Impact of climate change on allergic diseases in Germany

Background: Allergic diseases, especially inhalant allergies, have reached epidemic levels and environmental factors play an important role in their development. Climate change influences the occurrence, frequency, and severity of allergic diseases. Methods: The contents of this article were selected by the authors and developed section by section according to their expertise and the current state of knowledge. The sections were then discussed and agreed upon amongst all authors. Results: The article highlights direct and indirect effects of climate change on allergies. It goes into detail about the connections between climate change and (new) pollen allergens as well as (new) occupational inhalation allergens, explains the effects of climate change on the clinical picture of atopic dermatitis, discusses the connections between air pollutants and allergies, and provides information about the phenomenon of thunderstorm asthma. Conclusions: There is a need for action in the field of pollen and fungal spore monitoring, allergy and sensitisation monitoring, urban planning from an allergological perspective, and changes in the working environment, among others. This is part of a series of articles that constitute the German Status Report on Climate Change and Health 2023

Auswirkungen des Klimawandels auf allergische Erkrankungen in Deutschland

Hintergrund: Allergische Erkrankungen, vor allem Inhalationsallergien, haben ein epidemisches Ausmaß erreicht, und Umweltfaktoren spielen eine wichtige Rolle bei ihrer Entstehung. Der Klimawandel beeinflusst Auftreten, Häufigkeit und Schwere allergischer Erkrankungen. Methode: Die Inhalte dieses Artikels wurden durch die Autorinnen und Autoren ausgewählt und entsprechend ihren Expertisen nach dem aktuellen Wissensstand kapitelweise erarbeitet. Die Kapitel wurden anschließend mit allen Autorinnen und Autoren diskutiert und abgestimmt. Ergebnisse: Der Artikel beleuchtet direkte und indirekte Effekte des Klimawandels auf Allergien. Er geht näher auf Zusammenhänge zwischen Klimawandel und (neuen) Pollenallergenen sowie (neuen) beruflichen Inhalationsallergenen ein, erläutert Auswirkungen des Klimawandels auf das Krankheitsbild der Neurodermitis, geht auf Zusammenhänge zwischen Luftschadstoffen und Allergien ein und informiert über das Phänomen des Gewitterasthmas. Schlussfolgerungen: Es besteht unter anderem Handlungsbedarf für die Bereiche Pollen- und Schimmelpilzsporenmonitoring, Allergie- und Sensibilisierungsmonitoring, Städteplanung unter allergologischen Gesichtspunkten und Veränderungen der Arbeitswelt. Dieser Artikel ist Teil der Beitragsreihe zum Sachstandsbericht Klimawandel und Gesundheit 2023

Impact of climate change on wood and woodworkers — Cryptostroma corticale\textit {Cryptostroma corticale} (sooty bark disease)

Climate changes have promoted an increased fungal infection of maple trees with $\textit {Cryptostroma corticale}$, the causative agent of sooty bark disease. The hosts of $\textit {C. corticale}$ are maples, and since the early 2000s the fungus has been appearing more frequently in European forests, due to the droughts and hot summers of recent years. Infestation by $\textit {C. corticale}$ discolors the wood and makes it unusable for further processing, which leads to considerable economic damage in the timber industry. Therefore, the occurrence and spread of sooty bark disease raise serious problems. In addition to forestry and economic problems, the conidiospores of $\textit {C. corticale}$ can also cause health problems in exposed wood workers and they can trigger hypersensitivity pneumonitis (HP). Since the spores, which are deposited over the entire area under the bark of infected trees, can spread during processing, exposed workers must take special precautions to protect themselves against exposure. If an occupational disease is nevertheless suspected following exposure to $\textit {C. corticale}$, valid diagnostics are required to confirm possible HP and derive appropriate therapies and exposure reduction or avoidance. Diagnosis of HP is based on several criteria, one of them is the detection of specific IgG in patient's serum against the potentially triggering antigens, in this case $\textit {C. corticale}$ antigens. To produce a diagnostic tool to measure $\textit {C. corticale}$ specific IgG, which is not commercially available so far, spores and mycelial material from ITS-sequenced strains of $\textit {C. corticale}$ was prepared and analyzed. These biochemically characterized extracts of spore and mycelial antigens were biotinylated and coupled to Streptavidin-ImmunoCAPs. To validate these diagnostic test tools the first step is to measure the concentration of $\textit {C. corticale}$ specific IgG in sera of healthy non-exposed and healthy exposed subjects to establish cut-off values. Suitable participants were recruited and the individual exposure to $\textit {C. corticale}$ and symptoms experienced during or after working with infected maple trees were recorded using questionnaires. Finally, diagnostic tools for serological testing in suspected cases of HP by $\textit {C. corticale}$ were created and evaluated. The following article provides recommendations for the treatment and disposal of infected damaged wood and for occupational health protection procedures. Secondly, the diagnosis of HP induced by exposure to $\textit {C. corticale}$ as an occupational disease is described including the verification of newly developed serological test tools for antigens of $\textit {C. corticale}$

