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Notes: Background:  Worm infestations may play a role in preventing allergies. There is a lack of epidemiological information from Western countries on the association between worm infestation and eczema.Objective:  To investigate the association between worm infestation and eczema in a proper temporal sequence and under consideration of allergic sensitization.Methods:  Two surveys were performed in East German school children. Questionnaire data included the history of eczema and worm infestation and their time of onset. Specific IgE antibodies to five common aeroallergens were measured and used to define nonatopic and atopic eczema. Logistic regression analyses were performed to control for relevant confounders (age, sex, parental school education and history of allergies). In order to confirm the findings a corresponding conditional regression analysis was applied on cases and controls matched by age and sex.Results:  A total of 4169 children participated (response 75 and 76%) who were, on average, 9.2 years old (47% girls). Overall 17.0% reported a prior worm infestation (Ascaris 44%, Oxyuris 33%) and 18.1% had a history of eczema. Eczema occurred significantly less frequent in children who had a worm infestation (prior to the onset of eczema) compared with children without such a history (8.1%vs 16.5%, ORadj: 0.45, 95% CI: 0.33–0.60). The finding was confirmed by the corresponding matched case–control analysis (ORadj: 0.57, 95% CI: 0.41–0.79). Atopic eczema was affected more by a prior worm infestation (ORadj: 0.31, 95% CI: 0.18–0.56) than the nonatopic eczema (ORadj: 0.58, 95% CI: 0.40–0.84). A total of 29.1% exhibited specific IgE antibodies to at least one aeroallergen. Sensitized children gave significantly less frequent a history of worm infestation (14.2%vs 18.3%, ORadj: 0.74, 95% CI: 0.60–0.92). Stratified analysis revealed that this effect most pronounced for a sensitization to house dust mite.Conclusions:  A worm infestation is associated with a reduced frequency of subsequent eczema, especially the atopic type. Furthermore allergic sensitization, especially to house dust mite, and worm infestation are negatively associated. The data support the concept that a lack of immune-stimulation by parasitic infections contributes to the development of allergies.

Notes: Background:  Moisture is vitally important for house dust mites and they cannot survive in cold or hot-dry climates.Aims of the study:  To investigate the influence of two extraordinarily cold and dry winters in 1995/1996 and 1996/1997 on house dust mite levels in German homes.Methods:  Dust samples were collected between June 1995 and December 2001 on the mattresses of 655 adults and 454 schoolchildren living in five different areas of Germany. We compared house dust mite allergen Dermatophagoides pteronyssinus (Der p 1) levels before and during the winters of 1995/1996 and 1996/1997 with levels after these winters.Results:  D. pteronyssinus (Der p 1) levels in samples taken after the cold winters of 1995/1996 and 1996/1997 were approximately two times lower than Der p 1 levels in dust samples collected before or during these respective winters (Geometric means: Erfurt 89 vs 33 ng/g; Hamburg 333 vs 219 ng/g; Bitterfeld, Hettstedt, and Zerbst 296 vs 180 ng/g). Except for Hamburg, the decrease in Der p 1 levels was statistically significant. D. pteronyssinus levels measured in dust samples collected in 2001 (i.e. 3 years after the two cold winters) show a statistically non-significant increase (Geometric means: Erfurt 33 vs 39 ng/g; Hamburg 219 vs 317 ng/g), suggesting that it may take a long time for mite allergen levels to increase again after a sudden decrease.Conclusion:  We conclude that Der p 1 levels in German mattress dust samples have been approximately reduced by a factor of three to four by the two consecutive cold winters of 1995/1996 and 1996/1997.

Notes: Background:  It has been suggested that exposure to elevated levels of endotoxin decreases the risk of allergic sensitization.Objective:  To examine the associations between current exposure to bacterial endotoxin in house dust and allergic sensitization in adults.Methods:  In 1995–1996, we conducted a nested case–control study following a cross-sectional study performed within the European Community Respiratory Health Survey (ECRHS). Data of 350 adults aged 25–50 years was analysed. Allergic sensitization was assessed by measurement of specific immunoglobulin E (IgE) against several inhalant allergens. Living room floor dust samples were taken. The endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate test.Results:  Multiple logistic regression analysis showed a negative association between exposure to house dust endotoxin and severe allergic sensitization. Odds ratios (95% CI) adjusted for place of residence, gender, age, and ‘caseness’ were 0.80 (0.64–1.00) for sensitization to ≥1 allergen and 0.72 (0.56, 0.92) for sensitization to ≥2 allergens using 3.5 kU/l as a cut-off value for sensitization. With regard to single allergens, the protective effect of endotoxin was strongest for pollen sensitization [aOR (95% CI) = 0.74 (0.58, 0.93)].Conclusion:  Our results indicate that current exposure to higher levels of house dust endotoxin might be associated with a decreased odds of allergic sensitization in adults.

