Maternal exposure to pyrethroid insecticides during pregnancy and respiratory allergy symptoms among children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE).

BACKGROUND: Pyrethroid insecticides use for indoor residual spraying (IRS) in malaria-endemic areas results in high levels of exposure to local populations. Pyrethroids may cause asthma and respiratory allergies but no prior study has investigated this question in an IRS area. METHODS: We measured maternal urinary concentrations of pyrethroid metabolites (cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA) in samples collected at delivery from 751 mothers participating in the Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE), a birth cohort study based in Limpopo, South Africa. At 3.5-year and 5-year follow-up visits, caregivers of 647 and 620 children, respectively, were queried about children's respiratory allergy symptoms based on validated instruments. We applied marginal structural models for repeated outcomes to estimate associations between biomarker concentrations and asthma diagnosis as well as respiratory allergy symptoms at ages 3.5 and 5 years. RESULTS: We found that a10-fold increase in maternal urinary cis-DCCA, trans-DCCA and 3-PBA concentrations were associated with more than a doubling in the risk of doctor-diagnosed asthma (cis-DCCA: RR = 2.1, 95% CI = 1.3, 3.3; trans-DCCA: RR = 2.1, 95% CI = 1.1, 3.9; 3-PBA: RR = 2.4, 95% CI = 1.0, 5.8) and an about 80% increase in the risk of wheezing or whistling in the chest (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.0; trans-DCCA: RR = 1.7, 95% CI = 1.1, 2.6; 3-PBA: RR = 1.8, 95% CI = 1.0, 3.3) and suspected asthma (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.1; trans-DCCA: RR = 1.8, 95% CI = 1.1, 2.8). We also observed that higher concentrations of cis-DBCA and 3-PBA were related to increases in the risks of dry cough at night (RR = 3.5, 95% CI = 1.3, 9.5) and seasonal rhinoconjunctivitis (RR = 2.0, 95% CI = 1.1, 3.9), respectively. CONCLUSION: Maternal exposure to pyrethroids may increase the risk of asthma and other respiratory allergy symptoms among preschool children from an IRS area.

Do nasal and nasopharyngeal obstruction and their medical-surgical deobstruction significantly influence facial divergence? A concise review of major clinical studies with meta-analysis / L'obstruction du nez et du nasopharynx et leur désobstruction médico-chirurgicale influencent-elles significativement la divergence faciale ? Une revue concise des études cliniques majeures avec méta-analyse

Introduction: The term « adenoid facies ¼ suggests a causal relationship between nasopharyngeal obstruction and facial hyperdivergence in growing subjects. The strength of this association is controversial and few « quantified ¼ values exist. Materials and methods: A rapid electronic search was conducted on PubMed and Embase to find the main cephalometric studies involving patients with nasal/nasopharyngeal obstruction compared to a control sample. A meta-analysis was carried out to quantify the effect of obstruction (1) and intervention to relieve the obstruction (2) on mandibular divergence (SN/Pmand angle), maxillo-mandibular divergence (PP/Pmand angle), inclination of the occlusal plane (SN/Poccl) and the gonial angle (ArGoMe). Results: Qualitatively, the studies' bias level ranged from moderate to high. Results were concordant about the significant effect of the obstruction on facial divergence (1) with an increase in SN/Pmand (+3.6° on average, +4.1° in children <6 years), PP/Pmand (+5.4° on average, +7.7° <6 years), ArGoMe (+3.3°) and SN/Pocc (+1.9°). Surgical interventions to remove the respiratory obstacle in children (2) generally did not normalize the direction of growth, with the exception, with a very low level of evidence, of adenoidectomies/adeno-tonsillectomies, performed at an age less than 6-8 years. Conclusion: Early detection of respiratory obstacles and postural abnormalities associated with oral breathing appears to be decisive in order to hope for management at a young age and normalization of the direction of growth. However, the effects on mandibular divergence remain limited, requiring caution, and cannot be considered a surgical indication.

