Bridging allergologic and botanical knowledge in seasonal allergy: a role for phenology

Phenological Analysis of Grasses (Poaceae) in Comparison with Aerobiological Data in Moscow (Russia)

Grasses (Poaceae) produce large amounts of pollen and are among the main causes of pollinosis worldwide. Despite their morphological similarity, pollen grains of different grass species may have different allergenicities. Therefore, quantification of the roles of individual species in airborne pollen is an important task. There are very few studies on this topic, and none of them have been conducted in a temperate continental climate. Our study was carried out for three years (2020-2022) in the urban territory of Moscow (Russia) and aimed to understand what grass species contribute the most to the total pollen load of the atmosphere. The comparison of aerobiological and phenological data was based on calculating the phenological index, which is a combination of phenological parameters, pollen productivity of individual species, and their abundance. Our data showed that the decomposition of pollination curves based on the phenological index was sometimes very efficient but not always possible in temperate continental climates. The main reasons for disagreement between aerobiological and phenological data were weather conditions and lawn mowing. Not all grasses were equally important as sources of allergenic pollen. The greatest contribution to the pollen load at the beginning of the season in Moscow was made by Dactylis glomerata, and to a lesser extent by Phleum pratense and Festuca pratensis. These are the most common species, which are widespread throughout Europe. The contribution of minor components is insignificant.

Environmental DNA analysis of airborne poaceae (grass) pollen reveals taxonomic diversity across seasons and climate zones

BACKGROUND

Grasses populate most biogeographical zones, and their diversity influences allergic sensitisation to pollen. Previously, the contribution of different Poaceae subfamilies to airborne pollen has mostly been inferred from historical herbarium records. We recently applied environmental (e)DNA metabarcoding at one subtropical site revealing that successive airborne grass pollen peaks were derived from repeated flowering of Chloridoid and Panicoid grasses over a season. This study aimed to compare spatiotemporal patterns in grass pollen exposure across seasons and climate zones.

METHODS

Airborne pollen concentrations across two austral pollen seasons spanning 2017-2019 at subtropical (Mutdapilly and Rocklea, Queensland) and temperate (Macquarie Park and Richmond, New South Wales) sites, were determined with a routine volumetric impaction sampler and counting by light microscopy. Poaceae rbcL metabarcode sequences amplified from daily pollen samples collected once per week were assigned to subfamily and genus using a ribosomal classifier and compared with Atlas of Living Australia sighting records.

RESULTS

eDNA analysis revealed distinct dominance patterns of grass pollen at various sites: Panicoid grasses prevailed in both subtropical Mutdapilly and temperate Macquarie Park, whilst Chloridoid grasses dominated the subtropical Rocklea site. Overall, subtropical sites showed significantly higher proportion of pollen from Chloridoid grasses than temperate sites, whereas the temperate sites showed a significantly higher proportion of pollen from Pooideae grasses than subtropical sites. Timing of airborne Pooid (spring), Panicoid and Chloridoid (late spring to autumn), and Arundinoid (autumn) pollen were significantly related to number of days from mid-winter. Proportions of eDNA for subfamilies correlated with distributions grass sighting records between climate zones.

CONCLUSIONS

eDNA analysis enabled finer taxonomic discernment of Poaceae pollen records across seasons and climate zones with implications for understanding adaptation of grasslands to climate change, and the complexity of pollen exposure for patients with allergic respiratory diseases.

Effects of climate change on Platanus flowering in Western Mediterranean cities: Current trends and future projections

Ornamental trees can reduce some of the negative impacts of urbanization on citizens but some species, such as Platanus spp., produce pollen with high allergenic potential. This can exacerbate the symptomatology in allergic patients, being a public health problem. Therefore, it would be relevant to determine the environmental conditions regulating the flowering onset of the Platanus species. The aims of this study were to use aerobiological records for modelling the thermal requirements of Platanus flowering and to make future projections based on the effects that climate change could have on it under several possible future scenarios. This study was conducted in Badajoz and Malaga, two Western Mediterranean cities with different climate conditions. In the first step, several main pollen season definitions were applied to the aerobiological data and their onset dates were compared with in situ phenological observations. The main pollen season definition that best fitted the Platanus flowering onset was based on the 4th derivative of a logistic function. This definition was used as a proxy to model the thermal requirements of the Platanus flowering onset by applying the PhenoFlex statistical framework. The errors obtained by this model during the external validation were 3.2 days on average, so it was fed with future temperature estimations to determine possible future trends. According to the different models, the flowering onset of Platanus in Badajoz will show heterogeneous responses in the short and medium term due to different balances in the chilling-forcing compensation, while it will clearly delay in Malaga due to a significant delay in the chilling requirement fulfilment. This may increase the chances of cross-reactivity episodes with other pollen types in the future, increasing its impact on public health.

