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

Pollen season is reflected on symptom load for grass and birch pollen-induced allergic rhinitis in different geographic areas—An EAACI Task Force Report

Background: The effectiveness of allergen immunotherapy (AIT) in seasonal allergic rhinitis (AR) depends on the definition of pollen exposure intensity or time period. We recently evaluated pollen and symptom data from Germany to examine the new definitions of the European Academy of Allergy and Clinical Immunology (EAACI) on pollen season and peak pollen period start and end. Now, we aim to confirm the feasibility of these definitions to properly mirror symptom loads for grass and birch pollen-induced allergic rhinitis in other European geographical areas such as Austria, Finland and France, and therefore their suitability for AIT and clinical practice support. Methods: Data from twenty-three pollen monitoring stations from three countries in Europe and for 3 years (2014-2016) were used to investigate the correlation between birch and grass pollen concentrations during the birch and grass pollen season defined via the EAACI criteria, and total nasal symptom and medication scores as reported with the aid of the patient's hay-fever diary (PHD). In addition, we conducted a statistical analysis, together with a graphical investigation, to reveal correlations and dependencies between the studied parameters. Results: The analysis demonstrated that the definitions of pollen season as well as peak pollen period start and end as proposed by the EAACI are correlated to pollen-induced symptom loads reported by PHD users during birch and grass pollen season. A statistically significant correlation (slightly higher for birch) has been found between the Total Nasal Symptom and Medication Score (TNSMS) and the pollen concentration levels. Moreover, the maximum symptom levels occurred mostly within the peak pollen periods (PPP) following the EAACI criteria. Conclusions: Based on our analyses, we confirm the validity of the EAACI definitions on pollen season for both birch and grass and for a variety of geographical locations for the four European countrie

Allergy to tree-of-heaven pollen in Germany: detection by positive nasal provocation

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Advanced component-resolved diagnostics (CRD) in Hymenoptera venom allergy (HVA) has improved the precise description of individual sensitization profiles. However, diagnostic gaps, peptide-based cross-reactivity, early identification of severe reactors and diagnosis of patients with a clear history of sting reactions but negative specific IgE and skin tests, remain challenging.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Systematic literature search in PubMed and critical analysis of recently published studies on insect venom allergy diagnostics.</jats:p> </jats:sec><jats:sec> <jats:title>Results and discussion</jats:title> <jats:p>CRD has increased the sensitivity of IgE testing and improved the discrimination of primary sensitization from irrelevant cross-reactivity, ultimately providing a better rationale for therapeutic decisions. Despite these major advances, there is still room for improvement in routine HVA diagnostics. Peptide based cross-reactivity among homologous allergens from <jats:italic>Vespinae</jats:italic> and <jats:italic>Polistinae</jats:italic> venoms as well as still existing diagnostic gaps are particularly challenging. No marker allergens are currently available to differentiate <jats:italic>Vespula</jats:italic> and <jats:italic>Polistes</jats:italic> sensitizations. Several strategies including clinical setting of basophil activation test (BAT) for routine diagnostics, venomic analysis for the identification of novel allergens and characterization of the molecular basis of cross-reactivity could be used to address major limitations and unresolved issues in molecular diagnostics of HVA.</jats:p> </jats:sec&gt

