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Alergotoksikologija je znanstvenoistraživačko područje koje se bavi ispitivanjem utjecaja polutanata (onečišćivača zraka) na nastanak alergijskih reakcija i bolesti. Ispitivanja su prvobitno bila usmjerena na polutante vanjskih prostora, a u novije vrijeme sve više na polutante unutarnjih prostora u kojima ljudi provode većinu vremena. Polutanti po svojoj prirodi mogu biti krute, tekuće ili plinovite čestice, koje se razlikuju s obzirom na veličinu, sastav i izvor iz kojeg nastaju. S obzirom na izvor mogu biti biološkog i nebiološkog podrijetla. Polutanti koji su predmet suvremenih istraživanja s gledišta nastanka alergijskih bolesti su respirabilne krute čestice, ozon, dušični oksidi i bioaerosoli. Mehanizam djelovanja polutanata ovisi o veličini čestica, njihovoj topljivosti i mjestu ulaska u organizam. Dosadašnja ispitivanja su pokazala da različite čestice uvjetuju različite imunosne i neimunosne odgovore u organizmu. Interakcija polutanata i alergena može se zbivati izvan eksponirane osobe, tj. sa samim alergenom ili u eksponiranoj osobi na sluznicama i koži. Polutanti mogu biti nosioci alergena i mogu interferirati na različitim nivoima u nastanku alergijske reakcije. U ovom prikazu razma raju se dosadašnja saznanja o mehanizmima djelovanja polutanata na alergene, na imunosni sustav izloženih osoba na osnovi epidemioloških populacijskih istraživanja, kliničkih studija ekspozcije u kontroliranim uvjetima i eksperimentalnih testnih sistema in vivo i in vitro., Allergotoxicology studies the infl uence of pollutants on the development of allergic reactions and diseases. At the beginning, the research was focused on outdoor air pollutants, while recently it turns to the indoor environment, mainly because people this is where people spend most of their time. Air pollutants may be solid, soluble, or gaseous particles in nature, and they can differ in size, structure, and sources. Pollutants can be of biological or nonbiological origin. Currently interesting air pollutants include particulate matter, ozone, nitrogen oxides, and bioaerosols. The mechanisms of pollutant activity depend on the particle size, solubility, site of deposition, and specifi c chemical properties. Recent studies have shown that different pollutants provoke different immunological and nonimmunological responses in exposed persons. Interaction between air pollutants and allergens can take place outside the exposed person i.e. with allergen itself, or inside the organism on mucous membranes and skin. Pollutants may be the carriers of allergens and may exacerbate allergic reactions and diseases. This review presents recent views about the mechanisms of pollutant activity on allergens and immune system response in exposed persons, based on epidemiological population studies, clinical studies of exposure under controlled conditions, and experimental tests in vitro and in vivo.

The association of age, smoking, alcohol, superoxide dismutase (SOD), glutathione peroxidase (GPx), blood lead (BPb) and cadmium (BCd) levels, and serum levels of copper (SCu), zinc (SZn) and selenium (SSe) with atopic status and ventilatory function was examined in the groups of 166 women and 50 men with no occupational exposure to metals or other xenobiotics. Markers of atopy included serum total IgE, skin prick test (SPT) to common inhalatory allergens, non-specific nasal reactivity (NNR) and non-specific bronchial reactivity (NBR). Parameters of ventilatory function included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1 ). Significantly (P

Reports about the increasing prevalence of atopy and atopic diseases are common, but recently they have been critically reviewed and the need for relevant research methods has been established.This study evaluated a 15-year trend in the prevalence of atopy markers [elevated total IgE, positive skin prick test (SPT) to common aeroallergens and positive atopic symptoms] in Croatian adults, separately for women and men.The study included 721 subjects (445 men and 276 women), 18-45 years old, examined for allergies within a pre-employment preventive examination. All subjects underwent medical history, SPT with common inhalatory allergens and total serum IgE measurement. The trend analysis of atopy prevalence was performed after stratification of subjects into three consecutive 5-year periods from 1985 to 1999.The prevalence of concurrently elevated total IgE and positive atopic symptoms significantly increased during the studied period in men [odds ratio (OR) 2.44, 95% confidence interval (CI) 1.39-4.29, P=0.002]. Women showed an increased prevalence of positive SPT only, with borderline significance (OR 1.65, 95% CI 1.00-2.71, P=0.050). In women, rural residence was found to be a predictor of elevated total IgE (OR 5.36, 95% CI 2.41-11.93, P=0.000) and smoking to be a predictor of concurrently elevated total IgE and positive SPT (OR 6.20, 95% CI 1.67-23.07, P=0.006).An increasing trend in the prevalence of concurrently elevated total IgE and positive atopic symptoms was found in the Croatian adult male population between 1985 and 1999, but not in the female population. Sex differences responsible for the production and regulation of IgE were suggested.

