPOSE OF REVIEW: The definition of a pollen season determines the start and the end of the time period with a certain amount of pollen in the ambient air. Different pollen season definitions were used for a long time including the use of different terms for data and methods used to define a pollen season. Recently suggested pollen season definitions for clinical trials were tested and applied for the first time to more aeroallergens. RECENT FINDINGS: This is a review on pollen season definitions and the latest recommendations. Recently, proposed terminology in aerobiology is promoted here in order to support reproducibility and repeatability in research. Two pollen season definitions, one based on percentages and one based on pollen concentrations, were tested. Percentage definitions can be recommended for standard aerobiological routines and for retrospective applications, whereas pollen concentrations definitions can be recommended for prospective applications such as clinical trials.

The grass pollen season 2015: a proof of concept multi-approach study in three different European cities.

BACKGROUND: Grasses release the most widespread aeroallergens with considerable sensitization rates, while different species produce several pollen concentration peaks throughout the season. This study analyzed the prevalence of grass species in three different European city areas and compared the flowering period of these species with daily pollen concentrations and the symptom loads of grass pollen allergy sufferers. METHODS: The most prevalent grass species in Vienna (Austria), Berlin (Germany) and Turku (Finland) were studied and examined by use of three different approaches: phenology, pollen monitoring and symptom load evaluation. A mobile pollen exposure chamber was employed to observe reaction patterns of grass pollen allergy sufferers to three common grass species evaluated in this study versus placebo. RESULTS: Common meadow grass (Poa pratensis) and the fescue grass species (Festuca spp.) are important contributors within the grass pollen season. The pollination period of orchard grass (Dactylis glomerata) and false-oat grass (Arrhenatherum elatius) indicated a greater importance in Berlin and Vienna, whereas a broader spectrum of grass species contributed in Turku to the main pollen season. The standardized provocation induced a nasal symptom load, reduction in nasal flow and increased secretion, in contrary to the placebo control group in grass pollen allergic subjects. CONCLUSION: The phenological observations, pollen measurements and symptom data evaluation provided unique insights into the contribution of multiple grass species in different European regions. All investigated grass species in the provocation induced rhinitis symptoms of comparable significance, with some degree of variation in symptom patterns.

Propose of Standards Based IT Architecture to Enrich the Value of Allergy Data by Telemonitoring Data.

Interoperability is a key requirement for any IT-System to be future proof and cost efficient, due to the increasing interaction of IT-Systems in Healthcare. This feasibility study is part of a larger project focusing on the conceptualization and evaluation of interoperable and modular IT-Framework components for exchanging big data information sets. Hence, this project investigates the applicability of a standard based IT-Architecture for the integration of Personal Health Devices data and open data sources. As a proof of concept use case, pollen forecast data from the Medical University of Vienna were combined with Personal Health Device data and a data correlation was investigated. The standards were identified as well as selected in expert's reviewed and the Architecture was designed based on a literature research. Subsequently the prototype was implemented and successfully tested in interoperability tests. The study shows that the architecture meets the requirements. It can be flexibly extended according to further requirements due to its generic setup. However, further extensions of the Interoperability-Connector and a full test setup needs to be realized in future.

Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service.

BACKGROUND: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date. OBJECTIVE: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers. METHODS: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today's grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter. RESULTS: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the "readiness to flower" for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps. CONCLUSIONS: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered.

The medical and scientific responsibility of pollen information services.

Pollen information as such is highly valuable and was considered so far as a self-evident good free for the public. The foundation for reliable and serious pollen information is the careful, scientific evaluation of pollen content in the air. However, it is essential to state and define now the requirements for pollen data and qualifications needed for institutions working with pollen data in the light of technical developments such as automated pollen counting and various political interests in aerobiology including attempts to finally acknowledge pollen and spores as relevant biological particles in the air worth being considered for pollution and health directives. It has to be emphasized that inadequate pollen forecasts are a considerable health risk for pollen allergy sufferers. Therefore, the responsibility of institutions involved in pollen monitoring and forecasting is high and should be substantiated with respective qualifications and know-how. We suggest here for the first time a portfolio of quality criteria and demand rigorous scientific monitoring and certification of such institutions in the interest and for the protection of persons affected by a pollen allergy.

The grass pollen season 2014 in Vienna: A pilot study combining phenology, aerobiology and symptom data.

BACKGROUND: Grasses (Poaceae) are one of the largest plant families and are distributed worldwide. Grass pollen allergy is one of the most important pollen allergies affecting large parts of the population worldwide. The grass pollen season itself is special since it is caused by the flowering of various grass species that present unique profiles of allergenicity, which assumingly plays a significant role and impact on grass pollen sensitization profiles for the allergy sufferer. The aim of this study, conducted in Vienna, 2014, was to analyze the possible contribution of prevalent grass species to the grass pollen season and to the symptom load of grass allergy sufferers. METHODS: This was the first study that combines phenological observations (i.e. grass species and their flowering periods) with aerobiological measurements (i.e. daily grass pollen concentrations) in concert with allergic symptoms from local users of the Patient's Hayfever Diary (symptom load index calculation). RESULTS: Both the pollen concentrations and the symptom levels were higher in the first half of the main grass pollen season and therefore show the highest impact on pollen allergy sufferers. Of important note were the following species that are widely distributed in Vienna: Kentucky bluegrass (Poa pratensis), orchard grass (Dactylis glomerata), false oat-grass (Arrhenatherum elatius), fescue grass (Festuca sp.) and perennial rye-grass (Lolium perenne). CONCLUSION: Monitoring different grass species provided evidence for varying contribution in pollination across the main grass pollen season and highlighted the significance this impact may have on pollen allergy sufferers.

