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Venom immunotherapy (VIT) is the only efficient therapy for the Hymenoptera insect venom allergy. Immunotherapy with bee venom is encumbered with a higher risk of systemic side effects and/or therapeutic failures. The objective of the study was to assess if specific profiles of molecular IgE (Immunoglobulin E) responses are associated with an increased risk of systemic side effects and/or the treatment’s inefficacy. The study group numbered 64 bee venom allergic patients (BVA) who received venom immunotherapy modo ultra-rush (VIT-UR), (f/m: 32/32, mean age 43.4 ± 17.2). In total, 54.84% of them manifested allergic reactions of grades I-III (acc. to Mueller’s scale), while 48.66% manifested reactions of grade IV. In all the patients, IgE against bee venom extract, rApi m 1 and tryptase (sBT) were assessed. In 46 patients, assessments of IgE against rApi m 2, 3, 5, 10 were also performed. BVA patients manifesting cardiovascular symptoms (SYS IV0) showed higher levels of both sIgE-rApi m 5 (p = 0.03) and tryptase (p = 0.07) than patients with SYS I–III. Systemic adverse events during VIT with bee venom were more frequent in the induction phase than in the maintenance phase: 15.22% vs. 8.7%. In BVA patients who experienced systemic adverse events during VIT, higher concentrations of sIgE-rApi m 5 (p < 0.05), rApi m 1 (p = 0.009), and sBT (p = 0.019) were demonstrated. We conclude that higher levels of sIgE against rApi m 1, rApi m 5, and tryptase many constitute a potential marker of the severity of allergic reactions and therapeutic complications that can occur during VIT with bee venom.

Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is a rare disease characterized by recurrent swellings. This study aims to determine (i) the clinical characteristics of the HAE patient population from Poland, and (ii) real-life patients’ treatment practices. A cross-sectional study involved 138 adult HAE patients (88 females, 50 males) treated in six regional HAE centers in Poland. Consecutive patients during routine follow-up visits underwent a structured medical interview on the clinical characteristics of the course and treatment of HAE attacks within the last six months. A total of 118 of 138 patients was symptomatic. They reported in total 2835 HAE attacks predominantly peripheral and abdominal, treated with plasma-derived C1-INH (61.4%), icatibant (36.7%) and recombinant C1-INH (1.9%). An amount of 116 patients carried the rescue medication with them while traveling, and 74 patients self-administrated on demand treatment. There were twice as many symptomatic women (n = 78) as there were men (n = 40). Women treated their HAE attacks significantly more often than men. Older patients (≥65 years) reported a longer delay in diagnosis, and practiced the self-administration of rescue medication less frequently in comparison to other patients. Clinical features of the surveyed population are similar to other European, but not Asian, HAE patient groups. Self-administration still remains an unmet medical need. Some distinct HAE patients may require special attention due to the severe course of the disease (females) or a delay in diagnosis (the elderly).

Individuals with a history of allergy are potentially at risk of suffering from adverse effects after COVID-19 vaccination. We sought to assess the tolerance towards the Pfizer-BioNTech vaccine in allergic patients. To address this issue, we used a questionnaire conducted on-line in a group of medical professionals who were vaccinated with the Pfizer-BioNTech vaccine. A total of 1808 respondents, out of whom 1707 received two doses of the vaccine, returned the questionnaire. Local reactions after injection were more frequent in allergic individuals after both doses (swelling p = 0.0003). Systemic adverse events (AE-SYS) occurred more often after the second than the first dose in both groups (allergic persons: 77.29% vs. 41.06%), vomiting and arthralgia occurred more often in allergic subjects (p = 0.0009). AE-SYS in allergic individuals lasted longer than in non-allergic ones after the first (p = 0.01) and the second dose (p = 0.0009). Allergic reactions after vaccination were reported more frequently in allergic subjects: after the first dose (p = 0.00001) and after the second dose (p = 0.001). Rhinitis was the most frequent symptom observed more often in allergic patients. No severe allergic reactions occurred during the full cycle of vaccination. Although the Pfizer-BioNTech vaccine is tolerated worse by allergic than non-allergic individuals, the occurring adverse symptoms are mild and do not preclude a successful completion of the vaccination cycle. The presence of symptoms suggestive of allergy does not constitute a condition of increased risk of developing clinically significant adverse events following Pfizer COVID-19 vaccination.