Introduction: Le terme « faciès adénoïdien ¼ suggère une relation de causalité entre l'obstruction nasopharyngée et l'hyperdivergence chez le sujet en croissance. La force de cette association est controversée et peu de valeurs « chiffrées ¼ existent. Matériels et méthodes: Une recherche électronique rapide a été menée sur PubMed et Embase pour retrouver les principales études céphalométriques impliquant des patients avec obstruction nasale/nasopharyngée comparés à une population témoin. Une métanalyse a été réalisée pour quantifier l'effet de l'obstruction (1) et de la désobstruction (2) sur la divergence mandibulaire (angle SN/Pmand), la divergence maxillo-mandibulaire (angle PP/Pmand), l'inclinaison du plan occlusal (SN/Poccl) et l'angle goniaque (ArGoMe). Résultats: Qualitativement, le niveau de biais des études allait de modéré à élevé. Les résultats étaient concordants sur l'effet significatif de l'obstruction sur la divergence faciale (1) avec une augmentation de SN/Pmand (+3,6° en moyenne, +4,1° chez les enfants < 6 ans), PP/Pmand (+5,4° en moyenne, +7,7° < 6 ans), ArGoMe (+3,3°) et SN/Pocc (+1,9°). Les interventions chirurgicales pour lever l'obstacle respiratoire chez l'enfant (2) ne permettaient généralement pas une normalisation de la direction de croissance, à l'exception, avec un très faible niveau de preuve, des adénoïdectomies/adéno-amygdalectomies, réalisées à un âge inférieur à 6-8 ans. Conclusion: Le dépistage précoce des obstacles respiratoires et des anomalies posturales associées à la ventilation orale apparaît déterminant pour espérer une prise en charge en jeune âge et une normalisation de la direction de croissance. Les effets sur la divergence mandibulaire restent cependant limités, imposant la prudence et ne constituant pas une indication chirurgicale.

The intriguing possibility of using probiotics in allergen-specific immunotherapy.

Allergen immunotherapy (AIT) can be considered the etiological therapy for allergic rhinitis and hymenoptera venom allergy. Its role is increasingly emerging in the context of IgE mediated food allergy, where the achievement of tolerance, or the permanent resolution of an allergy, represents the optimal goal of AIT. AIT treatment, indicated in adults and children with allergic rhinitis, has a preventative effect on the development of asthma and can also be used when asthma is associated to rhinitis; however, it is not the first choice for treatment of isolated asthma. While knowledge on immunological mechanisms, efficacy, and safety of AIT is known, an intriguing line of investigation has arisen on how the action of AIT is modulated by the use of probiotics, starting from awareness that the microbiome is altered in allergic conditions: the use of probiotics in inducing the stimulation of innate immunity via toll-like receptor activation, thus acting as adjuvants in AIT, is hereby examined. Therefore, by analyzing literature on AIT and probiotics, we intend to draw attention to how the role and use of AIT are emerging as being increasingly important for both the short- and long-term management of allergic diseases and how recourse probiotics may represent an additional therapeutic strategy to modulate the effectiveness of AIT. However, further investigations are needed to better identify which probiotics to use, the dosage, and the optimal duration to obtain correct immunomodulation, and how to best customize their use, including a "AIT + probiotics" strategy in the field of precision medicine.

A real-world retrospective study of safety, efficacy, compliance and cost of combination treatment with rush immunotherapy plus one dose of pretreatment anti-IgE in Chinese children with respiratory allergies.