Notes: Background:  There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies. Methods:  A population-based nested case-control study was conducted in 2000–01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM. Results:  26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p =0.004) and better educated (school education 〉 8 year vs ≤ 8 year; odds ratio (OR) 2.17, 1.28–3.67) and was mostly motivated by the assumption of few side-effects (78.3%), by a wish to try everything (71.7%), and by unsatisfying results from conventional therapy (66.3%). Users also had more experience with conventional therapy than nonusers (94.6% vs 63.6%; OR 10.10, 4.00–25.72). Four procedures accounted for almost the entire usage: homeopathy (35.3%), autologous blood injection (28.1%), acupuncture (16.6%), and bioresonance (10.0%). The AM were mostly promoted (40.2%) and provided (60.9%) by medical doctors, and produced median costs for single and entire treatment of 4 € (15–205) and 205 € (15–1278)e. Reimbursement from insurance companies was received by 52.3%, in full (37.8%) or partial (14.5%). Most subjects (55.4%) admitted that they would pay more (median 153e) for the achieved result. Users scored the efficacy of conventional therapy significantly lower ( p 〈0.001) than nonusers, and assessed the results of AM as very good (28.6%) or rather good (53.8%). Conclusions:  AM is used widely for allergies by the general population and is associated with considerable costs. This has implications for the health care system and health policy.

Notes: Background: We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics. Methods: Within a population-based nested, case-control study in Germany, we performed patch tests with 25 standard allergens in 1141 adults (50.4% female, age median 50 years). Additional information was obtained by a dermatologic examination, a standardized interview, and blood analysis. Results: At least one positive reaction was exhibited by 40.0% of the subjects, with reactions most frequently observed to fragrance mix (15.9%), nickel (13.1%), thimerosal (4.7%), and balsam of Peru (3.8%). Women were sensitized more often than men (50.2%vs 29.9%, OR 2.36, CI 1.84–3.03), and this was also significant for fragrance mix, nickel, turpentine, cobalt chloride, and thimerosal. Contact sensitization was more frequent in subjects who reported adverse skin reactions (53.8% vs. 32.6%; OR 2.41, CI 1.85–3.14), and this was particularly true for sensitization to nickel (45.5%vs 8.8%, OR 8.64, CI 5.67–13.17) and fragrance mix (29.0%vs 14.0%, OR 2.51, CI 1.60–3.91) and the corresponding intolerance of fashion jewelry and fragrances. Contact sensitization decreased with increasing degree of occupational training (unskilled 45.9%, apprenticeship 40.1%, technical college 40.4%, and school of engineering 12.5%; P=0.023; trend test P=0.042). Significant associations of contact sensitization and presence of allergen-specific IgE antibodies, atopic eczema, or psoriasis were not observed. Frequency estimates for the general adult population based on these findings were 28.0% for overall contact sensitization and 11.4% for fragrance mix, 9.9% for nickel, and 3.2% for thimerosal. Conclusions: It is concluded that contact allergy is influenced by sociodemographic parameters and plays an important role in the general population.

Notes: Background:  The study of partners can help to understand the impact of environmental influences on the development of allergies. We aimed to test the hypothesis that subjects whose partners have hay fever are at increased risk for the same disease and that the risk increases with the time subjects live together with an affected partner.Methods:  A nested unmatched case–control study was performed in a random sample of 4261 inhabitants, aged 25–74 years, of the City of Augsburg, Germany, and two adjacent counties. Using standardized computer-assisted face-to-face interviews, we determined the risk of doctor-diagnosed hay fever in subjects who lived together with a partner having the same disease as opposed to subjects living with an unaffected partner. Furthermore, the risk of doctor-diagnosed hay fever depending on the time the subjects had lived together with an affected partner was calculated.Results:  After adjustment for age, sex, parental predisposition and social status, the risk of hay fever was more than double in subjects who lived together with a partner having the same disease (odds ratio, ORadj., 2.41; 95% confidence interval, CI, 1.48–3.92). If subjects lived together with an affected partner, the risk of developing the disease increased with the time the partners lived together (1–11 years, OR 1; 12–23 years, OR 1.8; 24–35 years, OR 7.4; 36–54 years, OR 13.7).Conclusion:  The risk of developing hay fever is significantly elevated in subjects who live together with a partner having the same disease. The risk further increases with the time the partners live together. This points to important shared environmental influences or behaviours and raises speculations on a transmissible cause.

Notes: Background: Recent cross-sectional studies suggested that highest sensitization prevalences occur with moderate cat allergen exposures. We aimed to assess the impact of moderate levels of second-hand cat allergen exposure on the incidence of specific sensitization and wheezing in the framework of a birth cohort study. Therefore we restricted our analysis to infants without a cat at home since birth.Methods: At infant's age 3 months, cat allergen levels were measured in the mattress dust of 1840 families without cats. At age 2 years, serum IgE specific to Fel d 1 was analyzed. Incidence of wheezing apart from respiratory infection was assessed by questionnaire. Logistic regression models were used to calculate adjusted odds ratios (OR) for the association between second-hand cat allergen exposure and health outcomes.Results: Until age 2 years, 13 of 1301 infants (1%) were sensitized to cat allergen and 56 of 1492 infants (4%) had ever-wheezing without infection. Early exposure to second-hand cat allergen levels ≥ 1 µg/g dust increased substantially the risk for specific sensitization to Fel d 1 (OR 10.9, 95% CI 3.4–35.0) and ever-wheeze without infection (OR 2.0, 95% CI 1.1–3.9) at age 2 years.Conclusions: Second-hand exposure to cat allergen in homes without cats is detrimental in terms of allergy development in infants.

