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THE CLIMATE AANNDD AAEERROO AALLLLEERRGGEENNSS IINN 
MMEEDDIITTEERRRRAANNEEAANN RREEGGIIOONN AANNDD AALLLLEERRGGEENN 
SSEENNSSIITTIIVVIITTYY IINN AALLLLEERRGGIICC 
RRHHIINNOOCCOONNJJUUNNCCTTIIVVIITTIISS AANNDD AALLLLEERRGGIICC AASSTTHHMMAA 
PPAATTIIEENNTTSS 
MMEEDD SSCCII MMOONNIITT 22001133((22)) 
ARZU DIDEM YALCIN, MD. 
Department of Internal Medicine, Allergy and 
Clinical Immunology Unit. 
XXI World Congress of Asthma 
Interasma Global Assosiation 
Sunday, August 19, Room B, 16.00-17.30 
Oral presentation 38 
QUEBEC/CANADA
Background: In this study, we evaluated 
the profiles of allergic rhino-conjunctivitis 
and asthma patients annually in a 
mediterranean coastal city Antalya in Turkey 
Methods: As well as evaluating patients’ 
allergic clinical status, we also recorded the 
climate and pollens in the air of city center if 
any correlation between pollination, climatic 
conditions and allergic disorders. Total and 
specific IgE levels and skin prick tests (SPT) 
were evaluated. The meteorological 
conditions and the pollen count/cm2 in each 
month of whole year and the concordance of 
this with the patient’s clinical status were 
evaluated.
 Results: 
 The major causes of allergic rhinoconjunctivitis symptoms 
were air pollens and house dust. SPT positivity for 
corylusavellana was significant in the age group of >40 
years old. SPT positivity for plantagolanceolata, aspergillus 
fumigatus and d. pteronyssinus was significant in patients 
younger than 40 years old Pollination levels are consistent 
from March 2010 to February 2011 and in Antalya high 
levels occur mostly from April to June. Thus skin prick test 
were performed mostly in May/June (~30%). During these 
months, the meteorological conditions of the city were 
windy with low humidity without rain and lukewarm 
temperatures, all of which contribute to high risk 
conditions for seasonal allergies. 

Results: 
 Of the 866 patients studied, 92.8 % of 
whom lived in the city center, 66.1 % were 
females. 61.21 % of these 866 patients had 
allergic rhinoconjunctivitis and 38.79 % had 
asthma and allergic rhinoconjunctivitis. 16.3 % 
of all cases were active smokers, and among all 
cases ~40% had increased symptoms with 
exposure to both active/passive cigarette 
smoking. Approximately the same numbers of 
patients with higher than 100 kU/L total IgE 
levels and who had allergen-specific IgE 
positivity, clustered in the age ranges 10-19, 
20-29, 30-39 and 40-49, as shown in Table I.
Number of patients Percentage % 
SEX 
Male 294 33.9 
Female 572 66.1 
AGE 
10-19 179 20.7 
20-29 192 22.2 
30-39 203 23.4 
40-49 155 17.9 
50-59 83 9.6 
60+ 54 6.2 
Table I. Demographics for the ppaattiieenntt ggrroouupp ((nn=86666))
CLINICAL VISIT NUMBERS PER MONTH 
January 59 6.8 
February 92 10.6 
March 86 9.9 
April 104 12.0 
May 152 17.6 
June 127 14.7 
July 55 6.4 
August 40 4.6 
September 48 5.5 
October 24 2.8 
November 40 4.6 
December 39 4.5
Table II. Skin prick test results for patients (nn==886666)) aanndd %% ppoossiittiivviittyy 
ttoo ddiiffffeerreenntt aalllleerrggeennss.. 
Test x ± SD (mm) Minimum maximum size(mm) 
Positive Result 
Number of patients Percentage of patients 
Positive control 11,15±3,79 1 - 24 863 99.6 
Negative control 0,17±1,03 2 - 10 23 2.6 
GRASS MIX 5,86±4,03 1 - 30 703 81.2 
holcuslanatus 4,14±4,08 3 - 23 512 59.1 
dactylisglomerata 4,75±4,40 3 – 26 594 68.6 
loliumperenne 4,56±4,29 1 - 28 568 65.6 
phleumpratense 3,46±3,76 3 – 21 452 52.2 
poapratensis 3,54±3,92 2 – 24 459 53.0 
festucapratensis 3,15±3,74 2 – 19 416 48.0 
BARLEY MIX 4,09±4,20 2 - 30 516 59.6 
hordeumvulgare 2,78±3,65 3 – 20 366 42.3 
triticumsativum 2,61±3,54 2 – 20 351 40.5 
secalecereale 2,32±3,63 2 – 22 316 36.5 
avenasativa 2,32±3,35 2 – 18 319 36.8 
WEED MIX 3,35±3,39 1 – 21 471 54.4 
artemissiavulgaris 3,26±3,21 3 – 14 477 55.1 
urticadioica 2,45±2,99 2 – 12 372 42.9 
plantagolanceolata 2,65±3,15 3 – 18 396 45.7 
taraxacumofficianele 2,46±3,33 3 – 20 353 40.8
Table II. Skin prick test results for patients (nn==886666)) aanndd %% ppoossiittiivviittyy 
ttoo ddiiffffeerreenntt aalllleerrggeennss.. 
