Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy

IgE-mediated food allergies are caused by adverse immunologic responses to food proteins. Allergic reactions may present locally in different tissues such as skin, gastrointestinal and respiratory tract and may result is systemic life-threatening reactions. During the last decades, the prevalence of food allergies has significantly increased throughout the world, and considerable efforts have been made to develop curative therapies. Food allergen immunotherapy is a promising therapeutic approach for food allergies that is based on the administration of increasing doses of culprit food extracts, or purified, and sometime modified food allergens. Different routes of administration for food allergen immunotherapy including oral, sublingual, epicutaneous and subcutaneous regimens are being evaluated. Although a wealth of data from clinical food allergen immunotherapy trials has been obtained, a lack of consistency in assessed clinical and immunological outcome measures presents a major hurdle for evaluating these new treatments. Coordinated efforts are needed to establish standardized outcome measures to be applied in food allergy immunotherapy studies, allowing for better harmonization of data and setting the standards for the future research. Several immunological parameters have been measured in food allergen immunotherapy, including allergen-specific immunoglobulin levels, basophil activation, cytokines, and other soluble biomarkers, T cell and B cell responses and skin prick tests. In this review we discuss different immunological parameters and assess their applicability as potential outcome measures for food allergen immunotherapy that may be included in such a standardized set of outcome measures

Pušenje među makedonskim radnicima pet godina nakon kampanje protiv pušenja

To assess the efficacy of a nationwide anti-smoking campaign, we compared the findings of a study on worker smoking performed in 2005 with our latest cross-sectional study completed in 2010. It included 753 randomly selected workers, of whom 126 office, 108 construction, 93 agricultural, 97 petroleum refinery, 114 textile, 117 food processing workers, and 98 cleaners. Information was collected with a selfadministered questionnaire. The prevalence of current smokers among all workers was 35.4 %, ranging from 30.2 % in office workers to 43.5 % in construction workers. It did not significantly differ from the prevalence recorded in 2005 (35.4 % vs. 36.8 %, respectively; P=0.441). Mean pack-years smoked among all smokers was 12.4±2.3, ranging from 10.9 in administrative workers to 13.7 in agricultural workers. We did not find any significant difference in the prevalence of current smokers between male and female workers and between workers aged less or more than 40 years, as well as between workers of higher and lower education. The prevalence of ex-smokers was 10.5 %, ranging from 8.4 % in construction workers to 12.1 % in administrative workers, whereas the prevalence of passive smokers was 29.1 %, ranging from 26.2 % in food processing workers to 32.9 % in agricultural workers. Our findings indicate that the prevalence of current and passive smokers has remained high regardless of the anti-smoking campaign and call for stricter implementation of anti-smoking regulations.Želeći utvrditi djelotvornost kampanje protiv pušenja u Makedoniji, usporedili smo rezultate istraživanja o pušenju u radničkoj populaciji provedenog 2005. s rezultatima našega najnovijega presječnoga randomiziranog ispitivanja koje je dovršeno 2010. Ispitivanje je obuhvatilo 753 radnika, od kojih je 126 uredskih, 108 građevinskih, 93 poljoprivrednih, 97 u rafineriji nafte, 114 tekstilnih, 117 prehrambenih te 98 čistač(ic)a. Podaci su prikupljeni s pomoću upitnika koji su ispunjavali ispitanici. Prevalencija aktivnih pušača među svim radnicima bila je 35,4 %, od 30,2 % u uredskih radnika do 43,5 % u građevinskih. Nije se značajno razlikovala od prevalencije zabilježene 2005. (35,4 % odnosno 36,8 %, P=0,441). Srednja vrijednost kutija/godina u pušača bila je 12,4±2,3, od 10,9 u uredskih do 13,7 u poljoprivrednih radnika. Značajnih razlika u aktivnome pušenju nije bilo među ženama i muškarcima, radnicima starijim i mlađima od 40 godina, niti među radnicima višeg i nižeg obrazovanja. Prevalencija bivših pušača bila je 10,5 %, od 8,4 % u građevinskih do 12,1 % u uredskih radnika, dok je prevalencija pasivnih pušača bila 29,1 %, od 26,2 % u radnika u preradi hrane do 32,9 % u poljoprivrednih radnika. Naši rezultati pokazuju da je prevalencija aktivnih i pasivnih pušača ostala visoka bez obzira na kampanju protiv pušenja te pozivaju na strožu provedbu propisa koji ograničavaju pušenje

Izloženost ambijentalnomu duhanskomu dimu na radnome mjestu u Makedoniji: kako sada stojimo?

