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Mensen die in de buurt van windturbines wonen, maken zich zorgen over hun gezondheid. Bijvoorbeeld over effecten van het geluid van de wieken of van de slagschaduw. Het RIVM heeft de mogelijkheden verkend voor onderzoek naar gezondheidseffecten van windturbines in Nederland. Hiervoor is de inbreng gebruikt van organisaties die bij dit onderwerp betrokken zijn, zoals organisaties van omwonenden, de GGD en provincies. Het onderzoek is in opdracht van het ministerie van Economische Zaken en Klimaat gedaan. Het ministerie zal op basis hiervan kiezen welk onderzoek wordt uitgezet. Het blijkt mogelijk en nuttig om gezondheidsonderzoek te doen. Keuzes voor de opzet ervan zijn afhankelijk van de vraag, en hoe snel een antwoord nodig is . Ook is op een rij gezet welk onderzoek nodig is voor de kennis die nog ontbreekt. Het RIVM heeft eerst de belangrijkste vragen in kaart gebracht: kunnen windturbines bij omwonenden gezondheidseffecten veroorzaken, en zo ja welke, hoe ontstaan deze, en hoeveel mensen hebben er last van. Per vraag is aangegeven met welke soorten onderzoek hij kan worden beantwoord en wat de voor- en nadelen daarvan zijn. Een van de onderzoeksmogelijkheden is om de gezondheid van een grote groep mensen meerdere jaren te volgen. Ook kan juist in de tijd worden teruggekeken of bepaalde gezondheidsklachten vaker voorkwamen in de omgeving van windturbines. Daarnaast is het mogelijk om een vast panel van mensen die dicht bij windturbines wonen, regelmatig te laten doorgeven of ze gezondheidsklachten hebben. Tot slot kan worden onderzocht of er samenhang is tussen een blootstelling en een gezondheidsprobleem op dat moment. Eerder onderzoek maakte al duidelijk dat bepaalde kennis nog ontbreekt over gezondheidseffecten. Hinder is een bewezen effect, maar voor andere effecten, zoals slaapverstoring, is niet genoeg wetenschappelijk bewijs. Ook is niet duidelijk hoe het specifieke geluid van windmolens bij omwonenden in kaart kan worden gebracht. Ten slotte is niet bekend bij welke geluidniveaus en op welke afstanden in Nederland gezondheidseffecten kunnen ontstaan.

Employees can be exposed to wood dust while performing woodworking processes such as sawing and sanding. Such exposure is known to be associated with health problems. RIVM has carried out a review of the scientific literature on wood dust and occupational exposure to wood dust. The data has not been compared or interpreted by RIVM. The data was collected at the request of the Health Council. The Health Council will use this data to provide a recommendation to the Minister of Social Affairs and Employment on whether or not the health-based occupational exposure limit for wood dust needs to be adjusted. The review focused on various aspects including characteristics of wood dust as a result of wood processing and the mechanism and degree of exposure, as well as what is known about what happens in the body after exposure and what diseases and conditions people can develop as a result. Long-term exposure to wood dust can cause nasal cancer. It can also impair lung function, leading to difficulty breathing, and cause irritation of the eyes, nose, lungs, and skin.