TREE MIX 3,22±3,46 3 - 21 433 50.0 
alnusglutinosa 2,40±3,19 3 – 18 337 38.9 
corylusavellana 2,42±3,50 3 – 44 326 37.6 
populusalba 2,52±3,12 3 – 13 366 42.3 
salixcaprea 2,69±3,08 2 – 11 397 45.8 
betulaverricosa 2,12±2.99 3 – 10 307 35.4 
pinussilvestris 1,45±2,68 3 – 10 207 23.9 
quereusrobur 2,58±3,03 3 – 10 386 44.6 
robininapseudoacacia 0,17±1,03 2 – 10 23 2.6 
oleaauropeae 3,57±3,48 3 – 18 491 56.7 
EPITHELIAL ALLERGENS 
dog 3,30±3,14 2 – 10 486 56.1 
cat 2,91±3,26 3 – 15 415 47.9 
horse 0,08±0,71 4 – 9 10 1.1 
FUNGAL ALLERGENS 
alternaria 3,38±3,18 2 – 18 496 57.3 
aspergillusfumigatus 3,36±3,17 3 – 19 493 56.9 
MITE MIX 
D. pteronyssinus 3,88±3,69 3 – 36 532 61.4 
D. farinae 3,95±4,54 3 – 45 517 59.7 
P. germanica 0,07±0,70 4 – 11 9 1.0 
P. america 0,03±0,39 3 – 8 4 0.5 
Blatella germanica 2,73±3,32 3 - 35 457 52.8
Table III. Age distribution (n=886666)) aanndd mmeeaann SSPPTT ppoossiittiivviittyy 
AGE Corylusavellana 
X±Sd (mm) 
Aspergillus fumigatus 
X±Sd (mm) 
Dpteronyssinus 
X±Sd (mm) 
Plantagolanceolata 
X±Sd (mm) 
<40 
2.21±3.14 3.59±3.12 4.12±3.78 3.00±3.49 
40+ 
2.82±4.09 2.93±3.23 3.42±3.47 2.19±2.90 
Independent-samples t-test 
p=0.02 p=0.004 p=0.008 p=0.001
Table IV: The most commonly detected mmoonntthhss ooff tthhee aalllleerrggeennss 
Allergens Most common on … % 
Grass mix (n:703) May (n:115), June(n:97) 30,2 
Barley mix (n:516) May (n:94), June (n:89) 35,5 
Weed mix (n:471) May (n:71), June (n:71) 30,1 
Tree mix (n:433) May (n:77), June (n:77) 35,6
Table V: Monthly pollination ratios
What is already known on this 
subject? 
 Allergic rhinoconjunctivitis-asthma is 
a common health problem that its 
prevalence and varies from region to 
region. Several studies have investigated 
the association between pollen exposure 
and asthma emergency admissions, but 
only two have investigated the effect of 
airborne allergens on consultations for 
rhinitis.
What this study adds? 
 In this study, we evaluated the 
climate and pollens in the air and the 
correlation between pollination, 
climatic conditions and clinical status 
of the allergic patients. The results 
suggesting that the pollination is 
correlated with allergic conditions and 
thus skin prick test might be best 
performed according to the pollen 
population. 

Conclusion: The major allergen between 
April and June was derived from 
Graminae; between February and March 
was Cupressus sp; and between March 
and June was Pinus sp. These results 
suggest that the pollination is correlated 
with allergic conditions and thus SPT 
might be best performed according to the 
pollen population.
TThhaannkk yyoouu 
PPrrooff.. DDrr.. TTssee WWeenn CCHHAANNGG,, PPhh..DD.. ((TTaaiiwwaann)) 
PPrrooff.. DDrr.. SSaaaaddeett GGUUMMUUSSLLUU,, PPhh..DD.. 
PPrrooff.. DDrr.. RReeggiinnaalldd MM GGOORRCCZZYYNNSSKKII,, MMDD,, PPhhDD.. ((CCaannaaddaa)) 
PPrrooff..DDrr.. OOllccaayy YYEEGGIINN,, MMDD.. 
