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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.

The document prepared by the expert panel of allergy/immunology specialists representing Polish Allergy Society intends to provide allergists with recommendations with respect to proper management of allergic patients during SARS-CoV-2 pandemics Allergist should aim at reducing patient’s social interactions by replacing face-to-face visits with communication via telephone or internet In parallel allergist is responsible for assuring that the patient is receiving proper care of underlying allergic disease The experts panel provides eighteen recommendations for management of patients with asthma and allergic diseases during pandemics, indicating that in majority of patients asthma treatment (including inhaled corticosteroids) and allergy treatment should be continued Specific recommendations for treatment with allergen immunotherapy and with biologics are discussed in details

Introduction It is known that the administration of the drug during the oral aspirin challenge (OAC) can cause hypersensitivity symptoms not only from the respiratory system or skin, but also from the cardiovascular system. Aim To assess the occurrence and nature of cardiovascular adverse events during the OAC in patients suspected of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). Material and methods The study included 52 patients with symptoms of hypersensitivity to aspirin (ASA) or other NSAIDs in the form of skin reactions or respiratory response in anamnesis. Patients were treated with OAC and simultaneously were subject to monitoring of clinical manifestations of hypersensitivity to ASA/NSAIDs, ventilation disorders and cardiovascular functions. Results The most common reaction of the cardiovascular system during OAC was tachycardia or supraventricular and ventricular extrasystoles, regardless of the day of the study and the result of OAC. Supraventricular and ventricular tachycardia was recorded incidentally. Atrial or ventricular fibrillation or flutter was not observed. There was no evidence of any ischemic heart disease. In 2 patients, hypotension was registered, but only 1 of them required typical treatment of anaphylaxis. Conclusions No clinically significant cardiac arrhythmias were recorded during OAC. The changes observed in the records of blood pressure and ECG monitoring show that OAC performed in accordance with the current guidelines does not pose a high risk to the patient’s health and life as a result of cardiovascular reactions.

Introduction The literature describes the influence of venom immunotherapy (VIT) on the subpopulation of T regulatory cells (CD4+ CD25+ Foxp3+) and the synthesis of IL-10, TGF-β1 as well as many other cytokines at various times after immunotherapy. Aim To assess changes in the percentage of cells of CD4+ and CD25+ in peripheral blood and serum concentrations of IL-10, IL-21 and TGF-β1 in the early stages of VIT. Material and methods The study included 18 patients who were allergic to wasp venom and who in the past underwent systemic anaphylactic reaction after stinging, meeting the criteria to qualify for VIT. The immunoenzymatic method (ELISA) was used to assess concentrations of cytokines IL-10, IL-21 and TGF-β1 and the surface antigens CD4 and CD25 on the cells. The concentrations were determined by flow cytometry method at baseline (before VIT) and after 2.5 and 24 h from the VIT starting point. Results The mean values of the activity of T lymphocytes CD4+ CD25+ FoxP3+ and concentrations of the cytokines IL-10, IL-21 and TGF-β1 are shown in table. Conclusions A 24-hour activation assessment of serum concentrations of cytokines IL-10, IL-21 and TGF-β1 during the first day of the Hymenoptera venom immunotherapy by ultra-rush protocol does not show the significant dynamics of change of the examined parameters.