Introduction The infectious factor like Helicobacter pylori (HP) has been thought to trigger the vicious circle of chronic idiopathic urticaria (CIU), therefore its eradication could modify the course of the disease. Aim To reveal the influence of HP eradication on CIU clinical course. Material and methods Sixty-four CIU patients, receiving fexofenadine, as the basic treatment, took part in the research, divided into 3 groups: HP patients treated by eradication, HP patients receiving placebo, and patients without bacteria. Gastroscopy, urease test and histopathology were done to detect HP. Patients with HP were randomized and received eradication treatment or placebo. The efficacy of eradication was checked after 6 weeks by means of another gastroscopy, urease test and histopathology. In the 6th week and in the 4th and 6th month after eradication, the symptoms were evaluated basing on the score symptom scale. Results Helicobacter pylori did not occur more frequently in CIU patients than in the healthy population. A statistically significant clinical improvement of CIU symptoms was observed in the 6th week after eradication as compared to the group receiving placebo (p = 0.02) and patients who were not infected (p = 0.02). Further observation in the eradicated patients group revealed the rebound phenomenon - worsening of the clinical state (p = 0.001), which in the 4th month did not differ from the patients not infected or patients receiving placebo. Conclusions Although HP occurs as frequently in CIU patients as in the healthy population, eradication, added to basic antihistaminic treatment, has a significant influence on CIU patients' recovery parallel to the reduction of stomach inflammation features.

We report the case of a 38-year-old woman suffering from allergic asthma since the age of 4. In the last 10 years, the patient presented with severe uncontrolled asthma with frequent exacerbations, despite stage-5 treatment according to GINA guidelines, including constant high doses of methylprednisolone. Long-time treatment with high doses of systemic corticosteroids induced many side effects including arterial hypertension, diabetes, GERD, hypercholesterolemia and obesity (weight 121 kg, height 176 cm, BMI 39 kg/m 2 ). Despite the treatment, asthma control remained poor, and quality of life and lung function test results were low (ACQ: 4,71 p, miniAQLQ: 3,2 p, FEV1 2,04 L 60,3% pred., FEV1/FVC 60,85%). The patient was enrolled into the omalizumab treatment program in March 2014. After 24 months of omalizumab treatment, the dose of methylprednisolone was reduced by 30 mg/day. At the same time, asthma control and quality of life improved significantly (ACQ 1,85, miniAQLQ 4,73). Body weight was reduced by 30 kg (BMI 29 kg/m 2 ) as well. Asthma exacerbation rate was also significantly reduced, and there was no asthma exacerbation in the last 12 months of the treatment. Unexpectedly, we observed improvement and further normalization of spirometry with finally normal FEV1/FVC ratio and FEV1 (FEV1 2,87 L 86,4% pred.). The patient has resumed her all daily-life activities.

Allergen immunotherapy (AIT) is a standard treatment for venom allergy. Our purpose was to determine if the administration of both allergen and protective vaccines during one visit is safe and if such a procedure does not deteriorate the tolerance of both vaccines. As current guidelines are based on theoretical assumptions, our aim was to establish the safety and tolerance of shortening the recommended interval between vaccinations. During two influenza seasons, 44 adult patients, with a history of systemic allergic reactions after a Hymenoptera sting, underwent 58 simultaneous allergen and seasonal influenza vaccinations (study group) while in the maintenance phase of venom immunotherapy (VIT). The control group consisted of 57 healthy adults who were vaccinated against influenza only. The conditions of the patients were monitored during hospital visits, and via telecommunication methods to evaluate the safety and tolerance of the procedure. Within the study group, there were no immediate or delayed allergic reactions after vaccinations. The presence of common, adverse influenza vaccine reactions among study group patients (29%) and control group patients (32%) did not differ significantly (p = 0.841). We did not observe a difference in the frequency of various adverse reactions in either group or a dependence of previous vaccinations against influenza on the occurrence of adverse reactions. The most frequent occurrences were local adverse reactions. All adverse reactions were resolved without treatment. These findings demonstrate the safety and tolerance of an influenza vaccination and Hymenoptera venom immunotherapy administration during one visit.

