Daily Hay Fever Forecast in The Netherlands

The literature on local pollen counts and their significance for hay fever is reviewed and a system for forecasting hay fever is described. Such forecasts have been broadcast by radio in The Netherlands since 1977. The hay fever forecast takes the form of a prognosis (in terms of three grades) of the influence of the expected weather situation on tomorrow's course of the subjective complaints of hay fever sufferers. It is not a forecast of the pollen count.
When the subjective complaints of about 150 hay fever patients were used as reference for evaluation, the forecasts proved to have been correct in 72, 85, and 88% of the cases in 1977, 1978, and 1979, respectively.
The practical usefulness and the limitations of the system are briefly discussed, with emphasis on the principle that not the local pollen count but the weather should be taken as the main determinative factor for the expected subjective experiences in a group of hay fever sufferers in a certain region.     

Natural history of hay fever and pollen sensitization,and doctors' diagnosis of hay fever and pollen asthma in German schoolchildren

BACKGROUND: In order to prevent pollen asthma by immunotherapy it is mandatory to know the best time to initiate it. Children with hay fever complaints are at considerable risk of developing pollen asthma. Population-based data on their natural history is urgently needed. METHODS: A longitudinal cohort study was conducted over four years in six rural towns in Baden-Württemberg, Germany. A questionnaire with questions taken from the International Study of Asthma and Allergies in childhood (ISAAC) was filled in every spring and autumn. Hay fever complaints, asthma defining symptoms and new doctors' diagnosis of hay fever and asthma were recorded. Additionally a skin prick test with pollen allergens was performed every autumn. RESULTS: In 1996, 19.7% of 1101 elementary school children (age: 8.1-9.9 years (5-95%)) were found to be sensitized to pollen and 8.7% had already been diagnosed as having hay fever. In a pooled analysis of 2478 children-summers, children with positive pollen sensitization had a significantly higher risk of developing hay fever symptoms (2.63; 2.17-3.10 odds ratio (OR); 95% confidence interval (CI)) and of being diagnosed as suffering from hay fever (7.88; 4.70-13.20). Furthermore, although their OR for the development of asthma symptoms during the pollen season was 3.88 (2.48-6.07 CI), it was only 0.69 (0.24-2.01 CI) for doctors' diagnosis of pollen asthma. CONCLUSION: Children of elementary school age with pollen sensitization and a history of hay fever are at considerable risk of getting pollen asthma, but they are not quickly diagnosed as such. Specific immunotherapy might be a means of preventing asthma completely in such a situation. Our data helps to estimate the sample size for intervention studies of this kind.     

Long-term falls in antibodies to dust mite and pollen allergens in patients with asthma or hay fever

‘Spontaneous’ improvement in, or alteration of, allergic symptoms is a common occurrence, and the immunological basis is of interest in attempts to develop effective specific therapy. In the present study we measured levels of serum antibodies to Dermatophagoides pteronyssinus in patients diagnosed as having house-dust-allergic asthma up to 40 years previously. The results show a progressive fall in both IgG and IgE antibodies to antigen P₁ and RAST binding lo crude D. pteronyssinus extract. By contrast changes in total serum IgE were not marked. Within each of the groups of patients diagnosed 20. 30 and 40 years previously, 70% no longer suffered severe symptoms. However, the absence of detectable IgE antibody in serum was neither a necessary nor a sufficient condition for loss of symptoms. A group of patients who had spontaneously recovered from hay fever had significantly lower IgG and IgE antibody for the major grass pollen allergen Rye I and also lower total IgE than current hay fever sufferers. In neither hay fever nor asthma was there evidence to link spontaneous improvement in symptoms with an increase in IgG antibodies.     

Hay fever, asthma and number of older siblings — a twin study

Background It has been suggested that allergic sensitization is inversely related to the number of siblings in the family. Objectives To study whether a similar relation can be observed for hay fever and asthma among Finnish adolescents in a population with relatively low prevalence of atopic diseases. Methods A questionnaire mailed to a nationwide sample of 1849 families with 16-year- old twins assessing the cumulative incidence of doctor-diagnosed hay fever and asthma among the adolescents and the number of older siblings in the family by parental report. Results The cumulative incidence of hay fever was significantly lower among the adolescents with three or more older siblings (3.9%, 95% CI= 1.2–6.5%) compared with adolescents with fewer older siblings (12.7%, 95% CI=11.4–14.0%). There was no difference in the cumulative incidence of asthma among the adolescents according to the number of older siblings in the family. Conclusions Large number of older siblings appears to be protective against the development of hay fever.     