Introduction Platelet-activating factor (PAF) has a direct role as a mediator in the pathogenesis of various disorders with an inflammatory component, including those with allergic aetiology. The peripheral blood concentration of PAF is dynamically regulated by plasma PAF acetylhydrolase (PAF-AH). Previous research suggest that low activity of plasma PAF-AH could be a predictive marker for increased severity of some types of allergic hypersensitivity reactions–especially anaphylaxis. The purpose of the study was to evaluate the association between plasma PAF-AH activity and severity in patients with anaphylactic reactions following a wasp or bee sting. Materials and methods The study group of 89 patients was divided into two subgroups depending on the increasing severity of the most severe anaphylactic reaction in the past, which was assessed according to the Müller’s scale. The first subgroup included participants with a history of hypersensitivity reactions up to grade II. The second subgroup consisted of patients who have experienced at least one grade III or IV reactions in the past. A control group of 20 people was established. Plasma PAF-AH activity was measured using a colorimetric method. Results It has been observed that plasma activity of platelet-activating factor acetylhydrolase was significantly lower in patients with anaphylaxis history compared to the control group with negative atopic history (on average 21.38 nmol/min/ml for the control group, 9.47 nmol/min/ml for the first subgroup and 10.16 nmol/min/ml for the second subgroup, in both cases p < 0.0001). Conclusion The plasma activity of PAF-AH is a promising parameter that can help to distinguish a group of patients not threatened with development of anaphylaxis and not requiring laborious or expensive prophylactic procedures.

Background: The emergence of tolerance during Hymenoptera venom immunotherapy (VIT) is a complex process. The main goal of VIT is to induce a change from proinflammatory Th2 response to the Th1 response. The immune mechanism of acquiring rapid tolerance during VIT has not yet been fully understood. Methods: We have analyzed (in 4 time points: 0, 2, 6 and 24 weeks after treatment) concentration of 30 cytokines and chemokines in serum using Luminex system, complement system, lymphocyte subpopulations (flow cytometry), and histamine and tryptase serum concentrations of 40 patients with Hymenoptera venom allergy (III and IV Muller grade) classified to ultra-rush treatment and 40 volunteers as control group (CG). Results: We have found that VIT influences the immune system by inducing changes in the complement system, cytokine secretion, histamine and tryptase concentration, and lymphocyte subpopulations. The study group (SG) at time 0 has higher percentage of T and B cells compared to the CG. The SG at time 0 is characterized by a decreased percentage of neutrophils. VIT decreased C3, C4, C5 concentration in the SG. The SG is also characterized by decreased IL-4 and MCP-1 concentrations. Patients with venom allergy have a higher percentage of CD3+ CD4+ T cells compared to the CG. VIT leads to normalization of the number of these cells 2 weeks after the first dose. The decreased concentrations of G-CSF and TGF-beta2 in patients at time 0 has normalized in two weeks after treatment. Conclusions: Preliminary test results suggest that VIT has immunoregulatory properties influencing G-CSF, TGF-beta2 concentration, and CD3+ CD4+ helper T cells percentage.

Introduction Hymenoptera venom allergy (HVA) in some patients occurs with general symptoms involving respiratory and cardiovascular system with anaphylactic shock with constitutes a significant threat to life. Aim Assessment of the prevalence of HVA in our own material. Material and methods There were 498 patients after a general reaction to wasp and/or bee venom. The survey included questions: the type of stinging insect, body parts stung by insects, profession, frequency of stings by wasps and bees depending on professional activity, places of stings, clinical symptoms using the scale according to Muller, and the treatment following the sting. Among 498 patients, there were 281 women and 217 men. Results Wasp stings were more frequent and affected 382 (77%) persons, while bee stings affected 116 (23%) persons. Limbs constituted the most common area of the body stung by both wasps and bees. The sting was more frequent in rural areas and during summer rest. A severe systemic reaction (class III and IV according to Muller) occurred more often in people stung by bees. The most common medications included intravenous glucocorticosteroids, calcium preparations and antihistamines. Intramuscular Adrenaline injection was used in 48% of patients, while only 15% received its prescription as an emergency medication. Bee stings were the most common cause of severe systemic symptoms. Conclusions The treatment after the sting in a significant percentage of episodes still deviates from the recommendations of the guidelines, especially in the field of adrenaline recommendations for patients in case of a resting by an insect.

Histamine intolerance is the most important biogenic amines intolerance syndrome, but not the only one. Clinically, significant reactions may be induced by tyramine, serotonin, putrescine, cadaverine, phenylethylamine and tryptamine. Substantial variation of these highly bioactive compounds determines multiplicity of potentially caused symptoms. In addition, the situation is complicated by frequent co-occurrence in food products. Therefore, the diagnostics of biogenic amines intolerance syndromes is difficult and depends heavily on meticulously collected information through an interview. The intention of the following literature review is to present the aforementioned subject.