Prikazani su pristupi liječenju zdravstvenih tegoba od prapočetka do današnjih dana. Opisane su osnovne značajke primitivne medicine koja se uglavnom temeljila na magiji i religiji te razvoj i dostignuća moderne konvencionalne medicine, koja se temelji na razvoju prirodnih znanosti i znanstvenim metodama evaluacije učinaka liječenja. Zasebno je prikazana medicina temeljena na dokazima koja se u zadnjih četrdeset godina razvila kao nova disciplina u medicini. Prikazani su različiti terapijski modaliteti komplementarne/alternativne medicine kojima je zajedničko obilježje da se razlikuju od metoda konvencionalne medicine i da učinkovitost nije evaluirana znanstvenim metodama. Posebno su opisane metode komplementarne/ alternativne medicine prisutne u Republici Hrvatskoj te one koje se koriste u psihijatriji. Raspravlja se o značenju sve većeg korištenja komplementarne/alternativne medicine u svijetu i u nas i o mogućnostima i opravdanosti objedinjavanja komplementarne/alternativne i konvencionalne medicine u integracijsku medicinu.

The objective of this study was to examine induced sputum (IS) cells profile from restorers/conservators of cultural heritage (restorers) with no lower airway symptoms and normal ventilatory lung function. The study involved 22 restorers and 48 control workers. Medical interview, physical examination, spirometry, skin prick testing to inhalatory allergens, and IS collection were performed. Compared with control workers, restorers demonstrated higher percentage of neutrophils (34% vs 15.5%; p = .004). This pattern was found only in male workers. They had almost 9 times greater chance to have increased proportion of sputum neutrophils than male controls (odds ratio [OR] 8.98, 95% confidence interval [CI] 1.98–40.7). The mobilization of eosinophils or macrophages into the airways was not established regardless of workers sex. Additional gender difference in sputum cells distribution was found for occupationally unexposed subjects, with higher proportion of sputum neutrophils in women.

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.

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 ermatophagoides) 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., Piroglifidne grinje smatraju se prvenstveno izvorom alergena u našim domovima. Postoji, međutim, sve više studija koje upućuju na izloženost piroglifidnim grinjama u javnim i radnim prostorima. Cilj je ovog pregleda prikazati alergene piroglifidnih grinja kao potencijalne štetnosti vezane uz radna mjesta i utvrditi rizična zanimanja za pojavu i progresiju bolesti uzrokovanih piroglifidnim grinjama. Iz baze PubMed izdvojene su studije koje su istraživale izloženost piroglifidnim grinjama (porodica Pyroglyphidae, rod Dermatophagoides) u različitim javnim i radnim prostorima. Piroglifidne grinje ili njihovi alergeni pronađeni su na različitim radnim mjestima, ali klinički značajne izloženosti zabilježene su u hotelima, kinima, školama, vrtićima, knjižnicama, vozilima (autobusima, vlakovima, taksi-vozilima), avionima, ribarskim brodovima, podmornicama, peradarnicima i crkvama. Predloženo je stupnjevanje rizika na radnim mjestima sa značajnom izloženosti alergenima piroglifidnih grinja kao niskog (povremena izloženost razinama >2 μg g-1), umjerenog (izloženost pretežno između 2 μg g-1 i 10 μg g-1) i visokog rizika (izloženost pretežno >10 μg g-1). Pri procjeni razine rizika treba uvijek uzeti u obzir čimbenike koji značajno utječu na populaciju grinja (klimatska regija, karakteristike zgrade, način čišćenja). Specijalisti medicine rada trebali bi razmotriti moguću profesionalnu izloženost piroglifidnim grinjama pri procjeni opasnosti za radna mjesta i provedbi mjera zaštite na radu, pri profesionalnoj orijentaciji, prethodnim i periodskim pregledima te dijagnostici bolesti vezanih uz rad, u svrhu prevencije pojave ili pogoršanja alergijskih bolesti uzrokovanih piroglifidnim grinjama. Mjere zaštite na radu trebaju biti u mjerene kontroli populacije grinja na radnom mjestu, uključujući odgovarajuće uređenje interijera te redovito čišćenje i održavanje zgrade.