Die Verteilung allergener Pollen in einer Metropolenregion

Worldwide, approximately every fifth person suffers from allergic rhinitis, frequently caused by a reaction to pollen. Nowadays, more than half of the global population lives in urban areas. Nevertheless, large cities are often equipped with just one pollen trap to provide information about aerial pollen content. Therefore, there is still a lack of information about the spatial distribution of pollen on an intra-urban scale and the possible effects on human health. In order to widen the knowledge about pollen distribution in urban environments, allergenic pollen – birch (Betula), grass (Poaceae), and mugwort (Artemisia) – was monitored with a network of fourteen traps within the large city of Berlin, and birch and grass pollen were monitored with four pollen traps within the Berlin/Brandenburg Metropolitan Region in 2014. Further, the detected pollen data and anonymously reported, geographically localized, pollen-induced symptom data were used to study temporal and spatial relationships between these two variables in the Berlin/Brandenburg metropolitan region, in the city of Berlin, and for the first time in different areas of a city on the example of Berlin. The seasonal pollen courses of birch and grass exhibited significantly positive correlations between all possible combinations of the fourteen traps in Berlin. For mugwort, the correlations were only to some extent significantly positive. In contrast to those mainly temporal similarities, remarkable spatial variations in the pollen distribution within the city were demonstrated, with the highest differences occurring in mugwort. The correlations between detected pollen and symptom levels during corresponding pollen seasons in the city of Berlin, its different areas, and the metropolitan region were found to be to a large extent significantly positive, with the weakest correlations occurring in mugwort. Higher amounts of birch and grass pollen measured in the suburban area than in the city center of Berlin were followed by more severe symptoms reported from the suburban area during the birch and grass pollen seasons. For mugwort, no such a relationship was found. The presented and discussed results of the study - substantiate the large differences in the spatial distribution of important allergenic pollen taxa within a city, - highlight the benefit of using further pollen traps to monitor pollen within large urban areas, - emphasize the importance of pollen as an significant cause of allergenic rhinitis and allergenic asthma. Considering the ongoing urbanization, it is necessary to expand further the knowledge about pollen exposure and pollen allergy in urban environments.Weltweit leiden ca. 20 % der Bevölkerung an allergischer Rhinitis, die am häufigsten durch den Kontakt mit Pollen hervorgerufen wird. Gegenwärtig leben mehr als 50 % der Weltbevölkerung in Städten. Ungeachtet dessen verfügen selbst große Städte oftmals nur über eine Pollenfalle zur Bereitstellung von Informationen zur Pollenbelastung der Luft. Daher gibt es immer noch ungenügende Informationen über die räumliche Verbreitung von Pollen innerhalb einer Stadt und die möglichen Auswirkungen auf die Gesundheit der Einwohner. Zum besseren Verständnis der Verteilung von Pollen in urbanen Räumen wurde 2014 der Pollenflug der allergenen Arten Birke (Betula), Gräser (Poaceae) und Beifuß (Artemisia) mit einem Messnetz von 14 Pollenfallen in der Großstadt Berlin sowie der Flug von Birken- und Gräserpollen mit vier Pollenfallen im Großraum Berlin/Brandenburg gemessen. Darüber hinaus wurden die ermittelten Pollendaten und anonym übermittelte, ortsgebundene Daten zu polleninduzierten Symptomen dazu verwendet, zeitliche und räumliche Beziehungen zwischen diesen beiden Variablen im Großraum Berlin/Brandenburg, in der Stadt Berlin und erstmalig auch in Teilbereichen einer Stadt am Beispiel Berlins zu untersuchen. Die zeitlichen Verläufe der Birken- und Gräserpollensaison ergaben für alle möglichen Kombinationen der vierzehn Fallen in Berlin einen signifikant positiven Zusammenhang. Für Beifuß waren diese Zusammenhänge weniger stark ausgeprägt und nur teilweise signifikant. Entgegen diesen vorwiegend saisonalen Übereinstimmungen traten deutliche Abweichungen hinsichtlich der räumlichen Verteilung der Pollen innerhalb des Stadtgebietes zu Tage, wobei die Unterschiede beim Beifuß am größten waren. Die statistischen Beziehungen zwischen den ermittelten Pollenzahlen und den gemeldeten Symptomstärken während den entsprechenden Pollensaisons waren in der Stadt Berlin, in deren Teilbereichen und im Großraum Berlin-Brandenburg größtenteils signifikant positiv, wobei der schwächste Zusammenhang beim Beifuß auftrat. Die Zahl der Birken- und Gräserpollen war in den Randbezirken der Stadt höher als im Stadtzentrum. Damit einher gingen Unterschiede in der Symptomschwere zwischen Stadtrand und Stadtzentrum, wobei die gemeldeten Symptomstärken am Stadtrand im Mittel höher lagen als im Zentrum. Beim Beifuß zeigte sich kein solcher Zusammenhang. Die vorgelegten und diskutierten Ergebnisse der Studie - belegen die sehr unterschiedliche Verteilung wichtiger allergener Pollenarten innerhalb einer Großstadt, - verdeutlichen den Vorteil des Einsatzes mehrerer Pollenfallen für das Monitoring von Pollen in Großstädten, - unterstreichen die große Bedeutung von Pollen als wichtige Auslöser von allergischer Rhinokonjunktivitis und allergischem Asthma. Die fortschreitende Urbanisierung verlangt nach einer noch eingehenderen Forschung zur Pollenexposition und Pollenallergie in Städten

Allergenic pollen: is it also an indoor problem?

Aims!#!The aim of the current study was to evaluate whether tubular markers kidney injury molecule-1 (KIM-1) and N-acetyl-ß-glucosaminidase (NAG) are related to acute kidney injury (AKI) and severe disease in patients with COVID-19.!##!Methods and results!#!In this prospective observational clinical trial we examined a cohort of 80 patients with proof of acute respiratory infection and divided them into a COVID-19 cohort (n = 54) and a control cohort (n = 26). KIM-1 and NAG were measured from urine samples collected in the emergency department. We assessed the development of AKI, admission to the intensive care unit (ICU) and intrahospital death as clinical endpoints. Urinary KIM-1 and NAG were not significantly different between patients with SARS-CoV-2 and those with other respiratory infections (each p = n.s.). Eight patients from the COVID-19 cohort and five of the non-COVID-19-patients suffered from acute kidney injury during their stay. Nine COVID-19 patients and two non-COVID-19 patients were admitted to the ICU. KIM-1 was significantly elevated in COVID-19 patients with, compared to those without AKI (p = 0.005), as opposed to NAG and creatinine (each p = n.s.). Furthermore, KIM-1 was significantly elevated in the patients with COVID-19 that had to be transferred to the ICU (p = 0.015), in contrast to NAG and creatinine (each p = n.s.).!##!Conclusion!#!Assessing KIM-1 in patients with COVID-19 might provide additional value in recognizing AKI at an early stage of disease. Further, KIM-1 might indicate higher risk for clinical deterioration as displayed by admission to the ICU

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. Keywords: Grass pollen allergy, Symptom data, Phenology, Patient’s Hayfever Diary, Pollen exposure chambe