Background: The efficacy of allergen immunotherapy (AIT) in treating pediatric allergy has been clearly demonstrated, however, many patients hesitate to initiate AIT due to weekly hospital visits during the 3-4 months up-dosing phase. Meanwhile, rush immunotherapy (RIT) shortens the duration of the up-dosing phase to 7 days. However, considering that patients receiving RIT are exposed to the allergens during a much shorter period of time and thus may be at a greater risk of systemic reactions, RIT is currently underused, especially in children. This study investigated the utility of combination treatment with RIT plus 1 dose of pretreatment anti-IgE in children with respiratory allergies. Methods: In this retrospective study, we reviewed records of children with allergic rhinitis (AR) and/or allergic asthma (AA) sensitized to dust mite allergens receiving RIT+1 dose of pretreatment anti-IgE (the RIT group) or conventional immunotherapy (the CIT group) at our hospital from January 2020 to March 2021. Data such as visual analogue scale (VAS) scores, comprehensive symptom and medication score (CSMS), allergy blood test results, adverse reactions, compliance and cost were collected and analyzed. Results: 40 patients in the RIT group and 81 patients in the CIT group were included in this study. Both treatments were well tolerated and patients in the 2 treatment groups had comparable local and systemic reactions. Compared to CIT, RIT + anti-IgE combination led to significantly faster symptomatic improvement as demonstrated by significantly decreased VAS and CSMS starting as early as 1 month after AIT initiation (P<0.05). Nobody dropped out in the RIT group during the 1 year follow-up, while 11 out of 81 patients in the CIT group dropped out (loss rate 13.5%). Thus, the RIT group had a significantly higher compliance rate than the CIT group (P<0.05). Finally, the 2 treatment regimens had comparable cost per patient per injection (P> 0.05). Conclusions: RIT + 1 dose of pretreatment anti-IgE combination has practical advantages over CIT, including comparable safety, better compliance, and probably a faster onset of clinical efficacy at no additional cost, so it can be an useful regimen for the treatment of Chinese children with respiratory allergies.

Association of Parasomnia Symptoms with Risk of Childhood Asthma and the Role of Preterm Birth.

Purpose: To examine whether parasomnia symptoms are associated with increased odds of childhood asthma and wheeze, and the role of preterm birth. Patients and Methods: The Shanghai Children's Allergy Study was cross-sectionally conducted in 31 kindergartens and 17 primary schools in Shanghai, China. After excluding the missing data of gestational week and child's age, this study included a total of 16,487 individuals with a mean age of 7.74 years and 52.4% of males. The association between parasomnia symptoms and wheeze/asthma was assessed by univariate and multivariate analyses. The interaction effects of parasomnias and preterm birth were primarily evaluated by P for multiplicative interaction, and the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were also measured. Results: Parasomnias, especially rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of childhood wheeze/asthma, and the interaction between parasomnia and preterm birth exhibited an excess risk of current wheeze (RERI, 1.43; 95% CI, 0.41-2.45) and ever asthma (RERI, 0.75; 95% CI, 0.01-1.50). In the stratification analyses, the combination of parasomnia symptoms and preterm birth had higher odds of wheeze/asthma. And the odds of current wheeze (OR, 4.55; 95% CI, 1.69-12.25; p=0.003) and ever asthma (OR, 6.17; 95% CI, 2.36-16.11; p<0.001) were much higher in cumulative parasomnia symptoms plus very preterm birth. And sensitive analyses were further conducted in populations without sleep disordered breathing (SDB), and an allergen test subgroup, yielding similar results. Conclusion: Parasomnia symptoms are associated with increased odds of childhood wheeze/asthma, and the odds were even higher in premature population. The findings suggest that parasomnia symptoms, as a developmental sleep disorder, are supposed to be closely watched among children who have asthma or are at risk for asthma, and that preterm children deserve more attention.

Comorbid allergic rhinitis and asthma: important clinical considerations.

INTRODUCTION: The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED: We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION: We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.

Differential Quercus spp. pollen-particulate matter interaction is dependent on geographical areas.