Notes: Background: House dust samples collected for exposure studies are often stored for variable time periods until analysis. However, there is currently no information on the effects of dust storage on the content of biocontaminants. Therefore, associations were analysed between the levels of mite allergens (Der p 1, Der f 1), cat allergen (Fel d 1) and microbial components (endotoxin, β(1→3)-glucan) on the one hand and the storage duration of dust samples at −20°C on the other hand.Methods: Within the framework of a study on the influences of INdoor factors and Genetics on Asthma (INGA), dust samples were collected from living room floors between June 1995 and August 1998 and extracted according to a standardized protocol. The concentrations of Der p 1, Der f 1, Fel d 1 and β(1→3)-glucan were determined with specific enzyme immunoassays. Endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate (LAL) test. All concentrations were expressed per gram of dustResults: Dust samples (n = 1236) were obtained from 655 homes in Hamburg, Hettstedt, Zerbst and Bitterfeld. Storage duration (range 8–298 days) was grouped into four categories (≤ 60 d; 61–90 d; 91–120 d; 〉 120 d). After adjustment for city of residence and season of dust sampling, means ratios comparing categories 2–4 to the first category were not statistically significant for Der p 1, Der f 1, endotoxin and β(1→3 glucan). However, Fel d 1 concentrations significantly declined with increased storage times of dust samples.Conclusions: Storage of house dust at −20°C for up to 10 months has no effect on mite allergen, endotoxin and β(1→3)-glucan levels. A potential loss of Fel d 1 during storage of frozen dust samples needs further investigations by repeated measurements of allergen in identical dust samples.

Notes: Recent studies have found a higher prevalence of allergic rhinitis and atopic sensitization among adults living in eastern than those living in western Germany. We hypothesize that prevalence rates were similar before Germany was divided and diverged after the division. Because there are no historical data comparing atopic status between the two parts of Germany, we tested this hypothesis by comparing the prevalence of atopy among persons who were born during different decades. As part of the EC Respiratory Health Survey, a respiratory health questionnaire was mailed to a population-based sample of 8363 subjects aged 20–44 years from a city in the former West Germany (Hamburg) and a city in the former East Germany (Erfurt). Of the target population. 6428 (77%) subjects responded. Subsamples of 731 subjects from Erfurt and 1159 subjects from Hamburg participated in medical examinations, including skin prick tests and specific IgE measurements. Prevalence rates of allergic sensitization were similar in Hamburg and Erfurt for those born in the periods 1946–51 and 1952–61. respectively, but differed between Hamburg and Erfurt subjects born in the period 1962–71. After adjustment for several potential predictors, the younger subjects from Hamburg had a higher odds ratio (OR) of sensitization than those Hamburg subjects born before 1952 (skin prick test reactivity: OR 2.06. any specific IgE 〉 0.35 kU/1: OR 1.61). The younger subjects from Erfurt were not more frequently sensitized than the older subjects (skin prick test reactivity: OR 1.05. any specific IgE 〉 0.35 kU/1: OR 0.79). No single allergen could be identified as responsible for the observed difference. We conclude that factors related to a “Western lifestyle”, which were prevalent in the West German city during the 1960s and i970s. may be responsible for the higher prevalence of allergic sensitization observed in Hamburg.

Notes: Background The increase in allergic diseases is still unexplained. It was hypothesized that the intake of unsaturated fatty acids is a contributing cause of this development. We investigated the relationship between serum cholesterol levels, intake of polyunsaturated fatty acids (PUFA) and manifestations of atopy in a population-based setting.Methods A nested case–control study was performed within the population of the 3rd MONICA survey in Augsburg (Germany). The serum levels of total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol of 1537 adults (aged 28–78 years, response 61.4%) and the estimated intake of PUFA in a subset of 139 men were compared with the frequency of a doctor's diagnosis of asthma, allergic rhinoconjunctivitis (AR), atopic eczema (AE) and allergic sensitization as measured by skin prick and Radio Allergo Sorbent Test.Findings In bivariate analyses, we obtained a negative linear association between total and LDL cholesterol levels and the frequency of AR and sensitization, which was no longer significant after adjustment for important confounders. In contrast, positive linear associations were found between HDL cholesterol levels and AR and AE and, furthermore, between the intake of PUFA and allergic sensitization in men (P〈0.01). After adjustment, an increasing risk for atopic diseases with increasing levels of HDL cholesterol and an increasing risk for allergic sensitization with increasing intakes of PUFA remained statistically significant.Interpretation There is indication that HDL cholesterol also plays a role in the complex interaction of fat intake, metabolism and the manifestation of atopy in adults. These findings may contribute to the understanding of time trends and regional differences of allergies.