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Birch (Betula pendula) pollen causes inhalant allergy in about 20% of human population in Europe, most of which is sensitive to the main birch allergen, Bet v1. The aim of the study was to find out (i) whether and how the analysed birch individuals differ in regard to composition of individual subunits of pollen proteins and to protein content in these subunits; (ii) whether the level of particulate matter relates to concentration of Bet v1 allergen. Study was performed in Southern Poland, in 2017–2019. Pollen material was collected at 20 sites, of highly or less polluted areas. Protein composition was analysed by SDS-PAGE, while the concentration of Bet v1 was evaluated by ELISA. The obtained results were estimated at the background of the particulate matter (PM10) level and the birch pollen seasons in Kraków. The electrophoregrams of pollen samples collected at different sites showed huge differences in staining intensities of individual protein subunits, also among important birch allergens: Bet v1, Bet v2, Bet v6 and Bet v7. The level of Bet v1 was significantly higher in the pollen samples collected at the more polluted sites. While the birch pollen allergenic potential is determined, the both pollen exposure and the content of the main allergenic components should be considered, as factors causing immunological response and clinical symptoms manifestation in sensitive individuals.

Przedstawiono rekomendacje Polskiego Towarzystwa Alergologicznego dotyczące kwalifikacji osób z alergią i anafilaksją do szczepienia przeciw COVID-19, zarówno dla lekarzy kwalifikujących do szczepień przeciw COVID-19 niebędących alergologami, jak i dla alergologów konsultujących pacjentów z wywiadem przebytej anafilaksji lub ciężkiego (niekontrolowanego) przebiegu chorób alergicznych i astmy szczepionych przeciw COVID-19. Recommendations of the Polish Society of Allergology regarding the qualification of person with allergies and anaphylaxis for vaccination against COVID-19 were presented, both for doctors qualifying for vaccination against COVID-19 who are not allergologists and for allergologists consulting patients with a history of anaphylaxis or severe (uncontrolled) allergic diseases and asthma vaccinated against COVID-19.

Introduction Urticaria is a frequent, mast cell driven disease of great social significance as it may lead to disablement, impair quality of life and affect performance at work and school. Aim A study on the prevalence and potential risk factors for acute and chronic urticaria in the population of children and adolescents living in Krakow, one of the major cities in Poland. Material and methods In this paper we present a study on the prevalence and potential risk factors of acute and chronic urticaria in the population of children aged 7-8 years old and adolescents aged 16-17 years old living in Krakow, one of the major cities in Poland. The relation of urticaria prevalence and exposure to polluted air was also investigated. In the period of 3 years between 2016 and 2018 we enrolled 17082 participants (9287 children and 7795 adolescents). Results Lifetime occurrence of at least one episode of urticaria was reported by 3.3% of respondents (3.6% in the children group and 2.8% in adolescents). The most frequently mentioned causative agent was medicines in children and food in adolescents. Chronic urticaria occurred in 2.1% of children and 1.1% of adolescents. We found no relationship between the volume of traffic and the distance of residence from the high-traffic street to the frequency of urticaria. Conclusions A higher incidence of urticaria in the younger age group may suggest an upward trend in the incidence of this disease in the near future. The incidence of chronic urticaria in children turned out to be higher than in the European population. As our research results show, the incidence of urticaria in children and adolescents does not depend on exposure to polluted air.

The prevalence of asthma and allergies among children has become an increasing problem in the last few decades. Data on the population of children and adolescents, especially living in polluted cities, are limited and based on studies carried out in small groups. In our study, we analyzed the incidence of asthma and allergic rhinitis between 2014 and 2018. We analyzed data collected from nearly 30,000 children aged seven to eight and adolescents aged 16–17, which allowed us to assess the frequency of allergic diseases in the population of children and youth in Krakow. More than 40% of respondents reported allergic symptoms, and nearly 50% of them were not diagnosed and treated. In the group of seven- and eight-year-olds with a positive history of allergies, 52% had allergic rhinitis and 9.1% had asthma. In the group of 16–17-year-olds, allergic rhinitis was diagnosed in 35.8%, while asthma was found in 4.9% of cases. The results obtained over the course of 10 years has shown the reduction in the frequency of asthma (from 22% in the case of asthma in both age groups) and allergic rhinitis cases (from 63.9% in adolescents). In our opinion, this can be considered a positive effect of the preventive measures taken in Kraków after 2010. Although there is still a higher incidence of allergic diseases among children and young people living in urban areas compared to rural areas, the trend apparently has reversed for some diseases.

Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) type I and II is a rare and life-threatening disease caused by SERPING1 gene mutations. Previous genetic studies indicated a wide spectrum of disease-associated variants in the SERPING1 gene and often lack of correlation with patient's phenotypes. The aim of this study was to evaluate the presence, type, and localization of mutations in the SERPING1 gene in 41 Polish patients with C1-INH-HAE and their relation with case/family history, type of C1-INH-HAE, fC1-INH, age of onset, and disease severity. Sanger sequencing and MLPA method were used for detection of disease-associated variants. In 34 (82.9%) patients, mutations located in various regions of SERPING1 gene were revealed. The detected alterations in patients with C1-INH-HAE type I differed and were positioned in various exons/introns of the SERPING1 gene. The most frequent disease-associated variants appeared in exon 3 (especially in type I) and in exon 8 (type I and II). Out of 20 different disease-causing variants, 9 were not previously described. We did not find any relation between the type and location of the mutations and no type of features included in phenotype evaluation of the patients, such as case and family history, type of C1-INH-HAE, age of onset, biochemical parameters, or severity of disease.