First comparison of symptom data with allergen content (Bet v 1 and Phl p 5 measurements) and pollen data from four European regions during 2009-2011.

BACKGROUND: The level of symptoms in pollen allergy sufferers and users of the Patient's Hayfever Diary (PHD), does not directly reflect the total amount of pollen in the air. It is necessary to explain the symptom load and thus the development of allergic symptoms and to determine which environmental factors, besides the pollen load, influence variables. It seems reasonable to suspect allergen content because the amount of allergen varies throughout seasons and regions and is not always correlated with the total pollen amount. METHODS: Data on the allergen content of ambient air (Bet v 1 and Phl p 5) from 2009 until 2011 was used to compare the respective pollen and symptom loads for study regions in Austria, Germany, France and Finland. RESULTS: Our findings suggest that allergen amount (Bet v 1/Phl p 5) has a strong but regionally dependent impact on the symptom load of pollen allergy sufferers. Peak symptom loads can be traced with peak allergen loads. The influence of other important aeroallergens should also be assessed during the pollen season. CONCLUSION: Allergen concentrations have an impact on pollen allergy sufferers although not as clear as assumed previously. The pattern of pollen load and major allergen content distribution does not directly explain the symptom load pattern, although significant positive correlations were found. Thus, monitoring of symptoms via voluntary crowdsourcing should be considered for future pollen and symptom forecasts in order to support pollen allergy sufferers.

Pollen information consumption as an indicator of pollen allergy burden.

BACKGROUND: The Austrian pollen information service distributes pollen forecasts and offers various options (webpages, a mobile "Pollen" app, interviews for newspapers, radio, TV and information for the press agency) to support and inform pollen allergy sufferers in Austria in the best way to help to avoid their allergen. These services are well received and user numbers have increased, especially in recent years. METHODS: Herein, we unravel for the first time the user pattern over time on a monthly basis and compare it to the major pollen seasons in Austria as well as to the allergic burden. RESULTS: The symptom load conforms to the web page user numbers and shows the same peaks from the study period of 2012 until 2014. The highest impact in user numbers and allergy burden occurred during the birch pollen season, although similar values were approached during the grass pollen season in 2014. Pollen loads during the respective pollen seasons of birch, grasses and herbs (mugwort and ragweed) mirrored the pattern as well, although to a minor extent, because different plant taxa have a different distribution within Austria and produce different amounts of pollen. CONCLUSION: This study provides evidence that pollen information consumption can be seen as an indicator of the burden of pollen allergy sufferers as well as an indicator of the main flowering periods of the main plants inducing pollen allergies in Austria.

Can we improve pollen season definitions by using the symptom load index in addition to pollen counts?

Airborne pollen measurements are the foundation of aerobiological research and provide essential raw data for various disciplines. Pollen itself should be considered a relevant factor in air quality. Symptom data shed light on the relationship of pollen allergy and pollination. The aim of this study is to assess the spatial variation of local, regional and national symptom datasets. Ten pollen season definitions are used to calculate the symptom load index for the birch and grass pollen seasons (2013-2014) in Austria. (1) Local, (2) regional and (3) national symptom datasets are used to examine spatial variations and a consistent pattern was found. In conclusion, national datasets are suitable for first insights where no sufficient local or regional dataset is available and season definitions based on percentages provide a practical solution, as they can be applied in regions with different pollen loads and produce more constant results.

Individual pollen exposure measurements: are they feasible?

PURPOSE OF REVIEW: The purpose of the recent review is to give insight into recent attempts to measure individual pollen exposure and to give advice for interpreting such data. RECENT FINDINGS: It is well recognized that there are various challenges in monitoring the atmospheric content of pollen in the air. Although pollen data gathered by Hirst type spore traps and evaluated by human expertise are of inestimable value because of long-time data series and as the basic foundation for pollen information services as well as for diagnosis and therapy of pollen allergies, there is a need for more precise information for individual pollen allergy sufferers. Different types of individual pollen exposure measurement samplers are presented, and estimates are offered. SUMMARY: Further developments, especially standardization of personal pollen samplers, are needed. Improvements should lead to more usability. Because of a variety of factors, a pollen count will always stay a pollen count, and a pollen forecast is not a symptom forecast, something pollen allergy sufferers actually desire. Thus, a different promising path to individualized pollen information was recently chosen: personal pollen information is now possible based on personal symptom data and regional pollen data. In future, personal pollen data could complete this achievement.

Development of personal pollen information-the next generation of pollen information and a step forward for hay fever sufferers.

Pollen allergies affect a large part of the European population and are considered likely to increase. User feedback indicates that there are difficulties in providing proper information and valid forecasts using traditional methods of aerobiology due to a variety of factors. Allergen content, pollen loads, and pollen allergy symptoms vary per region and year. The first steps in challenging such issues have already been undertaken. A personalized pollen-related symptom forecast is thought to be a possible answer. However, attempts made thus far have not led to an improvement in daily forecasting procedures. This study describes a model that was launched in 2013 in Austria to provide the first available personal pollen information. This system includes innovative forecast models using bi-hourly pollen data, traditional pollen forecasts based on historical data, meteorological data, and recent symptom data from the patient's hayfever diary. Furthermore, it calculates the personal symptom load in real time, in particular, the entries of the previous 5 days, to classify users. The personal pollen information was made available in Austria on the Austrian pollen information website and via a mobile pollen application, described herein for the first time. It is supposed that the inclusion of personal symptoms will lead to major improvements in pollen information concerning hay fever sufferers.