Hay fever, eczema and urticaria in southwest Norway

Information on hay fever, eczema, urticaria, respiratory symptoms, smoking habits and occupational dust or gas exposure was obtained by a self-administered questionnaire from a random sample of 4992 subjects of the general population aged 15-70 years of the Hordaland county, Norway. The response rate was 90% of the sample. The lifetime prevalences of hay fever, eczema and urticaria were 10%, 25% and 9% of the respondents, respectively. Eczema and urticaria were more often reported by women than by men. The lifetime prevalence of hay fever decreased substantially by age in both sexes. A history of hay fever was inversely related to cigarette smoking. The lifetime prevalences of eczema and urticaria were associated with occupational dust or gas exposure after adjusting for sex, age, smoking habits and area of residence. Adjusted odds ratios of respiratory symptoms in subjects with hay fever were almost 2.0 compared with those without.     

Self-reported hay fever and panic attacks in the community.

OBJECTIVE: The objective of this study was to determine the relationship between self-reported hay fever and common mental disorders among adults in the general population. METHODS: Data were drawn from the Midlife Development in the United States Survey, a representative household survey of the adult US population (25 to 74 years old; n = 3,032). Multivariate logistic regression analyses were used to determine the relationship between self-reported hay fever and current major depression, panic attacks, generalized anxiety disorder, and alcohol/substance use disorders. RESULTS: Self-reported hay fever was associated with a significantly increased odds of panic attack (odds ratio = 1.8 [1.2, 2.6]), which persisted after adjusting for differences in sociodemographic characteristics and comorbid mental disorders. Self-reported hay fever was not associated with a significantly increased likelihood of major depression, generalized anxiety disorder, or alcohol/substance use disorders. CONCLUSIONS: Consistent with previous findings, these data show a relationship between self-reported hay fever and increased likelihood of panic attacks among adults in the general population. The mechanism of the observed association remains unknown. Future work that examines the relationship between hay fever and panic attacks, as well as other mental disorders using both self-report and objective measurement of allergic response in prospective, longitudinal, epidemiologic data may be useful in improving our understanding of this observed link.     

The eczema risk variant on chromosome 11q13 (rs7927894) in the population-based ALSPAC cohort: a novel susceptibility factor for asthma and hay fever

In a genome-wide association study, a common variant on chromosome 11q13.5 (rs7927894[T]) has been identified as a susceptibility locus for eczema. We aimed to analyze the effect of this risk variant on asthma and hay fever and to determine its impact on the general population level in over 9300 individuals of the prospectively evaluated Avon Longitudinal Study of Parents and Children birth cohort. We demonstrate an association of rs7927894[T] with atopic asthma and with hay fever. The largest effect sizes were found in patients with the combined phenotype atopic asthma plus eczema [odds ratio (OR) = 1.50; 95% confidence interval (CI) 1.20-1.88; P = 3.7 × 10(-4)] and hay fever plus eczema (OR = 1.37; 95% CI 1.15-1.62; P = 3.8 × 10(-4)). We replicated the effects of rs7927894[T] on eczema-associated asthma and hay fever independently in the German GENUFAD (GEnetic studies in NUclear Families with Atopic Dermatitis) study and show that they are significantly larger than the effect observed in eczema. The estimated population attributable risk fractions for eczema, eczema-associated atopic asthma or hay fever were 9.3, 24.9 and 23.5%, respectively. Finally in eczema, we found a synergistic interaction of rs7927894[T] with filaggrin gene (FLG) mutations, which are a major cause of epidermal barrier dysfunction, and replicated the interaction in the German Multicenter Allergy Study birth cohort. The synergistic effect of rs7927894[T] and FLG mutations on eczema risk as well as the association of both variants with eczema-associated atopic asthma and hay fever point to an involvement of rs7927894[T] in a functional pathway that is linked to the barrier defect.     

Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis

BACKGROUND: We wondered whether short-term coseasonal sublingual immunotherapy (SLIT) can reduce the development of asthma in children with hay fever in an open randomized study. OBJECTIVE: We sought to determine whether SLIT is as effective as subcutaneous immunotherapy in reducing hay fever symptoms and the development of asthma in children with hay fever. METHODS: One hundred thirteen children aged 5 to 14 years (mean age, 7.7 years) with hay fever limited to grass pollen and no other clinically important allergies were randomized in an open study involving 6 Italian pediatric allergy centers to receive specific SLIT for 3 years or standard symptomatic therapy. All of the subjects had hay fever symptoms, but at the time of study entry, none reported seasonal asthma with more than 3 episodes per season. Symptomatic treatment was limited to cetirizine, loratadine, nasal budesonide, and salbutamol on demand. The hay fever and asthma symptoms were quantified clinically. RESULTS: The actively treated children used less medication in the second and third years of therapy, and their symptom scores tended to be lower. From the second year of immunotherapy, subjective evaluation of overall allergy symptoms was favorable in the actively treated children. Development of asthma after 3 years was 3.8 times more frequent (95% confidence limits, 1.5-10.0) in the control subjects. CONCLUSIONS: Three years of coseasonal SLIT improves seasonal allergic rhinitis symptoms and reduces the development of seasonal asthma in children with hay fever.     

Measles infection, measles vaccination and the effect of birth order in the aetiology of hay fever

BACKGROUND: It has recently been suggested that measles infection may reduce the risk of atopy. OBJECTIVE: To study the independent effect of measles infection and measles vaccination on the occurrence of hay fever in a British national birth cohort. METHODS: In over 6000 children born in 1970, details of immunizations and childhood diseases were collected by parental interviews at ages 5, 10 and 16 years, and hay fever within the past year at age 16 years. RESULTS: In univariate analysis, hay fever was less common in those contracting measles infection than in those not infected (OR 0.86, 95% CI 0.76-0.96), and more common in those given measles vaccination than in those not vaccinated (OR 1.16, 95% Cl 1.03-1.31). However, these effects were strongly confounded by birth order, which was closely associated with the likelihood of receiving measles vaccination and with the risk of hay fever. A strong interaction between the effects of measles vaccination and infection, and birth order was found, such that in those with many older sibling contacts, hay fever was significantly and independently reduced in relation to both measles infection and measles vaccination relative to those who were neither infected nor vaccinated. CONCLUSIONS: Both measles infection and measles vaccination in childhood appear to reduce the risk of hay fever in children with multiple older sibling contacts. Differential exposure or response to the measles virus may explain the effect of birth order on the occurrence of allergic disease.     

Specific sensitivity to individual grass pollens in some hay fever patients

It has been shown in a series of 338 hay fever sufferers that about 19% give one or more (up to nine) negative skin test reactions when tested by the prick test technique to extracts of the pollens of twelve of the most widespread British grasses.     

Allergy prevalence and causal factors in the domestic environment: results of a random population survey in the United Kingdom.

BACKGROUND: Surveys of the prevalence of allergic diseases associated with domestic allergens (eg, asthma, rhinitis, hay fever, eczema, and dermatitis) are usually undertaken in restricted geographic areas. They are often based on specific demographic subgroups (eg, children) or are derived from treatment data (eg, GP consultations). Causal factors are seldom quantified in these reports. OBJECTIVE: This study was designed to quantify the prevalence of allergic disease among a representative cross-section of population in the United Kingdom. It was also designed to quantify the reported causal factors in terms of domestic allergen and irritant sources and activities leading to exposure. METHODS: Two thousand respondents were selected from across the UK. These respondents were interviewed using a short series of questions that formed part of a larger, more general omnibus questionnaire. The questions required respondents to report on diagnosed allergic disease and causal factors within their household, giving a total sample base of 5,609 people. RESULTS: Asthma and hay fever account for the majority of reported cases of allergic disease in the UK (12% and 10% of total household, respectively). Pollen, house dust mite excreta (HDM allergen), and pet dander are the three most common allergic triggers (42%, 27%, and 17% respectively). Dusting and being near pets each account for about 20% of the reported domestic activities triggering an allergic response. CONCLUSION: The feedback from the general population indicates asthma and hay fever to be the predominant allergic conditions, with dust and pet dander the most common sources of allergen/irritant. Key tasks such as changing bed linen and vacuuming were not perceived as being as important as dusting in terms of activities leading to reaction.     