Until now, the simultaneous influence of air pollution assessed by measuring the objective marker of exposition (1-hydroxypirene, 1-OHP) and atopy on the development of allergic airway diseases has not been studied. The aim of this study was to determine the pathomechanism of the allergic response to PM2.5 in atopic and non-atopic patients. We investigated the changes in peripheral blood basophil activity of patients after stimulation with the birch pollen allergen alone, the allergen combined with PM2.5 (BP), PM2.5 alone, a concentration of 1-OHP in urine, and a distance of residence from the main road in 30 persons. Activation by dust alone was positive for all concentrations in 83% of atopic and 75% of non-atopic assays. In the group of people with atopy, the simultaneous activation of BP gave a higher percentage of active basophils compared to the sum of activation with dust and birch pollen alone (B + P) for all concentrations. The difference between BP and B + P was 117.5 (p = 0.02) at a PM concentration of 100 μg. Such a relationship was not observed in the control group. The correlation coefficient between the distance of residence from major roads and urinary 1-OHP was 0.62. A Pearson correlation analysis of quantitative variables was performed, and positive correlation results were obtained in the atopy group between BP and 1-OH-P. Exposure to birch pollen and PM2.5 has a synergistic effect in sensitized individuals. The higher the exposure to pollutants, the higher the synergistic basophil response to the allergen and PM in atopic patients.

Alergia na jad owadów błonkoskrzydłych to najczęstsza przyczyna wstrząsu anafilaktycznego u dorosłych, a druga po alergii pokarmowej u dzieci. W warunkach polskich najczęstszymi przyczynami alergii są użądlenia przez pszczoły miodne (Apis mellifera), osy (Vespula spp.) oraz szerszenie (Vespa spp., częściej u osób już wcześniej żądlonych przez osy). Skutkiem użądlenia jest zazwyczaj odczyn miejscowy, jednak ok. 3% dorosłych i 0,5% dzieci reaguje odczynami ogólnoustrojowymi o charakterze anafilaksji. Diagnostyka nadwrażliwości na jady bywa trudna, szczególnie gdy wywiad nie wskazuje jednoznacznie na owada sprawczego. Jej podstawą są testy skórne z jadem osy i pszczoły: punktowe (prick test) i śródskórne o łącznej czułości 94%, i oznaczenie poziomu specyficznych IgE, których czułość wynosi od 83% do 100%. Postawą leczenia jest immunoterapia swoista, do której są kwalifikowani pacjenci z ciężkimi reakcjami anafilaktycznymi i udowodnionym mechanizmem IgE-zależnym alergii. W wyjątkowych sytuacjach do leczenia są kwalifikowane osoby z dużymi odczynami miejscowymi narażone na częste użądlenia z racji wykonywanej pracy oraz z izolowanymi zmianami skórnymi, które znacznie obniżają jakość ich życia. Immunoterapia swoista jest jedyną skuteczną metodą leczenia, trwa 3–5 lat, a jej skuteczność wynosi 91–96% przy alergii na jad osy oraz 77–84% przy alergii na jad pszczoły.

Abstract In 2016, the highest birch (Betula spp.) pollen concentrations were recorded in Kraków (Poland) since the beginning of pollen observations in 1991. The aim of this study was to ascertain the reason for this phenomenon, taking the local sources of pollen in Poland and long-range transport (LRT) episodes associated with the pollen influx from other European countries into account. Three periods of higher pollen concentrations in Kraków in 2016 were investigated with the use of pollen data, phenological data, meteorological data and the HYSPLIT numerical model to calculate trajectories up to 4 days back (96 h) at the selected Polish sites. From 5 to 8 April, the birch pollen concentrations increased in Kraków up to 4000 Pollen/m3, although no full flowering of birch trees in the city was observed. The synoptic situation with air masses advection from the South as well as backward trajectories and the general birch pollen occurrence in Europe confirm that pollen was transported mainly from Serbia, Hungary, Austria, the Czech Republic, Slovakia, into Poland. The second analyzed period (13–14 April) was related largely to the local flowering of birches, while the third one in May (6–7 May) mostly resulted from the birch pollen transport from Fennoscandia and the Baltic countries. Unusual high pollen concentrations at the beginning of the pollen season can augment the symptomatic burden of birch pollen allergy sufferers and should be considered during therapy. Such incidents also affect the estimation of pollen seasons timing and severity. Graphical Abstract