Azbest je generičko ime za skupinu silikatnih minerala od kojih su najčešći krizotil, krocidolit, amozit, tremolit, antofi lit. Izloženost azbestu može uzrokovati benigne bolesti pluća i pleure, kao što su azbestoza, lokalna i difuzna zadebljanja pleure, bolest malih dišnih putova i maligne bolesti kao što su karcinom pluća i maligni mezoteliom. Inhalirana azbest a vlakna deponiraju se u donjem dijelu dišnog sustava, gdje dolazi do interakcije s alveolarnim makrofagima i aktivnoga celularnog imunosnog odgovora koji dovodi do kroničnog sporo progredirajućeg fibrozirajućeg procesa u plućnom intersticiju i pleuri. Azbest može u izloženih osoba afi cirati imunokompetentne stanice i inducirati malignu transformaciju mezotelnih stanica. Dosada nije jasno utvrđeno djeluju li azbestna vlakna direktno na mezotelne stanice ili indirektno dovode do nastanka malignog mezotelioma. Smatra se da je maligni mezoteliom kompleksan tumor koji je rezultat akumuliranih ultiplih genskih oštećenja. Zasada također nema potpuno specifi čnog protutijela za mezoteliom, koji bi izolirano bio dostatan za dijagnozu. Nedavno objavljena istraživanja djelovanja azbestnih vlakana na T-limfocite pokazala su da azbest djeluje kao superantigen. U oboljelih od malignog mezotelioma utvrđena je povećana ekspresija Bcl-2-gena na perifernim CD4+ T-limfocitima. Ovi nalazi su značajan doprinos saznanjima o biološkim učincima azbesta u različitim uvjetima izloženosti s obzirom na trajanje i intenzitet., Asbestos is a generic name for a group of silicate minerals. The most common are chrysotile, crocidolite, amosite, tremolite and anthophyllite. Exposure to asbestos may cause asbestos-related non-malignant diseases of the lung and pleura, including asbestosis, pleural plaques, diffuse pleural fi brosis, small airway disease, and malignant diseases such as lung cancer and malignant mesothelioma. Inhaled asbestos fi bres deposit in the distal regions of the respiratory system where they interact with epithelial cells and alveolar macrophages, and trigger active immunological response which leads to a slowly progressing lung fi brosis. Asbestos may affect immunocompetent cells and induce malignant transformation of mesothelial cells. It is still not clear whether asbestos causes mesothelioma directly or indirectly. There is a general opinion that malignant mesothelioma is a complex tumour that results from the accumulation of multiple genetic alterations over many years. There is no specifi c antibody for malignant mesothelioma as yet which could act as a single diagnostic tool. Recent studies have demonstrated that asbestos acts on peripheral T cells as superantigen and that in malignant mesothelioma patients there is an overexpression of the Bcl-2 gene on peripheral CD4+ T cells. These fi ndings contribute to better understanding of biological effects of asbestos in respect to the duration and intensity of exposure.