Platelet activating factor (PAF) has a proven role as a mediator in pathogenesis of various disorders with inflammatory component, including those with allergic aetiology. The peripheral blood concentration of PAF is dynamically regulated by plasma PAF acetylhydrolase. An association between the enzyme activity and incidence as well as progression of numerous ailments, such as diabetes, atherosclerosis or coronary artery disease, has been demonstrated. In terms of allergic disorders those connections are underlined in case of bronchial asthma and anaphylaxis. The studies suggest that low activity of plasma PAF acetylhydrolase could be a potential predictive marker for increased severity of some types of allergic hypersensitivity reactions. The possible connections between enzyme activity and population polymorphism, levels of lipoprotein fractions, applied pharmacotherapy and chronic disorders of different aetiology appear to be also interesting within the context of allergic diseases. The aim of the following review is to systematize the current state of knowledge regarding possible importance and utilization of platelet activating factor acetylhydrolase measurement for the needs of allergology.

The discovery of IgE was a major breakthrough in the development of allergology as a medical discipline. Exactly fifty years ago two independent research teams in USA and Sweden investigated and explained the role of unknown factor called reagin in allergic hypersensitivity. Provided evidence suggested that reagins are immunoglobulins of a new class. Further research of IgE properties significantly improved our understanding of the mechanism of allergic reaction. Current diagnostic and therapy of allergic diseases are largely based on these findings.

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.

Introduction : Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. Aim : To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life. Material and methods : Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. Results : In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. Conclusions : The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

The Nobel Prize in Physiology or Medicine 1913 awarded to Charles Robert Richet in recognition of his work on anaphylaxis was the first one granted for the research, currently associated with allergology. Although there were two authors of the first paper on anaphylaxis phenomenon, Paul Portier and Charles Richet respectively, only Richet received a credit. This article presents the circumstances of discovering anaphylaxis and possible reasons behind such a decision of the Nobel Assembly at Karolinska Institutet.

The article presents the public funding of health care in allergic diseases in terms of hospital treatment in 2014. On the basis of the National Health Fund (NHF) data available in the public domain, the authors analysed the financial outlay on the contracts by province and compared them with the waiting time for benefits. As a result, the analysis found inadequate public funding for hospital care to meet the growing health needs of the population in the field of allergic diseases. There have also been inter-province differences in the levels of financing hospital care and waiting lists.

The article presents the public funding of health care for allergic diseases in terms of outpatient specialist care in 2014. On the basis of the NHF data available in the public domain authors analysed the financial outlay on the contracts by province, and compared them with the waiting time for benefits and the number of allergists. As a result, the analysis found inadequate public funding to meet the growing health needs of the population in the field of allergic diseases. There have also been inter-province differences in the levels of financing health services and in the number of allergy specialists.

The paper presented selected problems regarding anaphylaxis and special situations connected with allergological practice, especially in the field of consultation medicine to another physician.

Local skin reactions after bites by unknown nonvenomous insects rarely have an allergic base. They are often toxic local reactions, being a result of the influence of the insects’ excretions. A case report of the woman is described with acute local allergic skin reactions after being stung by the pigeon tick ( Argas reflexus ).

Anaphylaxis is recently becoming an increasingly popular issue among allergists, particularly upon fatigue with asthma matters. The paper “Anaphylaxis as a cause of hospitalization—a single academic centre experience” published in this issue of “Polish Pneumonology and Allergology” follows this trend [...]