Introduction Hereditary angioedema (HAE) is a rare autosomal dominant disease caused by genetic dysfunction of C1 inhibitor (C1-INH) due to mutations in the SERPING1 gene. The disorder is mediated mainly by bradykinin. The clinical course of the disease is varied and not related to genetic changes. Objectives We aimed to evaluate redox homeostasis of peripheral blood mononuclear cells (PBMCs) in patients with HAE due to C1-INH deficiency (C1 INH HAE) by measuring the levels of reactive oxygen species (ROS) of PBMCs as well as plasma advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs). We also aimed to assess the effect of bradykinin on ROS levels. Patients and methods We enrolled 30 adults with C1-INH-HAE and 15 healthy individuals. The levels of ROS were measured by flow cytometry, while the plasma levels of AGEs and AOPPs were determined spectrophotometrically by enzyme‑ linked immunosorbent assays. Results Basal and hydrogen peroxide (H2O2)-induced ROS levels were higher in patients with HAE when compared with controls (P = 0.002 and P = 0.001, respectively), indicating abnormalities in redox homeostasis. Plasma AOPP and AGE levels were similar in both groups. Bradykinin reduced basal and H2O2-induced ROS generation in PBMCs only in patients with HAE (P = 0.03). Conclusions The higher basal and H2O2-induced ROS levels in patients with C1 INH HAE indicate redox imbalance. However, by reducing basal and H2O2-induced ROS levels, bradykinin shows antioxidant action in this disorder.

INTRODUCTION Hymenoptera insect stings (ISs) in the head and neck (HN) region are commonly considered to be a risk factor for grade IV systemic reactions (SRs) in patients with Hymenoptera venom allergy (HVA). However, clinical data addressing this issue are scarce. OBJECTIVES The aim of our study was to verify whether ISs in the HN region were related to a higher risk of grade IV SRs in patients with HVA. PATIENTS AND METHODS This retrospective cross‑sectional study included 195 patients aged 2 to 74 years and treated with venom immunotherapy due to at least a grade II SR to ISs. The study sample comprised 109 adults (56%; mean [SD] age, 41.08 [14.62] years; male, 50.5%) and 86 children (mean [SD] age, 9.53 [4.37] years; male, 72.1%; P0.001 for age and P = 0.002 for sex). The IS site was divided into 7 categories. RESULTS The HN region was the most common site for the IS (one‑third of the study group). In the entire study population, the risk of grade IV SRs was numerically, though insignificantly higher for ISs in the trunk (odds ratio [OR], 1.58; 95% CI, 0.42-5.92; P = 0.50) and legs (OR, 1.56; 95% CI, 0.49-5.10; P = 0.45), as compared with the HN region. The HN region showed a similar risk of grade IV SRs when compared with all the other IS sites combined into a single category (OR, 0.87; 95% CI, 0.43-1.75, P = 0.7). CONCLUSIONS ISs in the HN region were not confirmed to be a risk factor for grade IV SRs in patients with HVA, regardless of age and sex.

INTRODUCTION Hymenoptera insect stings (ISs) in the head and neck (HN mean [SD] age, 41.08 [14.62] years; male, 50.5%) and 86 children (mean [SD] age, 9.53 [4.37] years; male, 72.1%; P

INTRODUCTION Allergic rhinitis (AR) is the most common atopic disease. Specific immunotherapy (SIT) is the only effective treatment method for AR. In uncertain diagnostic cases, before establishing eligibility for SIT, nasal provocation tests (NPTs) should be performed. However, there are numerous contraindications to performing NPTs, and there is ongoing search for an alternative in vitro method. OBJECTIVES The aim of the study was to determine whether a specific in vitro provocation, that is, the basophil activation test (BAT), may replace a specific in vivo provocation, that is, the NPT, in establishing patient's eligibility for SIT. PATIENTS AND METHODS The study included 30 patients with AR caused by allergy to house dust mite or birch pollen, referred for SIT. The assessment of basophil activation by measuring CD63 antigen expression was performed using the Flow2 CAST test. Basophils were stimulated with allergen preparation (concentrations of 5000, 500, and 50 standardized biological units) used in NPTs. BAT results were expressed as stimulation index (SI) and basophil reactivity (BR). RESULTS Allergen concentrations of 500 and 50 SBU proved to be appropriate for basophil stimulation. Median SI and BR were higher for positive NPT results than for negative NPT results (P

Background Aspirin desensitization (AD) is an effective and safe therapeutic option for patients with nonsteroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (N-ERD). The mechanisms driving its beneficial effects remain poorly understood. Objective To investigate the effect of long-term AD on clinical, biochemical and radiological changes in N-ERD patients. Methods The study group consisted of twenty-three individuals with N-ERD who underwent AD, followed by ingestion of 325 mg aspirin twice daily. Twenty patients completed the 52 weeks of AD. The following evaluations were conducted at baseline and in the 52nd week of AD: (i) clinical: asthma exacerbations, Asthma Control Test (ACT), Visual Analogue Scale (VAS) for the assessment of nasal symptoms; (ii) blood and induced sputum supernatant (ISS) periostin, (iii) phenotypes based on induced sputum (IS) cells, (iiii) ISS and nasal lavage (NL) concentration of prostaglandin D2 (PGD2), prostaglandin E2 (PGE2), tetranor-PGD-M, tetranor-PGE-M, 8-iso-PGE2, leukotriene B4 (LTB4), LTC4, LTD4 and LTE4, and urine LTE4. Results A significant improvement was observed in ACT (P = 0.02) and VAS score (P = 0.008) in the 52nd week of AD. ISS periostin and IS eosinophil count decreased significantly in the 52nd week of AD (P = 0.04 and P = 0.01, respectively). ISS and NL eicosanoid concentrations did not change following long-term AD. Conclusion and Clinical Relevance: AD is associated with a decrease in sputum periostin biosynthesis, which may prevent the recruitment of eosinophils into respiratory tissue and be one of explanation of the clinical benefits of AD. Long-term aspirin administration does not lead to an imbalance between pro- and anti-inflammatory ISS eicosanoids.

