Study Recommends Stronger Focus on Non-Frequent Pollen Allergens

Galina Balakirski, MD

Investigators from Germany suggested that sensitization to non-frequent pollen allergens be considered when examining patients with seasonal symptoms.

Additionally, the team, led by Galina Balakirski, MD, Department of Dermatology and Allergology, University Hospital RWTH in Achen, recommended testing and respective therapy of allergens for non-frequent pollen allergies be made available, which could be accessed through a nationwide pollen monitoring system with continuous pollen data and systematic sensitization monitoring at a patient level.

In Germany, 15% of adults and 11% of children and adolescents suffer from allergic rhinitis. Regarding asthma, 9% of adults and 5% of children and adolescents are affected. Occupational allergens and other pollen allergens, though rare, have affected adult and adolescent patients in Germany.

Despite this, there has been a decline in the number and spectrum of commercially available allergen tests in Germany, which has resulted in a diagnostic and therapeutic gap regarding patients with non-frequent allergies.

Based on available data from 2 German federal states, Balakirski and colleagues expanded the list of tested allergens to an additional 6 non-frequent allergens using skin prick testing and/or sIgE analysis and complete sensitization data by anamnestic data on complaint periods and regional pollen data.

The Methods

A total of 952 patients with suspected allergic respiratory diseases were recruited between May 2011 and July 2013.

The study would be conducted at the Department of Dermatology and Allergology of the University Hospital of the Rhineland‐Westphalian Technical College Aachen and was divided between descriptive and analytical segments.

Balakirski and colleagues conducted medical interviews to gather information on symptomatic periods, and patients were asked to highlight all the months over the course of a year with symptoms related to their hay fever/allergic rhinitis disease. Questions were applied from the Mini Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ).

Additionally, data on 12 pollen types were provided by the German Pollen Information Service Foundation (PID and its associated monitoring stations Mönchengladbach (NRW) and Munich (Bavaria). Data on some pollen, such as goosefoot family pollen, were limited.

The Findings

Based on sensitization data collected by skin prick testing, investigators found that most patients were sensitized to pollen allergens from alder, hazel, birch, and sweet grasses with respective sensitization rates of more than 65% in NRW as well as in Bavaria.

The list was followed by ash (33%), olive (20%), mugwort (25%), ragweed (22%), and plane tree (11%) in NRW and olive (41%), ash (22%), mugwort (22%), and ragweed (13%).

Regarding pollen allergens, patients were typically sensitized to components of alder, hazel, birch, and Timothy grass, rates ranging from 45% for Aln g 1 (alder) in NRW to 66% for Bet v 1 (birch) in Bavaria. Cyn d 1 (Bermuda grass) showed sensitization rates of 49% in NRW and 52% in Bavaria.

Regarding pollen pan‐allergen components, 17% (119/699) of patients (NRW: 16% [56/360], Bavaria: 19% [63/339]; p = 0.287) were sIgE positive to at least 1, and exclusion of these patients from analysis did not significantly change the pollen sensitization pattern.

Compared to patients without respective pollen sensitization, patients with sensitization to tree pollen more often displayed symptoms in the first months of the year. Patients with sensitization to sweet grasses or weed pollen more often displayed symptoms in the middle of the year and in late summer.

Of the 16 allergens analyzed, 4 were explicitly within the scope of the German TAO and considered as frequent allergens: alder, hazel, birch and sweet grasses.

Population‐based data from DEGS1 showed that these allergens were the most frequent with respect to sensitization in German adults.

“Our data strongly underline the importance of a nationwide pollen and sensitization monitoring for adequate management of allergic patients,” the investigators wrote. “Ideally, pollen monitoring should provide continuous real‐time pollen data representative for a given region, and these data should be available for free.”