Allergic sensitization to cat in childhood as major predictor of incident respiratory allergy in young adults

BACKGROUND: Little is known on the predictive value of sensitization to specific aeroallergens in children with respect to asthma and hay fever incidence in young adulthood. We followed the incidence of asthma and hay fever in children (mean age 11 years) over 9 years, and analyzed the predictive value of sensitization to five common aeroallergens. METHODS: Three consecutive surveys were conducted in East German school children. Specific IgE antibodies to birch and timothy grass pollen, house dust mite, cat, and cladosporium were measured. In 1207 out of the 2453 children, the 9-year incidence of asthma and hay fever was assessed by reported doctors' diagnoses. For sensitization, diagnostic parameters were determined and logistic regression analyses controlled for relevant confounders. RESULTS: A total of 176/78 incident hay fever/asthma cases occurred equaling a cumulative incidence of 1.93/0.86% per year. Incident asthma was associated with previous sensitization to cat [risk ratio (RR) 3.49, 1.57-7.74] and grass pollen (RR 1.79, 1.01-3.19), whereas incident hay fever was associated with each allergen, with grass pollen (RR 6.00, 4.04-8.90) and cat (RR 5.36, 2.87-9.99) exhibiting the strongest associations. When mutually adjusting for all allergens, sensitization to cat remained significantly associated with asthma and hay fever. The latter was also associated with sensitization to grass pollen. The highest positive predictive values for asthma and hay fever were obtained for cat sensitization (10/49 = 20.4% and 23/49 = 46.9%). CONCLUSIONS: Childhood sensitization to cat and grass pollen predicts the incidence of asthma and hay fever in young adulthood. The predictive capacity differs by allergen and manifestation of atopy.     

Influence of physical inactivity on the prevalence of hay fever

BACKGROUND: Atopic diseases constitute a major public health problem, increasing constantly in frequency and severity. While treatments are improving, the main cause for an increasing trend of hay fever and its definite triggers remain unclear. The aim of our study was to assess whether physical inactivity could be a risk factor for hay fever. METHODS: We analysed data of a cohort of children aged 5-14 years at baseline (1992-1993) who were followed up until 2003-2005. Parental-reported information on physical activity (being active, doing sports) was obtained for 2429 children participating at the baseline survey (active: n = 1923; semi-active: n = 364; inactive: n = 142). A total of 1703 children (70.1%) were reapproached at least once during follow-up. Logistic regression models were applied to study associations between hay fever, allergic sensitization and physical activity, adjusted for potentially relevant confounders such as age, gender, study site, parental education, breastfeeding, crowding, daycare, dampness or visible moulds, contact to cats, current or prior environmental tobacco smoke exposure and parental atopy. RESULTS: Significantly higher rates of hay fever were seen for inactive children [aOR 2.39 (95% CI 1.31-4.36) for baseline survey 1992-1993 and aOR 1.76 (95% CI 1.14-2.71) for the follow-up-period until 2005]. In addition, the relative risk of incident cases of hay fever increased depending on inactivity [aRR 1.50 (95% CI 1.05-2.13)]. No association was found between physical inactivity and allergic sensitization assessed by radioallergosorbent test determinations. CONCLUSIONS: Although the underlying biological mechanisms could not be clarified, increasing physical activity in childhood is suggested to prevent hay fever.     

Narrative Identities and the Management of Personal Accountability in Talk about ME: A Discursive Psychology Approach to Illness Narrative

This article takes a discursive psychology approach to the analysis of illness narrative. The controversial topic of ME (myalgic encephalomyelitis), otherwise known as chronic fatigue syndrome (CFS), is used as a case study to examine the dilemmatics of illness talk. Using data from an ME narrative, I explore the complex and subtle discursive work performed by participants to show how attributional stories and identity formulations are linked together in a narrative that works to construct ME as a physical disease while countering potential accusations of malingering or psychological vulnerability. In working to counter such explanations, sufferers paradoxically implicate themselves in an interpretation of their illness as self-inflicted through overwork and mismanagement. In previous research, tales of frenetic lifestyles prior to the onset of ME have provided analysts (and journalists) with grounds for constructing their own attributional stories in the form of 'opt-out' or 'burnout' theories of ME/CFS. An ethnomethodologically informed discursive psychology provides a non-cognitivist approach to analysis which looks in detail at how sufferers themselves make sense of ME as a practical activity and how their identities are constructed as part of that process.     