Het RIVM onderzoekt sinds 2017 mogelijke effecten van langdurige blootstelling aan ultrafijnstof op de gezondheid van omwonenden van Schiphol. Het ministerie van Infrastructuur & Waterstaat (IenW) heeft het RIVM gevraagd om te verkennen of het haalbaar is dit onderzoek uit te breiden naar mogelijke gezondheidseffecten bij mensen die op Schiphol in de buurt van de vliegtuigen werken. De aanleiding hiervoor is een motie in de Tweede Kamer. Het blijkt praktisch niet mogelijk om gezondheidseffecten bij de platformmedewerkers binnen de opzet van het onderzoek naar omwonenden te bestuderen. Hiervoor zijn onder andere administratieve gegevens nodig over de aard en werkomstandigheden van oudmedewerkers. Maar de administratie van de vele organisaties waar platformmedewerkers voor werken, is onvolledig of gaat niet ver genoeg terug in de tijd. De weinige gegevens die er wel zijn mogen maar beperkt worden gebruikt vanwege de Algemene Verordening Gegevensbescherming. Verder zijn er inhoudelijke verschillen met het onderzoek naar omwonenden. Naar verwachting staan platformmedewerkers tijdens hun werk aan hogere concentraties ultrafijnstof bloot dan omwonenden. Ook worden platformmedewerkers aan meer luchtvervuilende stoffen blootgesteld dan ultrafijnstof. Bijvoorbeeld via de dieselmotoremissies van bagagekarretjes en de uitstoot van vliegtuigmotoren. Dit vraagt om een bredere blik naar gezondheidseffecten bij platformmedewerkers dan alleen van ultrafijnstof. Een ander type gezondheidsonderzoek is wel mogelijk, namelijk onderzoek naar onder andere de long- en hartfunctie en bloed en urine bij medewerkers die er nu werken. De resultaten geven een indicatie maar geen zekerheid over ziekten die door een langdurige blootstelling aan ultrafijnstof kunnen ontstaan. Voorbeelden daarvan zijn beroerte, COPD, longkanker en aandoeningen van het zenuwstelsel. Het duurt jaren om met zekerheid te zeggen wat de effecten van een langdurige blootstelling aan ultrafijnstof op de gezondheid van huidige medewerkers zijn.

Chroom-6 is een roestwerende stof en werd daarom toegevoegd aan sommige verf. In 2014 gaven veel (oud-)medewerkers aan bezorgd te zijn over hun gezondheid na berichten dat er bij Defensie was gewerkt met verf waar chroom-6 in zat. Het RIVM onderzoekt of er een samenhang kan zijn tussen gezondheidsklachten van medewerkers en een blootstelling aan verf met chroom-6. Het onderzoek begon op vijf locaties in Nederland waar Amerikaans legermaterieel werd onderhouden (POMS). Deze resultaten verschenen in 2018. Daarna is onderzoek gedaan naar alle locaties van Defensie die tussen 1970 en 2015 in gebruik waren. Het blijkt dat binnen de hele Defensieorganisatie medewerkers met chroom-6 in contact konden komen. Dus niet alleen de mensen die zelf het onderhoudswerk aan het legermaterieel deden, maar ook mensen die regelmatig in de werkplaatsen kwamen, zoals leidinggevenden, schoonmakers en anderen. Dit betekent dat niet alleen op basis van de functie van medewerkers kan worden bepaald of zij aan chroom-6 zijn blootgesteld. Op basis van de werkzaamheden kan worden beoordeeld of iemand ziek kan zijn geworden door blootstelling aan chroom-6. Mensen die in contact komen met chroom-6 hebben een grotere kans om bepaalde ziekten en aandoeningen te krijgen. Dat betekent niet dat iemand die in contact komt met de stof altijd deze ziekten krijgt. De kans is groter naarmate je meer, vaker of langer bent blootgesteld. Dat geldt vooral voor medewerkers die tijdens hun werk direct blootstonden aan chroom-6 en niet goed beschermd waren. Bijvoorbeeld als zij verflagen spoten of schuurden of aan het lassen of snijbranden waren. Net als op de POMS-locaties blijkt dat medewerkers ook op andere locaties niet altijd en overal genoeg waren beschermd tegen de blootstelling aan chroom-6. Beschermende maatregelen op de werkplek, zoals werkruimten afscheiden of afzuiginstallaties, werden niet altijd getroffen. Ook waren de persoonlijke beschermingsmiddelen, zoals stofmaskers, niet altijd aanwezig of effectief genoeg. In de loop van de jaren is hier bij Defensie meer aandacht voor gekomen, vooral vanaf de jaren negentig.