Particulate matter (PM) and pollen interaction, either airborne or at the respiratory mucosa needs further clarification, as allergic reaction intensification can be related to the PM physical characteristics and toxicity. This study aimed to investigate the physical-chemical properties of PM that can adhere to the pollen wall during its transport or inhalation, using Quercus spp. as a model, in three Portuguese cities with different geographical locations, meteorological influence and urbanization levels. Possible sources were evaluated through air masses trajectory analysis using the HYSPLIT model and correlation with meteorological factors. The sampling was performed using a 7-days Hirst-type volumetric sampler, and the pollen grains were observed using a Field Emission Electron Probe Microanalyser for PM analysis. A secondary electron image of each pollen grain was taken, to determine the adhered particles characteristics and energy dispersive x-ray spectroscopy (EDS) spectra were obtained for individual particles. A total of 484 pollen grains was observed, with 7683 particles counted and 1914 EDS spectra analyzed. The particle's equivalent diameter ranged from 0.3-16 µm, with most having a diameter < 3 µm. For the three cities, there were significant differences in the number of particles per pollen and the % area occupied by the particles. Particles adhered were mainly Si-rich, but variations in other dominant groups were observed. For Évora and Guarda, Ca-rich, SO-rich were second and third more representative, while Porto were Organic and Cl-rich. Metals&Oxides were found in all cities with the highest number in Porto. P-rich particles were only found in Évora. Sea salt particles were observed in Évora, coincide with air mass trajectories possible carrying them from the Mediterranean Sea. In conclusion, the PM physical characteristics are similar between the studied cities, however, the dominant chemical composition is different, certainly impacting the exposome influence and pollen-allergy intensification towards the same pollen type and concentration.

Diagnostic characterization of respiratory allergies by means of a multiplex immunoassay.

Allergic sensitization is commonly assessed in patients by performing the skin prick test (SPT) or determining specific immunoglobulin (IgE) levels in blood samples with the ImmunoCAP™ assay, which measures each allergen and sample separately. This paper explores the possibility to investigate respiratory allergies with a high throughput method, the Meso Scale Discovery (MSD) multiplex immunoassay, measuring IgE levels in low volumes of blood. The MSD multiplex immunoassay, developed and optimized with standards and allergens from Radim Diagnostics, was validated against the SPT and the ImmunoCAP assay. For 18 adults (15 respiratory allergy patients and three controls), blood collection and the SPT were performed within the same hour. Pearson correlations and Bland-Altman analysis showed high comparability of the MSD multiplex immunoassay with the SPT and the ImmunoCAP assay, except for house dust mite. The sensitivity of the MSD multiplexed assay was ≥78% for most allergens compared to the SPT and ImmunoCAP assay. Additionally, the specificity of the MSD multiplex immunoassay was ≥ 87% - the majority showing 100% specificity. Only the rye allergen had a low specificity when compared to the SPT, probably due to cross-reactivity. The reproducibility of the MSD multiplex immunoassay, assessed as intra- and interassay reproducibility and biological variability between different sampling moments, showed significantly high correlations (r = 0·943-1) for all tested subjects (apart from subject 13; r = 0·65-0·99). The MSD multiplex immunoassay is a reliable method to detect specific IgE levels against respiratory allergens in a multiplexed and high-throughput manner, using blood samples as small as from a finger prick.

Relationship between chemokines and T lymphocytes in the context of respiratory allergies (Review).

Allergic diseases have been classified in the last decades using various theories. The main classes of the newest classification in allergic respiratory diseases focus on the characterization of the endotype (which takes into account biomarkers related to determinant pathophysiological mechanisms) and of the phenotype (based on the description of the disease). Th2, Th1 and Th17 lymphocytes and the type of inflammatory response mediated by them represent the basis for Th2 and non-Th2 endotype classification. In addition, new lymphocytes were also used to characterize allergic diseases: Th9 lymphocytes, Th22 lymphocytes, T follicular helper cells (TFH) lymphocytes and invariant natural killer T (iNKT) lymphocytes. In the last decade, a growing body of evidence focused on chemokines, chemoattractant cytokines, which seems to have an important contribution to the pathogenesis of this pathology. This review presents the interactions between chemokines and Th lymphocytes in the context of Th2/non-Th2 endotype classification of respiratory allergies.