Aerobiological Monitoring and Metabarcoding of Grass Pollen

Grass pollen is one of the leading causes of pollinosis, affecting 10-30% of the world's population. The allergenicity of pollen from different Poaceae species is not the same and is estimated from moderate to high. Aerobiological monitoring is a standard method that allows one to track and predict the dynamics of allergen concentration in the air. Poaceae is a stenopalynous family, and thus grass pollen can usually be identified only at the family level with optical microscopy. Molecular methods, in particular the DNA barcoding technique, can be used to conduct a more accurate analysis of aerobiological samples containing the DNA of various plant species. This study aimed to test the possibility of using the ITS1 and ITS2 nuclear loci for determining the presence of grass pollen from air samples via metabarcoding and to compare the analysis results with the results of phenological observations. Based on the high-throughput sequencing data, we analyzed the changes in the composition of aerobiological samples taken in the Moscow and Ryazan regions for three years during the period of active flowering of grasses. Ten genera of the Poaceae family were detected in airborne pollen samples. The representation for most of them for ITS1 and ITS2 barcodes was similar. At the same time, in some samples, the presence of specific genera was characterized by only one sequence: either ITS1 or ITS2. Based on the analysis of the abundance of both barcode reads in the samples, the following order could describe the change with time in the dominant species in the air: Poa, Alopecurus, and Arrhenatherum in early mid-June, Lolium, Bromus, Dactylis, and Briza in mid-late June, Phleum, Elymus in late June to early July, and Calamagrostis in early mid-July. In most samples, the number of taxa found via metabarcoding analysis was higher compared to that in the phenological observations. The semi-quantitative analysis of high-throughput sequencing data well reflects the abundance of only major grass species at the flowering stage.

Constructing a pollen proxy from low-cost Optical Particle Counter (OPC) data processed with Neural Networks and Random Forests

Pollen allergies affect a significant proportion of the global population, and this is expected to worsen in years to come. There is demand for the development of automated pollen monitoring systems. Low-cost Optical Particle Counters (OPCs) measure particulate matter and have attractive advantages of real-time high time resolution data and affordable costs. This study asks whether low-cost OPC sensors can be used for meaningful monitoring of airborne pollen. We employ a variety of methods, including supervised machine learning techniques, to construct pollen proxies from hourly-average OPC data and evaluate their performance, holding out 40 % of observations to test the proxies. The most successful methods are supervised machine learning Neural Network (NN) and Random Forest (RF) methods, trained from pollen concentrations collected from a Hirst-type sampler. These perform significantly better than using a simple particle size-filtered proxy or a Positive Matrix Factorisation (PMF) source apportionment pollen proxy. Twelve NN and RF models were developed to construct a pollen proxy, each varying by model type, input features and target variable. The results show that such models can construct useful information on pollen from OPC data. The best metrics achieved (Spearman correlation coefficient = 0.85, coefficient of determination = 0.67) were for the NN model constructing a Poaceae (grass) pollen proxy, based on particle size information, temperature, and relative humidity. Ability to distinguish high pollen events was evaluated using F1 Scores, a score reflecting the fraction of true positives with respect to false positives and false negatives, with promising results (F1 ≤ 0.83). Model-constructed proxies demonstrated the ability to follow monthly and diurnal trends in pollen. We discuss the suitability of OPCs for monitoring pollen and offer advice for future progress. We demonstrate an attractive alternative for automated pollen monitoring that could provide valuable and timely information to the benefit of pollen allergy sufferers.

Isolating the species element in grass pollen allergy: A review

Grass pollen is a leading cause of allergy in many countries, particularly Europe. Although many elements of grass pollen production and dispersal are quite well researched, gaps still remain around the grass species that are predominant in the air and which of those are most likely to trigger allergy. In this comprehensive review we isolate the species aspect in grass pollen allergy by exploring the interdisciplinary interdependencies between plant ecology, public health, aerobiology, reproductive phenology and molecular ecology. We further identify current research gaps and provide open ended questions and recommendations for future research in an effort to focus the research community to develop novel strategies to combat grass pollen allergy. We emphasise the role of separating temperate and subtropical grasses, identified through divergence in evolutionary history, climate adaptations and flowering times. However, allergen cross-reactivity and the degree of IgE connectivity in sufferers between the two groups remains an area of active research. The importance of future research to identify allergen homology through biomolecular similarity and the connection to species taxonomy and practical implications of this to allergenicity is further emphasised. We also discuss the relevance of eDNA and molecular ecological techniques (DNA metabarcoding, qPCR and ELISA) as important tools in quantifying the connection between the biosphere with the atmosphere. By gaining more understanding of the connection between species-specific atmospheric eDNA and flowering phenology we will further elucidate the importance of species in releasing grass pollen and allergens to the atmosphere and their individual role in grass pollen allergy.