Mensen die binnen 250 meter van landbouwpercelen wonen waar bestrijdingsmiddelen worden gebruikt, hebben over het algemeen niet méér gezondheidsproblemen dan mensen met geen of weinig landbouwpercelen in de buurt. Deze conclusie komt overeen met de resultaten van een verkenning uit 2018. Hierin waren andere uitgangspunten gebruikt. Er zijn een paar uitzonderingen op dit algemene beeld uit de twee verkenningen. Het wonen dicht bij maisteelt lijkt samen te gaan met een grotere kans op overlijden aan luchtwegaandoeningen. Verder is dicht bij roulatieteelt granen/bieten/aardappelen mogelijk meer sterfte door leukemie en lijkt dicht bij graanteelt meer zelfdoding voor te komen. Met de beschikbare gegevens was het niet mogelijk om deze bevindingen te verklaren. Specifieker onderzoek is nodig om meer te weten te komen over de relatie tussen bestrijdingsmiddelen en de gezondheid van omwonenden. Als daartoe wordt overgegaan dan adviseren de onderzoekers om de blootstelling aan specifieke bestrijdingsmiddelen gedetailleerd in kaart te brengen. Centraal in dat onderzoek zouden dan kunnen staan COPD en andere gezondheidsproblemen die in de wetenschappelijke literatuur regelmatig naar voren komen, zoals leukemie, de ziekte van Parkinson en cognitieve effecten. Daarvoor is dan ook meer informatie nodig over individuele factoren die invloed hebben op de gezondheid, zoals leefstijl. Dit blijkt uit onderzoek van het RIVM, de Universiteit Utrecht en het Nivel. Het onderzoek is een aanvulling op onderzoek uit 2018 naar de gezondheid van omwonenden van landbouwpercelen voor bepaalde gewassen. De Gezondheidsraad gaat het kabinet adviseren welk vervolgonderzoek moet worden uitgevoerd. VWS heeft om deze aanvullende analyses gevraagd. Aanleiding was onderzoek uit 2019, gecoördineerd door het RIVM, naar de blootstelling van omwonenden van bloembollenvelden aan chemische bestrijdingsmiddelen. Daaruit bleek dat de concentraties bestrijdingsmiddelen in huisstof binnen 250 meter tot de bespoten bloembollenvelden weinig verschilden. Er waren meer verschillen ten opzichte van woningen op meer dan 500 meter van de bloembollenvelden.

De aanwezigheid van intensieve veehouderij kan invloed hebben op de gezondheid van omwonenden. De GGD'en hebben de richtlijn 'Veehouderij en gezondheid' ontwikkeld zodat ze op dezelfde manier hierover kunnen adviseren. De coördinatie van de richtlijn ligt bij het RIVM. De richtlijn beschrijft de huidige kennis over veehouderij en gezondheid. Ook geeft de richtlijn input voor gezondheidskundige adviezen voor omwonenden in verschillende situaties. Denk aan de uitbreiding of vestiging van veehouderijbedrijven, of de gebiedsinrichting van het platteland. Er is veel gezondheidswinst te behalen wanneer goed wordt nagedacht over de ruimtelijke inrichting, dus bij het opstellen van omgevingsvisies en plannen. Daarom is de GGD bij voorkeur vroeg in dit proces betrokken. De GGD heeft twee uitgangspunten bij zijn adviezen. De eerste is voorzorg: wees terughoudend met het plaatsen van gevoelige bestemmingen en veehouderijen binnen 250 meter van elkaar (bij geitenhouderijen binnen 2 kilometer). Gevoelige bestemmingen zijn bijvoorbeeld woningen, scholen, en ziekenhuizen. Het tweede uitgangspunt is het streven om de uitstoot van geur, stof, endotoxinen (kleine stukjes bacteriën) en ammoniak van veehouderijen te verminderen.

Background: Change in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy. Methods: The European Community Respiratory Health Survey (ECRHS) collected information on prevalent asthma-like symptoms from representative samples of adults aged 20-44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates. Findings: Over 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (-2.4% 95%CI -3.5 to -1.3%; -1.5% 95%CI -2.4 to -0.6%; respectively) but the prevalence of asthma attacks, use of asthma medication and hayfever/nasal allergies increased (0.6%, 95%CI 0.1 to 1.11; 3.6%, 95%CI 3.0 to 4.2; 2.7% 95%CI 1.7 to 3.7;). Changes were similar in the first ten years compared to the second ten years, except for hayfever/nasal allergies (increase seen in the first ten years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hayfever/nasal allergies at baseline. Interpretation: European adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hayfever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.