The Role of Vitamin D Deficiency in Children With Recurrent Wheezing-Clinical Significance.

Recurrent wheezing (RW) in infancy is one of the most frequent reasons for parents to consult health care providers and creates a significant global burden. Clinical course of RW is difficult to predict, also which infants will progress to asthma, since no valid biomarkers have been established. Identification of those infants with RW who are at risk of further recurrences and/or severe acute respiratory tract infection (ARTI) could help pediatricians to improve their therapeutic decisions. Increasing research interest is focused on the extra-skeletal actions of vitamin D (VD) and the clinical impact of VD insufficiency/deficiency. As VD deficiency could be a risk factor for causing RW in children, measurement of their serum level of 25-hydroxycholecalciferol [25(OH)D] is recommended. In the case of deficiency, VD administration is recommended in age-appropriate doses for at least 6 weeks, until achievement of normal blood 25(OH)D level, followed by supplementation as long as exposure to sun is inadequate. Higher doses of VD given in an attempt to prevent asthma development appear to be of no additional benefit. In children with severe ARTI, VD level is recommended to be assess.

Exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children at the age of 6 years.

AIM: We examined the associations between breastfeeding and respiratory allergies and types of asthma in American children. METHODS: This longitudinal study used data from mother-infant pairs who took part in the Infant Feeding Practices Study II in 2005-2007 and the Year 6 Follow-Up Study in 2012. The mothers reported breastfeeding practices on a monthly basis for the first year of life, childhood asthma and allergies at age 6 years, and associated factors. Generalised linear models were used in statistical analyses. RESULTS: Overall, 1177 mother-infant pairs were included in the sample. A third (32.9%) of the children were exclusively breastfed until the age of 3 months and by the age of 6 years 20.8% had been diagnosed with respiratory allergies and 11.3% with asthma. In the multivariable analyses, exclusive breastfeeding for 3 months was associated with a reduced relative risk of respiratory allergies of 0.77 at the age of 6 years. It also reduced the relative risk of asthma to 0.66, but only if the children did not have a family history of asthma. CONCLUSION: This longitudinal study provided evidence that exclusive breastfeeding for the first 3 months may reduce the risk of respiratory allergies and asthma in children 6 years of age, but concerning asthma, statistical significance was reached only in children without a family predisposition to asthma.

Five-Year Data on Pollen Monitoring, Distribution and Health Impact of Allergenic Plants in Bucharest and the Southeastern Region of Romania.

Background and objectives: Respiratory allergies induced by allergenic pollen represent an important public health problem with increasing prevalence and severity in Europe. Romania has no aerobiology network and pollen measurements have been done for about ten years in the west region only. Materials and Methods: We established the first pollen monitoring center in the capital of Bucharest in 2013, based on collaboration with the Réseau National de Surveillance Aérobiologique (RNSA) from France. The aim of our paper is to present results from five years of pollen monitoring in the city center of Bucharest and preliminary data on distribution and health impact of some allergenic plants, mainly Ambrosia artemisiifolia, which is considered a real danger for the public health. Results: Our data show a significant atmospheric amount and a longer season than previously considered of grass (Gramineae) pollen and short period with a high level of Ambrosia pollen, while tree pollen looks less important in this area. The plant distribution data provided by specialists and information from affected persons showed the wide and increasing spread of Ambrosia in Bucharest and other cities from the south region. Preliminary health data from allergists confirmed that the number of patients with allergies to Ambrosia pollen is increasing from one year to another and almost all patients describe a high urban exposure from their living or working place. Conclusions: We consider that the recently implemented Law 62/2018 against Ambrosia may help reduce weed distribution and the atmospheric pollen load, but a more complex and coordinated strategy for controlling urban vegetation and reducing biologic pollution is needed.