Background Multimorbidity is the co-occurrence of chronic diseases associated with low-grade chronic inflammation of connective tissue. Aim of study Frequency of occurrence and relative amounts of fibronectin (FN) complexes with fibrin (FN–fibrin) and FN monomer were analyzed in 130 plasma samples of 18 to 94-year-old multimorbid patients in relation to concentrations of FN and extra domain A (EDA)-FN, and C-reactive protein (CRP) as well as to age, number of coexisting chronic diseases and presence of specified diseases. Results Immunoblotting revealed, besides FN dimer, the presence of FN monomer, and 750-, 1000-, and 1300-kDa FN–fibrin complexes in the multimorbid plasmas. The FN–fibrin complexes appeared more frequently and in higher relative amounts, but FN monomer less frequently and in a lower relative amount in the groups of elderly multimorbid patients, with a higher number of coexisting diseases and with dominance of cardiovascular diseases and osteoarthrosis, and with CRP concentration of 3–5 mg/l. In contrast, the normal plasma contained only the FN–fibrin complex of 750 kDa in a lower relative amount, but with an increasing amount with normal aging. Moreover, FN concentration increased and EDA-FN decreased with the number of co-existing diseases and aging of patients, although both concentration values were lower than in the age-matched normal groups. FN concentration was the lowest in the exacerbation of a chronic disease and EDA-FN in the stable chronic disease groups. Conclusion The alterations in plasma FN molecular status were associated with micro-inflammation and micro-coagulation, as well as multimorbidity of subjects and their physiological aging.

Introduction The etiopathogenesis of elderly asthma appears to be poorly characterized. The role of low grade systemic inflammation in process of aging and age-related diseases is well known. Previous studies investigated the relation between asthma and serum proinflammatory markers were inconsistent. The relationship between bronchial airway hyperresponsiveness (AHR) and proinflammatory markers was establish in some studies of asthmatics but not among elderly asthmatics. Aims and Objectives The aim of this study was to determinate the relation between systemic inflammation, measured by interleukin-6 (IL-6), tumor necrosis alpha (TNF-alpha), C-reactive protein (CRP) concentration and local bronchial inflammation in the elderly asthmatics. Methods We evaluated 59 asthmatics. The age of participants ranged between 22 and 89 years old. Serum concentration of TNF-alpha and IL-6 were determined by elisa assay (R&D). Serum CRP concentration was determined by an immunoturbidimetric assay (Abbott). BHR was measured by metacholine challenge. Results IL6, TNF alpha and CRP concentration increases with increasing age. Among asthmatics treated with steroids there was no relation between proinflammatory markers and AHR (p=0.0954). Among steroid-naive patients we demonstrated relation between markers of systemic inflammation (TNF-alpha, IL-6, CRP) and AHR, statistically significant only for the CRP (p=0.0004) . Conclusions Correlation between CRP serum concentration and airway hyperresponsiveness may indicate that low grade systemic inflammation has possible effect on asthmatic inflammation in bronchial tree and may play a role in elderly asthma pathogenesis.

Płukanie oskrzelowo-pęcherzykowe (BAL, bronchoalveolar lavage) nadal zajmuje bardzo istotną po-zycję w diagnostyce pierwotnych chorób płuc o różnym podłożu: infekcyjnych, śródmiąższowych, no-wotworowych oraz patologii płucnych występujących w przebiegu innych schorzeń, w tym układowych [...]

