Based on our analysis, the validity of the EAACI definitions on pollen season is confirmed. Their use is recommended in future clinical trials on AIT as well as in daily routine for optimal patient care.

Background: The effectiveness of allergen immunotherapy (AIT) in seasonal allergic rhinitis (AR) depends on the definition of pollen exposure intensity or time period.We recently evaluated pollen and symptom data from Germany to examine the new definitions of the European Academy of Allergy and Clinical Immunology (EAACI) on pollen season and peak pollen period start and end. Now, we aim to confirm the feasibility of these definitions to properly mirror symptom loads for grass and birch polleninduced allergic rhinitis in other European geographical areas such as Austria, Finland and France, and therefore their suitability for AIT and clinical practice support.Methods: Data from twenty-three pollen monitoring stations from three countries in Europe and for 3 years (2014-2016) were used to investigate the correlation between birch and grass pollen concentrations during the birch and grass pollen season defined via the EAACI criteria, and total nasal symptom and medication scores as reported with the aid of the patient's hay-fever diary (PHD). In addition, we conducted a statistical analysis, together with a graphical investigation, to reveal correlations and dependencies between the studied parameters. Results:The analysis demonstrated that the definitions of pollen season as well as peak pollen period start and end as proposed by the EAACI are correlated to polleninduced symptom loads reported by PHD users during birch and grass pollen season. A statistically significant correlation (slightly higher for birch) has been found between the Total Nasal Symptom and Medication Score (TNSMS) and the pollen concentration levels. Moreover, the maximum symptom levels occurred mostly within the peak pollen periods (PPP) following the EAACI criteria. Conclusions:Based on our analyses, we confirm the validity of the EAACI definitions on pollen season for both birch and grass and for a variety of geographical locations for the four European countries (including Germany from a previous publication) analyzed so far. On this basis, the use of the EAACI definitions is supported in future clinical trials on AIT as well as in daily routine for optimal patient care. Further evaluation of the EAACI criteria in other European regions is recommended. K E Y W O R D Sallergen immunotherapy, allergic rhinitis, geographic differences, peak pollen period, pollen concentration, pollen season

For nearly a decade, the majority of the world's population has been living in cities, including a considerable percentage of people suffering from pollen allergy. The increasing concentration of people in cities results in larger populations being exposed to allergenic pollen at the same time. There is almost no information about spatial distribution of pollen within cities as well as a lack of information about the possible impact to human health. To obtain this increasing need for pollen exposure studies on an intra-urban scale, a novelty screening network of 14 weekly changed pollen traps was established within a large metropolitan area-Berlin, Germany. Gravimetric pollen traps were placed at a uniform street-level height from March until October 2014. Three important allergenic pollen types for Central Europe-birch (Betula), grasses (Poaceae), and mugwort (Artemisia)-were monitored. Remarkable spatial and temporal variations of pollen sedimentation within the city and the influences by urban local sources are shown. The observed differences between the trap with the overall highest and the trap with the overall lowest amount of pollen sedimentation were in the case of birch pollen 245%, grass pollen 306%, and mugwort pollen 1962%. Differences of this magnitude can probably lead to different health impacts on allergy sufferers in one city. Therefore, pollen should be monitored preferably in two or more appropriate locations within large cities and as a part of natural air quality regulations.

Climate change affects the reproductive life cycles of plants, including pollen production, which has consequences for allergic respiratory diseases. We examined climatic trends at eight locations in Bavaria, Southern Germany, with pollen times-series of at least 10 years (up to 30 years in Munich). Climate change in Bavaria was characterized by a rise in temperature, but not during winter. There is also a trend towards a more continental climate in Bavaria, which is significant in the Alps in the south of the territory. The influence of climate change depended on pollen type. Wind-pollinated arboreal species (e.g. Alnus, Betula and Cupressaceae/Taxaceae) showed advances in the start and end dates of pollen seasons and an increase in pollen load. These changes correlated negatively with late-winter (February) and spring temperatures (April). For herbaceous species, like Poaceae and Urticaceae, an earlier season was observed. Although precipitation is not a limiting factor in Southern Germany, water availability in spring did influence the magnitude of grass pollen seasons. The effect of climatic change on the characteristics of pollen seasons was also more pronounced at higher altitudes, significant at > 800 m above sea level. Our results show that trends for start, end dates and intensity were similar at all locations, but only statistically significant at some. If we assume that earlier and more intense pollen seasons result in increases in prevalence and severity of allergic diseases, then the effect of climate change on public health in Bavaria may be significant.