Domestic allergens and endotoxin in three hospitals offering in-patient rehabilitation for allergic diseases in the alpine mountain climate of Bavaria - The AURA study

Immunologic, genetic, and ecological interplay of factors involved in allergic diseases

An allergic or type I hypersensitivity reaction involves a misdirected immune overreaction to innocuous environmental and dietary antigens called allergens. The genetic predisposition to allergic disease, referred to as atopy, can be expressed as a variety of manifestations-e.g., allergic rhinitis, allergic conjunctivitis, atopic dermatitis, allergic asthma, anaphylaxis. Globally, allergic diseases are one the most common types of chronic conditions. Several factors have been identified to contribute to the pathogenesis and progression of the disease, leading to distinctively variable clinical symptoms. The factors which can attenuate or exacerbate allergic reactions can range from genetic heterozygosity, the prominence of various comorbid infections, and other factors such as pollution, climate, and interactions with other organisms and organism-derived products, and the surrounding environment. As a result, the effective prevention and control of allergies remains to be one of the most prominent public health problems. Therefore, to contextualize the current knowledge about allergic reactions, this review paper attempts to synthesize different aspects of an allergic response to describe its significance in the global health scheme. Specifically, the review shall characterize the biomolecular mechanisms of the pathophysiology of the disease based on underlying disease theories and current findings on ecologic interactions and describe prevention and control strategies being utilized. An integrated perspective that considers the underlying genetic, immunologic, and ecologic aspects of the disease would enable the development of more effective and targeted diagnostic tools and therapeutic strategies for the management and control of allergic diseases.

Exposure to household dust, allergens, and endotoxin and allergy-related outcomes alternation in the general U.S. population

It has been widely reported that the general population was at an increased risk of allergy diseases, which probably be related with household allergens exposure. However, the difference of local and systemic allergic reactions exposure to allergens has not been reported in the general population previously. The data of 1094 U.S. adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 data bank were analyzed. Dust, allergens (Bia g 1, Bia g 2, Can f 1, Feld 1, Derp 1, Mus m 1, Rat n 1, Alternaria alternate, and Aspergillus fumigatus), and endotoxin, were measured to estimate sensitizing source exposure. And allergy-related outcomes indicators including hay fever, sneezing, allergic rhinitis (AR), immunoglobulin E (IgE), and allergic sensitization, were evaluzted to estimate local and systemic allergic reactions. Multiple linear regression and logistic regression models were used to examine the associations of sensitizer and allergy-related outcomes. The mean or median concentration of dust and endotoxin were 0.66 g and 12.98 EU/mg dust. The Derp 1, Mus m 1, Rat n 1, Alternaria alternate, and Aspergillus fumigatus were the main allergens in the dust, with the concentrations of 30.66 ng/g dust, 30.73 ng/g dust, 5.94 ng/g dust, 5.20 ng/g dust, and 207.68 μg/g dust, respectively. The prevalence of AR was 34.2% among the general population. After controlling for sociodemographic factors, we found that the allergens, such as Can f 1 and Feld 1, were positively associated with AR. The prevalence of allergic sensitization was about 20%. Dust and endotoxin were found positively associated with allergic sensitization, while Bia g 2, Rat n 1, Alternaria alternate, and Aspergillus fumigatus were inversely associated with that. Dust and endotoxin probably be associated with higher risk of local allergic reactions, while some allergens, such as Bia g 2, Rat n 1, Alternaria alternate, and Aspergillus fumigatus probably be associated with lower risk of systemic allergic reactions.

Respiratory Allergens from Furred Mammals: Environmental and Occupational Exposure

Furry mammals kept as pets, farm and laboratory animals are important allergen sources. The prevalence of sensitization to furred mammals appears to be increasing worldwide. Several mammalian allergens from diverse species are well characterized with regard to their molecular structure and immunogenicity, and some are already available for component-resolved allergy diagnostics. The distribution of various mammalian allergens has been extensively studied during the past few decades. Animal allergens were found to be ubiquitous in the human environment, even in places where no animals reside, with concentrations differing considerably between locations and geographical regions. This review presents an overview of identified mammalian respiratory allergens classified according to protein families, and compiles the results of allergen exposure assessment studies conducted in different public and occupational environments.

Respiratory Allergens from Furred Mammals: Environmental and Occupational Exposure

Furry mammals kept as pets, farm and laboratory animals are important allergen sources. The prevalence of sensitization to furred mammals appears to be increasing worldwide. Several mammalian allergens from diverse species are well characterized with regard to their molecular structure and immunogenicity, and some are already available for component-resolved allergy diagnostics. The distribution of various mammalian allergens has been extensively studied during the past few decades. Animal allergens were found to be ubiquitous in the human environment, even in places where no animals reside, with concentrations differing considerably between locations and geographical regions. This review presents an overview of identified mammalian respiratory allergens classified according to protein families, and compiles the results of allergen exposure assessment studies conducted in different public and occupational environments.