Background Inhalation incidents are an important cause of acute respiratory symptoms, but little is known about how these incidents affect chronic respiratory health. Methods We assessed reported inhalation incidents among 3,763 European Community Respiratory Health Survey (ECRHS) participants with and without cough, phlegm, asthma, wheezing or bronchial hyperresponsiveness. We then examined whether inhalation incidents during the 9-year ECRHS follow-up period were associated with a new onset of any of these respiratory outcomes among 2,809 participants who were free of all five outcomes at the time of the baseline ECRHS survey. Results Inhalation incidents were reported by 5% of participants, with higher percentages reported among individuals with asthma-related outcomes at the time of the baseline survey. Among participants without symptoms at baseline, our analyses generated non-statistically significant elevated estimates of the risk of cough, phlegm, asthma and wheezing and a non-statistically significant inverse estimate of the risk of bronchial hyperresponsiveness among participants who reported an inhalation incident compared to those without such an event reported. Discussion Our findings provide limited evidence of an association between inhalation incidents and asthma-related symptoms. These data could be affected by differences in the reporting of inhalation incidents according to symptom status at the time of the baseline survey; they should thus be interpreted with caution.

Background: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients. Methods: We studied 338 patients hospitalized for a first exacerbation of COPD in 9 Spanish hospitals, obtaining full occupational history in a face-to-face interview; job codes were linked to a job exposure matrix for semi-quantitative estimation of exposure to mineral/biological dust, and gases/fumes for each job held. Patients underwent spirometry, diffusing capacity testing and analysis of gases in stable conditions. Quality of life, dyspnea and chronic bronchitis symptoms were determined with a questionnaire interview. A high-resolution CT scan was available in 133 patients. Results: 94% of the patients included were men, with a mean age of 68(8.5) years and a mean FEV1% predicted 52 (16). High exposure to gases or fumes was associated with chronic bronchitis, and exposure to mineral dust and gases/fumes was associated with higher scores for symptom perception in the St. George's questionnaire. No occupational agent was associated with a lower FEV1. High exposure to all occupational agents was associated with better lung diffusion capacity, in long-term quitters. In the subgroup with CT data, patients with emphysema had 18% lower DLCO compared to those without emphysema. Conclusions: In our cohort of COPD patients, high exposure to gases or fumes was associated with chronic bronchitis, and high exposure to all occupational agents was consistently associated with better diffusion capacity in long-term quitters.

Exposure to endotoxin has been associated with increased respiratory symptoms and decrements in lung function in occupational settings but little is known about the health effects of domestic exposure in adults. Here, we describe the association of respiratory disease, immunoglobulin (Ig)E sensitisation, bronchial reactivity and lung function with mattress endotoxin levels in adults, and determine whether these associations are modified by polymorphisms in CD14. Endotoxin levels in mattress dust from a population-based sample of 972 adults were measured. Associations were examined using generalised linear mixed models, adjusting for individual and household confounders. Effect modification of these associations by CD14/-260 (rs2569190) was assessed. Mattress endotoxin levels varied from 0.1 to 402.6 EU·mg(-1). Although there was no overall association of lung function with endotoxin exposure, there was evidence that the association of forced expiratory volume in 1 s and forced vital capacity with endotoxin was modified by CD14/-260 genotype (p-value for interaction 0.005 and 0.013, respectively). There was no evidence that symptoms, IgE sensitisation or bronchial reactivity were associated with mattress endotoxin levels. In this large epidemiological study of adults, there was no evidence that mattress endotoxin level was associated with respiratory symptoms or IgE sensitisation but the association of lung function with endotoxin levels may be modified by CD14 genotype.