Swimming pool attendance and hay fever rates later in life

BACKGROUND: Exposure to chlorination by-products through swimming pool attendance showed adverse health effects on children. The aim of our study was to assess whether pool attendance in childhood would be related to higher rates of allergic diseases in adulthood, with special regard to hay fever. METHODS: 2606 adults aged 35-74 years provided retrospectively collected information on swimming pool attendance and medical history, including data on atopic diseases. Information was assessed by a combination of a personal interview and a self-administered questionnaire. Logistic regression models were applied to study associations between hay fever and swimming pool attendance, adjusted for potentially relevant confounders, such as age, gender, region, education and smoking. RESULTS: Higher rates of hay fever could be seen when frequently exposed at school age (aOR: 1.74, 95% CI: 1.09-2.77), frequently exposed during the past 12 months (aOR: 1.32, 95% CI: 0.92-1.89) and ever exposed (aOR: 1.65, 95% CI: 0.98-2.78). Strongest associations were found for the youngest subjects and were dose-related to the extent of current and school-age pool attendance. CONCLUSIONS: Impaired integrity of the lung epithelial by exposure to chlorination by-products might facilitate a closer contact to allergens and therefore could result in higher rates of hay fever.     

Seasonal variation in suppressor T cell subsets and non-specific suppressor cell function in hay fever sufferers

The helper/suppressor T cell ratio, as defined by monoclonal antibodies, was significantly higher in hay fever sufferers compared with controls (P less than 0.05), but only during or shortly after the pollen season. This was due to a reduction in the suppressor subset, which returned to control values in the winter. There was no significant difference in the non-specific concanavalin A-induced suppressor cell function compared with controls. The mean summer value was significantly lower than the winter value (P less than 0.05), but we cannot be sure that this was not the result of changes in laboratory conditions. No relationship was found between T cell subsets or suppressor cell function and total or specific IgE levels, or between T cell subsets and suppressor cell function. Our findings suggest that in hay fever, reduction in suppressor cell numbers and function is a secondary phenomenon.     

Concentrations of major grass group 5 allergens in pollen grains and atmospheric particles: implications for hay fever and allergic asthma sufferers sensitized to grass pollen allergens

BACKGROUND: Grass pollen allergens are the most important cause of hay fever and allergic asthma during summer in cool temperate climates. Pollen counts provide a guide to hay fever sufferers. However, grass pollen, because of its size, has a low probability of entering the lower airways to trigger asthma. Yet, grass pollen allergens are known to be associated with atmospheric respirable particles. OBJECTIVE: We aimed (1) to determine the concentration of group 5 major allergens in (a) pollen grains of clinically important grass species and (b) atmospheric particles (respirable and nonrespirable) and (2) to compare the atmospheric allergen load with clinical data to assess different risk factors for asthma and hay fever. METHODS: We have performed a continuous 24 h sampling of atmospheric particles greater and lower than 7.2 microm in diameter during the grass pollen season of 1996 and 1997 (17 October 1996-16 January 1997) by means of a high volume cascade impactor at a height of about 15 m above ground in Melbourne. Using Western analysis, we assessed the reactivity of major timothy grass allergen Phl p 5 specific monoclonal antibody (MoAb) against selected pollen extracts. A MoAb-based ELISA was then employed to quantify Phl p 5 and cross-reactive allergens in pollen extracts and atmospheric particles larger and smaller than 7.2 microm. RESULTS: Phl p 5-specific MoAb detected group 5 allergens in tested grass pollen extracts, indicating that the ELISA employed here determines total group 5 allergen concentrations. On average, 0.05 ng of group 5 allergens were detectable per grass pollen grain. Atmospheric group 5 allergen concentrations in particles > 7.2 microm were significantly correlated with grass pollen counts (rs = 0.842, P < 0. 001). On dry days, 37% of the total group 5 allergen load, whereas upon rainfall, 57% of the total load was detected in respirable particles. After rainfall, the number of starch granule equivalents increased up to 10-fold; starch granule equivalent is defined as a hypothetical potential number of airborne starch granules based on known pollen count data. This indicates that rainfall tended to wash out large particles and contributed to an increase in respirable particles containing group 5 allergens by bursting of pollen grains. Four day running means of group 5 allergens in respirable particles and of asthma attendances (delayed by 2 days) were shown to be significantly correlated (P < 0.001). CONCLUSION: Here we present, for the first time, an estimation of the total group 5 allergen content in respirable and nonrespirable particles in the atmosphere of Melbourne. These results highlight the different environmental risk factors for hay fever and allergic asthma in patients, as on days of rainfall following high grass pollen count, the risk for asthma sufferers is far greater than on days of high pollen count with no associated rainfall. Moreover, rainfall may also contribute to the release of allergens from fungal spores and, along with the release of free allergen molecules from pollen grains, may be able to interact with other particles such as pollutants (i.e. diesel exhaust carbon particles) to trigger allergic asthma.     