Cilj: Procijeniti učinkovitost kemoterapije u liječenju malignog mezotelioma poplućnice. Metode: U ovom radu retrospektivno je analizirana učinkovitost kemoterapije malignog mezotelioma poplućnice (MPM) u 29 oboljelih, liječenih u Klinici za plućne bolesti KB Split od 2002. – 2005. godine. Većina oboljelih 24/29, (82,7 %) bili su profesionalno izloženi azbestu. Liječenje je provedeno nakon što je patohistološkom imunohistokemijskom metodom dokazan podtip MPM. Rezultati: U 23/29 (79,3 %) oboljelih utvrđen je epiteloidni tip mezotelioma. Analizirani su rezultati liječenja u tri skupine oboljelih: 1. gemcitabin /cisplatin u prvoj liniji (PG protokol) u 6 oboljelih, 2. epirubicin / mitomicin u prvoj liniji (EM protokol) u 9 oboljelih, 3. suportivna terapija u 14 oboljelih koji su odbili kemoterapiju. Efikasnost terapije ocijenjena je definiranom stopom odgovora – response rate (RR) i izračunom krivulje preživljenja – mean survival (MS) prema preporukama WHO. Utvrđeni RR 33 % nije se razli- kovao između skupina liječenih PG i EM protokolom, ali je MS bolesnika liječenih EM protokolom u prvoj liniji znatno bolje od onih koji su liječeni PG protokolom ili suportivnom terapijom. Zaključak: Rezultati liječenja pokazuju da se EM protokolom postiže značajno bolje MS, nego PG protokolom. No, rezultati studije se slažu s rezultatima iz literature koji kazuju da je tumor kemorezistentan, te da je stopa tumorskog odgovora niska, a iznosi 10-30 % i bez značajnog utjecaja na MS., Aim: To evaluate the effect of chemotherapy in treatment of patients with malignant pleural mesothelioma. Methods: The effectiveness of chemotherapy was evaluated in 29 patients with malignant pleural mesothelioma (MPM). The patients were treated in Clinical Hospital Split, University Hospital for Lung Diseases, between the years 2002-2005. 24/29 patients (82.7 %) were occupationally exposed to asbestos. Chemotherapy was applied after determination of MPM subtype by pathohystological immunohystochemistry. Results: Epitheloid mesothelioma was determined in 23/29 (79.3 %) patients. Results of treatment were analyzed separately in 6 patients treated with gemcitabine/cisplatine (PG protocol) in first line therapy, in 9 patients treated with epirubicine/mitomycine (EM protocol) in first line therapy, and in 14 patients who refused chemotherapy and were on supportive therapy. In accordance with WHO recommendations the evaluation of chemotherapy effectiveness by response rate (RR) and mean survival curve (MS) was done. RR was 33% in both groups: those on PG and EM protocol, but MS was significantly better in patients treated with EM protocol in the first line chemotherapy comparing to PG protocol and supportive care. Conclusions: The EM protocol has better MS results then PG protocol treatment. However, this study have confirmed the chemo resistance of the tumor, low response rate to the chemotherapy (only 10-30 %), without significant influence to MS.

Background: Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare. Objectives: A case series which describes clinical characteristics, diagnostic patways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented. Patients/Methods: Seven out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens, and total IgE measurement. Results: Airborne ACD caused by azithromycin was established in four examined workers with positive patch test to azithromycin. Two workers additionally had positive patch test to intermediate substances. Occupationally related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnea were described in additional two workers without clearly positive patch test to azithromycin. Two atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months vr. 1-3 years, respectively). Conclusions: Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Beside contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.

This study estimated the exposure to dust mites in various occupational environments in Croatia. In total, 29 occupational dust samples were collected: 10 from urban areas (offices, archive of an insurance company, tobacco, paper-recycling, fish-processing and textile plants, animal unit for experimental rats, winery), nine from rural areas (barley, hay, animal food and flour warehouses, tailor’s shops, wood processing plant, swine confinement house, grocer’s storeroom), and 10 samples from cabins of five fishing boats (five floor and five bed samples). Mites were microscopically identified, and the levels of Der p 1, Der f 1, and Der 2 allergens measured using the DUSTSCREENTM test (Heska AG, Switzerland). Microscopy showed no mites in urban areas. Pyroglyphid mites (D. pteronyssinus) were found in all bed samples from fishing boats. Non-pyroglyphid mites were found in samples taken from barley, hay and animal food warehouses, the swine confinement house, grocer’s storeroom, and fishing boats. Pyroglyphid mite allergens were detected in eight of 10 dust samples from the fishing boats. Median levels of Der p 1, Der f 1, and Der 2 in cabin bed samples were 10 μg g-1, 0.2 μg g-1, and 3.5 μg g-1, respectively. Our findings on fishing boats suggests that pyroglyphid mites could be considered work-related allergens for fishermen. The results of this study confirmed non-pyroglyphid mites as occupational risk factors in various rural environments., U ovome istraživanju ispitana je izloženost prašinskim grinjama u uzorcima prašina iz različitih radnih sredina u Hrvatskoj. Ukupno je analizirano 29 uzoraka prašine: 10 iz gradskih područja (uredi, arhiva osiguravajućeg društva, tvornica duhana, tvornica recikliranog papira, tvornica tekstila i prerade riba, eksperimentalni laboratorij, vinarija), devet iz seoskih područja (skladišta ječma, sijena, stočne hrane i brašna; krojački obrti, tvornica za preradu drva, skladište trgovine mješovitom robom, svinjogojilište), te 10 iz pet kabina ribarskih brodova (pet uzoraka s poda i pet s kreveta). Grinje su identificirane mikroskopski, a razine alergena Der p 1, Der f 1 i Der 2 određene su DUSTSCREENTM testom (Heska AG, Switzerland). Mikroskopski grinje nisu nađene u uzorcima prašina iz gradskih sredina. Piroglifidne grinje nađene su u svih pet uzoraka s kreveta kabina ribarskih brodova, a nepiroglifidne grinje u uzorcima iz skladišta ječma, sijena, stočne hrane, svinjogojilšta, skladišta trgovine mješovitom robom i ribarskih brodova. Razine alergena piroglifidnih grinja utvrđene su u 8 od 10 uzoraka prašine s ribarskih brodova. Medijan razina alergena Der p 1 bio je 10 μg g-1, Der f 1 0,2 μg g-1, a Der 2 3,5 μg g-1. Na ribarskim je brodovima utvrđena povećana izloženost piroglifidnim grinjama, što ukazuje da piroglifidne grinje mogu biti profesionalni rizični čimbenik za ribare. Rezultati ovoga istraživanja potvrdili su nepiroglifidne grinje kao rizični čimbenik u različitim seoskim radnim sredinama.