Abdominal angioedema attacks are a frequent and typical symptom of hereditary angioedema (HAE) but very often generate diagnostic problems. The study presents laboratory and clinical findings of 7 patients with HAE 1/2 hospitalized due to severe attacks. In all cases, at admittance severe abdominal pain, flatulence, strong weakness, different grade of nausea/vomiting or diarrhoea and abundant free fluid in peritoneal cavity were present. In the history of all patients, recurrent 2 to 3 day long abdominal attack with ascites, were announced. Laboratory data done before the treatment showed elevated leukocytosis, hematocrit, serum glucose, high D-dimers and decreased value of APTT. All patients had an abdominal ultrasound examination, in 5 patients additional abdominal angio-CT was performed to exclude thromboembolic episode. The infusion of human C1 inhibitor concentrate was administered as causative treatment. Completely withdrawal of symptoms was noted up to72 hrs after infusion. In addition all laboratory parameters normalized as well as the free fluid in abdominal cavity disappeared, however, D-dimers serum level despite a decreasing tendency reached the normal range just after 2 weeks.

The ‘Wieliczka’ Salt Mine with specific stable, microclimatic conditions is a unique place, where pulmonary and allergy-related diseases are treated. The aim of this study was to determine the occurrence of biological particles in the air of the ‘Wieliczka’ Salt Mine in relation to the location and time. Twenty measurements were taken quarterly in 2012–2016, in four salt chambers. The volumetric and impact methods were used to measure microbiological contamination, while the mite and cat allergens were measured using FEIA assay. The statistically significant differences among the study sites and time of measurements, treated as the following seasons, for spores and bacteria were found. Pollen grains were observed in the underground chambers rarely and in significantly lower quantities than outdoors. No statistically significant differences between the content of Der p1 and Fel d1 allergens among the study locations, seasons and patient presence/absence were found. The qualitative content of micro-organisms in the air of salt chambers seems to be related to the biological material carrying in by patients and staff.

Anaphylaxis is an increasing problem in public health. The food allergens (mainly milk, eggs, and peanuts) are the most frequent cause of anaphylaxis in children and youth. In order to define the cause of anaphylaxis, skin tests, the determination of the concentration of specific IgE in the blood and basophil activation test are conducted. In vitro tests are preferred due to the risk of allergic response during in vivo tests. Component-resolved diagnosis (CRD) is an additional tool in allergology, recommended in the third level of diagnostics when there are diagnostic doubts after the above mentioned tests have been carried out. The paper presents 3 cases of patients with anaphylactic response, and the application of CRD in these patients helped in planning the treatment. Patient 1 is a 4-year-old boy with diagnosed atopic dermatitis and bronchial asthma reported an anaphylactic shock at the age of seven months caused by cow's milk and the exacerbation of bronchial asthma after eating some fruit. Patient 2 is a 35-year-old woman who has had anaphylactic shock three times: in June 2015, 2016, and 2017 and associates these episodes with the consumption of dumplings with a caramel, bun, and the last episode took place during physical exertion few hours after eating waffle. Patient 3 is a 26-year-old man with one-time loss of consciousness after eating mixed nuts and drinking beer. CRD offers the possibility to conduct a detailed diagnostic evaluation of patients with a history of anaphylactic reaction.

Allergic reactions to drugs are a matter of great concern, both for patients and health care professionals. The diagnosis is primarily based on a clinical history and in vivo tests, but they have some significant limitations in a range of clinical situations. This review presents currently available in vitro methods for the identification of the culprit drug in drug-induced immediate reactions (specific IgE determination, basophil activation test), T-cell-mediated drug allergy (lymphocyte transformation test, enzyme-linked immunosorbent spot assay, cell activation markers and cytokine release) and in nonallergic hypersensitivity to nonsteroidal anti-inflammatory drugs. Perspectives for further improvement of the in vitro diagnosis of drug allergy are also discussed.

During the past years, air pollution created by humans has become a major problem increasing the public awareness. The incidence of allergic disease is high and continues to increase in populations of urban areas of Westernized countries throughout the world. The aim of this article is to summarize current knowledge of the effects of air pollution on the development of allergic diseases. In the paper the effect of outdoor and indoor air pollution is described with potential and proven mechanisms of action on the development of allergic diseases.