Dress and address: patient preferences regarding doctor's style of dress and patient interaction

We sought to determine patient preferences regarding doctor's dress styles and mode of doctors introducing themselves to patients and addressing patients. A survey of patients attending a general medical/endocrinology outpatient clinic in a tertiary referral hospital over a 6 week period was performed. 124 people completed the survey (62 male, 62 female). Mean age was 52.3 years (Range 19-84). Patients preferred to be addressed by their first name while they prefer doctors to introduce themselves by their first and last name. However the majority of patients found all forms of doctors introducing themselves acceptable. Patients preferred formal attire for both male and female doctors, with a white coat being the most preferred option. 84.5% of patients felt that doctors should wear name badges in a clearly visible place although only 26% of patients saw name badges always or almost always during a consultation. This study raises important points regarding the doctor patient interaction.     

Hay fever and asthma in relation to markers of infection in the United States

BACKGROUND: The hygiene hypothesis proposes that declining exposure to infections is implicated in the rising trend of allergy and asthma. OBJECTIVE: We sought to test this hypothesis by examining the relationship of hay fever, asthma, and atopic sensitization with markers of infection in a large general population sample of the United States. METHODS: We analyzed the data of 33,994 US residents recorded in a public database of a nationally representative cross-sectional survey (Third National Health and Nutrition Examination Survey, 1988-1994). The variables examined were sociodemographic information, lifetime diagnosis and age at first diagnosis of hay fever or asthma, current skin sensitization to 9 airborne allergens and peanut, and current serology for Toxoplasma gondii, herpes simplex viruses type 1 and 2, and hepatitis A, B, and C viruses. RESULTS: Hay fever (adjusted odds ratio, 0.27; 95% CI, 0.18-0.41; P <.001) and asthma (adjusted odds ratio, 0.45; 95% CI, 0.31-0.66; P <.001) were less frequent in subjects seropositive for hepatitis A virus (HAV), T gondii, and herpes simplex virus 1 versus seronegative subjects after adjusting for age, sex, race, urban residence, census region, family size, income, and education. Skin sensitization to peanut and to all the airborne allergens examined, except for cockroach, was less frequent among HAV-seropositive versus HAV-seronegative subjects younger than 40 years of age. The prevalence of hay fever and asthma diagnosed at or before 18 years of age in HAV-seronegative subjects increased progressively from 2.7% (95% CI, 0.7%-4.7%) and 0.4% (95% CI, 0.1%-1.6%), respectively, in cohorts born before 1920 to 8.5% (95% CI, 7.3%-9.7%) and 5.8% (95% CI, 4.8%-6.8%), respectively, in cohorts born in the 1960s, whereas they remained constant at around 2% in all cohorts of HAV-seropositive subjects. CONCLUSION: In the United States serologic evidence of acquisition of certain infections, mainly food-borne and orofecal infection, is associated with a lower probability of having hay fever and asthma. Third National Health and Nutrition Examination Survey data support the hypothesis that hygiene is a major factor contributing to the increase in hay fever, asthma, and atopic sensitization in westernized countries.