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BackgroundComplete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. ObjectiveThe objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. MethodsThe @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. ResultsOverall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P

Today a large part of the European population is exposed to levels of air pollution exceeding the standards recommended by the World Health Organization. Moreover, air pollution and the seasonal emission of allergenic pollen are progressively affecting human health and can cause severe allergic reactions, particularly when air pollution combines with pollen allergen peaks. Unlike atmospheric pollutants of anthropogenic origin, pollen sources have a pulsating trend that leads to high values in the flowering period and values close to, or equal to, zero in the rest of the year. This aspect makes essential the definition of data coverage standards for the main allergenic taxa. For air quality assessment detailed classification criteria for monitoring stations are defined by international standards, not the same from the European Standards for the Sampling and analysis of airborne pollen grains and fungal spores. This paper describes the status and the air concentration trends of the main allergenic pollen and the Alternaria spore measured in Rome from 2003 to 2019 by the Aerobiological Monitoring Center of Tor Vergata (Rome) and calculated by the Seasonal Kendall test with the open-source OpenAir R package. The analysis was carried out on the daily concentrations of the most widespread allergenic taxa in Italy: Asteraceae, Betulaceae, Corylaceae, Cupressaceae/Taxaceae, Poaceae, Oleaceae, Urticaceae and the Alternaria spores. [ABSTRACT FROM AUTHOR]

(1) Background: Rome is a municipality with an area of 1287 km2 and presents floristic-vegetational complexity that is reflected in the composition of aerospora, which are responsible for pollinosis. The presence of airborne pollen can be detected by pollen monitoring. The large extent of the city's territory makes it possible to verify possible changes in pollen composition in different sites of the city. With this in mind, a study was conducted to assess the differences in airborne pollen concentration, considering phenological and production indicators at three different sites in the city. (2) Methods: Pollen data of eight taxa were considered, Alnus spp., Castanea sativa Miller, Cupressaceae-Taxaceae, Olea europaea L., Platanaceae, Poaceae, Quercus spp., and Urticaceae, during 2020 and 2021, using three monitoring samplers. The airborne pollen concentration and the seasons of the three centers were calculated and compared with each other. (3) Results: The diversity between the three samplers shows a phenological succession in accordance with the microclimatic diversity present in the city. The heterogeneity of the airborne pollen concentration reflects the floristic-vegetational diversity, while qualitative and quantitative parameters indicate a homogeneous flowering trend reflecting the seasonality of the various species. (4) Conclusions: The present work and the Italian geographic context suggest the need for a greater number of sampling points to guarantee a true localization of the data. Having several sampling stations also contributes to the protection of health and green areas, which are difficult to manage, conserve, and maintain. [ABSTRACT FROM AUTHOR]

A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the allergic rhinitis and its impact on asthma severity items. For our analysis, we used the (i) cumulative dSS/CSMS/VAS; (ii) average dSS/CSMS/VAS; and (iii) number of "high days", surpassing the arbitrarily chosen thresholds of >=1 for dSS (max. 3), >=2 for CSMS (max. 6) and >=3 for VAS (max. 10). While patients who retrospectively judged their AR symptoms as persistent, indicated to suffer from allergic symptoms during more than 50% of the recorded days (Figure 1, bottom left), those retrospectively assessing their symptoms as intermittent, showed a broader range of data entries indicating symptoms. [Extracted from the article]

Objective: In aerobiological monitoring and agriculture there is a pressing need for accurate, label-free and automated analysis of pollen grains, in order to reduce the cost, workload and possible errors associated to traditional approaches. Methods: We propose a new multimodal approach that combines electrical sensing and optical imaging to classify pollen grains flowing in a microfluidic chip at a throughput of 150 grains per second. Electrical signals and synchronized optical images are processed by two independent machine learning-based classifiers, whose predictions are then combined to provide the final classification outcome. Results: The applicability of the method is demonstrated in a proof-of-concept classification experiment involving eight pollen classes from different taxa. The average balanced accuracy is 78.7% for the electrical classifier, 76.7% for the optical classifier and 84.2% for the multimodal classifier. The accuracy is 82.8% for the electrical classifier, 84.1% for the optical classifier and 88.3% for the multimodal classifier. Conclusion: The multimodal approach provides better classification results with respect to the analysis based on electrical or optical features alone. Significance: The proposed methodology paves the way for automated multimodal palynology. Moreover, it can be extended to other fields, such as diagnostics and cell therapy, where it could be used for label-free identification of cell populations in heterogeneous samples. [ABSTRACT FROM AUTHOR]