Qualification for specific immunotherapy (SIT) according to the guidelines of the European Academy of Allergy and Clinical Immunology (EAACI) includes medical history, skin prik tests (SPT) and/or measuring the concentration of sIgE. It is necessary to perform additional diagnostic tests in case of discrepancies between the history and the results of SPT/sIgE or differences between SPT and sIgE. Basophil activation test (BAT) assesses the expression of activation markers of these cells, eg. CD63 and CD203c after stimulation. The aim of our study was to evaluate the usefulness of BAT in the qualification for the SIT in comparison to the SPT and sIgE and in case of discrepancies between the results of SPT and sIgE. The study included 30 patients with allergic rhinitis (AR) caused by allergy to house dust mite (Dermatophagoides pteronyssinus, Dp) or birch pollen qualified for SIT. All patients had SPT, sIgE and BAT determination. The group of patients with allergy to birch was a control group for Dp allergic and vice versa. BAT with CD63 antigen expression was performed using a Flow2CAST test. Basophils were stimulated with allergen preparation (50, 500, and 5000 SBU/ml concentrations). BAT results were expressed as a stimulation index (SI). For optimal concentrations of 50 and 500 SBU/ml parameters comparing BAT to SPT and sIgE as the gold standards were consecutively: sensitivity 82-100% and 93-100%, specificity 50-94% and 47-89%, positive predictive value 65- 94% and 61-87%, negative predictive value 86-100% and 93-100%. Correlation BAT - SPT and BAT - sIgE ranged within 0.59 to 0.84 and 0.51 to 0.72. BAT was helpful in 2 of 30 patients with incompatible results of SPT and sIgE. Optimal concentrations for basophil stimulation are 50 and 500 SBU/ ml. BAT may be useful diagnostic tool in the qualification for the SIT in case of discrepancies between the results of SPT and sIgE.

The severity of allergic symptoms in patients with atopic dermatitis (AD) intensifies when the number of colonies patient’s of Staphylococcus aureus on patents’ skin increases. The basic feature determining the quality of any diagnostic test for S. aureus is its credibility. Performing a test always carries the risk of obtaining false positive and/or false negative results. Furthermore, producing material for microbiological analysis of internal body cavities is sometimes difficult. Therefore, in our study, we compared the results of three tests to determine if their results were mutually compatible and if they confirmed whether S. aureus was present in patients with AD and what was its role in the development of the disease in those patients. Infection with S. aureus was tested in patients with AD and healthy volunteers using the API Staph system. The specific IgE antibodies for staphylococcal enterotoxin A (SEA) and B (SEB) were measured using the UniCAP system. The secretion of IFN-γ, IL-2, IL-13 by peripheral blood mononuclear cells (PBMCs) after stimulation with SEA and SEB were studied with Elispot assay. We found that only certain patients with AD and S. aureus produced antibodies against SEA and SEB in the acute phase of AD. The secretion of IFN-γ was low in patients with exacerbated AD and S. aureus. Testing for the presence of S. aureus in the mucous membrane of the nasal vestibule and skin lesions is not sufficient for complex diagnosis of the role of S. aureus in the pathomechanism of AD. Measuring the presence of antibodies against bacterial components in patients’ serum and the reactivity of patients’ immune cells against these bacterial components is required in order to accurately diagnose this role of S. aureus in a patient.

Acquired angioedema is a rare disease caused by a deficiency of C1 esterase inhibitor with recurrent swelling symptoms. It may occur in the course of lymphoproliferative disorders or autoimmune diseases. Symptoms resemble hereditary angioedema, and the only differentiating features is negative family history, late onset of symptoms and accompanying lymphoproliferative disorder. The aim of the study was to analyze the cases of acquired angioedema. The retrospective analysis of 341 patients from the registry of patients with C1 inhibitor deficiency. Results: We identified 4 patients among 119 with HAE (3.57%) diagnosed in this same period of time 2012-2016 who fulfilled the criteria of acquired edema. In two cases the primary reason of angioedema was lymphoproliferive disease, in two monoclonal gammapathy of unknown reason. We analyzed also the results of laboratory tests C4, C1 inhibitor, C1q. In all cases the face was dominated localization. After the treatment of primary lymphoproliferive disease, in two cases, we observed total remission of angioedema. Only one patient with gammapathy require treatment with C1 inhibitor during the attacks. In these case we observed both plasma deriver, and recombinant C1 inhibitor were effective.

Honey bee venom (Apis mellifera) is a mixture of many components, both amines, peptides enzymes and toxins. Most of the enzymes are allergens with different allergenic potential. It may affect not only to the symptoms, it may also contribute to the success of immunotherapy. In some cases the problem of a bee venom allergy diagnosis is difficult due to the imperfection of the classical diagnostic methods. In the present work reports in the literature regarding the bee venom allergy diagnosis on the basis of identification of the venom allergen sIgE to components are summarized. The use of recombinant allergens has allowed for the study of sIgE against the allergenic components, and thus determination of the individual profile of allergy. Extending the test panel of bee venom components to rApi m10 and rApi m3 compared to rApi m1 increases the diagnostic sensitivity by identifying new allergens that are not always present in the available preparations used in immunotherapy.

PM10, one of the air pollution components has a significant effect on plant pollen by the deposition on the surface of pollen grains, morphological changes of pollen walls and interference in the structure of the allergenic proteins. The aim of the study was to verify whether and in what weather conditions the concentration of pollen of alder, hazel and birch coincides with the elevated level of PM10 in Kraków, in 2010-2015. In the days when the alder pollen concentration exceeded 95 PG/m3, causing severe inhalant allergy symptoms and the concentration of hazel pollen was80 PG/m3 and the admissible level of PM10 was exceeded, the maximum air temperature ranged from 5.1 to 22.6oC, the days were dry (humidity60%), without precipitation and mostly windless. High concentration of birch pollen and exceeded admissible level of PM10 concentration were found in more than 60% of the days in the city center. In 70.3% of the days in which the birch pollen concentration reached values that caused the symptoms of asthma (155 PG/m3), the dust concentration was exceeded (50μg/m3), and rainfall and wind speed of 1-3 m/s occurred. Symptoms in people allergic to trees pollen in Kraków can be exacerbated during periods when the standard limits of PM10 are exceeded. Such situations have occurred mostly in March (pollen of alder and hazel) and April (birch pollen), especially in the city center.

