This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe.

Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.

We report for the first time that SE-IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE-IgE is significantly and independently associated with asthma in the general population.

103Sinusitis 104 105 Conflicts of interest 106Jan Lötvall has received consultancy and speaker fees from AstraZeneca, GlaxoSmithKline, MSD/Merck, 107Novartis, and Schering-Plough. 109Author contributions 110PT, RN, RH, and DJ analyzed the data and wrote the manuscript. WF, CB, PB and DJ conceived and supervised 111 the study. All authors collected data and critically revised the manuscript. 113Body word count: 2673 114Page 3 of 17 Allergy 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 118in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and 119validity of a symptom based definition of CRS using data from the GA2LEN European survey. 120Methods: On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, 121allergic rhinitis and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in 122prevalence of CRS between two study points, the standardized absolute repeatability and the chance corrected 123 repeatability (kappa) were determined. In two centers 342 participants underwent nasal endoscopy. The 124 association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. 125Results: There was a decrease in prevalence of CRS between the two study phases, and this was consistent 126across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I 2 =0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 160Study design 161In a first cross-sectional phase (the GA²LEN Survey), 11 participating centers sent a questionnaire by mail to a 162 random sample of at least 3000 subjects aged 15 to 75 years, with up to three attempts to elicit a response. 163Samples were identified by random sampling from a population based local sampling frame. 164The questionnaire was newly developed for the diagnosis of chronic rhinosinusitis ( (Table 1); additionally, subjects were asked if a doctor had ever told whether the subject had CRS 167(further referred to as 'self-reported doctor-diagnosed CRS'). Asthma was defined as reporting 'having ever had 168 asthma' and at least one of the following symptoms in the last 12 months: 1) wheeze or whistling in the chest; or 1692) waking up with chest tightness, shortness of breath or an attack of coughing. Allergic rhinitis was defined by 170 the self reported history of 'nasal allergy'. 171In a second phase (the GA²LEN Survey Follow-Up), each center invited 120 randomly selected subjects with 172 asthma, 120 with CRS, 40 with asthma and CRS and 120 with neither asthma or CRS for a clinical study visit 173with further investigations among which a questionnaire including the same questions as those describ...

Geographical variation in the prevalence of skin prick test positivity in Europe is unlikely to be explained by geographical variation in gender, age, smoking history, farm exposure, family size and BMI. Higher prevalence in younger, compared to older, adults may reflect cohort-associated increases in sensitization or the influence of ageing on immune or tissue responses.

Heated tobacco products (HTPs) are a form of nicotine delivery intended to provide an alternative to traditional cigarettes. The aim of this systematic review was to present the current state of knowledge on HTPs with an emphasis on the potential impact of HTP use on human health. During the preparation of this systematic review, the literature on HTPs available within Medline/PubMed, EMBASE, CINAHL, ScienceDirect, and Google Scholar was retrieved and examined. In the final review, 97 research papers were included. The authors specifically assessed the construction and operation of HTPs, as well as the chemical composition of HTP tobacco sticks and the generated aerosol, based on evidence from experimental animal and cellular studies, and human-based studies. Heated tobacco products were found to generate lower concentrations of chemical compounds compared to traditional cigarettes, except for water, propylene glycol, glycerol, and acetol. The nicotine levels delivered to the aerosol by HTPs were 70-80% as those of conventional combustion. The results of in vitro and in vivo assessments of HTP aerosols revealed reduced toxicity, but these were mainly based on studies sponsored by the tobacco industry. Independent human-based studies indicated that there was a potentially harmful impact of the active and passive HTP smoking on human health. Currently, a large body of knowledge on HTP exposures and health effects is provided by the tobacco industry (52% of identified studies). Based on the available evidence, HTPs produce lower levels of toxic chemicals, compared to conventional cigarettes, but they are still not risk-free. Int J Occup Med Environ Health. 2019;32(5):595 -634

Electronic cigarettes (e-cigarettes) are an alternative to traditional tobacco cigarette smoking. The aim of this study was to assess the prevalence of cigarette smoking and e-cigarette use among university students from Central and Eastern Europe and to investigate personal characteristics associated with cigarette and e-cigarette smoking. A questionnaire-based cross-sectional survey was performed between 2017–2018 among university students in five European countries: Belarus, Lithuania, Poland, Russia, and Slovakia. The questionnaire included 46 questions related to the frequency and habits of traditional cigarettes and e-cigarettes use. Completed questionnaires were obtained from 14,352 students (8800 medical; aged 20.9 ± 2.4 years) with an overall response rate of 72.2%. Two-thirds of the respondents had smoked a traditional tobacco cigarette and 43.7% had used an e-cigarette. Overall current smoking status included 12.3% traditional cigarette smokers, 1.1% e-cigarette users, and 1.8% were dual users with the remainder being non-smokers. Smoking status differed between the research centres (p < 0.001). Females were less likely to try either cigarettes (OR = 0.83) or e-cigarettes (OR = 0.62) and were less likely to be current cigarette (OR = 0.64), e-cigarette (OR = 0.34), or dual users (OR = 0.33) than males. Perception of e-cigarettes significantly differed between smokers and non-smokers (p < 0.001). Among university students, cigarettes are more popular than e-cigarettes.

E-cigarettes are often considered less addictive than traditional cigarettes. This study aimed to assess patterns of e-cigarette use and to compare nicotine dependence among cigarette and e-cigarette users in a group of highly educated young adults. From 3002 healthy adults, a representative group of 30 cigarette smokers, 30 exclusive e-cigarette users, and 30 dual users were recruited. A 25-item questionnaire was used to collect information related to the patterns and attitudes towards the use of cigarettes and e-cigarettes. The Fagerström test for nicotine dependence (FTND) and its adapted version for e-cigarettes were used to analyze nicotine dependence in each of the groups. The nicotine dependence levels measured with FTND were over two times higher among e-cigarette users (mean 3.5) compared to traditional tobacco smokers (mean 1.6; p<0.001). Similarly, among dual users, nicotine dependence levels were higher when using an e-cigarette (mean 4.7) compared to using traditional cigarettes (mean 3.2; p=0.03). Habits and behaviors associated with the use of e-cigarettes did not differ significantly (p>0.05) between exclusive e-cigarette users and dual users. The findings suggest that e-cigarettes may have a higher addictive potential than smoked cigarettes among young adults.