Background: Allergen immunotherapy (AIT) is the only disease‐modifying treatment in patients with seasonal allergic rhinoconjunctivitis (SAR). Its efficacy depends on the precise identification of the triggering allergen. However, diagnostics based on retrospective clinical history and sensitization to whole extracts (SWE) often leads to equivocal results. Objectives: To assess the usability and impact of a recently established algorithm for a clinical decision support system (@IT2020‐CDSS) for SAR and its diagnostic steps [anamnesis, SWE (skin prick test or serum IgE), component resolved diagnosis, CRD, and real‐time digital symptom recording, eDiary] on doctor's AIT prescription decisions. Methods: After educational training on the @IT2020‐CDSS algorithm, 46 doctors (18 allergy specialists, AS, and 28 general practitioners, GP) expressed their hypothetical AIT prescription for 10 clinical index cases. Decisions were recorded repeatedly based on different steps of the algorithm. The usability and perceived impact of the algorithm were evaluated. Results: The combined use of CRD and an eDiary increased the hypothetical AIT prescriptions, both among AS and GP (p <.01). AIT prescription for pollen and Alternaria allergy based on anamnesis and SWE was heterogeneous but converged towards a consensus by integrating CRD and eDiary information. Doctors considered the algorithm useful and recognized its potential in enhancing traditional diagnostics. Conclusions and clinical implications: The implementation of CRD and eDiary in the @IT2020‐CDSS algorithm improved consensus on AIT prescription for SAR among AS and GP. The potential usefulness of a CDSS for aetiological diagnosis of SAR and AIT prescription in real‐world clinical practice deserves further investigation. [ABSTRACT FROM AUTHOR]

Nowadays, technology permeates every aspect of human activity, from the professional to the recreational side, and the recent pandemic crisis has only amplified a clearly defined trend. Through portable devices, people play, work, and get information. The immediacy of information and of many aspects of our life is a condition that, once acquired, is difficult to give up. However, immediate information must also be correct, and not all issues can easily be simplified to the point of being understandable in the absence of basic theoretical notions to a large audience. This aspect is particularly relevant when dealing with issues related to human health and the communication problems encountered in recent months concerning the spread of SARS‐CoV‐2, and the vaccination campaign is there to prove it. With the intent of clarifying the advantages and disadvantages of fast and accessible information, in this article, some of the most widespread applications for mobile devices, dedicated to pollen allergens, air quality, parks, gardens, and green areas, were examined. A widespread lack of clarity on the sources of the data and on the criteria used to formulate synthetic judgments—that often confuse the final users—was noted. [ABSTRACT FROM AUTHOR]

Summary: Background: The identification of the primary sensitizing pollen is difficult in Southern European patients with Seasonal Allergic Rhinitis (SAR) if sensitized to various pollen sources with overlapping seasonality. A more precise diagnosis is obtained by IgE assays to allergen molecules, currently available as singleplex or microarrays. Objectives: To test the analytical performance of a multi‐parameter immunoblot molecular "Pollen Test" specifically designed to test IgE antibodies to pollen extracts and molecules clinically relevant in Southern Europe. Methods: Sera were obtained from 101 children and 98 adults with SAR and tested with a customized multiplex immunoblot assay (EUROLINE Southern European Pollen Profile [ESEP]; EUROIMMUN AG, Luebeck, Germany) containing a comprehensive panel of allergen extracts and molecules. ESEP's outcomes were then compared in selected sera (ESEP positive to negative = 2:1) with those of singleplex IgE assays (ImmunoCAP; ThermoFisher Scientific, Uppsala, Sweden). For each of the examined reagents, qualitative (sensitivity, specificity, accuracy), semi‐quantitative (classes) and quantitative (Spearman's rank correlation, Bland‐Altmann plots) comparisons were performed. Results: Compared to ImmunoCAP, cumulative ESEP's sensitivity and specificity were 87% (95% CI 84%‐90%) and 88% (83%‐93%) for extracts and 99% (98%‐100%) and 87% (83%‐91%) for molecules. Cohen's kappa coefficients (κC) ranged for extracts from 0.18 (Pellitory) to 0.50 (Cypress) and for molecules from 0.21 (Ole e 1) to 0.68 (Phl p 7). The quantitative outcomes of the two diagnostic tests were highly correlated, with Spearman's rank correlation coefficients always exceeding 0.80. Bland‐Altmann plots showed a tendency of ESEP to overestimate serum specific IgE levels, when compared to ImmunoCAP. Conclusions and clinical relevance: Sensitivity and specificity of ESEP in testing serum IgE antibodies against pollen allergen extracts and molecules, in Italian patients with SAR, both exceeded 85%. The advantages and limitations of a multiplex customized immunoblot assay, in the routine clinical use of molecular diagnostics in Southern European pollen allergic patients, deserve to be tested. [ABSTRACT FROM AUTHOR]

In the last few years, we have witnessed an important development in the medical field of both Mobile Health, such as the use of mobile communication devices, and other telemedicine tools in general, in order to support the surveillance of diseases from the moment of the first diagnosis to the therapeutic follow‐up. Long before COVID‐19, some authors had analyzed various possible evidence‐based scenarios and had indicated how the use of telemedicine could prove to be extremely useful in epidemic situations, especially for the management of chronic patients, such as immune‐allergic ones, who are notoriously in greater need of regular follow‐up; however, as expected, the advent of the COVID‐19 pandemic has amplified the differences between various countries, from the point of view of the propensity to use technological solutions in the health sector. The hope is that one positive outcome of the ongoing pandemic is that it will lead to an acceleration, by all the stakeholders involved, of the process of modernization of health care. [ABSTRACT FROM AUTHOR]