During specific immunotherapy (SIT) it is recommended to monitor the patient symptoms in relation to the exposure of allergen which the patient is treated. The aim of the study was to analyze the clinical symptoms of allergic rhinitis (AR) and cross reactivity in patients undergoing specific immunotherapy using pollen allergens (SIT) (birch and/or grasses) against the pollen exposure in 2014-2016. The study group, consisted of patients with pollen allergy, treated by SIT with birch and grasses allergens, who showed oral allergy symptoms. Patients of the control group were sensitive to birch and/or grasses allergens and they were not treated with SIT. The analyses were based on the results of questionnaires and patient symptom diaries. Timing of the pollen seasons of birch and grasses were similar, however the significantly higher concentration of birch pollen was found in 2014 and 2016, comparing to 2015. The strongest relationship between the pollen concentration and symptoms severity was revealed in the study group in patients desensitized by combined vaccine (birch/grasses), while in the control group, in patients sensitive to both taxa. In 35.3% of patients in the study group, a significant decrease in symptoms after foods was found, especially in patients desensitized with mixed vaccine (birch, grasses) after consumption of vegetables and in patients desensitized with grasses allergens after the fruits and nuts. SIT has a significant impact on the symptoms score reduction, which could be modified by the changeable seasonal pollen exposure.

In the original publication of the article, the authors given and family names were swapped in the author group. The correct author group is given in this correction.

[b]Abstract Introduction and objective[/b]. Gluten proteins (gliadins and glutenins) are polymorphic wheat storage proteins of allergenic properties. Significant differences in chemical composition between both protein groups allow to expect highly specific immunological response of individual subunits and fractions in reactions with IgE sera of people allergic to wheat. The aim of these studies was to identify and characterize the most allergenic gluten proteins (GP) and nongluten proteins (NGP) occurred in two closely related wheat hybrid genotypes. [b]Materials and method.[/b] 3xC and 3xN wheat hybrids, which differ strongly in regard of gliadin composition, were analyzed. Seven people manifesting different symptoms of wheat allergy donated sera for the experiment. The technique of immunoblotting after SDS-PAGE was used for identification of allergenic subunits and fractions among GP and NGP. Immunologically active protein bands were visualized by chemiluminescence. [b]Results[/b]. Great variation of immunodetection spectra was observed. Results of immunoblotting showed LMW glutenins to be of highest, gliadins of medium, while NGP of lowest allergenicity for selected patients. The 43-kDa and 47-kDa LMW glutenin subunits, 40-kDa and 43-kDa γ-gliadin fractions and 49-kDa NGP can be considered as the most immunoreactive among all protein bands [b]separated by SDS-PAGE. Conclusion [/b] The observed differentiation of immunodetection spectra allows to model highly specific IgE-binding profiles of allergenic wheat proteins attributed to individual patients with symptoms of gluten intolerance. Highly immunoreactive subunits and fractions among GP and NGP were identified. The observed immunoreactivity of 49 kDa NGP is worth to emphasize, as it has never been reported as wheat allergenic protein before.

Food allergy is most often linked to the type I allergic reaction, while IgE-dependent mechanism causes symptoms in only about 50% of patients. If symptoms are coming from other types of allergic reactions we do not have enough standardized diagnostic methods. The purpose of our review is to discuss the possibilities of diagnosis of food allergies. Regardless of the causal mechanism the interview has the most important role in the diagnosis, and the gold standard is a double blind placebo controlled food challenge. Additional tests that can be performed in suspected IgE-mediated reactions include: skin prick tests, specific IgE measurement, component-resolved diagnostics and in doubtful cases basophil activation test (BAT). Due to the fact that the spectrum of the symptoms of the type I food hypersensitivity can include potentially life-threatening reactions, diagnosis is often limited to in vitro assays. In these cases BAT may play an important role--in a recent publication, for the first time BAT reactivity reflected the allergy severity and BAT sensitivity reflected the threshold of response to allergen in an oral food challenge. Atopy patch tests are valuable diagnostic tool in suspected type IV food hypersensitivity, but due to the lack of standardization they are not used routinely. The cytotoxic test has been developed on the basis of the observations that leucopenia developing in the type II hypersensitivity reaction mechanism may be one of the symptoms of food allergy. Unfortunately its use is not justified in any method fulfill the criteria of controlled clinical trial. Food allergy can also develop in the type III hypersensitivity reaction, but there is lack of research supporting the role of IgG measurement in the detection of allergens responsible for symptoms. Each result of additional diagnostic tests before the introduction of food elimination should be confirmed in double-blind, placebo-controlled or open food challenge, because non proper diet is not only ineffective but also can be harmful.