Allergens Prevalence among Patients with Respiratory Allergies in Mashhad, Iran.

BACKGROUND: Respiratory allergies are among the most common allergies in the world with an increasing number of people affected in recent decades. Determination of allergens prevalence in each area is considered as the first step in prevention of allergic diseases and developing novel and more effective immunotherapies. The aim of this study was to determine the prevalence of the most common allergens among patients with respiratory allergies in Mashhad, Iran. MATERIALS AND METHODS: This cross sectional study included 1246 people who were referred to Allergy Clinic of Mashhad University of Medical Sciences with respiratory allergic symptoms from 2012 to 2017 in which a questionnaire containing demographic information was completed and Skin Prick Test was performed for each patient. RESULTS: Among 1246 patients with respiratory symptoms, there were 1084 patients with allergic rhinitis (87%), 69 patients with allergic asthma (5.5%), 14 patients with allergic rhinoconjunctivitis (1.1%) and 79 patients with both allergic rhinitis and asthma (6.3%) with an overall male to female ratio of 1.18. Rhinorrhea (86.3%), sneezing (81.1%) and itchy eyes (68.4%) were the most common symptoms in patients with respiratory allergic disorders in this study and the highest rate of sensitivity was to pollens including Salsola kali (82.3%), pigweed mix (65.1%), tree mix (51.7%) and ash (49.8%), respectively. CONCLUSION: Generally, Salsola kali seems to be the main allergen in different respiratory allergies including allergic rhinitis, asthma and rhinoconjunctivitis in semi-arid climate of Mashhad, Iran.

Collaboration between specialties for respiratory allergies in the International Classification of Diseases (ICD)-11.

BACKGROUND: The International Classification of Diseases (ICD) has been grouping the allergic and hypersensitivity disorders involving the respiratory tract under topographic distribution, regardless of the underlying mechanisms, triggers or concepts currently in use for allergic and hypersensitivity conditions. In order to strengthen awareness and deliberate the creation of the new "Allergic or hypersensitivity disorders involving the respiratory tract" section of the ICD-11, we here propose make the building process public. METHODS: The new frame has been constructed to cover the gaps previously identified and was based on consensus academic reports and ICD-11 principles. Constant and bilateral discussion was kept with relevant groups representing specialties and resulted in proposals submission into the ICD-11 online platform. RESULTS: The "Allergic or hypersensitivity disorders involving the respiratory tract" section covers 64 entities distributed across five main categories. All the 79 proposals submitted resulted from an intensive collaboration of the Allergy working group, relevant Expert working groups and the WHO ICD governance. CONCLUSION: The establishment of the ICD-11 "Allergic or hypersensitivity disorders involving the respiratory tract" section will allow the dissemination of the updated concepts to be used in clinical practice by many different specialties and health professionals.

Knowledge on bronchial asthma among teachers and educators - preliminary results of a pilot study.

One of the elements contributing to development of health-promoting behaviors is knowledge transmitted by teachers. AIM: The aim of the research was to assess the teachers' and educators' knowledge on bronchial asthma. MATERIALS AND METHODS: The survey consisting of closed multiple choice questions concerning bronchial asthma was conducted among 106 teachers. The questionnaire contained 12 questions selected by competent judges. To verify statistical hypotheses, we used Pearson Chi2 test with Benjamini-Hochberg correction. RESULTS: 98 respondents knew that bronchial asthma is a disease of allergic etiology. Seventy-two people believed that smoking induces asthma and 63 - that genetic factors predispose to development of the disease. The respondents estimated that the course of asthma is severe in 50% of patients and only 10 people answered that it is such in 5% of patients (which is the right answer). 47 claimed that a person suffering from mild asthma cannot participate in physical education classes, practice sports, or ride a bicycle. 94 respondents were aware that respiratory allergies and allergic rhinitis are risk factors for the development of bronchial asthma. As indicated by 98 respondents, a child with asthma should have inhalators with them and inform the teachers about the disease. Only 30 people estimated correctly the prevalence of bronchial asthma at the level of 5-9%, 2 at the level of 1-2%, the remaining respondents overestimated the prevalence of asthma in the Polish population. Only 42 people reported inhaled corticosteroids as drugs important in the treatment of bronchial asthma. According to 94 people, inhaled steroids caused numerous post-steroid diseases. CONCLUSIONS: The knowledge of teachers about associations between bronchial asthma and allergy is reliable and reflects scientific knowledge. However, teachers feel concern over the presence of a child with asthma in the class. The results of the survey indicate the teachers' anxiety about inhaled steroid therapy and lack of reliable knowledge on inhaled steroids. Yet, the knowledge of organization of asthma treatment among teachers and educators in Poland is relatively reliable.

