The grass pollen season 2015: a proof of concept multi-approach study in three different European cities

Urban Greening and Pollen Allergy: Balancing Health and Environmental Sustainability

Urban living requires a careful balance between human health and environmental sustainability when selecting urban vegetation. Public gardens and green roofs offer significant environmental benefits, including air filtration, exposure to health-associated microbiota, and mitigation of the urban heat island effect. However, prioritizing allergy-friendly species is crucial to prevent the exacerbation of pollen allergies. This review highlights 3 primary criteria for selecting vegetation that supports these ecosystem services while minimizing allergy risks. First, reducing the use of many wind-pollinated plants, such as birch trees and grasses, is crucial due to their high pollen production and cross-reactivity with other species, which can exacerbate allergies. In contrast, insect-pollinated plants are generally safer for allergy sufferers. Secondly, cultivating multispecies plant communities with minimal maintenance supports habitats for microbiota and invertebrates, further providing ecosystem services. Lastly, balancing plant gender ratios in urban spaces can help control pollen levels. Together these criteria provide a framework for urban planners to create green spaces that are both environmentally beneficial and allergy friendly. Although this review focuses on European data, the principles discussed have global relevance, reinforcing the need to integrate environmental sustainability with public health considerations in urban planning. Future studies should also investigate the health impacts of plant volatile emissions, explore heat-resistant plant varieties, and assess the ecological risks of invasive species to support sustainable, allergy-friendly urban environments.

An emerging aeroallergen in Europe: Tree-of-Heaven (Ailanthus altissima [Mill.] Swingle) inventory and pollen concentrations - Taking a metropolitan region in Germany as an example

Urban areas are often hotspots for the dissemination of non-native (invasive) plant species, some of which release (potentially) allergenic pollen. Given the high population density in cities, a considerable number of people can be regularly and potentially intensively exposed to the pollen from these plants. This study delves into the Tree-of-Heaven (Ailanthus altissima, [Mill.] Swingle), native to East Asia, which is known for its high invasiveness in temperate regions worldwide, particularly favoring urban colonization. This study explores the botanical and aerobiological dimensions of this species using the central European metropolitan region of Berlin, Germany, as a case study, and provides a comprehensive global overview of allergological insights. The number of Ailanthus trees decreased markedly from the center to the periphery of Berlin City, following a temperature gradient. The same spatial trend was mirrored by airborne Ailanthus pollen concentrations measured with volumetric spore traps (Hirst-type) at five sites using seven traps. Ailanthus pollen was most abundant around midday and in the afternoon, with concentrations tenfold higher at street level than at roof level. The Ailanthus flowering period in June and July coincided well with the pollen season. To the best of our knowledge this is the first study to investigate Ailanthus altissima pollen production. On average, 5539 pollen grains were found per anther. A literature review on the allergy relevance of Ailanthus altissima pollen indicates the high allergenic potential of pollen from this species. Considering the anticipated expansion of suitable habitats for Ailanthus owing to global warming and the allergological significance of its pollen, it is recommended to include Ailanthus pollen in routine pollen monitoring, particularly in areas colonized by this species. This comprehensive study provides new insights into a pollen taxon whose significance as an emerging aeroallergen should be factored into plant selection and greenspace management in all temperate regions.

Green Roof Gardens - Selecting Allergy-Friendly Vegetation: A Global Allergy and Asthma Excellence Network (GA²LEN) Position Paper

Green roof gardens are important for planetary health by mitigating the effects of urbanization. Because of the nature of green roof gardens, only particular plants can be used. The allergologic impact of these plants remains ill-characterized and guidance on building allergy-friendly green roof gardens is missing. To address this gap, we investigated the plant spectrum of several German green roof companies and categorized plants based on their primary pollination mechanism. Except for grasses, most plants were insect-pollinated and of low allergenicity. In addition, we conducted a review on the allergologic impact of plants used for green roof gardens. Our aim was to provide landscape architects with guidance on how to develop allergy-friendly green roof gardens. We highlight the need for universally accepted standards for assessing the allergenicity of roof top plants. Also, we recommend the joint development, by green roof producers and allergists, of criteria for allergy-friendly roof gardens. Their implementation may help to reduce the risk of allergen sensitization and allergy exacerbation, such as by avoiding the use of wind-pollinated plants of proven allergenicity including grasses. Green infrastructure, such as green roofs, should benefit planetary health without increasing the prevalence and burden of allergies.

The Clinical Significance of Pollen and Fungi Concentrations for Allergic Rhinitis: A Three-Year Study

INTRODUCTION

The relationship between disease severity and exposure to allergens in allergic rhinitis (AR) patients is not fully clarified presently. We aimed to detect the correlation between airborne pollen and fungi concentrations in a Mediterranean region with symptom scores.

METHODS

A total of 98 patients suffering from AR rated their symptoms at the time of exacerbation using the Total 5 Symptoms Score (T5SS) and the Visual Analogue Scale (VAS). Patients' quality of life (QoL) was estimated by using either disease-specific (Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ) or generic (Short-Form 36 (SF-36) and Beck Depression Inventory (BDI)) questionnaires. All patients' responses were correlated with aerobiological data. Skin prick tests (SPTs) were used to detect sensitivities to the most common registered pollen and fungi species.