The year of 2013 is a major milestone for Polish allergology since it marks the 40th anniversary of this specialty and the 30th anniversary of National Supervisory Board of Allergology. This paper presents the beginnings of allergology in Poland as well as highlights its most important achievements during the two decades between WWI and WWII. It describes the significance of Ludwik Hirszfeld's scientific accomplishments, including his work on anaphylaxis, which in 1914 granted him the title of “Privatdozent” at the Hygiene Institute of the University of Zurich, and which could be considered as the first Polish habilitation in allergology. Hirszfeld's friendship with the leading American allergist Arthur Fernandez Coca resulted in a series of lectures on allergy delivered by the latter one in Poland in 1928. The paper also emphasizes Mieczyslaw Wierzuchowski's achievements of peptone treatment of asthma as well as the early works of Mieczyslaw Obtulowicz, the nestor of Polish allergology, including his most significant accomplishment of that period, “About Pollen Rhinitis” (1938). Mieczyslaw Obtulowicz completely dedicated himself to the field of allergology, becoming the first world-class Polish allergist who after WWII fulfilled his ambitious plans and received wide recognition.

Określenie drobne drogi oddechowe (DDO) dotyczy oskrzeli poniżej 7. generacji, o średnicy mniejszej niż 2 mm. W artykule przedstawiono dowody, że ta część drzewa oskrzelowego charakteryzuje się pewnymi odmiennymi cechami zarówno w kontekście budowy, fizjologii, jak i patofizjologii. Szczególnie ważną funkcję odgrywają DDO w chorobach obturacyjnych układu oddechowego. U zdrowych osób opór DDO nie jest większy niż 10% całkowitego oporu dróg oddechowych, natomiast u pacjentów chorych na choroby obturacyjne, poprzez nałożenie się elementu zapalnego i skurczowego ich opór może stanowić nawet 60% oporu całkowitego. Zmiany w DDO w astmie oskrzelowej i przewlekłej obturacyjnej chorobie płuc (POChP) są odpowiedzialne także za powstawanie tak zwanej pułapki powietrznej, szczególnie w POChP. Nie ma obecnie doskonałych metod diagnostyki DDO, w zależności od doświadczeń własnych w różnych ośrodkach przeprowadza się tomografię komputerową wysokiej rozdzielczości, badanie pletyzmograficzne całego ciała (stosunku objętości zalegającej/całkowitej ilości zawartego w płucach powietrza [RV/TLC] lub innych parametrów). Pewne nadzieje wiąże się obecnie z połączeniem oscylometrii impulsacyjnej, testu wypłukiwania azotu w jednym wydechu i pomiaru wydychanego tlenku azotu(eNO). Ze względu na coraz szerszą wiedzę o istotnej roli DDO w patofizjologii chorób obturacyjnych, stworzono superdrobne aerozole, których cząstki zarówno teoretycznie, jak i praktycznie (doświadczenia na impaktorze kaskadowym, skany ozonowe po inhalacjach) mogą wnikać do tej części dróg oddechowych. Autorzy przedstawiają wybrane badania z dwiema grupami leków—agonistami receptora b2-adrenergicznego (BA) i wziewnymi glikokortykosteroidami (wGKS). W przypadku tych pierwszych nie udowodniono, że tak głęboka depozycja w drogach oddechowych przekłada się na poprawę efektu klinicznego. Natomiast w przypadku wGKS, głęboka depozycja ultradrobnego aerozolu powoduje możliwość zmniejszenia dawki leku (nawet ponad dwukrotnej) przy utrzymaniu tego samego efektu terapeutycznego (poprawa indeksu terapeutycznego). Reasumując, DDO wydają się być miejscem podstawowych procesów w rozwoju chorób obturacyjnych i w związku z tym celem potencjalnych terapii.

The following paper reviews the latest news on antihistamines used in the treatment of allergic rhinitis. It describes the new results of investigations on clinical application of H3 and H4 receptors in therapy of allergic diseases as well as the effect of emedastine on histamine-induced tissue remodeling. Contemporary clinical research of these drugs fulfills the requirements of placebo-controlled trials, including the comparison with a reference drug, usually cetirizine. The paper discusses efficacy and safety of a new drug--bilastine, and the possibility to improve clinical outcome by combining antihistamine drugs with inhaled glucocorticosteroids and antileukotrienes. It also presents the studies on high efficacy of nasal antihistamines, which most probably results from their high concentration in inflamed tissue, as well as describes the latest news on safe use of antihistamines, including studies of fexofenadine enantiomers in drug interactions with P-glycoprotein, safety of a new antihistamine medication--rupatadine, and psychostimulating effect of some other antihistamines. The review shows that antihistamines, the most frequently used class of anti-allergy medications, have been constantly improved, which is of significant importance for progress of allergic diseases treatment.