To assess the prevalence and the level of exposure to environmental tobacco smoke (ETS) in the workplace after the enactment of the law restricting indoor smoking in Macedonia, we performed a cross-sectional, self-administered questionnaire study including 372 never-smoking workers recruited from six workplaces. We found a high prevalence of workers exposed to ETS in the workplace (27.4 %) with no significant difference between particular occupation groups. We found no significant difference in the prevalence of passive smokers in the workplace between this study and our study conducted before the law was enacted (31.5 % vs. 27.4 %, P=0.324). The prevalence of workers exposed to ETS for less than three hours a day was significantly lower than of passive smokers with longer exposure (28.4 % vs. 71.6 %, P=0.038). The prevalence of workers exposed to ETS from less than 10 cigarettes smoked by coworkers per day was lower than the prevalence of workers with higher exposure, but statistical significance was not reached (37.9 % vs. 62.1 %, P=0.087). Our findings indicate a high prevalence and a high level of exposure to ETS in the workplace, which calls for stricter adherence to smoking-free legislation or even the total ban of smoking in the workplace.Ovo je ispitivanje obuhvatilo 372 radnika na šest različitih radnih mjesta koji nikad nisu pušili kako bi se procijenila zastupljenost osoba izloženih duhanskomu dimu na radnome mjestu i razina njihove izloženosti nakon zakonskih ograničenja pušenja u zatvorenim prostorijama u Makedoniji. Ispitivanje je provedeno s pomoću upitnika koji su radnici ispunjavali sami. Utvrdili smo visoku zastupljenost radnika izloženih ambijentalnomu duhanskomu dimu na radnome mjestu (27,4 %) te nisu zamijećene statistički značajne razlike među zanimanjima. Nisu uočene značajne razlike između zastupljenosti pasivnih pušača na radnome mjestu u ovome ispitivanju i u našem ranijem ispitivanju, kada još nije na snagu stupio zakon o ograničenju pušenja (31,5 % naprema 27,4 %, P=0,324). Zastupljenost radnika izloženih ambijentalnomu duhanskomu dimu ne dulje od tri sata na dan bila je statistički značajno niža negoli onih čija je izloženost trajala duže (28,4 % naprema 71,6 %, P=0,038). Zastupljenost radnika koji su bili izloženi dimu kolega koji su pušili manje od 10 cigareta na dan bila je niža negoli onih s većom izloženosti, ali razlika nije bila statistički značajna (37,9 % naprema 62,1 %, P=0,087). Naši rezultati potvrđuju da i dalje postoje visoka zastupljenost izloženih radnika i visoke razine izloženosti ambijentalnomu duhanskomu dimu na radnome mjestu, što upućuje na potrebu uvođenja strožih zakona o zabrani pušenja

Recognition of COVID-19 with occupational origin: a comparison between European countries

Objectives This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. Methods A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. Results The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. Conclusions COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.This publication is based on work from COST Action CA16216 (OMEGA-NET), supported by COST (European Cooperation in Science and Technology)

Development of Harmonized COVID-19 Occupational Questionnaires

Harmonized tools and approaches for data collection can help to detect similarities and differences within and between countries and support the development, implementation, and assessment of effective and consistent preventive strategies. We developed open source occupational questionnaires on COVID-19 within COVID-19 working groups in the OMEGA-NET COST action (Network on the Coordination and Harmonisation of European Occupational Cohorts, omeganetcohorts.eu), and the EU funded EPHOR project (Exposome project for health and occupational research, ephor-project.eu). We defined domains to be included in order to cover key working life aspects of the COVID-19 pandemic. Where possible, we selected questionnaire items and instruments from existing questionnaire resources. Both a general occupational COVID-19 questionnaire and a specific occupational COVID-19 questionnaire are available. The general occupational COVID-19 questionnaire covers key working life aspects of the COVID-19 pandemic, including the domains: COVID-19 diagnosis and prevention, Health and demographics, Use of personal protective equipment and face covering, Health effects, Work-related effects (e.g. change in work schedule and work–life balance), Financial effects, Work-based risk factors (e.g. physical distancing, contact with COVID-19-infected persons), Psychosocial risk factors, Lifestyle risk factors, and Personal evaluation of the impact of COVID-19. For each domain, additional questions are available. The specific occupational COVID-19 questionnaire focusses on occupational risk factors and mitigating factors for SARS-CoV2 infection and COVID-19 disease and includes questions about the type of job, amount of home working, social distancing, human contact (colleagues, patients, and members of the public), commuting, and use of personal protective equipment and face coverings. The strength of this initiative is the broad working life approach to various important issues related to SARS-CoV-2 infection, COVID-19 disease, and potentially future pandemics. It requires further work to validate the questionnaires, and we welcome collaboration with researchers willing to do this. A limitation is the moderate number of questions for each of the domains in the general questionnaire. Only few questions on general core information like ethnicity, demographics, lifestyle factors, and general health status are included, but the OMEGA-NET questionnaires can be integrated in existing questionnaires about sociodemographic and health-related aspects. The questionnaires are freely accessible from the OMEGA-NET and the EPHOR homepages