Towards European automatic bioaerosol monitoring: Comparison of 9 automatic pollen observational instruments with classic Hirst-type traps

To benefit allergy patients and the medical practitioners, pollen information should be available in both a reliable and timely manner; the latter is only recently possible due to automatic monitoring. To evaluate the performance of all currently available automatic instruments, an international intercomparison campaign was jointly organised by the EUMETNET AutoPollen Programme and the ADOPT COST Action in Munich, Germany (March-July 2021). The automatic systems (hardware plus identification algorithms) were compared with manual Hirst-type traps. Measurements were aggregated into 3-hourly or daily values to allow comparison across all devices. We report results for total pollen as well as for Betula, Fraxinus, Poaceae, and Quercus, for all instruments that provided these data. The results for daily averages compared better with Hirst observations than the 3-hourly values. For total pollen, there was a considerable spread among systems, with some reaching R² > 0.6 (3 h) and R² > 0.75 (daily) compared with Hirst-type traps, whilst other systems were not suitable to sample total pollen efficiently (R² < 0.3). For individual pollen types, results similar to the Hirst were frequently shown by a small group of systems. For Betula, almost all systems performed well (R² > 0.75 for 9 systems for 3-hourly data). Results for Fraxinus and Quercus were not as good for most systems, while for Poaceae (with some exceptions), the performance was weakest. For all pollen types and for most measurement systems, false positive classifications were observed outside of the main pollen season. Different algorithms applied to the same device also showed different results, highlighting the importance of this aspect of the measurement system. Overall, given the 30 % error on daily concentrations that is currently accepted for Hirst-type traps, several automatic systems are currently capable of being used operationally to provide real-time observations at high temporal resolutions. They provide distinct advantages compared to the manual Hirst-type measurements.

Pollen Allergy in a Changing Planetary Environment

Airborne pollens are one of the common causative and triggering agents of respiratory allergy in a changing planetary environment. A growing number of people worldwide are contracting allergic diseases caused by pollens. The seasonal variations in pollens have occurred everywhere and the sensitization rate to pollens has increased in children as well as in adults. Moreover, allergenic plants, such as ragweed and Japanese hop, grow in soil damaged by human’s activities and deforestation with air pollution. It is impossible to avoid plants that cause allergies, because pollens can travel many kilometers in the breeze or wind. Hence, it is essential to survey and forecast pollens for the management of pollen allergy. Weather conditions may alter pollen concentrations. A number of studies have shown that increases in CO₂ concentration and atmospheric temperature raise pollen concentration. Hence most of the studies on the impact of climate change on aeroallergens must include the amount and allergenicity of pollens. It is yet unknown whether complex interactions with pollens, meteorological variables, and air pollutants in the changing environment. Considering the effect of climate change on the long-term trends in pollen levels and emerging viral infection, it is crucial to forecast and eliminate the associated risk for human health in future and take appropriate measures to reduce it.

Serum IgE profiles in Chinese pollinosis patients with grass pollen sensitisation

Purpose

Methods

Results

Conclusions

The Impact of Climate Change on Pollen Season and Allergic Sensitization to Pollens

Pollens are a major cause of seasonal allergic diseases. Weather may alter the production of pollens. Increased atmospheric temperatures lead to earlier pollination of many plants and longer duration of pollination, resulting in extended pollen seasons, with early spring or late winter. Longer pollen seasons increase duration of exposure, resulting in more sensitization, and higher pollen concentrations may lead to more severe symptoms. Climate changes in contact to pollens may affect both allergic sensitization and symptom prevalence with severity. The future consequences of climate change, however, are speculative, because the influence on humans, is complex.

Spatio-temporal flowering patterns in Mediterranean Poaceae. A community study in SW Spain

This study focused on phenological timing and spatial patterns in 30 Poaceae species flowering in spring in different types of plant cover (scrub, riverbank and pasture). Grass community composition was studied, and the influence of species and plant cover on the start date and duration of flowering was assessed from March to June in both 2014 and 2015. Twenty-nine sampling sites were selected for phenological monitoring using the BBCH scale. Data were subjected to GLMM analyses. Binary discriminant analysis revealed differences in grass community composition as a function of plant cover type; scrub cover comprised a considerably larger number of species than those in riverbank and pasture. Moreover, more species diversity was observed in 2014 than in 2015 with a drier and stressed pre-flowering period. Differences on phenology were also recorded between plant cover types and study years. Species in pasture and riverbank flowered before (113.4 days; 116.1 days) than species in scrub (120.9 days), being these species with shorter flowering length because they are more exposed to the characteristic of the Mediterranean region during the summer. In general, flowering onset occurred later in 2014 (118.2 days) than in 2015 (115.8 days), probably attributable to precipitation occurring during March. On the other hand, spatial autocorrelation within some cover types has been observed, showing spatial patterns exist at a smaller scale. The findings of this study contribute to a better understanding of grass phenology in different environments.

New biomolecular tools for aerobiological monitoring: Identification of major allergenic Poaceae species through fast real-time PCR

Grasses (Poaceae) are very common plants, which are widespread in all environments and urban areas. Despite their economical importance, they can represent a problem to humans due to their abundant production of allergenic pollen. Detailed information about the pollen season for these species is needed in order to plan adequate therapies and to warn allergic people about the risks they take in certain areas at certain moments. Moreover, precise identification of the causative species and their allergens is necessary when the patient is treated with allergen‐specific immunotherapy. The intrafamily morphological similarity of grass pollen grains makes it impossible to distinguish which particular species is present in the atmosphere at a given moment. This study aimed at developing new biomolecular tools to analyze aerobiological samples and identifying major allergenic Poaceae taxa at subfamily or species level, exploiting fast real‐time PCR. Protocols were tested for DNA extraction from pollen sampled with volumetric and gravimetric methods. A fragment of the matK plastidial gene was amplified and sequenced in Poaceae species known to have high allergological impact. Species‐ and subfamily‐specific primer–probe systems were designed and tested in fast real‐time PCRs to evaluate the presence of these taxa in aerobiological pollen samples. Species‐specific systems were obtained for four of five studied species. A primer–probe set was also proposed for the detection of Pooideae (a grass subfamily that includes also major cereal grains) in aerobiological samples, as this subfamily includes species carrying both grass allergens from groups 1 and 5. These, among the 11 groups in which grass pollen allergens are classified, are considered responsible for the most frequent and severe symptoms.