PPrrooff.. DDrr.. LLuuddwwiigg GG.. SSTTRRAAUUSSSS,, MMDD ((GGeerrmmaannyy)) 
PPrrooff..DDrr.. FFeelliixx HHEERRTTHH,, MMDD,, PPhhDD.. ((GGeerrmmaannyy)) 
PPrrooff.. DDrr.. AAyykkuutt CCIILLLLII,, MMDD.. 
GGiizzeemm EEssrraa PPAARRLLAAKK MMSScc.. 
DDrr.. AAttiill BBIISSGGIINN,, MMDD,, PPhhDD ((SSwweeddeenn)) 
PPrrooff.. DDrr.. HHaassaann HHuusseeyyiinn PPOOLLAATT,, MMDD.. 
DDrr.. EEmmeell SSAAHHIINN,, PPhhDD.. 
Arzu Didem Yalcin ,MD adidyal@yahoo.com
AAttiill ,,HHaassaann,, SSaaiimmee,, RReegg,, ÖÖzzlleemm,, IIbbrraahhiimm,, RReeyyhhaann,, RRaahhiimmee,, BBuulleenntt,, HHaallee.. 
TTHHAANNKK YYOOUU

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THE CLIMATE AND AERO ALLERGENS IN MEDITERRANEAN REGION AND ALLERGEN SENSITIVITY IN ALLERGIC RHINOCONJUNCTIVITIS AND ALLERGIC ASTHMA PATIENTS

  • 1. THE CLIMATE AANNDD AAEERROO AALLLLEERRGGEENNSS IINN MMEEDDIITTEERRRRAANNEEAANN RREEGGIIOONN AANNDD AALLLLEERRGGEENN SSEENNSSIITTIIVVIITTYY IINN AALLLLEERRGGIICC RRHHIINNOOCCOONNJJUUNNCCTTIIVVIITTIISS AANNDD AALLLLEERRGGIICC AASSTTHHMMAA PPAATTIIEENNTTSS MMEEDD SSCCII MMOONNIITT 22001133((22)) ARZU DIDEM YALCIN, MD. Department of Internal Medicine, Allergy and Clinical Immunology Unit. XXI World Congress of Asthma Interasma Global Assosiation Sunday, August 19, Room B, 16.00-17.30 Oral presentation 38 QUEBEC/CANADA
  • 2. Background: In this study, we evaluated the profiles of allergic rhino-conjunctivitis and asthma patients annually in a mediterranean coastal city Antalya in Turkey Methods: As well as evaluating patients’ allergic clinical status, we also recorded the climate and pollens in the air of city center if any correlation between pollination, climatic conditions and allergic disorders. Total and specific IgE levels and skin prick tests (SPT) were evaluated. The meteorological conditions and the pollen count/cm2 in each month of whole year and the concordance of this with the patient’s clinical status were evaluated.
  • 3.  Results:  The major causes of allergic rhinoconjunctivitis symptoms were air pollens and house dust. SPT positivity for corylusavellana was significant in the age group of >40 years old. SPT positivity for plantagolanceolata, aspergillus fumigatus and d. pteronyssinus was significant in patients younger than 40 years old Pollination levels are consistent from March 2010 to February 2011 and in Antalya high levels occur mostly from April to June. Thus skin prick test were performed mostly in May/June (~30%). During these months, the meteorological conditions of the city were windy with low humidity without rain and lukewarm temperatures, all of which contribute to high risk conditions for seasonal allergies. 
  • 4. Results:  Of the 866 patients studied, 92.8 % of whom lived in the city center, 66.1 % were females. 61.21 % of these 866 patients had allergic rhinoconjunctivitis and 38.79 % had asthma and allergic rhinoconjunctivitis. 16.3 % of all cases were active smokers, and among all cases ~40% had increased symptoms with exposure to both active/passive cigarette smoking. Approximately the same numbers of patients with higher than 100 kU/L total IgE levels and who had allergen-specific IgE positivity, clustered in the age ranges 10-19, 20-29, 30-39 and 40-49, as shown in Table I.