Alergijske bolesti rastući su zdravstveni problem u industrijski razvijenim zemljama, ali i u zemljama u razvoju, i to osobito u djece i mlađih odraslih osoba te se smatraju bolestima moderne civilizacije. Populacijska istraživanja pokazala su kumulativnu prevalenciju alergijskih bolesti u djetinjstvu od 25-30 %, uključujući alergijski rinokonjunktivitis, astmu i dermatitis. Uzroci porasta alergijskih bolesti još nisu sasvim razjašnjeni. Hipotetskim rizičnim čimbenicima smatraju se: nasljedna predispozicija, izloženost alergenima, onečišćenja okoliša, smanjena stimulacija imunosnog sustava u ranim razvojnim stadijima i suvremeni način života. Prema postojećim saznanjima alergijske bolesti treba tretirati kao općenit poremećaj zdravlja. One se mogu javiti u bilo koje doba života, u različitim organima istodobno ili u različitome vremenskom slijedu, dugotrajna su tijeka i zahtijevaju kompleksnu medicinsku skrb. Značajno utječu na kvalitetu života i smanjenje radne sposobnosti oboljelih te su veliko socioekonomsko opterećenje za pojedinca i društvo. U ovom prikazu iznesena su neka suvremena stajališta i dileme s gledišta epidemiologije, patogeneze, dijagnostike, liječenja i prevencije alergijskih bolesti., Allergic diseases are an increasing health problem in the industrialised and developed countries especially in children and young adult persons. They are considered diseases of modern civilisation. The reported cumulative prevalence of allergic diseases in childhood of 25-30 % includes allergic rhinoconjunctivitis, asthma and dermatitis. The reasons for this increasing prevalence are unknown. The main risk factors are genetic predisposition, allergen exposure, environmental pollutants, decreased stimulation of immune system during the critical period of development and lifestyle. Allergic diseases must be treated as common health disorder. They can express themselves in any age groups and in many different organs. IgE antibody is the main connection between involved organs. Specific IgE is still being identified using the 100 years old skin testing method and quantitative immunoenzymatic method in serum. In spite of the permanent improvement of both methods, neither skin reactivity to allergens nor measurable specific IgE necessarily mean a clinically manifested disease. The interpretation of these findings is still in the clinician’s domain. Allergic diseases rarely have a fatal outcome, but have a long duration. They need a complex treatment and are a substantial individual and public socio-economic burden. Studies of factors influencing the ontogeny and maturation of the immune system in the early human development as well as studies of interaction between environment and genetic predisposition will provide a new insight in the aetiology of allergic diseases. This rewiev presents curent views on the epidemiology, pathogenesis, diagnosis, therapy and prevention of allergic diseases.