Standardised index for measuring atmospheric grass-pollen emission

Grass pollen is the main cause of pollen allergy in Europe, and-given its marked allergenic potential and elevated airborne concentrations-constitutes a major public health risk. This study sought to identify the grass species triggering allergies during the highest-risk periods, and to measure the contribution of each species to airborne grass pollen concentrations. This type of research is particularly useful with a view to optimising the prevention and diagnosis of pollen allergies and developing the most effective immunological treatments. To that end, a total of 28 species potentially responsible for allergies were analysed. In order to assess the potential contribution of these species to overall airborne pollen concentrations, an index was designed (Pollen Contribution Index) based on the following parameters for each species: flowering phenology, pollen grain size (polar and equatorial axes), abundance of the species in the area and pollen production. The species contributing most to airborne pollen concentrations were, in order: Dactylis glomerata subsp. hispanica, Lolium rigidum, Trisetum paniceum and Arrhenatherum album. These species all shared certain features: small grain size (and thus greater buoyancy in air), high pollen production and considerable abundance. This Index was applied to a case study in a Mediterranean-climate area of the central Iberian Peninsula, but could equally be applied to other areas and other allergenic pollens. Findings showed that a small number of species were responsible for most airborne grass pollen.

The grass pollen season 2015: a proof of concept multi-approach study in three different European cities

Background

Grasses release the most widespread aeroallergens with considerable sensitization rates, while different species produce several pollen concentration peaks throughout the season. This study analyzed the prevalence of grass species in three different European city areas and compared the flowering period of these species with daily pollen concentrations and the symptom loads of grass pollen allergy sufferers.

Methods

The most prevalent grass species in Vienna (Austria), Berlin (Germany) and Turku (Finland) were studied and examined by use of three different approaches: phenology, pollen monitoring and symptom load evaluation. A mobile pollen exposure chamber was employed to observe reaction patterns of grass pollen allergy sufferers to three common grass species evaluated in this study versus placebo.

Results

Common meadow grass (Poa pratensis) and the fescue grass species (Festuca spp.) are important contributors within the grass pollen season. The pollination period of orchard grass (Dactylis glomerata) and false-oat grass (Arrhenatherum elatius) indicated a greater importance in Berlin and Vienna, whereas a broader spectrum of grass species contributed in Turku to the main pollen season. The standardized provocation induced a nasal symptom load, reduction in nasal flow and increased secretion, in contrary to the placebo control group in grass pollen allergic subjects.

Conclusion

The phenological observations, pollen measurements and symptom data evaluation provided unique insights into the contribution of multiple grass species in different European regions. All investigated grass species in the provocation induced rhinitis symptoms of comparable significance, with some degree of variation in symptom patterns.

A survey on the perception of allergy specialists about the reimbursed grass pollen tablets for seasonal allergic rhinitis in Italy

Background

Sublingual immunotherapy (SLIT) is a feasible option to classical subcutaneous immunotherapy to treat respiratory allergy and is increasingly prescribed in Europe. However, the lack of reimbursement may limit its prescription. In 2015, the 5-grass pollen tablets was authorized by the European Medicine Agency to treat grass-pollen induced rhinitis and was approved in Italy for full reimbursement. We evaluated the opinions of allergy specialists after the availability of the reimbursed 5-grass pollen tablets.

Methods

A multiple choice questionnaire composed by six questions was used to assess the specialists opinion. The questionnaire was uploaded on the free access online platform SurveyMonkey. The link to access the platform was sent to all members of the Società Italiana di Asma, Allergologia e Immunologia Clinica (SIAAIC). The access to the questionnaire was anonymous. At survey ending, the access was closed and data were downloaded directly from SurveyMonkey website.

Results

The questionnaire was filled by 70 allergists. The majority of allergists felt as most important the concept of SLIT as a drug, the content of allergen extract mirroring the natural exposure, the pre-coseasonal schedule as the most patient’s oriented, the very good profile of tolerability and safety, the importance of the build-up phase, and the importance of checking the patient after starting immunotherapy.

Conclusions

The opinions of the Italian allergy specialists about the reimbursed 5-grass-pollen tablets are very positive and make likely an appropriate prescription of SLIT for grass-pollen induced rhinitis in the next years.