Background The direct comparison between children and adults with Hymenoptera venom anaphylaxis (HVA) has never been extensively reported. Severe HVA with IgE-documented mechanism is the recommendation for venom immunotherapy, regardless of age. Objective To determine the differences in the basic diagnostic profile between children and adults with severe HVA and its practical implications. Methods We reviewed the medical records of 91 children and 121 adults. Results Bee venom allergy was exposure dependent, regardless of age ( P P = .01), whereas cardiovascular comorbidities were present almost exclusively in adults ( P = .001). In the bee venom allergic group, specific IgE levels were significantly higher in children (29.5 kU A /L; interquartile range, 11.30-66.30 kU A /L) compared with adults (5.10 kU A /L; interquartile range, 2.03–8.30 kU A /L) ( P P P = .002), as well as in bee ( P = .002) and wasp venom allergic groups ( P = .049). Conclusion The basic diagnostic profile in severe HVA reactors is age dependent. Lower skin test reactivity to culprit venom in children may have practical application in starting the intradermal test procedure with higher venom concentrations.

Diagnosis and treatment of chronic urticaria (CU - Chronic Urticaria) is one of the most difficult issues in allergy practice. Studies on the etiopathogenesis of chronic urticaria suggest that environmental factors, immune, genetic and hormonal are involved in triggering and maintaining the reaction of hives. In practice, despite detailed diagnosis is usually not possible to determine the real cause of the disease. For this reason, the use of causal treatment for patients suffering from chronic urticaria is not possible and supportive treatment is often ineffective. 0.1% of the population suffers from chronic spontaneous urticaria, which main cause has not been detected. Very often CU coexists with autoimmune thyroid dysfunction. Studies confirm higher incidence of thyroid antibodies in patients with chronic urticaria than in the general population. We analyzed 100 patients who met the criteria for chronic urticaria according to the WHO, in Allergology Clinic of the University Hospital Jagiellonian University Medical College. According to our study 17.4% of patients with chronic spontaneous urticaria occurred elevated titer of anti-TPO antibodies. In patients with non-spontaneous type of CU, elevated titer of anti-TPO antibodies only occurred in 8.3% of patients, and this difference was statistically significant p =0.003. All the patients had thyroid levels normal and there were no clinical symptoms of thyroid dysfunction. Our research indicates a link with autoimmune thyroid diseases, especially Hashimoto's disease, with a prevalence of CU. It is necessary to conduct further studies to confirm the relationship of pathogenic autoimmune thyroid disorders with the occurrence of CU, which will help to provide the causal treatment of spontaneous CU coexisting with high levels of anti-TPO antibodies in patients with euthyroid status.

Recent remarkable findings of pharmacogenomics and basic scientific research provided insights in the pathogenesis of severe drug hypersensitivity reactions such as drug rush with eosinophilia and systemic symptoms (DRESS), abacavir hypersensitivity syndrome or blistering reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). There is increasing evidence for the strong associations of certain human leukocyte antigen (HLA) alleles with hypersensitivity to particular drugs. HLA genes may serve as genomic biomarkers of predisposition to severe adverse drug reactions and enable to prevent them. In this paper we review essentials and advances in this area.

Allergy is a worldwide medical problem and prevalence of allergic diseases is on the rise. In the study a population of 7494 children and adolescents living in Cracow responded to a questionnaire based on the ISAAC study complemented with questions concerning food allergy. 49.1% of respondents reported symptoms suggestive of allergic disease. 52.7% of them (25.9% of respondents in total) had not received any treatment despite the reported symptoms. The most frequently reported allergic disease was allergic rhinitis followed by atopic dermatitis, asthma, food allergy and allergic contact dermatitis. In the adolescents group allergic rhinitis was followed by asthma. 487 voluntary applicants were further analysed in order to confirm specific allergic disease. Given the final diagnosis, allergic rhinitis was also the most common disease. Interestingly in both categories (preliminary and final diagnoses) we noticed that it is substantially more frequent in the older group which in our opinion can be linked to the impact of polluted urban environment but there is a need for further research in this area.

Adverse drug reactions, especially drug hypersensitivity reactions (DHR) are common problem, which impacts on prescription choices. In general pediatric populations data on the epidemiology of DHRs are scarce compared to in-patient and adult populations. In the current study, we assess the prevalence of parental-reported drug allergy in school children.We performed a cross-sectional survey of a general 6- to 7-yr-old children population from Krakow. The life occurrence of drug allergy along with basic data on sensitization to common environmental allergens was assessed using a self-administered questionnaire. Four thousand eighty questionnaires were collected.The prevalence of drug allergy according to answers given by parents was 3.38% (138/4080). The most common reported drugs were penicillin and its derivatives (39%), followed by sulphonamides (25%), cephalosporins (9%) and non-steroidal anti-inflammatory drugs (8%). Sensitization to inhalant allergens, food allergens or haptens was not significant risk factor for drug allergy.The study showed that drug allergy claims in children are highly prevalent. Although results are based on parental perception, they point out how many patients need complete diagnostic work-up to confirm or exclude drug allergy. Otherwise they are treated with alternative drugs, which are usually less effective and/or more expensive.