The aim of this study was to compare exercise-induced bronchial reaction between healthy control subjects and subjects with allergic rhinitis (AR) and allergic asthma (AA). It included 16 controls, 16 subjects with AR and 19 subjects with AA. A skin prick test, pulmonary function test, histamine challenge test and exercise challenge test (ECT) were performed in all subjects. Bronchial reaction to exercise was expressed as the fall index FEV1 (%), AUC0-30 (min x %), and fall index FEF25-75 (%). After ECT, subjects with AA had a significantly greater bronchial reaction to exercise than subjects with AR and controls (respective fall index FEV1 8.4, 2.9, and 2.4 %, P=0.0083; AUC0-30 127.7, 29.6, and 33.1 min x %, P=0.025; and fall index FEF25-75 14.6, 0.06, and 1.9 %, P, Malo je istraživanja ispitivalo bronhalnu reakciju na tjelesno opterećenje u oboljelih od alergijskog rinitisa. Cilj ovog istraživanja bio je ispitati bronhalnu reakciju na tjelesno opterećenje u oboljelih od alergijske astme, alergijskog rinitisa i zdravih ispitanika. U ispitivanje je uključeno 16 zdravih ispitanika dobrovoljaca (17-51 godina), 16 ispitanika oboljelih od alergijskog rinitisa prema kriterijima EAACI (15-45 godina) i 19 oboljelih od alergijske astme prema kriterijima GINA-e (15-48 godina). U svih ispitanika napravljeno je kožno prick testiranje, određena je ventilacijska funkcija pluća registracijom MEFV-krivulje, napravljen je provokativni bronhalni test histaminom i konstantni submaksimalni test tjelesnim opterećenjem. Bronhalna reakcija na tjelesno opterećenje evaluirana je kao indeksni pad FEV1, AUC0-30 i indeksni pad FEF25-75. Nakon tjelesnog opterećenja oboljeli od alergijske astme u odnosu na oboljele od alergijskog rinitisa i zdrave ispitanike imali su značajno veći indeksni pad FEV1 (8,4, 2,9, 2,4 %; P=0,0083), značajno veću AUC0-30 (127,7, 29,6, 33,1 min x %; P=0,025), kao i značajno veći indeksni pad FEF25-75 (14,6, 0,06, 1,9 %; P

Background: The mean wheal diameter ≥ 3 mm is the usual criterion for positive skin prick test (SPT) reaction to dust mites. The study assessed the accuracy of this SPT criterion with respect to specific IgE values of above 0.35 kUA/l (+ sIgE). Methods: Specific IgE (ImmunoCAP, Pharmacia AB Diagnostics, Uppsala, Sweden) and standard SPT to Dermatophagoides pteronyssinus (DP) and farinae (DF), Lepidoglyphus destructor (LD) and Tyrophagus putrescentiae (TP) (ALK, Horsholm, Denmark) were performed in a random sample of 457 subjects, of whom 273 men (mean age 35.3 ± 11.0 years) and 184 women (mean age 37.9 ± 9.5 years). Statistical analysis was performed using the chi-square test, regression analysis and discriminant analysis. Results: When the mean wheal diameter of ≥ 3 mm was considered positive (+ SPT), the correlation between + SPT and + sIgE was 0.47 for DP (P

The aim of this study was to determine the prevalence of markers of atopy and contact sensitisation in asymptomatic young adults and to assess their role in pre-employment screening. The study included 351 subjects, of whom 166 women (mean age 28.0±6.4 years) and 185 men (mean age 26.3±5.4 years). The pre-employment examination commissioned by a pharmaceutical company included a questionnaire, the patch test with the European standard series of contact allergens, prick test with common inhalatory allergens, and the serum-specific IgE measurement. According to the medical history 115/166 (69.3%) women and 142/185 (76.8%) men were asymptomatic, but 28 (24.3%) asymptomatic women and 40 (28.2%) asymptomatic men showed atopy and/or contact sensitisation. Pre-employment allergy examination can be considered a reliable detection procedure for the majority of asymptomatic persons with atopy and contact sensitisation. The knowledge of these conditions gives the opportunity for secondary prevention and better diagnostic validation of occupational allergic diseases., Cilj ovog rada bio je utvrditi učestalost pokazatelja atopije i kontaktne senzibilizacije u asimptomatske mlade odrasle populacije tijekom prethodnih pregleda te procijeniti njihovo značenje u otkrivanju rizičnih osoba za razvoj alergijskih bolesti prije zapošljavanja. Ispitivanje je obuhvatilo 351 ispitanika, od toga 166 žena (srednja dob 28,0±6,4 godine) i 185 muškaraca (srednja dob 26,3±5,4 godine). Svi ispitanici ispitani su tijekom prethodnih pregleda za farmaceutsku industriju koja se smatra rizičnom za razvoj dišnih i kožnih bolesti. Za sve ispitanike ispunjen je alergološki upitnik, učinjeno je epikutano testiranje s europskom standardnom serijom kontaktnih alergena (Epipharm-ALK), prick-testiranje s najčešćim inhalacijskim alergenima (Imunološki zavod, Zagreb) i mjerenje serumskoga specifičnog IgE (UNICAP 100, Pharmacia). Ispitanici bez dišnih i/ili kožnih simptoma u anamnezi smatrani su asimptomatskima. Atopičarima su smatrani ispitanici s pozitivnim prick-testom i povišenim specifičnim IgE na jedan ili više inhalacijskih alergena. Ispitanici s pozitivnim epikutanim testom na jedan ili više kontaktnih alergena smatrani su osobama s kontaktnom senzibilizacijom. S obzirom na anamnestičke podatke, 115/166 (69,3%) žena i 142/185 (76,8%) muškaraca bili su asimptomatski. U 28 (24,3%) asimptomatskih žena i 40 (28,2%) asimptomatskih muškaraca utvrðeno je postojanje atopije i/ili kontaktne senzibilizacije. Prethodni alergološki pregledi mogu se smatrati pouzdanom metodom za otkrivanje većine asimptomatskih osoba s atopijom i kontaktnom senzibilizacijom. Znanje o postojanju ovih stanja kod radnika omogućuje provoðenje sekundarne prevencije i bolju dijagnostičku procjenu profesionalnih alergijskih bolesti.