Pretjerana bronhalna reaktivnost u kuharica i čistača

The aim of this cross-sectional study was to assess the prevalence and characteristics of bronchial hyperresponsiveness (BHR) in 43 women cleaners (aged 26 to 57) and 37 women cooks (aged 29 to 55) and compare them with 45 controls (women office workers aged 27 to 58). The evaluation of all subjects included a questionnaire, skin prick tests to common aeroallergens, spirometry, and histamine challenge (PC20≤8 mg mL-1). We found higher BHR prevalence in cleaners and cooks than in office workers (30.2 % and 29.7 %, vs. 17.7 %, respectively), but statistical significance was not reached. The prevalence of mild and moderate to severe BHR was similar in all groups. Borderline BHR prevalence was significantly higher in cleaners than in controls (16.2 % vs. 6.6 %, P=0.032) whereas the difference was on the verge of significance in cooks (13.5 % vs. 6.6 %, P=0.081). Moderate to severe BHR was strongly associated with positive family history of asthma and atopy in all groups. Mild BHR was significantly associated with daily smoking in cleaners (P=0.031) and cooks (P=0.021), as well as with the duration of exposure in cleaners (P=0.038). Borderline BHR was closely related to daily smoking and duration of exposure in both cleaners and cooks. Our findings indicate an important role of workplace exposure in borderline BHR development, as well as the significant effect of smoking on mild BHR development in women cleaners and cooks.Svrha je ovoga presječnog ispitivanja bila utvrditi prevalenciju i značajke pretjerane bronhalne reaktivnosti (engl. bronchial hyperresponsiveness, krat. BHR) u profesionalnih čistačica (43 ispitanice u dobi od 26 do 57 godina) i kuharica (37 ispitanica u dobi od 29 do 55 godina). Kontrolna skupina obuhvatila je 45 uredskih radnica u dobi od 27 do 58 godina. Ocjena izloženih i kontrolnih ispitanica obuhvatila je upitnik, skin prick testove na uobičajene inhalacijske alergene, spirometriju te histaminski test (PC20 ≤8 mg mL-1). ^istačice odnosno kuharice iskazale su veću prevalenciju BHR-a od kontrolnih uredskih radnica (30,2 % odnosno 29,7 % prema 17,7 %), ali ona nije bila statistički značajna. Sve su skupine iskazale podjednaku prevalenciju umjerenog i snažnog BHR-a. Prevalencija graničnoga BHR-a bila je značajno viša u čistačica negoli u kontrole (16,2 % naprema 6,6 %, P=0,032), a na rubu statističke značajnosti bila je i razlika između kuharica i kontrole (13,5 % prema 6,6 %, P=0,081). Umjeren odnosno snažan BHR u svih je skupina bio značajno povezan s obiteljskom povijesti astme i atopija. Blagi BHR značajno je povezan sa svakodnevnim pušenjem u čistačica (P=0,031) i kuharica (P=0,021), a u čistačica i s trajanjem izloženosti (P=0,038). Granični BHR je i u čistačica i u kuharica povezan sa svakodnevnim pušenjem i trajanjem profesionalne izloženosti. Naši podaci upućuju na važnu ulogu profesionalne izloženosti u nastanku graničnoga BHR-a te na značajan utjecaj pušenja na nastanak blagoga BHR-a u profesionalnih čistačica i kuharica

Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food—A first step in an initiative to better inform patients and avoid fatal allergic reactions: A GA²LEN position paper

Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as “may contain traces of” is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement “this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product” for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged

Chronic Obstructive Pulmonary Disease and Occupational Exposures: Epidemiological Evidence from R. Macedonia