Background and objectives: Allergic rhinitis is a global health concern of increasing prevalence that can impact quality of life and work and school performance of affected individuals. Antihistamines are recommended as the first-line treatment. This randomized, controlled trial aimed to investigate the effects of rupatadine in adult subjects with perennial allergic rhinitis. Methods: We randomly assigned 283 patients to receive placebo (n = 69), loratadine 10 mg (n = 70), rupatadine 10 mg (n = 73) or rupatadine 20 mg (n = 71). The study design was double blind and treatment was continued for 4 weeks. Subjective assessment of symptoms (reflective evaluation) was recorded by patients in a diary card. The primary end point was the percentage of days where the score of the most severe symptom was less than or equal to one (Pdmax1). Furthermore, the change from baseline in the severity of total symptom score and nasal symptom score were recorded, and the investigator and patient global assessments were evalua...

Antihistamines are the first line of pharmacotherapy in allergic diseases, especially in allergic rhinitis. The article also presents the interesting 2005-2007 publications on the use of antihistamine in practical point of view, especially the newly introduced ones (desloratadine, fexofenadine, levocetirizine) and those which are to be introduced soon (rupatadine). The efficacy in skin histamine provocation model and various clinical model were discussed.

Summary The aim of the study was to estimate the skin microcirculation reactivity after histamine administration in patients treated with 10 mg daily dose of cetirizine for 180 days. Material and methods Thirty seven young men age 27 + 12 year, patients suffering from persistent rhinitis were randomized into three groups which received 10 mg/day of cetirizine, 5 mg/day of levocetirizine or placebo respectively. Twenty eight completed the study. The skin microcirculation reaction after 10 mg/ml histamine administration was estimated visually on the forearm (diameter of wheal and flare) and by laser Doppler flowmetry before and after study drug or placebo administration 24 hours and every 30 days during the time of the study. The blood flow was measured by Periflux PF3, using a skin probe 5 mm away from the histamine-induced point. Results Statistically significant inhibition of skin reaction (over 92%) and blood flow (over 85%) in relation to the start values in cetirizine group as well as between the groups which received cetirizine or placebo (p Conclusion Tachyphylaxis phenomenon for antihistamine effect of 10 mg/day cetirizine and 5 mg/day levocetirizine was not observed during the whole 180-days treatment.

The possibility of an excess electron binding to canonical isomers of xanthine in the gas phase was studied at the coupled-cluster level with single and double excitations using the 6-31++G** basis sets supplemented with the 4(sp)3d set of diffuse functions. It was found that xanthine should exist in the gas phase as one canonical tautomer while all the other tautomers are not likely to be detected experimentally because of their significant thermodynamic instability. On the other hand, all canonical tautomers (except one) were found to be capable of forming electronically stable anionic states of dipole-bound nature. However, the only thermodynamically stable anion (with vertical electron binding energy estimated to be 0.041 eV) based on xanthine tautomers is the one supported by the most stable neutral species.

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.