Modeling pollen time series using seasonal-trend decomposition procedure based on LOESS smoothing

Analysis of airborne pollen concentrations provides valuable information on plant phenology and is thus a useful tool in agriculture-for predicting harvests in crops such as the olive and for deciding when to apply phytosanitary treatments-as well as in medicine and the environmental sciences. Variations in airborne pollen concentrations, moreover, are indicators of changing plant life cycles. By modeling pollen time series, we can not only identify the variables influencing pollen levels but also predict future pollen concentrations. In this study, airborne pollen time series were modeled using a seasonal-trend decomposition procedure based on LOcally wEighted Scatterplot Smoothing (LOESS) smoothing (STL). The data series-daily Poaceae pollen concentrations over the period 2006-2014-was broken up into seasonal and residual (stochastic) components. The seasonal component was compared with data on Poaceae flowering phenology obtained by field sampling. Residuals were fitted to a model generated from daily temperature and rainfall values, and daily pollen concentrations, using partial least squares regression (PLSR). This method was then applied to predict daily pollen concentrations for 2014 (independent validation data) using results for the seasonal component of the time series and estimates of the residual component for the period 2006-2013. Correlation between predicted and observed values was r = 0.79 (correlation coefficient) for the pre-peak period (i.e., the period prior to the peak pollen concentration) and r = 0.63 for the post-peak period. Separate analysis of each of the components of the pollen data series enables the sources of variability to be identified more accurately than by analysis of the original non-decomposed data series, and for this reason, this procedure has proved to be a suitable technique for analyzing the main environmental factors influencing airborne pollen concentrations.

The grass pollen season 2014 in Vienna: A pilot study combining phenology, aerobiology and symptom data

BACKGROUND

Grasses (Poaceae) are one of the largest plant families and are distributed worldwide. Grass pollen allergy is one of the most important pollen allergies affecting large parts of the population worldwide. The grass pollen season itself is special since it is caused by the flowering of various grass species that present unique profiles of allergenicity, which assumingly plays a significant role and impact on grass pollen sensitization profiles for the allergy sufferer. The aim of this study, conducted in Vienna, 2014, was to analyze the possible contribution of prevalent grass species to the grass pollen season and to the symptom load of grass allergy sufferers.

METHODS

This was the first study that combines phenological observations (i.e. grass species and their flowering periods) with aerobiological measurements (i.e. daily grass pollen concentrations) in concert with allergic symptoms from local users of the Patient's Hayfever Diary (symptom load index calculation).

RESULTS

Both the pollen concentrations and the symptom levels were higher in the first half of the main grass pollen season and therefore show the highest impact on pollen allergy sufferers. Of important note were the following species that are widely distributed in Vienna: Kentucky bluegrass (Poa pratensis), orchard grass (Dactylis glomerata), false oat-grass (Arrhenatherum elatius), fescue grass (Festuca sp.) and perennial rye-grass (Lolium perenne).

CONCLUSION

Monitoring different grass species provided evidence for varying contribution in pollination across the main grass pollen season and highlighted the significance this impact may have on pollen allergy sufferers.

Major grass pollen allergens and components detected in a southern Chinese cohort of patients with allergic rhinitis and/or asthma

There is so far a paucity of data about allergen component-resolved diagnosis, and the prevalence of grass pollen allergen components in China, in contrast to those from western countries. Even in this country, allergies to grass pollen allergen components in the vast south are inadequately described. This study aimed to determine the major sensitizing grass pollens in Guangzhou, the largest city in Guangdong province of southern China. Included in this study were 258 patients having allergic rhinitis with or without asthma and 88 healthy controls. ImmunoCap100 was used to examine the serum samples for sIgE to Bermuda, Timothy, and Humulus scandens. Subjects who tested positive were further examined for sIgE to Bermuda antigen Cyn d 1, Timothy antigens Phl p 1/4/5/6/7/11/12, and CCD. The relationship of grass pollen allergy to specific antigen sensitization was assessed. As a result, 22.5% of patients with allergic rhinitis and/or asthma were positive for Bermuda-sIgE, 13.6% for Timothy-sIgE, and 7.0% for Humulus scandens-sIgE. These patients were more likely to be sensitized compared with controls (P<0.001). Of the Bermuda-sIgE positive patients, 53.4% were Cyn d 1 positive and 60.3% were Timothy-sIgE positive. Of the Timothy positive patients, 100% were positive for Phl p 4, 17.1% were positive for Phl p 1 and 8.6% tested positive for Phl p 5/6/7/11/12. Patients with high Bermuda-sIgE levels were more likely to be positive for other grasses. In 41.4% of Bermuda grass positive patients, CCD-sIgE was also positive. Sensitization to Phl p 4 was significantly correlated with CCD (r_s=0.928).In summary, we found that these southern Chinese patients with allergic rhinitis and/or asthma tested positive for Bermuda, Timothy, and Humulus scandens IgE. A high Bermuda-sIgE level may predict sensitization to other grasses. Correlations between sensitization to CCD and grass pollen allergens suggested a likelihood of cross-reactivity. Further in vitro inhibition assays are required to confirm this relationship.

Differences in grass pollen allergen exposure across Australia

Objective: Allergic rhinitis and allergic asthma are important chronic diseases posing serious public health issues in Australia with associated medical, economic, and societal burdens. Pollen are significant sources of clinically relevant outdoor aeroallergens, recognised as both a major trigger for, and cause of, allergic respiratory diseases. This study aimed to provide a national, and indeed international, perspective on the state of Australian pollen data using a large representative sample.

Methods: Atmospheric grass pollen concentration is examined over a number of years within the period 1995 to 2013 for Brisbane, Canberra, Darwin, Hobart, Melbourne, and Sydney, including determination of the ‘clinical’ grass pollen season and grass pollen peak.