Endotoxin exposures have manifold effects on human health. The geographical variation and determinants of domestic endotoxin levels in Europe have not yet been extensively described. To investigate the geographical variation and determinants of domestic endotoxin concentrations in mattress dust in Europe using data collected in the European Community Respiratory Health Survey follow-up (ECRHS II). Endotoxin levels were measured in mattress dust from 974 ECRHS II participants from 22 study centers using an immunoassay. Information on demographic, lifestyle, and housing characteristics of the participants was obtained in face-to-face interviews. The median endotoxin concentration in mattress dust ranged from 772 endotoxin units per gram (EU/g) dust in Reykjavik, Iceland, to 4806 EU/g in Turin, Italy. High average outdoor summer temperature of study center, cat or dog keeping, a high household crowding index, and visible damp patches in the bedroom were significantly associated with a higher endotoxin concentrations in mattress dust. There is a large variability in domestic endotoxin levels across Europe. Average outdoor summer temperature of study center, which explains only 10% of the variation in domestic endotoxin level by center, is the strongest meteorological determinant. The observed variation needs to be taken into account when evaluating the health effects of endotoxin exposures in international contexts.The incoherent observations of the health effects of endotoxin may be partly owing to the geographical heterogeneity of endotoxin exposure. Therefore, the observed variation should be considered in further studies. Measurements of indoor endotoxin are recommended as an indicator for the level of exposures of individual domestic environments.

Background In 2002, a voluntary registry of occupational respiratory diseases was initiated in the test phase in Asturias, Catalonia, and Navarre (Spain). Based on data from the fully implemented voluntary registry, we assessed the differences in the incidence and characteristics of the diseases reported in the three regions studied and compared them with those notified to the compulsory official system. Methods Physicians whose daily practice includes patients with occupational respiratory diseases were invited to participate. Newly diagnosed cases occurring during 2003 in the work force of the three regions studied were reported on a notification form every 2 months. Data from the compulsory official notification system were obtained from statistics on work-related diseases for possible disability benefits. Results Five hundred thirty-three new cases, representing a cumulative incidence of 183.52 (168.27-199.78) per million workers per yew; were reported. The number of cases and the incidence, overall and for each disease, causes of the diseases, and the occupations varied considerably between regions. The number of cases reported to the voluntary system was more than threefold greater than the number reported to the compulsory official system. Conclusions The compulsory scheme for reporting occupational respiratory diseases is seriously under-reporting in the three Spanish regions studied. Our voluntary surveillance program, which showed considerable differences in the characteristics and incidence of these diseases among the regions, appears to be more effective. Am. J. Ind. Med. 53:922-930, 2010. (C) 2010 Wiley-Liss, Inc.

Background: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability. Methods: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems. Results: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9). Conclusions: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures.

Background: Professional use of hypochlorite (bleach) has been associated with respiratory symptoms. Bleach is capable of inactivating allergens, and there are indications that its domestic use may reduce the risk of allergies in children. Objective: To study the associations between household use of bleach and atopic sensitization, allergic diseases, and respiratory health status in adults. Methods: We identified 3626 participants of the European Community Respiratory Health Survey 11 in 10 countries who did the cleaning in their homes and for whom data on specific serum IgE to 4 environmental allergens were available. Frequency of bleach use and information on respiratory symptoms were obtained in face-to-face interviews. House dust mite and cat allergens in mattress dust were measured in a subsample. Associations between the frequency of bleach use and health outcomes were evaluated by using multivariable mixed logistic regression analyses. Results: The use of bleach was associated with less atopic sensitization (odds ratio [OR], 0.75; 95% CI, 0.63-0.89). This association was apparent for specific IgE to both indoor (cat) and outdoor (grass) allergens, and was consistent in various subgroups, including those without any history of respiratory problems (OR, 0.85). Dose-response relationships (P