Introduction: The research found consistent associations between workplace exposures across a wide&nbsp; range of sectors and the development of chronic obstructive pulmonary disease (COPD) independently of or in concert with cigarette smoking. Objective: To present the epidemiological evidence for COPD among never-smoking workers from&nbsp; occupations associated with exposure to dusts, gases and/or fumes (dusty occupations) performed in R. Macedonia in the period 2011-2015. Methods: Prevalence and characteristics of COPD were assessed in the groups of bricklayers, cotton workers, grain workers, diary farmers, and welders. In addition, an equal group of administrative workers matched to dusty occupation workers by age and smoking status were studied as a control. Each study was performed by the same study protocol including questionnaire for respiratory symptoms in the last 12 months, baseline and post-bronchodilator spirometry and COPD diagnosis. Results: The prevalence of overall and particular respiratory symptoms in the last 12 months was higher in the dusty occupation groups as compared to their prevalence in the groups of matched administrative&nbsp; workers. The mean values of all measured spirometric parameters, both baseline and post-bronchodilator, were lower in the dusty occupation groups than in the groups of matched administrative&nbsp; workers. The prevalence of COPD was significantly higher in the dusty occupation groups as compared to its prevalence in the groups of matched administrative workers, varying from 10.7% in diary farmers, 10.8% in grain workers, 11.4% in cotton workers, 14.9% in bricklayers to 15.2% in welders. At the same time the COPD prevalence in the groups of matched administrative workers varied from 2.3% to 4.3%. COPD in all examined groups was close related to age over 45 years, as well as to duration of employment over 20 years in dusty occupation groups. Conclusion: Findings from the presented studies indicated that certain occupational exposures may be associated with the development of COPD. Findings from the presented studies also indicated a need of&nbsp; implementation of adequate preventive measures in order to protect respiratory health of exposed workers.</p

Clinical and Functional Outcomes of Sensitizer-Induced Asthma in Bakers and Cotton Workers after Removal from Exposure

Introduction: Sensitizer-induced occupational asthma (OA) has significant health and socioeconomic outcomes in affected subjects. Objective: To evaluate clinical and functional outcomes of sensitizer-induced OA in bakers and cotton workers three to five years after cessation of exposure to the offending workplace agent. Methods: We studied 16 patients with sensitizer-induced OA (10 bakers and 6 textile workers), eight males and eight females, aged 32 to 48 years. All study subjects completed a questionnaire and underwent spirometric measurements and metacholine challenge, in the same manner as at the time of diagnosis. The findings obtained were compared with findings registered at the time of diagnosis. Results: We found significantly lower prevalence of patients with respiratory symptoms in the previous 12 months after the mentioned period of removal from exposure than their prevalence at the time of&nbsp; diagnosis (100% vs. 68.7%; P = 0.014). In regard to nasal symptoms, their prevalence at the time of the study was lower than at the time of diagnosis but statistical significance was not reached (62.5% vs. 37.5%; P = 0.107). The values of spirometric parameters at the time of the study were similar to their values at the time of diagnosis. The level of the non-specific bronchial hyper responsiveness (NSBHR) at the time of the study was improved in all study subjects. The mean value of the provocative concentration 20 (PC 20) at the time of the study was significantly higher than its mean value registered at the time of diagnosis (2.9 vs. 2.1;P = 0.032). However, none subject normalized his/her NSBHR. Conclusions: Our findings indicate resolution of the respiratory and nasal symptoms in a part of the study subjects. In addition, all study subjects are left with their NSBHR, although all of them improve.</p

Distribution of Sensitizer-Induced Occupational Asthma

Introduction: Occupational asthma (OA) became an important public health problem worldwide in the last few decades. From two different OA types, sensitizer-induced OA accounts for approximately 90% of all OA cases. Aim of the study was to present the distribution of sensitizer-induced OA by occupation in R. Macedonia in the period 2005-2014.Methods: Sensitizer-induced OA was diagnosed by serial measurement of peak expiratory flow (PEF) at and away from work or by combination of serial PEF measurement at and away from work and non-specific bronchial provocation at and away from work in subjects with diagnosed asthma and work-relatedness of the symptoms.Results: The annual incidence rate of the diagnosed sensitizer-induced OA in the mentioned period varied from 1.8/100,000 working population in 2013 to 2.8/100,000 in 2006. Sensitizer-induced OA in bakers, cleaners, textile workers and agricultural workers accounted up to more than a third of the all diagnosed cases. Atopy was registered in approximately a half of the sensitized-induced OA cases. Majority of the cases with sensitizer-induced OA caused by HMW agents (i.e. OA in bakers, textile workers, tanners, herbal and fruit tea processors, and health care workers) was atopics and had positive prick tests to occupational allergens.Conclusion: Our findings indicate the sectors with highest occurrence of sensitizer-induced OA in R. Macedonia in the period 2005-2014. The data obtained enable directing of adequate activities to prevent developing of the disease, as well as to identify affected ones and to prevent further respiratory impairment.&nbsp; &nbsp;&nbsp;</p