Quantitative measurement of IgG to SARS-CoV-2 antigens using monoclonal antibody-based enzyme-linked immunosorbent assays

$\bf Objective:$ Standardised quantitative analysis of the humoral immune response to SARS-CoV-2 antigens may be useful for estimating the extent and duration of immunity. The aim was to develop enzyme-linked immunosorbent assays (ELISAs) for the quantification of human IgG antibodies against SARS-CoV-2 antigens. $\bf Methods:$ Enzyme-linked immunosorbent assays were developed based on monoclonal antibodies against human IgG and recombinant SARS-CoV-2 antigens (Spike-S1 and Nucleocapsid). The WHO 67/086 immunoglobulin and WHO 20/136 SARS-CoV-2 references were used for standardisation. Sera of a study group of COVID-19-positive subjects ($\it n$ = 144), pre-pandemic controls ($\it n$ = 135) and individuals vaccinated with BioNTech–Pfizer BNT162b2 vaccine ($\it n$ = 48) were analysed. The study group sera were also tested using EuroImmun SARS-CoV-2-ELISAs and a quantitative S1-specific fluorescence enzyme immunoassay (FEIA) from Thermo Fisher. $\bf Results:$ The ELISA results were repeatable and traceable to international units because of their parallelism to both WHO references. In the study group, median anti-S1-IgG concentrations were 102 BAU $mL^{−1}$, compared to 100 and 1457 BAU $mL^{−1}$ in the vaccination group after first and second vaccination, respectively. The ELISAs achieved an area under the curve (AUC) of 0.965 (S1) and 0.955 (Nucleocapsid) in receiver operating characteristic (ROC) analysis, and a specificity of 1 (S1) and 0.963 (Nucleocapsid) and sensitivity of 0.903 (S1) and 0.833 (Nucleocapsid) at the maximum Youden index. In comparison, the commercial assays (S1-FEIA, S1 and Nucleocapsid ELISA EuroImmun) achieved sensitivities of 0.764, 0.875 and 0.882 in the study group, respectively. $\bf Conclusions:$ The quantitative ELISAs to measure IgG binding to SARS-CoV-2 antigens have good analytical and clinical performance characteristics and units traceable to international standards

The microbial metabolite butyrate induces expression of Th1- associated factors in cD4⁺ T cells.

Short-chain fatty acids (SCFAs), which are generated by the bacterial fermentation of dietary fibers, promote expansion of regulatory T cells (Tregs). Potential therapeutic value of SCFAs has been recently highlighted in the experimental models of T cell-mediated autoimmunity and allergic inflammation. These studies suggest that physiological intestinal concentrations of SCFAs within the millimolar range are crucial for dampening inflammation-mediated processes. Here, we describe opposing effects of SCFAs on T cell-mediated immune responses. In accordance with published data, lower butyrate concentrations facilitated differentiation of Tregs in vitro and in vivo under steady-state conditions. In contrast, higher concentrations of butyrate induced expression of the transcription factor T-bet in all investigated T cell subsets resulting in IFN-γ-producing Tregs or conventional T cells. This effect was mediated by the inhibition of histone deacetylase activity and was independent of SCFA-receptors FFA2 and FFA3 as well as of Na + - coupled SCFA transporter Slc5a8. Importantly, while butyrate was not able to induce the generation of Tregs in the absence of TGF-β1, the expression of T-bet and IFN-γ was triggered upon stimulation of CD4 + T cells with this SCFA alone. Moreover, the treatment of germ-free mice with butyrate enhanced the expression of T-bet and IFN-γ during acute colitis. Our data reveal that, depending on its concentration and immunological milieu, butyrate may exert either beneficial or detrimental effects on the mucosal immune system

Monitoring of occupational and environmental aeroallergens - EAACI Position Paper: concerted action of the EAACI IG occupational allergy and aerobiology & air pollution

Exposure to high molecular weight sensitizers of biological origin is an important risk factor for the development of asthma and rhinitis. Most of the causal allergens have been defined based on their reactivity with IgE antibodies, and in many cases, the molecular structure and function of the allergens have been established. Significant information on allergen levels that cause sensitization and allergic symptoms for several major environmental and occupational allergens has been reported. Monitoring of high molecular weight allergens and allergen carrier particles is an important part of the management of allergic respiratory diseases and requires standardized allergen assessment methods for occupational and environmental (indoor and outdoor) allergen exposure. The aim of this EAACI task force was to review the essential points for monitoring environmental and occupational allergen exposure including sampling strategies and methods, processing of dust samples, allergen analysis, and quantification. The paper includes a summary of different methods for sampling and allergen quantification, as well as their pros and cons for various exposure settings. Recommendations are being made for different exposure scenarios

EAACI Molecular Allergology User's Guide 2.0

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.Peer reviewe