We studied the relationship between occupational exposures, chronic bronchitis, and lung function in a general population survey in 14 industrialized countries, including 13,253 men and women aged 20 to 44 yr. We studied associations between occupational group, occupational exposures, bronchitis symptoms (cough and phlegm production for at least 3 mo each year), FEV1, and nonspecific bronchial responsiveness (NSBR) separately in lifetime nonsmokers, cigarette smokers, and ex-smokers. Occupational exposure to vapors, gas, dust, or fumes, estimated with a job exposure matrix (JEM), was associated with chronic bronchitis among current smokers only (prevalence ratio (PR): 1.2 to 1.7). The interaction of occupational exposure with smelting, however, was not statistically significant (p > 0.1). Self-reported exposure was related to chronic bronchitis in all smoking groups. An increased risk for chronic bronchitis was found in agricultural, textile, paper, wood, chemical, and food processing workers, being more pronounced in smokers. Lung function and NSBR were not clearly related to occupational exposures. Findings were similar for asthmatic and nonasthmatic subjects. in conclusion, occupational exposures contributed to the occurrence of chronic (industrial) bronchitis in young adults. Fixed airflow limitation was not evident, probably due to the relatively young age of this population.

A measuring system is described for the determination of oxygen consumption (V-O2) and carbon dioxide production (V-CO2) in swimming rats. V-O2 and V-CO2 were measured by means of an O-2-analyzer (Ametek S3A) and a mass spectrometer (Balzers QMG 511), respectively, combined with a gas flow meter. The measurements were made in a 5-1 metabolic chamber on top of a swimming pool in which a water flow of 0.22 mis was maintained. The rats were fitted with an indwelling catheter with its tip at the entrance of the right atrium for the repeated determination of energy substrate and hormone concentrations, before, during, and after swimming. The inaccuracy of the V-O2, and V-CO2, measurements was 0.18% and 0.31% of the reading, respectively; the Imprecision was 2.15% and 2.59%. This high accuracy and precision of the system was attained by measuring room air for 20 s after each 100 s of measuring air from the metabolic chamber, and by using demineralized water in the swimming pool. V-O2, during steady-state swimming was 1.89 +/- 0.06 mmol/kg . min (ca. 60% V-O2max), indicating moderate exercise. Respiratory quotient (RQ), during steady-state exercise, was 0.80 +/- 0.01. V-O2, and RQ resulted in rates for carbohydrate and fat utilization of 15.6 +/- 0.8 and 15.1 +/- 0.7 mg/kg . min, respectively.

Udgivelsesdato: 2009-Jul Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. The Global Allergy and Asthma European Network (GA(2)LEN), a Sixth EU Framework Program for Research and Technological Development (FP6) Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy in its globality. The Global Allergy and Asthma European Network has benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA(2)LEN the world leader in the field. Besides these activities, research has also been carried out and the first papers are being published. Achievements of the Global Allergy and Asthma European Network can be grouped as follows: (i) those for a durable infrastructure built up during the project phase, (ii) those which are project-related and based on these novel infrastructures, and (iii) the development and implementation of guidelines. The major achievements of GA(2)LEN are reported in this paper.

Udgivelsesdato: July BACKGROUND: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS: The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS: All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION: This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.

Nonallergic rhinitis (NAR) can be defined as a chronic nasal inflammation which is not caused by systemic IgE-dependent mechanisms. It is common and probably affects far more than 200 million people worldwide. Both children and adults are affected. However, its exact prevalence is unknown and its phenotypes need to be evaluated using appropriate methods to better understand its pathophysiology, diagnosis and management. It is important to differentiate between infectious rhinitis, allergic/NAR and chronic rhinosinusitis, as management differs for each of these cases. Characterization of the phenotype, mechanisms and management of NAR represents one of the major unmet needs in allergic and nonallergic diseases. Studies on children and adults are required in order to appreciate the prevalence, phenotype, severity and co-morbidities of NAR. These studies should compare allergic and NAR and consider different age group populations including elderly subjects. Mechanistic studies should be carried out to better understand the disease(s) and risk factors and to guide towards an improved diagnosis and therapy. These studies need to take the heterogeneity of NAR into account. It is likely that neuronal mechanisms, T cells, innate immunity and possibly auto-immune responses all play a role in NAR and may also contribute to the symptoms of allergic rhinitis.