Urban allergy review: Allergic rhinitis and asthma with plane tree sensitization (Review)

Greenspaces And Cardiovascular Health

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.

Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study

BACKGROUND

Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach.

OBJECTIVE

To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach.

METHODS

Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed.

RESULTS

Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers.

CONCLUSIONS

In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Identification of Pla a 7 as a novel pollen allergen group in Platanus acerifolia pollen

BACKGROUND

Platanus acerifolia is recognized as a source of allergenic pollen worldwide. Currently, five Platanus acerifolia pollen allergens belonging to different protein families have been identified, in which profilin and enolase were characterized by our group recently. Besides, we also screened and identified a novel allergen candidate as triosephosphate isomerase, which was different from already known types of pollen allergens. However, the role of this novel allergen group in Platanus acerifolia pollen allergy was unclear. Therefore, we further investigated the allergenicity and clarify its clinical relevance in this study.

METHODS

The natural triosephosphate isomerase from Platanus acerifolia pollen was purified by three steps of chromatography and identified by mass spectrometry. The cDNA sequence of this protein was matched from in-house transcripts based on internal peptide sequences, which was further confirmed by PCR cloning. The recombinant triosephosphate isomerase was expressed and purified from E. coli. Allergenicity analysis of this protein was carried out by enzyme linked immunosorbent assay, immunoblot, and basophil activation test.

RESULTS

A novel allergen group belonging to triosephosphate isomerase was firstly identified in Platanus acerifolia pollen and named as Pla a 7. The cDNA of Pla a 7 contained an open reading frame of 762 bp encoding 253 amino acids. The natural Pla a 7 displayed 41.4% IgE reactivity with the patients' sera by ELISA, in which the absorbance value showed correlation to the serum sIgE against Platanus acerifolia pollen extract. Inhibition of IgE-binding to pollen extracts reached 26%-94% in different Pla a 7-positive sera. The recombinant Pla a 7 exhibited weaker IgE-reactivity in ELISA than its natural form, but showed comparable activity in immunoblot. The allergenicity was further confirmed by basophil activation test.

CONCLUSIONS

Triosephosphate isomerase (Pla a 7) was first recognized as pollen allergen in Platanus acerifolia pollen, which is a completely different type of pollen allergen from those previously reported. This finding is essential to enrich information on allergen components and pave the way for molecular diagnosis or treatment strategies for Platanus acerifolia pollen allergy.

Influence of synoptic meteorology on airborne allergenic pollen and spores in an urban environment in Northeastern Iberian Peninsula

The influence of the most frequent patterns of synoptic circulation on the dynamics of airborne pollen/spores recorded at the Barcelona Aerobiological Station (BCN) was analysed. Six pollen types (Platanus, Cupressaceae, Olea, Poaceae, Urticaceae and Amaranthaceae), and one fungal spore (Alternaria) were selected for their high allergenic effect in sensitive people. Six synoptic meteorological patterns were identified through cluster analysis of sea level pressure fields as the main responsible of the weather conditions in the Iberian Peninsula. The local meteorological conditions in Barcelona associated with each one of the synoptic types were also stablished. Different statistical methods were applied to analyse possible relationships between concentrations and timing of the recorded aerobiological particles and specific synoptic types. The study, focused in the 19-year period 2001-2019, shows that one of the scenarios, frequent in winter and linked to high stability and air-mass blockage, registered the highest mean and median values for Platanus and Cupressaceae, but it was not very relevant for the other taxa. It was also this scenario that turned out to be the most influent on the pollination timing showing a significant influence on the start occurrence of Urticaceae flowering and on the peak date of Platanus. On the other hand, the most frequent synoptic type in the period, relevant in spring and summer, was linked to sporadic episodes of levels considered to be of high risk of allergy to Platanus, Poaceae, and Urticaceae pollen, and Alternaria fungal spore. This synoptic pattern, characterized by the presence of the Azores anticyclone and the Atlantic low located in the north of the United Kingdom, was associated with high temperatures, low relative humidity and moderate winds from the NW in Barcelona. The identification of an interaction between synoptic meteorology and pollen/spore dynamics will allow better abatement measures, reducing adverse health effects on sensitive population.

Impact of environmental factors on the epidemiology of eosinophilic esophagitis in southwestern Europe (2007-2020)

Background

Eosinophilic esophagitis (EoE) is a disease characterized by symptoms of esophageal dysfunction and at least 15 eosinophils/hpf in the esophagus. Other systemic and local causes of esophageal eosinophilia should be excluded.