Prikazani su utjecaji neprofesionalnih i profesionalnih uvjeta života na razvoj respiratornih bolesti. Navedeni su mehanizmi deponiranja i odstranjivanja Čestica iz respiratornog sustava, kao i učinci duhanskog dima, plinova nadražljivaca i alergena na dišni sustav. Opisane su najčešće respiratorne bolesti i akutni simptomi koji se mogu razviti u uvjetima neprofesionalne i profesionalne izloženosti raznim atmosferskim onečišćenjima. Navedene su i neke mjere prevencije za zaštitu od učinaka atmosferskih onečišćenja na dišni sustav., The effects of nonoccupational and occupational life style on respiratory diseases are reported. Listed are mechanisms of rettention and elimination of particles from respiratory system as well as effect of cigarette smoke, gaseous irritants and allergens on respiratory system. Described are most frequent respiratory diseases as well as acute symptoms which develop in the environment of nonoccupational and occupational atmospheric pollution. Some measures of prevention are listed as protection of the effects of atmospheric pollutants on respiratory system.

Broj oboljelih od alergijskih bolesti u značajnom je porastu posljednjih 30-ak godina, osobito u industrijski razvijenim zemljama svijeta. U ovom radu opisani su najvažniji individualni i okolišni čimbenici koji se povezuju s nastankom i porastom alergijskih bolesti: genetska sklonost, onečišćenje vanjskog i unutarnjeg okoliša, suvremeni način života uključujući način stanovanja, prehranu, uzimanje lijekova i kronični stres. Razmotren je utjecaj veće dostupnosti i poboljšanja dijagnostike alergijskih bolesti. Navedene su mjere prevencije alergijskih bolesti u rizičnim obiteljima., The prevalence of allergic diseases is rapidly increasing over the last 30 years, especially in most industrialized countries of the world. In this paper, the most important individual and environmental factors involved in occurance of allergic diseases are described: genetic predisposition, environmental pollution, modern life style including dwellings, diet, chronic stress and medications. The influence of increased allergy diagnosis and awareness is considered as well as recommended preventive measures in risk families

Ispitivali smo respiracijsku funkciju i imunološki status u 101 radnika zaposlenog na recikliranju papira. U ispitivanje je uključena i kontrolna neizložena skupina od 87 radnika za usporedbu učestalosti respiracijskih simptoma. Ventilacijska funkcija pluća mjerena je registriranjem krivulje maksimalnog ekspiracijskog protoka i volumena na kojoj su očitavani forsirani vitalni kapacitet, forsirani ekspiracijski volumen u prvoj sekundi te maksimalni ekspiracijski protok pri 50% i zadnjih 25% vitalnog kapaciteta (FEF50, FEF25). Alergološko ispitivanje obavljeno je u 101 radnika na recikliranju papira i 37 radnika kontrolne skupine kožnim prick testovima s alergenima papira i nekim općim alergenima te određivanjem ukupnog imunoglobulina IgE. Značajno veća učestalost kroničnih respiracijskih simptoma zabilježena je u izloženih u usporedbi s radnicima kontrolne skupine (P, Respiratory function and allergic reactions were studied in 101 male workers in paper recycling and in 87 nonexposed male control workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves with readings on forced vital capacity (FVC), one-second forced expiratory volume (FEV1), and maximum expiratory flows at 50% and the last 25% (FEF50 and FEF25, respectively). Skin prick test with paper dust allergens, some nonoccupational allergens, and total immunoglobulin IgE analysis were used to assess immunological status. Significantly higher prevalences of all chronic respiratory symptoms were recorded in the exposed workers than in controls. The highest prevalence was recorded for chronic cough (36.6%), followed by chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), nasal catarrh (29.7%), and dyspnea (16.8%). Occupational asthma was diagnosed in four paper recycling workers only (4.0%). FEF50 and FEF25 values were significantly lower than predicted, indicating obstructive changes located mostly in the smaller airways. Skin tests to paper allergens were found positive in 16 (15.8%) paper recycling workers and none in controls. An increase in total immunoglobulin IgE was found in 21% of paper recycling workers and 5% of controls (P