Results: The results of this study describe, for the first time, a striking spatial and temporal variability in grass pollen seasons in Australia, with important implications for clinicians and public health professionals, and the Australian grass pollen‐allergic community.

Conclusions: These results demonstrate that static pollen calendars are of limited utility and in some cases misleading. This study also highlights significant deficiencies and limitations in the existing Australian pollen monitoring and data.

Implications: Establishment of an Australian national pollen monitoring network would help facilitate advances in the clinical and public health management of the millions of Australians with asthma and allergic rhinitis.

Regional and seasonal variation in airborne grass pollen levels between cities of Australia and New Zealand

Although grass pollen is widely regarded as the major outdoor aeroallergen source in Australia and New Zealand (NZ), no assemblage of airborne pollen data for the region has been previously compiled. Grass pollen count data collected at 14 urban sites in Australia and NZ over periods ranging from 1 to 17 years were acquired, assembled and compared, revealing considerable spatiotemporal variability. Although direct comparison between these data is problematic due to methodological differences between monitoring sites, the following patterns are apparent. Grass pollen seasons tended to have more than one peak from tropics to latitudes of 37°S and single peaks at sites south of this latitude. A longer grass pollen season was therefore found at sites below 37°S, driven by later seasonal end dates for grass growth and flowering. Daily pollen counts increased with latitude; subtropical regions had seasons of both high intensity and long duration. At higher latitude sites, the single springtime grass pollen peak is potentially due to a cooler growing season and a predominance of pollen from C₃ grasses. The multiple peaks at lower latitude sites may be due to a warmer season and the predominance of pollen from C₄ grasses. Prevalence and duration of seasonal allergies may reflect the differing pollen seasons across Australia and NZ. It must be emphasized that these findings are tentative due to limitations in the available data, reinforcing the need to implement standardized pollen-monitoring methods across Australasia. Furthermore, spatiotemporal differences in grass pollen counts indicate that local, current, standardized pollen monitoring would assist with the management of pollen allergen exposure for patients at risk of allergic rhinitis and asthma.

Trans-disciplinary research in synthesis of grass pollen aerobiology and its importance for respiratory health in Australasia

Grass pollen is a major trigger for allergic rhinitis and asthma, yet little is known about the timing and levels of human exposure to airborne grass pollen across Australasian urban environments. The relationships between environmental aeroallergen exposure and allergic respiratory disease bridge the fields of ecology, aerobiology, geospatial science and public health. The Australian Aerobiology Working Group comprised of experts in botany, palynology, biogeography, climate change science, plant genetics, biostatistics, ecology, pollen allergy, public and environmental health, and medicine, was established to systematically source, collate and analyse atmospheric pollen concentration data from 11 Australian and six New Zealand sites. Following two week-long workshops, post-workshop evaluations were conducted to reflect upon the utility of this analysis and synthesis approach to address complex multidisciplinary questions. This Working Group described i) a biogeographically dependent variation in airborne pollen diversity, ii) a latitudinal gradient in the timing, duration and number of peaks of the grass pollen season, and iii) the emergence of new methodologies based on trans-disciplinary synthesis of aerobiology and remote sensing data. Challenges included resolving methodological variations between pollen monitoring sites and temporal variations in pollen datasets. Other challenges included "marrying" ecosystem and health sciences and reconciling divergent expert opinion. The Australian Aerobiology Working Group facilitated knowledge transfer between diverse scientific disciplines, mentored students and early career scientists, and provided an uninterrupted collaborative opportunity to focus on a unifying problem globally. The Working Group provided a platform to optimise the value of large existing ecological datasets that have importance for human respiratory health and ecosystems research. Compilation of current knowledge of Australasian pollen aerobiology is a critical first step towards the management of exposure to pollen in patients with allergic disease and provides a basis from which the future impacts of climate change on pollen distribution can be assessed and monitored.

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Pollen information consumption as an indicator of pollen allergy burden

BACKGROUND

The Austrian pollen information service distributes pollen forecasts and offers various options (webpages, a mobile "Pollen" app, interviews for newspapers, radio, TV and information for the press agency) to support and inform pollen allergy sufferers in Austria in the best way to help to avoid their allergen. These services are well received and user numbers have increased, especially in recent years.

METHODS

Herein, we unravel for the first time the user pattern over time on a monthly basis and compare it to the major pollen seasons in Austria as well as to the allergic burden.

RESULTS

The symptom load conforms to the web page user numbers and shows the same peaks from the study period of 2012 until 2014. The highest impact in user numbers and allergy burden occurred during the birch pollen season, although similar values were approached during the grass pollen season in 2014. Pollen loads during the respective pollen seasons of birch, grasses and herbs (mugwort and ragweed) mirrored the pattern as well, although to a minor extent, because different plant taxa have a different distribution within Austria and produce different amounts of pollen.

CONCLUSION

This study provides evidence that pollen information consumption can be seen as an indicator of the burden of pollen allergy sufferers as well as an indicator of the main flowering periods of the main plants inducing pollen allergies in Austria.