Objectives

The study objectives were to examine the annual epidemiology of EoE for 14 consecutive years, investigate whether there is a relationship between the count of aeroallergens and the incidence of EoE for 12 years, evaluate whether there are family ties between the patients with EoE, and determine whether there are cases of EoE that are triggered or exacerbated by pollens.

Methods

We conducted a prospective, descriptive, and analytic study in patients with EoE for 14 years (2007-2020). The study variables were age, sex, relatives with EoE, time of evolution of the symptoms until diagnosis of the disease, and symptoms. We examined incidence and prevalence, annual counts of aeroallergens for 12 years, and number of diagnoses per year (in 2007-2020). We studied patients with active EoE (in April-July) and EoE in remission (in August-March) for 2 consecutive years. Exacerbations were investigated by measuring symptoms using a visual analog scale of 1 to 10.

Results

Of the 366 patients with EoE (studied from 2007 to 2020), 83.5% were atopic, with respiratory allergy and 28% had a food allergy. Their mean age was 35 years. The time of evolution of the symptoms was more than 6 years. Only 11% of the patients had a degree of kinship. Of the 366 patients, 87% had dysphagia, 27% had had impactions, and 12.5% had other symptoms of esophageal dysfunction. We found a positive correlation between the incidence of EoE and Platanaceae pollens. We did not detect any case of EoE triggered or exacerbated by pollens.

Conclusions

The epidemiology of EoE in southwestern Europe continues to grow. We have corroborated the relevant impact of the environment on genetics. Future studies will clarify the possible relevance of Platanaceae pollens in the increased epidemiology of EoE. The role of grass and Oleaceae pollens in triggering EoE is limited by having a short pollination in time.

Responses of tree growth, leaf area and physiology to pavement in Ginkgo biloba and Platanus orientalis

Trees growing on paved lands endure many environmental stresses in the urban environment. However, the morphological and physiological mechanisms underlying tree adaptation to pavement in the field are less known. In this study, we investigated 40 sites where Ginkgo biloba and Platanus orientalis grow on adjacent pairs of paved and vegetated plots in parks and roadsides in Beijing, China. Relative to the vegetated land, the mean increments in the diameter at breast height and height in the paved land were significantly decreased by 44.5% and 31.9% for G. biloba and 31.7% and 60.1% for P. orientalis, respectively. These decreases are related to both the decrease in assimilation products due to the reductions in leaf area, leaf total nitrogen content, and chlorophyll content and the increase in energy cost due to the synthesis of more soluble sugar and proline for mitigating stress. The increase in leaf soluble sugar content, proline content, and δ¹³C indicated that trees could adapt to the paved land through the regulation of osmotic balance and the enhancement of water-use efficiency. Piecewise structural equation models showed that trees growing on the paved land are stressed by compounding impacts of the leaf morphological and physiological changes. Therefore, it is critical to explore the complex response of plant morphological and physiological traits to the pavement-induced stress for improving tree health in urban greening.

Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart?

PURPOSE OF REVIEW

Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity.

RECENT FINDINGS

Recent findings suggest that both these types of plant food allergy occur in children and adults. Although it is true that PFS allergy is more prevalent in Northern Europe and LTP allergy is more well known in Southern Europe, these conditions are not hidebound by geography, and the increasing spread and allergenicity of pollen due to global warming continues to change their presentation. Both conditions have a spectrum of symptom severity, with PFS sometimes presenting with more severe symptoms, including anaphylaxis and LTP allergy with milder reactions.

SUMMARY

It is important to consider that in many parts of Europe, reactions to plant foods, especially fruits or vegetables, could be mediated either by pollen cross-reactivity or primary sensitization to LTP allergens. All those presenting with symptoms to plant foods will benefit from a detailed clinical history and appropriate tests so that an accurate diagnosis can be made, and correct management implemented.