RESULTS

A significant positive correlation between total pollen and fungi counts and disease-specific questionnaires was found only for the RQLQ. Accordingly, a significant positive correlation was found between total pollen and fungi counts and T5SS (r = 0.655, p = 0.021), with breathing (r = 0.620, p = 0.032) and sneezing (r = 0.660, p = 0.020) being strongly affected. Moreover, a tendency toward a higher VAS score was found as total pollen and fungi counts increased (r = 0.523, p = 0.081).

CONCLUSION

We found a significant correlation between patients' symptoms and pollen and fungal air concentrations. Our results emphasize the clinical significance of pollen and fungi maps in everyday clinical practice.

The "allergic nose as a pollen detector" concept: e-Diaries to predict pollen trends

Hirst pollen traps and operator pollen recognition are worldwide used by aerobiologists, providing essential services for the diagnosis and monitoring of allergic patients. More recently, semiautomated or fully automated detector systems have been developed, which facilitate prediction of pollen exposure and risk for the individual patient. In parallel, smartphone apps consisting of short questionnaires filled in daily by the patient/user provide daily scores, time trajectories, and descriptive reports of the severity of respiratory allergies in patients with pollen allergy. The usual scientific and clinical approach to this matter is to monitor the environment (pollen concentration) in order to predict the risk of symptoms (allergic rhinitis) in a population. We discuss here the opposite, contraintuitive possibility, that is, the use of e-diaries to collect daily information of mono-sensitized pollen-allergic patients in order to predict the clinically efficient airborne exposure to a given pollen, area, and time period. In line with the "Patient as Sensor" concept, proposed in 2013 by Bernd Resch, the "allergic nose" may be used as a pollen detector in addition to existing calibrated hardware sensors, namely the pollen stations, thus contributing with individual measurements, sensations, and symptoms' perception. The target of this review is to present a novel concept of pollen monitoring based on "pollen-detector" patients to inspire future cooperative studies aimed at investigating and hopefully validating our hypothesis.

Isolating the species element in grass pollen allergy: A review

Grass pollen is a leading cause of allergy in many countries, particularly Europe. Although many elements of grass pollen production and dispersal are quite well researched, gaps still remain around the grass species that are predominant in the air and which of those are most likely to trigger allergy. In this comprehensive review we isolate the species aspect in grass pollen allergy by exploring the interdisciplinary interdependencies between plant ecology, public health, aerobiology, reproductive phenology and molecular ecology. We further identify current research gaps and provide open ended questions and recommendations for future research in an effort to focus the research community to develop novel strategies to combat grass pollen allergy. We emphasise the role of separating temperate and subtropical grasses, identified through divergence in evolutionary history, climate adaptations and flowering times. However, allergen cross-reactivity and the degree of IgE connectivity in sufferers between the two groups remains an area of active research. The importance of future research to identify allergen homology through biomolecular similarity and the connection to species taxonomy and practical implications of this to allergenicity is further emphasised. We also discuss the relevance of eDNA and molecular ecological techniques (DNA metabarcoding, qPCR and ELISA) as important tools in quantifying the connection between the biosphere with the atmosphere. By gaining more understanding of the connection between species-specific atmospheric eDNA and flowering phenology we will further elucidate the importance of species in releasing grass pollen and allergens to the atmosphere and their individual role in grass pollen allergy.

Variability of grass pollen allergy symptoms throughout the season: Comparing symptom data profiles from the Patient's Hayfever Diary from 2014 to 2016 in Vienna (Austria)

Background

Grass pollen allergy is the most widespread pollen allergy in the world. It still remains unknown in which aspects and in which extent symptoms from grass pollen allergy differ throughout the grass pollen season, although individual sensitization profiles of persons concerned are known for a long time.

Methods

The crowd-sourced symptom data of users of the Patient's Hayfever Diary were filtered for significant positive correlated users to grass pollen from Vienna (Austria) during the respective grass pollen seasons from 2014, 2015, and 2016. These symptom data were the foundation for 3 statistical approaches in order to examine different sections of the grass pollen season defined either by grass pollen data, phenology (grass species determination in the field), or symptom data itself.

Results

Results from all 3 approaches are similar and come to the same major conclusion. The symptom peak of most users is observed in the second section of the grass pollen season (70%), followed by the first section (20%), and with the least user numbers (10%) the third section. The profiles from single users entering data for all 3 years under study are robust and show a comparable behavior from year to year.

Conclusion

Grass taxa such as Arrhenatherum, Festuca, and Lolium seem to induce the highest symptom severity in most users during the second section of the grass pollen season. Poa and Dactylis are the main triggers for the first section of the grass pollen season. The flower of Phleum und Cynodon is documented for the last section of the grass pollen season. Crowd-sourced symptom data is the prerequisite for personal pollen information to consider the individuality of grass pollen allergy sufferers. Phenological monitoring is needed to provide information on specific grass taxa of importance to allergic persons.

The role of mobile health technologies in allergy care: An EAACI position paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed.

Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing

Background

Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose.

Methods

Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship.

Results

In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature.

Conclusions

PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.

Assessment of the potential real pollen related allergenic load on the atmosphere of Porto city

The knowledge of the allergen content in the atmosphere is a useful tool to stablish the risk allergy warnings for the sensitive people. In Portugal the main airborne allergenic pollen come from trees (such as Betula or Olea), grasses or weeds (mainly Urticaceae). The present study sought the quantification of the Bet v 1, Ole e 1, Lol p1 and Par j1-2 aeroallergen concentration as well as how weather variables influence in the pollen and allergen concentration in Porto city. Aerobiological study was carried out by a Hirst-type volumetric sampler for pollen collection and a Burkard Cyclone sampler for the aeroallergens. A regression analysis between pollen and allergens was conducted for the identification the allergenic risk days. High Pollen Allergen Potency in the atmosphere was observed considering the low levels of airborne pollen detected. A significant and positive correlation has been obtained between pollen and aeroallergen values with the temperatures whereas the correlation was negative with relative humidity, rainfall and wind speed. Back trajectory methodology was applied in order to analyse the discordances between pollen and allergen maximum concentrations. The analysis showed that when the pollen and allergen peaks were registered on the same day, air masses always comes from the continent. However, when the peaks do not coincide, the air mass comes from the continent in the case of the pollen peak and from the sea for the allergen peak. This behaviour can be a consequence of the high humidity in the air masses from the sea, which can benefit the allergen release from pollen grains. In our study it was observed that the available traditional information for allergenic Type I patients, corresponding to the amount of pollen grains in the bioaerosol, do not accurately identify the real allergenic load in the air.

Allergen-specific IgE and IgG4 patterns among patients with different allergic diseases

Background

In addition to allergen-specific IgE (sIgE), allergen-specific IgG4 (sIgG4) antibodies are also involved in the immune response resulting from an allergen exposure. The aim of our study was to analyze sIgE and sIgG4 patterns in the most common allergic disorders: bronchial asthma, upper airway disorders and atopic dermatitis.

Methods

In this study a screening analysis of blood serum samples from 673 patients aged from 6 months to 17 years with different allergic entities was performed on microarrays. sIgE and sIgG4 levels to the most common allergens were estimated.

Results

sIgE response to most pollen allergens is more strongly associated with respiratory diseases than with atopic dermatitis, while sIgE responses to cat and dog dander are more strongly associated with bronchial asthma than with atopic dermatitis and upper airway disorders such as rhinosinusitis and allergic rhinitis. A lower prevalence of sIgG4 to pollen allergens in cases of atopic dermatitis is observed compared with that in cases of asthma and upper airway disorders. Analyzing all the allergic disorders, one can see that sIgG4 response to inhalant allergens is strongly associated with sensitization to the corresponding allergen.

Conclusion

Allergen-specific IgE and IgG4 patterns that are relevant to concrete allergic diseases differ by sIgE and sIgG4 prevalences to defined allergens.

Electronic supplementary material

The online version of this article (10.1186/s40413-018-0220-5) contains supplementary material, which is available to authorized users.

The connection of pollen concentrations and crowd-sourced symptom data: new insights from daily and seasonal symptom load index data from 2013 to 2017 in Vienna

Background

Online pollen diaries and mobile applications nowadays allow easy and fast documentation of pollen allergy symptoms. Such crowd-sourced symptom data provides insights into the development and the onset of a pollen allergy. Hitherto studies of the symptom load index (SLI) showed a discrepancy between the SLI and the total pollen amount of a season, but did not analyze the daily data.

Methods

The Patient’s Hayfever Diary (PHD) was used as data pool for symptom data. Symptom data of Vienna (Austria) was chosen as a large and local sample size within the study period of 2013 until 2017. The city was divided into three different areas based on equal population densities and different environmental factors. Correlation factors, regression lines, locally weighted smoothing (LOESS) curves and line plots were calculated to examine the data.

Results

Daily SLI and pollen concentration data correlates well and the progress of the SLI within a pollen season is mirrored by the pollen concentrations. The LOESS curves do not deviate much from the regression line and support the linearity of the symptom-pollen correlation on a daily basis. Seasonal SLI data does not follow the same pattern as the respective seasonal pollen indices. Results did not vary in the three areas within Vienna or when compared with the Eastern region of Austria showing no significant spatial variation of the SLI.

Discussion

Results indicate a linear relationship of the SLI and pollen concentrations/seasonal polllen index (SPIn) on a daily basis for both in general and throughout the season, but not on a seasonal basis. These findings clarify the frequent misinterpretation of the SLI as index that is tightly connected to pollen concentrations, but reflects as well the seasonal variation of the burden of pollen allergy sufferers.

Conclusion

More than just the seasonal pollen index has to be considered when the SLI of a selected pollen season has to be explained. Cross-reactivity to other pollen types, allergen content and air pollution could play a considerable role. The similar behavior of the SLI in Vienna and a whole region indicate the feasibility of a possible symptom forecast in future and justifies the use of a single pollen monitoring station within a city of the size of Vienna.