  • 5. Number of patients Percentage % SEX Male 294 33.9 Female 572 66.1 AGE 10-19 179 20.7 20-29 192 22.2 30-39 203 23.4 40-49 155 17.9 50-59 83 9.6 60+ 54 6.2 Table I. Demographics for the ppaattiieenntt ggrroouupp ((nn=86666))
  • 6. CLINICAL VISIT NUMBERS PER MONTH January 59 6.8 February 92 10.6 March 86 9.9 April 104 12.0 May 152 17.6 June 127 14.7 July 55 6.4 August 40 4.6 September 48 5.5 October 24 2.8 November 40 4.6 December 39 4.5
  • 7. Table II. Skin prick test results for patients (nn==886666)) aanndd %% ppoossiittiivviittyy ttoo ddiiffffeerreenntt aalllleerrggeennss.. Test x ± SD (mm) Minimum maximum size(mm) Positive Result Number of patients Percentage of patients Positive control 11,15±3,79 1 - 24 863 99.6 Negative control 0,17±1,03 2 - 10 23 2.6 GRASS MIX 5,86±4,03 1 - 30 703 81.2 holcuslanatus 4,14±4,08 3 - 23 512 59.1 dactylisglomerata 4,75±4,40 3 – 26 594 68.6 loliumperenne 4,56±4,29 1 - 28 568 65.6 phleumpratense 3,46±3,76 3 – 21 452 52.2 poapratensis 3,54±3,92 2 – 24 459 53.0 festucapratensis 3,15±3,74 2 – 19 416 48.0 BARLEY MIX 4,09±4,20 2 - 30 516 59.6 hordeumvulgare 2,78±3,65 3 – 20 366 42.3 triticumsativum 2,61±3,54 2 – 20 351 40.5 secalecereale 2,32±3,63 2 – 22 316 36.5 avenasativa 2,32±3,35 2 – 18 319 36.8 WEED MIX 3,35±3,39 1 – 21 471 54.4 artemissiavulgaris 3,26±3,21 3 – 14 477 55.1 urticadioica 2,45±2,99 2 – 12 372 42.9 plantagolanceolata 2,65±3,15 3 – 18 396 45.7 taraxacumofficianele 2,46±3,33 3 – 20 353 40.8
  • 8. Table II. Skin prick test results for patients (nn==886666)) aanndd %% ppoossiittiivviittyy ttoo ddiiffffeerreenntt aalllleerrggeennss.. TREE MIX 3,22±3,46 3 - 21 433 50.0 alnusglutinosa 2,40±3,19 3 – 18 337 38.9 corylusavellana 2,42±3,50 3 – 44 326 37.6 populusalba 2,52±3,12 3 – 13 366 42.3 salixcaprea 2,69±3,08 2 – 11 397 45.8 betulaverricosa 2,12±2.99 3 – 10 307 35.4 pinussilvestris 1,45±2,68 3 – 10 207 23.9 quereusrobur 2,58±3,03 3 – 10 386 44.6 robininapseudoacacia 0,17±1,03 2 – 10 23 2.6 oleaauropeae 3,57±3,48 3 – 18 491 56.7 EPITHELIAL ALLERGENS dog 3,30±3,14 2 – 10 486 56.1 cat 2,91±3,26 3 – 15 415 47.9 horse 0,08±0,71 4 – 9 10 1.1 FUNGAL ALLERGENS alternaria 3,38±3,18 2 – 18 496 57.3 aspergillusfumigatus 3,36±3,17 3 – 19 493 56.9 MITE MIX D. pteronyssinus 3,88±3,69 3 – 36 532 61.4 D. farinae 3,95±4,54 3 – 45 517 59.7 P. germanica 0,07±0,70 4 – 11 9 1.0 P. america 0,03±0,39 3 – 8 4 0.5 Blatella germanica 2,73±3,32 3 - 35 457 52.8
  • 9. Table III. Age distribution (n=886666)) aanndd mmeeaann SSPPTT ppoossiittiivviittyy AGE Corylusavellana X±Sd (mm) Aspergillus fumigatus X±Sd (mm) Dpteronyssinus X±Sd (mm) Plantagolanceolata X±Sd (mm) <40 2.21±3.14 3.59±3.12 4.12±3.78 3.00±3.49 40+ 2.82±4.09 2.93±3.23 3.42±3.47 2.19±2.90 Independent-samples t-test p=0.02 p=0.004 p=0.008 p=0.001
  • 10. Table IV: The most commonly detected mmoonntthhss ooff tthhee aalllleerrggeennss Allergens Most common on … % Grass mix (n:703) May (n:115), June(n:97) 30,2 Barley mix (n:516) May (n:94), June (n:89) 35,5 Weed mix (n:471) May (n:71), June (n:71) 30,1 Tree mix (n:433) May (n:77), June (n:77) 35,6
  • 11. Table V: Monthly pollination ratios
  • 12.
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  • 19. What is already known on this subject?  Allergic rhinoconjunctivitis-asthma is a common health problem that its prevalence and varies from region to region. Several studies have investigated the association between pollen exposure and asthma emergency admissions, but only two have investigated the effect of airborne allergens on consultations for rhinitis.
  • 20. What this study adds?  In this study, we evaluated the climate and pollens in the air and the correlation between pollination, climatic conditions and clinical status of the allergic patients. The results suggesting that the pollination is correlated with allergic conditions and thus skin prick test might be best performed according to the pollen population. 
  • 21. Conclusion: The major allergen between April and June was derived from Graminae; between February and March was Cupressus sp; and between March and June was Pinus sp. These results suggest that the pollination is correlated with allergic conditions and thus SPT might be best performed according to the pollen population.
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