Platanus hybrida’s Phenolic Profile, Antioxidant Power, and Antibacterial Activity against Methicillin-Resistant Staphylococcus aureus (MRSA)

Methicillin-resistant S. aureus (MRSA) are a threat to public health as they frequently reveal a multidrug-resistant pattern. Researchers all over the world are on an urgent hunt for new treatments to help fight infections before antibiotics become obsolete, and some natural alternatives, such as polyphenols, have already exhibited therapeutic properties. Therefore, this study aimed to determine the phenolic profile, antioxidant capacity, and antimicrobial activity against MRSA of the leaf, fruit, and stem bark extracts of Platanus hybrida. The polyphenols were extracted with a water/ethanol (20:80) mixture and the methodology included HPLC-DAD, DPPH, FRAP, and CuPRAC. To address this issue from a One Health perspective, the Kirby–Bauer disc diffusion method was performed against nine MRSA strains from three different sources (livestock, wild animals, and humans). Fourteen phenolics were identified and the leaf extract showed the highest phenolic content, followed by the fruit extract. The leaf extract also showed the highest antioxidant capacity while the fruit extract had the lowest antioxidant capacity. Both leaf and fruit extracts inhibited the growth of strains from all sources, while the stem bark extract did not inhibit the growth of human strains. This work highlights the complex chemical composition and the antioxidative and antimicrobial potential of extracts derived from P. hydrida.

Data Mining Methods to Detect Airborne Pollen of Spring Flowering Arboreal Taxa

Variations in the airborne pollen load are among the current and expected impacts on plant pollination driven by climate change. Due to the potential risk for pollen-allergy sufferers, this study aimed to analyze the trends of the three most abundant spring-tree pollen types, Pinus, Platanus and Quercus, and to evaluate the possible influence of meteorological conditions. An aerobiological study was performed during the 1993–2020 period in the Ourense city (NW Spain) by means of a Hirst-type volumetric sampler. Meteorological data were obtained from the ‘Ourense’ meteorological station of METEOGALICIA. We found statistically significant trends for the Total Pollen in all cases. The positive slope values indicated an increase in pollen grains over the pollen season along the studied years, ranging from an increase of 107 to 442 pollen grains. The resulting C5.0 Decision Trees and Rule-Based Models coincided with the Spearman’s correlations since both statistical analyses showed a strong and positive influence of temperature and sunlight on pollen release and dispersal, as well as a negative influence of rainfall due to washout processes. Specifically, we found that slight rainfall and moderate temperatures promote the presence of Pinus pollen in the atmosphere and a marked effect of the daily thermal amplitude on the presence of high Platanus pollen levels. The percentage of successful predictions of the C5.0 models ranged between 62.23–74.28%. The analysis of long-term datasets of pollen and meteorological information provides valuable models that can be used as an indicator of potential allergy risk in the short term by feeding the obtained models with weather prognostics.

Steroid-Responsive Gradenigo's Syndrome Mimicking Subdural Hematoma

Gradenigo's syndrome (GS) is featured by a clinical triad of otorrhea, retro-orbital pain, and a sixth nerve palsy. Clinical examination is crucial prior to considering neuroimaging. The majority of cases are secondary to infection thus requiring long-term broad-spectrum antibiotics; severe cases also require surgical intervention for risk of intracranial abscess or even death. The patient was a 35-year-old female who presented with right temporal headache and right retro-orbital pain. The initial diagnosis from the local clinic was of subdural hemorrhage. Cranial nerve (CN) VI paresis was noted upon examination and inflammatory process was documented based on brain MR. The patient was diagnosed with Gradenigo's syndrome and administered antibiotics and steroids. Symptoms recurred after cessation of steroids and once antibiotics-related fever developed. The symptoms resolved after stopping the antibiotics and reintroducing steroids. The MRI performed after three months recorded no brain inflammation. We report a Gradenigo's syndrome caused by chronic inflammation with good response to steroids. To our best knowledge, there were merely approximately 80 patients who were reported with Gradnigo or Gradenigo's syndrome before. Infection comprised 76% of cases, thus broad-spectrum and long-term antibiotics use have been emphasized instead of steroid use. However, steroids also play an important role in reducing nerve injury by edematous change.

Safety Precautions for Self-Performed Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Case of a Swallowed Swab

Oropharyngeal and nasopharyngeal specimens collected by swabbing are the pillars of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics. Commercially available rapid antigen tests and self-sampling polymerase chain reaction services have made specimen collection available anytime and anywhere in nonmedical settings. In this study, we report the case of a 45-year-old man who accidentally ingested a swab during self-performed SARS-CoV-2 rapid antigen testing. Imaging studies revealed an elongated foreign body in the stomach. Urgent gastroscopy confirmed the presence of the swabbing applicator in the gastric lumen, which was retrieved using a loop without any complications. Millions of SARS-CoV-2 tests are performed daily, of which an increasing proportion are performed by laypeople. Foreign bodies account for a particular set of complications, which can be avoided by cautious sampling and using the correct technique. Radiopaque labeling of instruments would be useful. Otherwise, rare serious events can occur that may require immediate medical interventions.