IMPORTANCE Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and is driven by a complex pathophysiology underlying highly heterogeneous phenotypes. Current advances in precision medicine emphasize the need for stratification. OBJECTIVE To perform deep phenotyping and identification of severity-associated factors in adolescent and adult patients with AD. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional data from the baseline visit of a prospective longitudinal study investigating the phenotype among inpatients and outpatients with AD from the Department of Dermatology and Allergy of the University Hospital Bonn enrolled between November 2016 and February 2020.MAIN OUTCOMES AND MEASURES Patients were stratified by severity groups using the Eczema Area and Severity Index (EASI). The associations of 130 factors with AD severity were analyzed applying a machine learning-gradient boosting approach with cross-validationbased tuning as well as multinomial logistic regression.RESULTS A total of 367 patients (157 male [42.8%]; mean [SD] age, 39 [17] years; 94% adults) were analyzed. Among the participants, 177 (48.2%) had mild disease (EASI Յ7), 120 (32.7%) had moderate disease (EASI >7 and Յ 21), and 70 (19.1%) had severe disease (EASI >21).
Intraspecific genetic variation might limit the relevance of environmental factors on plant traits. For example, the interaction between genetics and (a-)biotic factors regulating pollen production are still poorly understood. In this study, we investigated pollen production of 28 birch (Betula pendula Roth) individuals in the years 2019–2021. We sampled catkins of eleven groups of genetically identical trees, which were partially topped, but of the same age and located in a seed plantation in southern Germany characterized by similar microclimatic conditions. Furthermore, we monitored environmental factors such as air temperature, characterized air quality (NO2, NOx and O3), and assessed potential solar radiation. We especially checked for differences between years as well as between and within clones and assessed the synchronicity of years with high/low pollen production. We present a robust mean for the pollen production of Betula pendula (1.66 million pollen grains per catkin). Our findings show temporal (H(2) = 46.29, p < 0.001) and clonal variations (H(4) = 21.44, p < 0.001) in pollen production. We conclude that synchronized high or low pollen production is not utterly site-specific and, in addition, not strictly dependent on genotypes. We suggest that appropriate clone selection based on application (seed plantation, urban planting) might be advantageous and encourage a long-term monitoring.
The climate crisis poses a major challenge to human health as well as the healthcare system and threatens to jeopardize the medical progress made in recent decades. However, addressing climate change may also be the greatest opportunity for global health in the 21st century. The climate crisis and its consequences, such as rising temperatures, forest fires, floods, droughts, and changes in the quality and quantity of food and water, directly and indirectly affect human physical and mental health. More intense and frequent heat waves and declining air quality have been shown to increase all-cause mortality, especially among the most vulnerable. Climate warming alters existing ecosystems and favors biological invasions by species that better tolerate heat and drought. Pathogen profiles are changing, and the transmission and spread of vector-borne diseases are increasing. The spread of neophytes in Europe, such as ragweed, is creating new pollen sources that increase allergen exposure for allergy sufferers. In addition, the overall milder weather, especially in combination with air pollution and increased CO2 levels, is changing the production and allergenicity of pollen. The phenomenon of thunderstorm asthma is also occurring more frequently. In view of the increasing prevalence of allergic diseases due to climate change, early causal immunomodulatory therapy is therefore all the more important. During a climate consultation, patients can receive individual advice on climate adaptation and resilience and the benefits of CO2 reduction—for their own and the planet’s health. Almost 5% of all greenhouse gas emissions in Europe come from the healthcare sector. It thus has a central responsibility for a climate-neutral and sustainable transformation.
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