Respiratory allergy in immigrants to a highly industrialised area in Italy according to area of origin and time period

BACKGROUND

Migrants from developing to Western countries tend to become more sensitised to host than to origin country allergens, although substantial changes in migration patterns have occurred in recent decades.

METHODS

We investigated adult immigrants with respiratory allergy, first tested for allergic sensitisation between 1985 and 2012 in a highly industrialised area in Italy. A comparison was made of the sensitisation pattern between immigrants and a random sample of native-born subjects affected by a respiratory allergy, and among immigrants according to macro-region of origin and time period.

RESULTS

Between 1985 and 2012, 480 immigrants with respiratory allergy had a first positive allergy test. Immigrants were sensitised mainly to grass (67.1%), house dust mites (HDM) (38.5%) and birch (27.5%), with a pattern of sensitisation very similar to that observed in Italians (native-born). An increase in the proportion of subjects with asthma and of subjects with polysensitisation was observed from the first (1985-2002) to the middle (2003-2007) and the most recent period (2008-2012). In recent years, the proportion of subjects with polysensitisation in immigrants is higher than in Italians (native-born) (53.3% vs. 40.1%). Among immigrants, the risk of sensitisation to grass was higher in those from Sub-Saharan Africa (odds ratio, OR=2.76) and Latin America (OR=2.49), whereas risk of sensitisation to HDM was higher among immigrants from South Asia (OR=2.71), compared to immigrants from Eastern Europe.

CONCLUSIONS

Immigrants develop multiple sensitisations more frequently than native-born people, and are especially sensitised to local allergens; the country of origin seems to play a role.

Specific IgE recognition of pollen allergens from subtropic grasses in patients from the subtropics

BACKGROUND

Pollens of subtropical grasses, Bahia (Paspalum notatum), Johnson (Sorghum halepense), and Bermuda (Cynodon dactylon), are common causes of respiratory allergies in subtropical regions worldwide.

OBJECTIVE

To evaluate IgE cross-reactivity of grass pollen (GP) found in subtropical and temperate areas.

METHODS

Case and control serum samples from 83 individuals from the subtropical region of Queensland were tested for IgE reactivity with GP extracts by enzyme-linked immunosorbent assay. A randomly sampled subset of 21 serum samples from patients with subtropical GP allergy were examined by ImmunoCAP and cross-inhibition assays.

RESULTS

Fifty-four patients with allergic rhinitis and GP allergy had higher IgE reactivity with P notatum and C dactylon than with a mixture of 5 temperate GPs. For 90% of 21 GP allergic serum samples, P notatum, S halepense, or C dactylon specific IgE concentrations were higher than temperate GP specific IgE, and GP specific IgE had higher correlations of subtropical GP (r = 0.771-0.950) than temperate GP (r = 0.317-0.677). In most patients (71%-100%), IgE with P notatum, S halepense, or C dactylon GPs was inhibited better by subtropical GP than temperate GP. When the temperate GP mixture achieved 50% inhibition of IgE with subtropical GP, there was a 39- to 67-fold difference in concentrations giving 50% inhibition and significant differences in maximum inhibition for S halepense and P notatum GP relative to temperate GP.

CONCLUSION

Patients living in a subtropical region had species specific IgE recognition of subtropical GP. Most GP allergic patients in Queensland would benefit from allergen specific immunotherapy with a standardized content of subtropical GP allergens.

Grass pollen allergens globally: the contribution of subtropical grasses to burden of allergic respiratory diseases

Grass pollens of the temperate (Pooideae) subfamily and subtropical subfamilies of grasses are major aeroallergen sources worldwide. The subtropical Chloridoideae (e.g. Cynodon dactylon; Bermuda grass) and Panicoideae (e.g. Paspalum notatum; Bahia grass) species are abundant in parts of Africa, India, Asia, Australia and the Americas, where a large and increasing proportion of the world's population abide. These grasses are phylogenetically and ecologically distinct from temperate grasses. With the advent of global warming, it is conceivable that the geographic distribution of subtropical grasses and the contribution of their pollen to the burden of allergic rhinitis and asthma will increase. This review aims to provide a comprehensive synthesis of the current global knowledge of (i) regional variation in allergic sensitivity to subtropical grass pollens, (ii) molecular allergenic components of subtropical grass pollens and (iii) allergic responses to subtropical grass pollen allergens in relevant populations. Patients from subtropical regions of the world show higher allergic sensitivity to grass pollens of Chloridoideae and Panicoideae grasses, than to temperate grass pollens. The group 1 allergens are amongst the allergen components of subtropical grass pollens, but the group 5 allergens, by which temperate grass pollen extracts are standardized for allergen content, appear to be absent from both subfamilies of subtropical grasses. Whilst there are shared allergenic components and antigenic determinants, there are additional clinically relevant subfamily-specific differences, at T- and B-cell levels, between pollen allergens of subtropical and temperate grasses. Differential immune recognition of subtropical grass pollens is likely to impact upon the efficacy of allergen immunotherapy of patients who are primarily sensitized to subtropical grass pollens. The literature reviewed herein highlights the clinical need to standardize allergen preparations for both types of subtropical grass pollens to achieve optimal diagnosis and treatment of patients with allergic respiratory disease in subtropical regions of the world.