Prevention of allergies in childhood - where are we now?

Allergic diseases represent an increasing health problem for children worldwide. Along with allergic airway diseases, food allergy comes to the fore and herewith closely intertwined the hypothesis that an early allergic sensitization might occur via skin barrier defect(s). The importance of the skin barrier has been documented by several studies meanwhile. Not only genetic studies screen the associations between Filaggrin loss-of-function mutations, atopic dermatitis, allergic sensitization, food allergy and even airway diseases, but also epidemiological studies cast new light on the hypothesis of the atopic march. As another focus in context of the development of an allergic phenotype, the specific microbial exposure with all its diversities has been crystallized as it shapes the immune system in (early) infancy. Studies explored both, the role of human intestinal microbiota as well as the external microbial diversity. Unfortunately suitable markers for atopic predictors are still rare. New studies point out that specific IgE antibodies (e.g., IgE to Phl p 1) in children without allergic symptoms so far, might function as a pre-clinical biomarker, which may help to identify candidates for primary (allergen non-specific) or secondary (allergen-specific) prevention in terms of specific immunoprophylaxis. These manifold research activities document a complex increase in knowledge. Nevertheless new assumptions need to be substantively confirmed in order to finally generate the urgently needed preventive strategies for allergic diseases in childhood.

Characterisation of particulate matter on airborne pollen grains.

A characterization of the physical-chemical composition of the atmospheric PM adsorbed to airborne pollen was performed. Airborne pollen was sampled using a Hirst-type volumetric spore sampler and observed using a Field Emission Electron Probe Microanalyser for PM analysis. A secondary electron image was taken of each pollen grain and EDS spectra were obtained for individually adsorbed particles. All images were analysed and the size parameters of the particles adsorbed to pollen was determined. The measured particles' equivalent diameter varied between 0.1 and 25.8 µm, mostly in the fine fraction. The dominant particulates identified were Si-rich, Organic-rich, SO-rich, Metals & Oxides and Cl-rich. Significant daily differences were observed in the physical-chemical characteristics of particles adsorbed to the airborne pollen wall. These differences were correlated with weather parameters and atmospheric PM concentration. Airborne pollen has the ability to adsorb fine particles that may enhance its allergenicity.

Microorganism-induced suppression of allergic airway disease: novel therapies on the horizon?

Allergic airway disease is a major global health burden, and novel treatment options are urgently needed. Numerous epidemiological and experimental studies suggest that certain helminths and bacteria protect against respiratory allergies. These microorganisms are strong regulators of the immune system, and various potential regulatory mechanisms by which they protect against allergic airway inflammation have been proposed. Whereas early studies addressed the beneficial effect of natural infections, the focus now shifts toward identifying the dominant protective molecules and exploring their efficacy in models of allergic airway disease. In this article, we will review the evidence for microbe-mediated protection from allergic airway disease, the potential modes of action involved and discuss advances as well as limitations in the translation of this knowledge into novel treatment strategies against allergic airway disease.