Skin tests with Dermatophagoides pteronyssinus were carried out by the standard prick method in six groups of industrial workers: meat processing workers (n=107), brewery workers (n-96), animal food workers (n-40), swine farmers (n=32), paper-mill workers (n-132) and wool-textile workers (n-111). The control group consisted of 158 subjects who were tested during the preemployment examinations and had not worked in industrial plants before. Skin reactions were read after 20 minutes by measuring the largest urtica diameter in millimeters. A diameter >3 mm was considered to be a sign of a positive skin reaction. In relation to the control group a significant (P, Ispitana je prevaleneija senzibilizacije na Dermatophagoides ptamnyssinus u skupinama radnika zaposlenih u različitim industrijama. Kožno testiranje prick metodom učinjeno je na standardni način alergenskim pripravkom imunološkog zavoda u Zagrebu (0,2%). Ispitivanje je provedeno u šest skupina radnika: iz mesne industrije - obrade peradi (n-107), proizvodnje piva (n=96), tvornice stočne hrane (n=40), svinjogojske farme (n=32) (prerade papira (n-132) i iz tekstilne industrije (n=111). Kontrolna skupina sastojala se od 158 ispitanika koji su testirani tijekom prethodnih pregleda i koji nisu do tada radili u industrijskim pogonima. U odnosu prema kontrolnoj skupini dobivene su značajne razlike (P

Ispitivana je skupina od 158 radnica zaposlenih na preradi vune. Respiracijski simptomi registrirani su u 158 izloženih i u 87 neizloženih (kontrolnih) radnica. U svih radnica registrirana je visoka prevalencija kroničnih respiracijskih simptoma i bolesti. Ventilacijski kapacitet u izloženih radnica mjeren je registriranjem krivulje maksimalni ekspiracijski protok-volumen (MEFV) na kojoj su očitavani forsirani vitalni kapaciteti (FVK), forsirani ekspiracijski volumen u prvoj sekundi (FEV1) te maksimalni ekspiracijski protoci pri 50% i zadnjih 25% vitalnog kapaciteta (FEF50, FEF25). Utvrđena je značajno viša prevalencija svih kroničnih respiracijskih simptoma u izloženih nego u radnica kontrolne skupine. Izloženost prašini vune uzrokovala je značajne akutne redukcije tijekom radne smjene koje su varirale od 2,0 do 9, 1 % . A radnice zaposlene dulje od 10 godina pokazivale su slične akutne redukcije ventilacijskog kapaciteta kao i one s kratim zaposlenjem. Pušači su pokazivali slične akutne i kronične promjene ventilacijskih testova kao i nepušači. U velikog broja radnica utvrđene su vrijednosti FEF50 i FEF25 niže od 70% predviđenih vrijednosti. Rezultati bronhoprovokativnih testova s ekstraktom vune ne pokazuju korelaciju s respiracijskim smetnjama. Naši rezultati upućuju na to da izloženost prašini vune može dovesti do razvoja kroničnih respiracijskih simptoma i oštećenja plućne funkcije., Subjects in the study were 158 female wool textile workers and 87 control non-exposed workers. Respiratory symptoms were assessed by means of a questionnaire. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on monday before and after the work shift Forced vital capacity (FVC), one-second forced expiratory volume (FEV,) and now rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on MEFV curves. Significantly higher prevalences or all chronic respiratory symptoms were recorded in exposed than in control workers (P

Keywords: azithromycin; macrolide; antibiotics; allergic contact dermatitis; occupational; airborne; workplace challenge; pharmaceutical worker