Economic evaluation of 5-grass pollen tablets versus placebo in the treatment of allergic rhinitis in adults

Background

Allergen immunotherapy (AIT) is aimed at modifying the immune response to a causative allergen, thereby reducing clinical symptoms and symptomatic medication intake and improving quality of life. Long-term AIT research has led to the development of 5-grass pollen tablets, currently indicated for the treatment of grass pollen-induced allergic rhinitis (AR).

Methods

A post-hoc analysis was conducted using the Average Adjusted Symptom Score (AAdSS) to compare the effect of treatment of AR with 5-grass pollen tablets versus placebo treatment. Using the results of the VO34.04 and VO53.06 trials and economic data, cost-effectiveness analysis of 5-grass pollen tablet treatment was performed from the Italian third-party payer perspective with cost data derived from a study of 2008 updated to 2011. Also a societal perspective was considered by using the costs related to the losses of productivity by following the human capital approach. Using the results of the analysis, the estimated receiver-operating characteristic curve was plotted to evaluate medication effectiveness in terms of quality-adjusted life years (QALYs) and a decision tree constructed to model the possible outcomes and costs for adults and paediatric patients with a low, medium, and high AAdSS. Finally, probabilistic sensitivity analysis was conducted to test the robustness of the results as well as their consistency at an assumed cost-effectiveness threshold of € 30,000/QALY.

Results

The results indicate that compared to the placebo, the 5-grass pollen tablet treatment provides a benefit of 0.127 QALYs in medium AAdSS patients and of 0.143 QALYs in high AAdSS patients. The 5-grass pollen tablet treatment was found to cost € 1,024/QALY for patients with a medium AAdSS and € 1,035/QALY for patients with a high AAdSS. Of all the simulations performed in the probabilistic sensitivity analysis, 99 % indicated that the incremental cost-effectiveness ratio of the 5-grass pollen tablet treatment was below the threshold of € 30,000/QALY in patients with medium and high AAdSS, whereas it was found to be dominated in 67 % of simulations related to patients with low AAdSS.

Conclusion

The 5-grass pollen tablet is a cost-effective treatment for adult AR patients with a medium or high AAdSS. This finding should be carefully considered when deciding the management strategy for these patients.

Airborne pollen of allergenic herb species in Toledo (Spain)

This study analysed airborne pollen counts for allergenic herb taxa in Toledo (central Spain), a major tourist city receiving over 2 million visitors per year, located in the region of Castilla-La Mancha. The taxa selected were Chenopodiaceae-Amaranthaceae, Plantago, Poaceae and Urticaceae, all of which produce allergenic pollen giving rise to serious symptoms in pollen-allergy sufferers. Aerobiological data were recorded over a 6-year period (2005 to 2010) using the sampling and analysis procedures recommended by the Spanish Aerobiology Network. The abundance and the temporal (annual, daily and intradiurnal) distribution of these pollen types were analysed, and the influence of weather-related factors on airborne pollen counts was assessed. Pollen from herbaceous species accounted for 20.9% of total airborne pollen in Toledo, the largest contributor being Poaceae, with 8.5% of the total pollen count; this family was also the leading cause of respiratory allergies. Examination of intradiurnal variation revealed three distinct distribution patterns: (1) peak daily counts for Chenopodiaceae-Amaranthaceae and Plantago were recorded during the hottest part of the day, i.e. from 1400 to 1600 hours; (2) Urticaceae displayed two peaks (1400-1600 and 2200 hours); and (3) Poaceae counts remained fairly stable throughout the day. Two main risk periods were identified for allergies: spring, with allergies caused by Urticaceae, Plantago and Poaceae pollen, and summer, due to Chenopodiaceae-Amaranthaceae pollen.

Specific IgE response to different grass pollen allergen components in children undergoing sublingual immunotherapy

Background

Grass pollen is a major cause of respiratory allergy worldwide and contain a number of allergens, some of theme (Phl p 1, Phl p 2, Phl p 5, and Phl 6 from Phleum pratense, and their homologous in other grasses) are known as major allergens. The administration of grass pollen extracts by immunotherapy generally induces an initial rise in specific immunoglobulin E (sIgE) production followed by a progressive decline during the treatment. Some studies reported that immunotherapy is able to induce a de novo sensitisation to allergen component previously unrecognized.

Methods

We investigated in 30 children (19 males and 11 females, mean age 11.3 years), 19 treated with sublingual immunotherapy (SLIT) by a 5-grass extract and 11 untreated, the sIgE and sIgG4 response to the different allergen components.

Results

Significant increases (p < 0.001) were detected for Phl p 1, Phl p 2, Phl p 5, and Phl p 6, while sIgE levels induced in response to Phl p 7 and Phl p 12 were low or absent at baseline and unchanged following SLIT treatment; no new sensitisation was detected. As to IgG4, significant increases were found for Phl p2 and Phl p 5, while the increase for Phl p 12 was not significant. In the control group, no significant increase in sIgE for any single allergen component was found.

Conclusions

These findings confirm that the initial phase of SLIT with a grass pollen extract enhances the sIgE synthesis and show that the sIgE response concerns the same allergen components which induce IgE reactivity during natural exposure.