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    The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children
    Idrose, NS ; Lodge, CJ ; Peters, RL ; Douglass, JA ; Koplin, JJ ; Lowe, AJ ; Perrett, KP ; Tang, MLK ; Newbigin, EJ ; Abramson, MJ ; Erbas, B ; Vicendese, D ; Dharmage, SC (WILEY, 2022-10)
    BACKGROUND: While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children. METHODS: We investigated 1- (n = 1108) and 6-year-old (n = 675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1 year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers. RESULTS: Grass pollen at lag 0-3 (every 20 grains/m3 increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only. CONCLUSION: Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.
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    5-grass-pollen SLIT effectiveness in seasonal allergic rhinitis: Impact of sensitization to subtropical grass pollen.
    van Nunen, SA ; Burk, MB ; Burton, PK ; Ford, G ; Harvey, RJ ; Lozynsky, A ; Pickford, E ; Rimmer, JS ; Smart, J ; Sutherland, MF ; Thien, F ; Weber, HC ; Zehnwirth, H ; Newbigin, E ; Katelaris, CH (Elsevier BV, 2022-02)
    BACKGROUND: Temperate grass (eg, ryegrass) pollen is a major driver of seasonal allergic rhinitis (SAR) and asthma risks, including thunderstorm asthma. Data for the effectiveness of temperate grass pollen allergen immunotherapy (AIT) in SAR patients from the southern hemisphere, who are frequently polysensitized to subtropical grass pollens, are limited. The 300 IR 5-grass pollen sublingual immunotherapy tablet (300 IR 5-grass SLIT) is known to be effective in polysensitized SAR patients with primary allergy to temperate grasses, however, the influence of polysensitization to subtropical grass pollen on treatment responses has yet to be specifically addressed. Key aims of this study were to measure patient treatment satisfaction during 300 IR 5-grass SLIT treatment and evaluate how polysensitization to subtropical grass pollens affects treatment responses. METHODS: A prospective observational study was conducted in 63 patients (aged ≥5 years) in several temperate regions of Australia prescribed 300 IR 5-grass SLIT for SAR over 3 consecutive grass pollen seasons. Ambient levels of pollen were measured at representative sites. Patient treatment satisfaction was assessed using a QUARTIS questionnaire. Rhinoconjunctivitis Total Symptom Score (RTSS) and a Hodges-Lehmann Estimator analysis was performed to evaluate if polysensitization to subtropical grass pollen affected SAR symptom intensity changes during SLIT. RESULTS: A diagnosis of ryegrass pollen allergy was nearly universal. There were 74.6% (47/63) polysensitized to subtropical and temperate grass pollens. There were 23.8% (15/63) monosensitized to temperate grass pollens. From the first pollen season, statistically significant improvements occurred in SAR symptoms compared with baseline in both monosensitized and polysensitized patients, particularly in those polysensitized (P = 0.0297). Improvements in SAR symptoms were sustained and similar in both groups in the second and third pollen seasons, reaching 70-85% improvement (P < 0.01). Polysensitized patients from both northerly and southerly temperate regions in Australia showed similar improvements. Grass pollen counts in both regions were consistently highest during springtime. CONCLUSIONS: 300 IR 5-grass SLIT is effective in a real-life setting in SAR patients in the southern hemisphere with primary allergy to temperate grass pollen and predominantly springtime grass pollen exposures. Importantly, SLIT treatment effectiveness was irrespective of the patient's polysensitization status to subtropical grass pollens.
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    Outdoor pollen-related changes in lung function and markers of airway inflammation: A systematic review and meta-analysis
    Idrose, NS ; Walters, EH ; Zhang, J ; Vicendese, D ; Newbigin, EJ ; Douglass, JA ; Erbas, B ; Lowe, AJ ; Perret, JL ; Lodge, CJ ; Dharmage, SC (WILEY, 2021-05)
    BACKGROUND: Experimental challenge studies have shown that pollen can have early and delayed effects on the lungs and airways. Here, we qualitatively and quantitatively synthesize the evidence of outdoor pollen exposure on various lung function and airway inflammation markers in community-based studies. METHODS: Four online databases were searched: Medline, Web of Science, CINAHL and Google Scholar. The search strategy included terms relating to both exposure and outcomes. Inclusion criteria were human-based studies published in English that were representative of the community. Additionally, we only considered cross-sectional or short-term longitudinal studies which investigated pollen exposure by levels or season. Study quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was conducted using random-effects models. RESULTS: We included 27 of 6551 studies identified from the search. Qualitative synthesis indicated associations between pollen exposure and predominantly type-2 inflammation in both the upper and lower airways, but little evidence for lung function changes. People with ever asthma and/or seasonal allergic rhinitis (SAR) were at higher risk of such airway inflammation. Meta-analysis confirmed a positive relationship between pollen season, eosinophilia and eosinophil cationic protein (ECP) in people with ever SAR but the results between studies were highly variable. Heterogeneity was reduced after further subgrouping by age, and the forest plots indicated that eosinophilic airway inflammation to outdoor pollen exposure increased with age. CONCLUSION: Among people with ever asthma and ever SAR, exposure to increased ambient pollen triggers type-2 upper and lower airway inflammation rather than a non-specific or innate inflammation. These findings can lead to the formulation of specific pollen immunotherapy for susceptible individuals. Future research should be directed towards investigating lagged associations and effect modifications using larger and more generalized populations. SYSTEMATIC REVIEW REGISTRATION: CRD42020146981 (PROSPERO).