Pollen exposure in occupational settings involves different categories of workers. In this paper the effects of diurnal pollen variations have been evaluated in two sites characterized by different vegetation and urbanization: the suburban site of Tor Vergata (TV) and the rural site of Monte Porzio Catone (MPC). Aerobiological and meteorological monitoring was performed in the two sites during the winter of 2017. The data analysis focuses on the comparison between pollen concentrations observed in relation to meteorological variables. In general, it can be stated that the indoor and outdoor dynamics for MPC and TV are different, with the outdoor concentration of pollen for MPC always higher than for TV, in accordance with significant presence of vegetation. The high nocturnal peaks detected in MPC and completely absent in TV could be caused by the presence of particular conditions of stagnation combined with greater emissions from the pollen sources. Furthermore the higher I/O ratio observed during the working hours in TV compared to MPC could be ascribed to the workers' behavior. Exposure to pollen can be responsible for several health effects and the knowledge of its level can be useful to improve the evaluation and management of this biological risk. [ABSTRACT FROM AUTHOR]

Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording.Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach.Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season.Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=-0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone.Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts. [ABSTRACT FROM AUTHOR]

Background: Pollen food allergy syndrome (PFAS) is a frequently underdiagnosed disease due to diverse triggers, clinical presentations, and test results. This is especially relevant in geographic areas with a broad spectrum of pollen sensitization, such as Southern Europe., Objectives: To elucidate similarities and differences of PFAS in nine Southern European centers and identify associated characteristics and unique markers of PFAS., Methods: As part of the @IT.2020 Multicenter Study, 815 patients with seasonal allergic rhinitis (SAR), aged 10-60 years, were recruited in seven countries. They completed questionnaires regarding SAR, comorbidities, family history, and PFAS, and underwent skin prick testing (SPT) and serum IgE testing., Results: Of the 815 patients, 167 (20.5%) reported PFAS reactions. Most commonly, eliciting foods were kiwi (58, 34.7%), peach (43, 25.7%), and melon (26, 15.6%). Reported reactions were mostly local (216/319, 67.7%), occurring within 5 min of contact with elicitors (209/319, 65.5%). Associated characteristics included positive IgE to at least one panallergen (profilin, PR-10, or nsLTP) (p = 0.007), maternal PFAS (OR: 3.716, p = 0.026), and asthma (OR: 1.752, p = 0.073). Between centers, heterogeneity in prevalence (Marseille: 7.5% vs. Rome: 41.4%, p < 0.001) and of clinical characteristics was apparent. Cypress played a limited role, with only 1/22 SPT mono-sensitized patients reporting a food reaction (p < 0.073)., Conclusions: PFAS is a frequent comorbidity in Southern European SAR patients. Significant heterogeneity of clinical characteristics in PFAS patients among the centers was observed and may be related to the different pollen sensitization patterns in each geographic area. IgE to panallergen(s), maternal PFAS, and asthma could be PFAS-associated characteristics., (© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: The adequate definition of pollen seasons is essential to facilitate a correct diagnosis, treatment choice, and outcome assessment in patients with seasonal allergic rhinitis. A position paper by the European Academy of Allergy and Clinical Immunology (EAACI) proposed season definitions for Northern and Middle Europe., Objective: To test the pollen season definitions proposed by EAACI in six Mediterranean cities for seven pollen taxa., Methods: As part of the @IT.2020 multi-center study, pollen counts for Poaceae, Oleaceae, Fagales, Cupressaceae, Urticaceae (Parietaria spp.), and Compositae (Ambrosia spp., Artemisia spp.) were collected from January 1 to December 31, 2018. Based on these data, pollen seasons were identified according to EAACI criteria. A unified monitoring period for patients in AIT trials was created and assessed for feasibility., Results: The analysis revealed a great heterogeneity between the different locations in terms of pattern and length of the examined pollen seasons. Further, we found a fragmentation of pollen seasons in several segments (max. 8) separated by periods of low pollen counts (intercurrent periods). Potential monitoring periods included often many recording days with low pollen exposure (max. 341 days)., Conclusion: The Mediterranean climate leads to challenging pollen exposure times. Monitoring periods for AIT trials based on existing definitions may include many intermittent days with low pollen concentrations. Therefore, it is necessary to find an adapted pollen season definition as individual solution for each pollen and geographical area., (© 2019 The Authors. Allergy published by John Wiley & Sons Ltd.)

In recent years, the interest of the scientific world towards vitamin D gradually increased, and several studies have been conducted to dissect its possible role in modulating the development/course of allergic diseases. Also, Vitamin D supplementation has been assessed as a beneficial approach for treating allergies in some, but not all studies. We reviewed herein the available and relevant literature concerning the possible links between Vitamin D, its supplementation and allergic diseases. A literature search was made independently by the Authors, identifying articles for a narrative review. As per literature, Vitamin D plays a key role in calcium and phosphate metabolism, and it is essential for bone health in infants, children and adolescents. However, there is presently insufficient evidence to support vitamin D supplementation for prevention or treatment of allergic diseases in infants, children and adolescents, concerning allergic rhinitis, asthma, food allergy and atopic dermatitis.