Introduction: Asthmatic inflammation is responsible for vital features of the disease, including bronchial hyperresponsiveness (BHR). At present we do not have precise markers for monitoring asthmatic inflammation. C-reactive protein (CRP), a marker of systemic inflammation, seemed to be a factor which could also reflect the level of asthmatic inflammation expressed by BHR. Therefore the relationship between CRP concentration and BHR was evaluated. Materials and Methods: One hundred and two patients entered the study. A skin prick test with a broad spectrum of common aeroallergens as well as baseline spirometry and a histamine bronchoprovocation test were performed in each subject. Blood samples for high-sensitivity CRP (hsCRP) measurement were taken before the bronchial challenge tests. Results: Serum hsCRP concentrations ranged from 0.20 to 14.5 mg/l (median: 1.2 mg/l, 25–75% quartiles: 0.6–2.4). Positive skin prick tests were found in 26 subjects. Bronchial hyperresponsiveness was confirmed in 42 patients (first subgroup), while 60 subjects did not demonstrate BHR (second subgroup). Among the patients with BHR, asthma was diagnosed in 33 cases and Corrao syndrome in 9. In both subgroups, serum hsCRP concentrations had similar levels (median: 1.4 mg/l, 25–75% quartiles: 0.8–2.4 and median: 0.9 mg/l, 25–75% quartiles: 0.5–2.8, respectively; p=0.297). There was no statistically significant correlation (r= −0.163, p=0.302) between serum hsCRP concentration and the level of BHR expressed as the 20% provocative concentration for histamine. In addition, hsCRP serum concentration, after adjustment for age, atopy, body mass index, and gender, was not a significant predictor of positive histamine bronchoprovocation test results (p=0.22, OR=0.86, 95% CI). Conclusions: Serum hsCRP concentration is not a good marker of BHR, which is mainly dependent on asthmatic inflammation and is measured during bronchial challenge with histamine. This finding is important for interpreting and discussing results obtained from epidemiological and population-based studies on relationships between either CRP concentration and BHR or local and systemic inflammation.

BACKGROUND Birth weight (BW) is an important factor for determining the development of the respiratory system. The majority of research analyzed the impact of BW on lung function in youth. BW influence and smoking on lung function in adults with asthma and COPD is an interesting issue. OBJECTIVES The aim of the study was to investigate relationships between BW, smoking, and lung function in adult healthy individuals and diagnosed with asthma or COPD. MATERIAL AND METHODS Four hundred seventy-nine subjects were divided into 5 groups: 123 healthy non-smokers, 180 healthy smokers, 72 non-smoking asthmatics, 57 smoking asthmatics, and 47 COPD patients. Relationships between 4 BW quartiles and lung function was analyzed with respect to smoking. RESULTS Impact analyzes of BW, smoking, and asthma on FVC% revealed that asthma is the only significant differentiating factor in this spirometric parameter (p < 0.01). FEV1% was significantly influenced by asthma and BW, and FEV1/ FVC% was exclusively influenced by asthma. Spirometric parameters increased proportionally to particular BW quartiles in healthy non-smokers group; however optimal BW quartile predicting increase of parameters was 2751-3250 g. In asthma, BW quartile predicting the increase of spirometric parameters was 3251-3750 g, but BW quartile predicting decrease of FEV1/FVC% was 2751-3250 g. The comparison of results between COPD group and results from other 4 groups showed that values of all parameters in patients with COPD did not change proportionally to all quartiles of BW. In terms of FEV1/FVC%, the proportional increase of parameter in BW quartile 2751-3250 g was observed. CONCLUSIONS BW, as independent factor influences on spirometric parameters of healthy individuals, patients with asthma, COPD in a differentiated manner depending on quartile of BW rather than on simple linear increase of BW, regardless of smoking.