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    Nicotiana paulineana, a new Australian species in Nicotiana section Suaveolentes
    Bally, J ; Marks, CE ; Jung, H ; Jia, F ; Roden, S ; Cooper, T ; Newbigin, E ; Waterhouse, PM (CSIRO PUBLISHING, 2021)
    Nicotiana is found predominantly in the Americas and Australia, but also has representatives in Africa and the Pacific Islands. All native Australian Nicotiana species belong to section Suaveolentes. The number of species in this section is uncertain and subject to revision. An example of this uncertainty is the taxonomic status of a South Australian Nicotiana accession colloquially termed ‘Corunna’. Here, we report sequences for nuclear and plastid markers for N. sp. Corunna (D.E.Symon 17088) and accessions of two other Australian species, N. burbidgeae and N. benthamiana. Phylogenetic comparison of these sequences with those of other members of Nicotiana places all three taxa in N. section Suaveolentes and shows that ‘Corunna’ represents a distinct phylogenetic lineage in a well supported clade along with N. goodspeedii, N. maritima, N. amplexicaulis and N. suaveolentes. Phenetic analysis of floral characters also supports recognition of N. sp. Corunna (D.E.Symon 17088) as a distinct species, which we describe here as Nicotiana paulineana Newbigin & P.M.Waterh., sp. nov. The enlarged molecular dataset described here contributes to a better understanding of taxonomic relationships within the section.
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    Atmospheric modelling of grass pollen rupturing mechanisms for thunderstorm asthma prediction
    Emmerson, KM ; Silver, JD ; Thatcher, M ; Wain, A ; Jones, PJ ; Dowdy, A ; Newbigin, EJ ; Picking, BW ; Choi, J ; Ebert, E ; Bannister, T ; Lee, C-L (PUBLIC LIBRARY SCIENCE, 2021-04-14)
    The world's most severe thunderstorm asthma event occurred in Melbourne, Australia on 21 November 2016, coinciding with the peak of the grass pollen season. The aetiological role of thunderstorms in these events is thought to cause pollen to rupture in high humidity conditions, releasing large numbers of sub-pollen particles (SPPs) with sizes very easily inhaled deep into the lungs. The humidity hypothesis was implemented into a three-dimensional atmospheric model and driven by inputs from three meteorological models. However, the mechanism could not explain how the Melbourne event occurred as relative humidity was very low throughout the atmosphere, and most available grass pollen remained within 40 m of the surface. Our tests showed humidity induced rupturing occurred frequently at other times and would likely lead to recurrent false alarms if used in a predictive capacity. We used the model to investigate a range of other possible pollen rupturing mechanisms which could have produced high concentrations of SPPs in the atmosphere during the storm. The mechanisms studied involve mechanical friction from wind gusts, electrical build up and discharge incurred during conditions of low relative humidity, and lightning strikes. Our results suggest that these mechanisms likely operated in tandem with one another, but the lightning method was the only mechanism to generate a pattern in SPPs following the path of the storm. If humidity induced rupturing cannot explain the 2016 Melbourne event, then new targeted laboratory studies of alternative pollen rupture mechanisms would be of considerable value to help constrain the parameterisation of the pollen rupturing process.
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    Is short-term exposure to grass pollen adversely associated with lung function and airway inflammation in the community?
    Idrose, NS ; Tham, RCA ; Lodge, CJ ; Lowe, AJ ; Bui, D ; Perret, JL ; Vicendese, D ; Newbigin, EJ ; Tang, MLK ; Aldakheel, FM ; Waidyatillake, NT ; Douglass, JA ; Abramson, MJ ; Walters, EH ; Erbas, B ; Dharmage, SC (WILEY, 2021-04)
    BACKGROUND: The association between grass pollen exposure and early markers of asthma exacerbations such as lung function changes and increase in airway inflammation is limited. We investigated the associations between short-term grass pollen exposure and lung function and airway inflammation in a community-based sample, and whether any such associations were modified by current asthma, current hay fever, pollen sensitization, age, and other environmental factors. METHODS: Cross-sectional and short-term analyses of data from the Melbourne Atopy Cohort Study (MACS) participants (n = 936). Lung function was assessed using spirometry. Airway inflammation was assessed by fractional exhaled nitric oxide (FeNO) and exhaled breath condensate pH and nitrogen oxides (NOx). Daily pollen counts were collected using a volumetric spore trap. The associations were examined by linear regression. RESULTS: Higher ambient levels of grass pollen 2 days before (lag 2) were associated with lower mid-forced expiratory flow (FEF25%-75% ) and FEV1 /FVC ratio (Coef. [95% CI] = -119 [-226, -11] mL/s and -1.0 [-3.0, -0.03] %, respectively) and also 3 days before (lag 3). Increased levels of grass pollen a day before (lag 1) were associated with increased FeNO (4.35 [-0.1, 8.7] ppb) and also at lag 2. Adverse associations between pollen and multiple outcomes were greater in adults with current asthma, hay fever, and pollen sensitization. CONCLUSION: Grass pollen exposure was associated with eosinophilic airway inflammation 1-2 days after exposure and airway obstruction 2-3 days after exposure. Adults and individuals with asthma, hay fever, and pollen sensitization may be at higher risk.