Influence of alpine mountain climate of Bavaria on patients with atopic diseases: studies at the Environmental Research Station Schneefernerhaus (UFS - Zugspitze) - a pilot study

Mountain and maritime climate therapy takes advantage of specific climatic conditions to treat chronic allergic diseases. It was the aim of the study to investigate effects of a 5 day sojourn on atopic diseases at the highest German mountain. In this pilot study 18 patients with grass pollen-induced rhinoconjunctivitis, atopic ezcema or asthma and 11 non-allergic controls were included. Skin physiology parameters, changes of the respiratory and nasal functions, subjective symptoms and blood parameters were measured during a 5-day observation period in the Environmental Research Station Schneefernerhaus (UFS) at the moderate altitude mountain region (Zugspitze; 2650 m alt.) compared to a low altitude area (Munich; 519 m alt.). Several of the skin physiology parameters changed significantly during the observation period (decrease of skin hydration, increase of skin smoothness, skin roughness, skin scaliness and pH-value). In patients with atopic eczema, the SCORAD (Severity Scoring of Atopic Dermatitis) and the scores of the DIELH (Deutsches Instrument zur Erfassung der Lebensqualität bei Hauterkrankungen) did not change significantly. Histamine induced itch decreased significantly. Parameters of nasal function did not change significantly. Several lung parameters showed a slight, but statistically significant improvement (forced expiratory volume in one second/volume capacity [FEV1/VC], peak expiratory flow [PEF], maximum expiratory flow at 50% of vital capacity [MEF 50], maximal mid-expiratory flow between 25% and 75% of vital capacity [MMFEF 25/75]), whereas the vital capacity (VC) decreased significantly. ECP (eosinophil cationic protein) in the serum and parameters of blood count changed significantly. These results show that the benefit of a moderate altitude mountain climate sojourn over a period of 5 days differs in depending on the atopic disease. Especially asthma parameters and itching of the skin improved. It would be interesting to assess the parameters during longer observation periods in alpine climate.

Pyroglyphid mites as a source of work-related allergens

Pyroglyphid mites are primarily associated with allergen exposure at home; hence the name house dust mites. However, we have found numerous studies reporting pyroglyhid mite levels in public and occupational settings. This review presents the findings of house dust mite allergens (family Pyroglyphidae, species Dermatophagoides) as potential work-related risk factors and proposes occupations at risk of house dust mite-related diseases. Pyroglyphid mites or their allergens are found in various workplaces, but clinically relevant exposures have been observed in hotels, cinemas, schools, day-care centres, libraries, public transportation (buses, trains, taxies, and airplanes), fishing-boats, submarines, poultry farms, and churches. Here we propose a classification of occupational risk as low (occasional exposure to mite allergen levels up to 2 μg g(-1)), moderate (exposure between 2 μg g(-1) and 10 μg g(-1)), and high (exposure >10 μg g(-1)). The classification of risk should include factors relevant for indoor mite population (climate, building characteristics, and cleaning schedule). To avoid development or aggravation of allergies associated with exposure to house dust mites at work, occupational physicians should assess exposure risk at work, propose proper protection, provide vocational guidance to persons at risk and conduct pre-employment and periodic examinations to diagnose new allergy cases. Protection at work should aim to control dust mite levels at work. Measures may include proper interior design and regular cleaning and building maintenance.

Guidelines for treatment of atopic eczema (atopic dermatitis) part I

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

Comparison of endotoxin levels and gram-negative bacteria under different conditions in microbial laboratories and a biowaste site

In this study, we assessed airborne endotoxin levels in university laboratories, hospital diagnostic laboratories, and a biowaste site. We also investigated indoor and outdoor sampling, sampling site, type of ventilation system, presence of open biowaste boxes, weather, and detection of Gram-negative bacteria (GNB). A total of 69 air samples were collected from 11 facilities in three institutions. Average total airborne endotoxin levels ranged from <0.01 to 10.02 EU m(-3), with an overall mean of 1.03 EU m(-3). Endotoxin levels were high in window-ventilated facilities, in facilities in which GNB were detected; levels were also high when it was rainy (all ps<0.05). Endotoxin levels were significantly correlated with humidity (r=0.70, p<0.01). The presence of HVAC; humidity; and the presence of open biowaste boxes affect endotoxin levels in laboratories.