Many different methods of treatment use at least partially not only their obvious influence on a disease mechanism but also their non-specific effects on the patients. It can be measured using different types of indicators using both self-assessment of a patient and different types of measuring devices. The aim of this study was to assess the size of the placebo effect in asthma treatment based on analysis of previously published high-quality research of the efficacy of inhaled antiasthmatic drugs and and to investigate its dependence on the type of measurement used.A systematic review of the Medline database (using the Entrez PubMed browser) was done by typing international drug name in English and words: inhaled, randomised and placebo-controlled and meta-analysis of publications of the results of randomized placebo-controlled efficacy trials of the inhaled drugs used to treat asthma (454 publications - ultimately enrolled 41). For comparison, a similar method was used for hypertension treated with captopril (232 tests - ultimately enrolled 10).During the investigation of its dependence on the type of indicators used it has been demonstrated that placebo effect in treatments of asthma was significantly higher (reaching even 29%) than in treatments of hypertension with captopril (17%). The share of the placebo effect was also significantly higher in the studies in which clinical (subjective) indicators were used compared with the studies using objective (based on measuring devices) indicators of drug efficacy.The share of a placebo effect in treatments of asthma is higher than in treatments of hypertension and depends on the drugs efficacy indicators used (it is higher when clinical indicators are being used). This allows to draw conclusions as to the discrepancy between treatment goals of patient and physician and shows the need to take more account of such important issues as the patient's commitment to manage a disease in order to achieve his greater satisfaction.

Introduction: Apart from the well-studied mechanisms of disease course modification, many therapeutic interventions, at leastin part, exert non-specific effects on patients. These effects can be measured by patient self-assessment or by technicalanalyses. The aim of the study was to assess the extent of placebo effect in the treatment of asthma based on revaluation ofresults of high-quality trials on inhaled antiasthmatic drugs and in the context of various applied investigative methods. Material and methods: A systematic search of the Medline database (using the Entrez Pubmed browser) was performedusing international drug names and English terms: inhaled, randomised, placebo-controlled. The aim of the search was toidentify trials on the efficacy of inhaled antiasthmatic drugs. Of the returned 454 studies, 41 were further included inmetaanalysis and assessed for correlations between drug effects and respective applied investigative methods. For com-parison, analogical analysis was performed for captopril, with 232 identified published studies of which 10 were included inthe metaanalysis. Results: The placebo effect in the treatment of asthma was significantly stronger (29%) as compared to the placebo effect ofcaptopril in patients treated for arterial hypertension (17%). The placebo effect was more prominent in studies applyingclinical (subjective) indicators of drug efficacy as compared to trials using objective (device-based) methods of drug effectmeasurement. Conclusions: The placebo effect is more prominent in treatment of asthma as compared to pharmacotherapy of arterialhypertension. Its extent depends on the applied methods of drug efficacy measurement and is often greater if only clinicalindicators are used. This phenomenon can lead to different interpretations of treatment goals in asthma as perceived by thephysician and the patient. This also points out the necessity of patient activation in taking control over his/her disease so asto achieve a better and more satisfying treatment result.

The term small airways (SA) applies to the bronchi below 7th generation with diameter smaller than 2 mm. This paper presents data showing that this part of the respiratory system is distinct in terms of its architecture, physiology and pathophysiology. The most important role SA play in obstructive airway diseases. In healthy subjects SA resistance accounts for 10% of the total airway resistance while in patients with obstructive disease, due to the constriction of the airways together with airway inflammation, SA are responsible even for 60% of the total resistance. Changes in SA in asthma and COPD are responsible for air trapping especially prominent in the latter disease. There are no precise tools to diagnose SA. Depending availability and experience HRCT, body pletysmography (RV/TLS plus other parameters) are frequently used. Some hope for the future is placed in combined use of oscilometry, multiple (or single) breath nitrogen wash-out and eNO concentration measurement. Due to our increasing knowledge on the role of SA in airway obstruction ultra-fine particle aerosols have been developed that penetrate to this compartment of the respiratory system (deposition confirmed in cascade impactors as well as by ozone scans after aerosol inhalation). Authors present selected publications investigating whereas deep drug penetration influences its clinical efficacy. For LABAs deposition in SA doesn't seem to increase their bronchodilating effect. Using ultrafine CS aerosol allows to maintain clinical effects even with half the dose of the active steroid, however. In summary, SA seem to be crucial in obstructive diseases of the airways and therefore constitute an important target for therapy.

Prick tests are commonly used in allergy diagnosis but in some cases obtained results are difficult for objective interpretation. Application of liquid-crystal contact thermography improves this kind of diagnosis especially in case of coloured or sick skin.