Background: Asthma in the elderly is underdiagnosed and consequently undertreated because age of patients detains diagnosis of disease Aims and Objectives: The aim of this study was to determine the risk factors especially age of patients which may be connected with the delay of asthma diagnosis. Methods: We evaluated 59 asthmatics: 40 female and 19 male. Diagnosis of asthma was confirmed by positive results of bronchodilator reversibility test and methacholine challenge. Skin prick tests with aeroallergens were performed. Participants answered a questionnaire regarding smoking status, atopy, how long have the symptoms been present, when did the patient9s doctor made the initial asthma diagnosis, and comorbidities. Results: Age of asthmatics ranged from 22 to 89 years old (median 71). Average symptoms duration period related to asthma was 15 years, while median delay of asthma diagnosis was 0,98 years. The average age of patients whose delay of diagnosis did not exceed 1 year was 68 years old. The average age of patients whose delay of asthma diagnosis was more than one year was 75 years old . Median difference between these two groups was 7 years CI95% (1, 14.5). The odds ratio for more than one year delay of asthma diagnosis increased by 7,3% per each year of patient9s life (OR=1,073). The other findings showed that the delay of asthma diagnosis was not correlated with patients9 gender or history of past smoking (p=0.4253). We also did not find any evidence of relation between delay of asthma diagnosis and atopy, presence of cardiovascular disease, or number of other chronic diseases ( p=0.7048). Conclusion: Old age is a risk factor of delayed asthma diagnosis, regardless of gender, atopy, history of past smoking and comorbidities.

Introduction: Fractional exhaled nitric oxide (FeNO) is considered a useful, noninvasive marker of airway inflammation in asthma and allergic rhinitis. It has also been suggested that anti-inflammatory treatment guided by monitoring of exhaled NO could improve overall asthma control. However, long-term intrasubject variability of this parameter as well as the rate of its change, which can be considered clinically significant, have not been established yet. The aim of our study was to assess the long-term variability of FeNO in pregnant asthmatic women with controlled asthma. Material and methods: Pregnant, non-smoking women with asthma were recruited at between 3 and 6 months of gestation. Exhaled nitric oxide (FeNO) spirometric parameters were measured, and asthma control tests (ACT) were completed at monthly visits up to delivery. The data of 26 subjects with well controlled asthma during pregnancy (ACT values within the range 20–25, normal spirometric parameters, stable treatment) were analysed. The variability of FeNO values was assessed using the variation coefficient CV (standard deviation × 100%/arithmetic mean). Results: The median level of FeNO coefficient of variation (CV) was: 33.8% (range 11.3 to 121.9) in all subjects with well controlled asthma during pregnancy. There were no statistically significant differences in FeNO variability between groups of patients who had at least one measurement of FeNO higher than 50 ppb (39%; 11.8–121.9%) and those with all FeNO values below 50 ppb (29.9%; 11.3–71.8%), as well as between atopic (35.7%; 11.8–121.9%) and nonatopic (24.2%; 11.3–71.8%) pregnant asthmatics (p = 0.95 and 0.11, respectively). Conclusions: High long-term variability of fractional exhaled nitric oxide values revealed in pregnant women with well controlled asthma indicates that changes in this parameter should be interpreted with caution when used for asthma treatment monitoring.

Low lung function is associated with increased risk of morbidity and mortality in the population. Lung development seems to be important factor in pathogenesis of respiratory disorders. Airway development is a complex process. Birth weight (BW) is one of perinatal factors which influences development of pulmonary system and multiorgan function of the body. Aforementioned relationships are visible especially at first years of life. However, not very many studies have examined the associations between birth weight and lung function in later age then childhood and adolescence. The aim of this review is to discuss relationships between BW and lung function parameters in healthy individuals and patients with lung disease in childhood and adulthood.

Urticaria and angioedema are one of the most frequent skin diseases, nevertheless no etiologic factors have been found in a large number of cases. This review summarizes the available medical literature from Medline regarding Helicobacter pylori and mentioned disease. Different studies have shown a high prevalence of Helicobacter pylori infection in patients with chronic urticaria, and occasional remission of the skin lesions after eradication therapy. However there are several papers, which support lack of relationship between H. pylori infection and the course of urticaria and angioedema. Thus we need further randomized, double-blind and placebo controlled studies including adequate diagnostic schedules, sufficient eradication treatment protocols, confirmation of eradication, and adequate control groups to establish a role of H. pylori in urticaria and angioedema.