Allergic diseases are important health problems. Medical history and results of additional tests play a crucial role in the diagnosis. Cytometric basophil activation test (BAT) is widely evaluated technique in inhaled, food, Hymenoptera venom and drugs allergy. The aim of our review is to systematize the available knowledge about possibilities of applying BAT, especially in the diagnosis of inhaled allergies. Basophil activation markers with proven sensitivity and specificity are CD63 and CD203c--each of them has its supporters and opponents among researchers. Use of the first one is more popular because of the direct relation of its appearance on the cell membrane of basophils with degranulation. The usefulness of BAT has been confirmed in the diagnosis of grass pollen, trees and house dust mites allergies in children and adults. BAT has a comparable to the routinely used tests sensitivity and higher (in most studies evaluated as 100%) specificity. The disadvantage of BAT that has been observed by some authors is "hyperreactivity" of basophils in atopic patients, leading to the appearance of false positives results. Basophil activation test seems to have a significant advantage over skin tests due to safety and lack of necessary to withdrawal antihistamines medications. Future research should focus on the use of BAT in diagnostically difficult cases and in monitoring of immunotherapy.

The in vitro diagnosis of delayed drug hypersensitivity reactions remains a research problem. We measured drug-specific IFNγ release in peripheral blood mononuclear cells sampled from patients with drug-induced maculopapular exanthema and the age- and sex-matched control group. This is the first study to directly cross-compare an ultrasensitive assay based on an emerging electrochemiluminescence technology (ECL), the standard lymphocyte proliferation assay and three following tests detecting IFNγ at different steps of its production: intracellular in CD3+CD4+ cells (flow cytometry), secretion at the single cell level (enzyme-linked immunospot assay), bulk content in cell culture supernatant (enzyme-linked immunosorbent assay, ELISA). The highest rate of drug-positive responses were recorded for ELISA and ECL tests (56.25%). No false-positive responses were observed--all tests were negative in the control group. We demonstrated that IFNγ-detecting ELISA is not less efficient than ECL test, however, it is easily available and cheap, which makes it a potential method of choice in the future.

Mastocytosis is a heterogeneous group of diseases characterized by excessive proliferation and accumulation of mast cells--in one or more organs. The number of symptoms and clinical prognosis vary depending on the disease. One of the most severe potential outcome of mastocytosis is anaphylactic shock. Early diagnosis and identification of triggers enables education and avoidance them. We describe the case of a 31-year-old woman with systemic mastocytosis (SM) without skin symptoms with multiple anaphylactic reactions, including two severe. Systemic mastocytosis was confirmed in bone marrow and genetic studies. We identify allergic triggers: latex and cefuroxime and also other non-immunological triggers as non-steroidal anti-inflammatory drugs (NSAIDs). The patient never had any allergic reaction after Hymenoptera stings. Only one result of serum tryptase was elevated. There was a need to determine the safety of antibiotic use and anesthetic drugs before cesarean. The moment when the disease was diagnosed and triggers were identifie, helped avoid further severe reactions.

Nasal mucosa cytology is an additional examination useful to differentiate chronic rhinitis in allergological and laryngological diagnostics, including chronic sinusitis. The aim of the study was to estimate the cytological picture in a group of patients with the highest percentage of squamous epithelia, suggesting the atrophic rhinitis. The analysis was carried out on the basis of cytological results performed in 3055 patients diagnosed because of chronic rhinitis. Among these patients, in 31 individuals the higher percentage (30% - 76%) of squamous cells was found. In six patients, the clear predominance of squamous cells over ciliated and goblet cells (3:1) was reported. Only in three patients the increased percentage in eosinophils was stressed (3%, 5% and 9% respectively). No basic and metaplastic cells were observed in the studied cytograms. The squamous cells occurred probably as a result of normal mucosa damages during the different inflammatory changes, both allergic and non-allergic, the impact of toxic agents, irritants (including nasal drops). The higher percentage of squamous cells in the nasal cytogram could have explained the low effectiveness of local inflammatory treatment in these patients.

According to asthma treatment guidelines the main goal of pulmonary rehabilitation is optimum asthma control. The Asthma Control Test (ACT) is a standardised five-item questionnaire for the assessment of asthma control. The study compares the pre- and post-treatment (subterraneotherapy) ACT score with other conventional respiratory parameters. The study included 21 patients with bronchial asthma who underwent a 3-week long subterraneotherapy programme in the 'Wieliczka' Salt Mine. The patients completed the ACT questionnaire before and 2 weeks after subterraneotherapy. At the same time, they underwent testing for concentration of nitric oxide in exhaled breath (FENO), peak expiratory flow (PEF) and spirometry. Subterraneotherapy influenced significantly the change of MEF75 (p = 0.03255) and improvement of ACT score (N = 21, p = 0.0016). The differences in other parameters were not statistically important, but in the case of FEV1 and VC parameters, the differences found were close to the statistical significance (0.05p0.10). The differences of results before and after subterraneotherapy were higher in the group assigned as patient with poor or moderate asthma control (ACT score20, N = 10) than in the group with good control of asthma (ACT score ≥ 20, N = 11). For parameters FEV1, VC, MEF75 and ACT score the improvement was significantly higher in the poor control group. The pulmonary rehabilitation programme combined with subterraneotherapy helps to control asthma especially in patients suffering from poorly or moderate controlled asthma.