The following paper reviews the latest news on antihistamines used in the treatment of allergic rhinitis. It describes the new results of investigations on clinical application of H3 and H4 receptors in therapy of allergic diseases as well as the effect of emedastine on histamine-induced tissue remodeling. Contemporary clinical research of these drugs fulfills the requirements of placebo-controlled trials, including the comparison with a reference drug, usually cetirizine. The paper discusses efficacy and safety of a new drug--bilastine, and the possibility to improve clinical outcome by combining antihistamine drugs with inhaled glucocorticosteroids and antileukotrienes. It also presents the studies on high efficacy of nasal antihistamines, which most probably results from their high concentration in inflamed tissue, as well as describes the latest news on safe use of antihistamines, including studies of fexofenadine enantiomers in drug interactions with P-glycoprotein, safety of a new antihistamine medication--rupatadine, and psychostimulating effect of some other antihistamines. The review shows that antihistamines, the most frequently used class of anti-allergy medications, have been constantly improved, which is of significant importance for progress of allergic diseases treatment.

Numerous epidemiological studies concluded recently have suggested that the prevalence of allergic diseases has increased, which mainly results from an increase in the prevalence of atopic diseases. The problem is even more difficult because the number of people sensitized, who are prone to fall ill, exceeds the number of people presently ill. The prevalence of sensitization to atopic allergens and its time dynamic is still unknown. The aim of the study was to determine the prevalence of atopic sensitization in the population of young Polish males and to compare these findings with those obtained 16 years before. The present study was performed on a group of 156 randomized healthy men, voluntary blood donors, aged 18-27 years. Having filled out a questionnaire, they underwent skin prick tests (SPTs) to common inhalant allergens. They also had a blood sample taken to have serum total IgE concentration and allergen-specific IgE (asIgE) determined to inhalant and food allergens. Positive SPT findings to at least one allergen were found in 50 (32%) subjects, and in equivocal 12 (8%). In 54 (35%) subjects asIgE to inhalant allergens was found, including 11 (7%) who had been tested for food allergens. The most common sensitizing allergen was house dust mite (20%), followed by grass/rye pollen (17%), while mould spore was the least common (4%). In town dwellers, positive SPTs were found in 41%, and were positive in 19% of people living in rural areas. While comparing the present findings with those of a similar study carried out in 1986, we found that in the last 16 years there had been a 52% increase in the prevalence of asIgE to atopic allergens. This means that the percentage of sensitized people can be estimated to have increased at a rate of approximately 3.25%/year.

was to estimate the skin microcirculation reactivity after histamine administration in patients treated with 10 mg daily dose of cetirizine for 180 days.Thirty seven young men age 27+12 year, patients suffering from persistent rhinitis were randomized into three groups which received 10 mg/day of cetirizine, 5 mg/day of levocetirizine or placebo respectively. Twenty eight completed the study. The skin microcirculation reaction after 10 mg/ml histamine administration was estimated visually on the forearm (diameter of wheal and flare) and by laser Doppler flowmetry before and after study drug or placebo administration 24 hours and every 30 days during the time of the study. The blood flow was measured by Periflux PF3, using a skin probe 5 mm away from the histamine-induced point.Statistically significant inhibition of skin reaction (over 92%) and blood flow (over 85%) in relation to the start values in cetirizine group as well as between the groups which received cetirizine or placebo (p0.001), remained at the same level all the time during the examination.Tachyphylaxis phenomenon for antihistamine effect of 10 mg/day cetirizine and 5 mg/day levocetirizine was not observed during the whole 180-days treatment.

Antihistamines are the first line of pharmacotherapy in allergic diseases, especially in allergic rhinitis. The article also presents the interesting 2005-2007 publications on the use of antihistamine in practical point of view, especially the newly introduced ones (desloratadine, fexofenadine, levocetirizine) and those which are to be introduced soon (rupatadine). The efficacy in skin histamine provocation model and various clinical model were discussed.

The aim of the study was to compare the effect of inhibition skin reactivity after administration of single dose administration of various second generation antihistamines in the healthy people group.Forty two healthy subjects (aged 22+/-18 years) were randomized into seven groups which received orally: cetirizine 10 mg, loratadine 10 mg, desloratadine 5 mg, levocetirizine 5 mg, fexofenadne 120 mg and 180 mg, or placebo respectively. The skin microcirculation reaction after 10 mg/ml histamine administration was estimated visually on the forearm (diameter of wheal and flare) and by Laser Doppler flowmetry before and after study drug or placebo administration prior and, 2, 4, 6, 8, 10, 12, 18, 24 h and one time daily every next 9 days.There were significant differences of histamine-induced wheal, flare and skin blood flow inhibition vs baseline and placebo after drug administration. There were different dyr'mmics in suppression effect after histamine-induced skin reactivity in various drug groups. The overall inhibitory potency was statistically higher for cetirizine, levocetirizine and fexofenadine (even 95% ve basline) as compared to loratadine and desloratadine (even 65% vs basline). Different times of retreated inhibition effect after administered drugs were observed.The study drugs shown significant different dynamics of skin reaction inhibition vs baseline and placebo. There were observed strongest effect after levocetirizine and cetirizine and next order after fexofenadine, desloratadine and loratadine.

of this study was to compare the effect of the following antihistamines: cetirizine 10mg, desloratadine 5mg, fexofenadine 120 and 180mg, levocetirizine 5mg, loratadine 10mg, and placebo, administered in the recommended doses over the period of 5 days, on the visually assessed histamine-induced skin reaction, using the Laser Doppler flowmetry (LDF).Forty two volunteers (aged 18-22) who gave a written consent before entering the study, were randomized in seven groups of six subjects each. The skin prick test with histamine solution of 10mg/ml was performed on the ventral forearm, 10 cm from the elbow, before and at 2, 4, 6, 8, 10, 12, 18, and 24 hours after drug administration, as well as once daily for the next 4 days of antihistamine drug or placebo intake, and 9 days following the treatment. Diameters of wheal and flare as well as the LDF index measured with Periflux PF3 flowmeter and skin probe, 5mm from the histamine-provoked area, were assessed 10 minutes after performing the above-mentioned skin prick test.The current study revealed that during the 5-day treatment with recommended doses of cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine, a significant reduction of histamine-induced wheal, flare and the LDF index was observed as compared to the initial values and placebo intake, reaching the maximum value within the first 24 hours, weakening on the next day, and then gradually increasing during the following days. After the 5-day treatment drugs used for the study were lined up according to the volume of reduction in histamine-induced skin reaction (largestsmallest): levocetirizinecetirizinefexofenadine 180mg = fexofenadine 120mgloratadine = desloratadine.Following the end of the treatment, the effect of the antihistamines on skin reaction was subsiding in such an order: after 24 hours in case of loratadine and desloratadine, after two days for both doses of fexofenadine, and 3-4 days for cetirizine and levocetirizine.

There is different opinion whether antileukotrienes can influence skin prick tests (SPT) results.Estimation of SPT results with laser Doppler flowmetry (LDF) for histamine solutions and allergens before and after usage of antileukotrienes.The study group consisted of 27 patients with allergic diseases. Before and after 4 days of zafirlukast or placebo usage, there were done SPT on the skin of the back with three histamine solutions (0.1 mg/ml, 1.0 mg/ml, 10.0 mg/ml) and with standard inhalant allergens. The estimation of SPT was done visually and with use of LDF. The cutaneous blood flow was measured after 15 minutes using Periflux PF 3 (PERIMED, Sweden) in point 5 mm of distance from prick center.Both visual estimations and flow rate didn't show the statistical differences between SPT with histamine solutions and allergens before and after 4 days use of antileukotrienes.Zafirlukast usage in dose 20 mg twice daily for 4 days does not influence on immediate skin reactivity on histamine solutions or allergens in visual evaluations as well laser Doppler flowmetry. There is no need of zafirlukast discontinuation before skin prick tests.