Allergy to pollen grains in certain regions of Rumania

Review of Palaeobotany and Palynology Elsevier Publishing Company, Amsterdam--Printed in the Netherlands

A L L E R G Y TO POLLEN GRAINS IN C E R T A I N REGIONS OF R U M A N I A I. GR. POPESCU, R. P,~UN, T. G H E O R G H I U , C. O L A R U ANO C. M O L N E R

Institute of Internal Medicine, Bucharest (Rumania) (Received May 31, 1966)

SUMMARY

In Rumania, as in Hungary and Yugoslavia, the part played by pollen in the etiology of allergic syndromes is of medium importance. Though variations from year to year and from region to region are important, it is possible to establish a mean in the aerobiology of pollen: predominance of tree pollen in April-May, of Poaceae (Gramineae) pollen in May-June-July, and of Poaceae and Asteraceae (Compositae) pollen in August-September. The incidence of pollen allergy in our clinical material on 136 cases of pollinoses, is 9 . 5 ~ of the total number ofallergoses, with variations between 1 and 25~o; pollen allergy is negligible in the region of Bucharest, medium in the city of Bucharest, and rather heavy in the sub-Carpathian District C. Allergization with Poaceae pollen is maximum in all areas; tree pollen as well as that of shrubs plays a certain role in the city of Bucharest, but tree pollen alone is important in District C. The association of pollen and fungi sensitization is relatively rare.

INTRODUCTION

In Rumania, as in Hungary (HAJOS, 1963) and Yugoslavia (SPoUJITCH, 1958), pollen plays a small part in the etiology of allergic respiratory disturbances. Moreover, a chart of relationships between allergy and pollen has not yet been drawn. However, the differences from region to region are so obvious that we feel it worthwhile to report now some preliminary data. BULLA et al. (1963) have submitted the pollen diffused in the atmosphere of Bucharest to a quantitative and qualitative analysis. From early April until the beginning of May they recorded a quantity of 240 pollen grains/cm 3, derived mainly from trees (Corylus, Populus nigra, Ulmus, Pinus, Acer, Salix, Fraxinus, Anthoxanthum odoratum, Taraxacum officinale). From May until August the pollen of Poaceae (Gramineae) prevails ( Dactylis glomerata, Lolium perenne, Poa pratensis, Festuca pratensis, Phleum pratense = Triticum (Secale) cereale), while in August

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and September, in addition to pollen of some Poaceae (Phleum, Agrostis, etc.), that of Asteraceae (Compositae) is also to be found. The duration of these three periods varies from year to year, and even if the respective plants have flowered normally, the existence of these periods is not constant. Our investigations covered a territory stretching from the Danube to the southern slopes of the Meridional Carpathians (except for a zone about 60-km wide north of Bucharest). The surface of this territory is equal to that of The Netherlands (QuARLES VAN UFFORD, 1962; SEROVIAY et al., 1963) but with only one third of that nation's population. This territory comprises the administrative region of Bucharest, the city itself, and District C (administrative region of Ploiesti). It is a region of plains, relatively poorly wooded, with a continental climate. In summer the temperature sometimes rises to 35-40 °C, and precipitation is rather scarce. In winter it is very cold, and the winds are very strong. The yearly variations are so marked that it is better to record the averages rather than the constants of the climate. In the northern sub-Carpathian part of the investigated territory, spring is very short, and the winds are violent. Farming is highly developed in this region, but industry has also been established during the last few years. The rate of urbanization has, therefore, increased and, consequently, exposure to the pollen of Poaceae is less constant than it was 40 or 50 years ago. Towns, which are more numerous and more important in the southern half of this territory, include Bucharest, with its population of about 1,500,000.

TECHNIQUE The following methods of investigation were used: (1) On special clinic cards we collected data on the personal and family allergic and allergenic past history of each patient, as these play an important part. (2) Skin tests were carried out: scarification, pricktests, and intradermal reactions with tree and Poaceae pollen (in spring, and in early, middle, and late summer), bush pollen grains and monovalent pollen grains (Taraxacum, Populus, Tilia, Phleum, Poa, Dactylis, etc.) 1. (3) Provocation tests were made, both respiratory and nasal. (4) Eosinophilia of the peripheric blood and that of the rhinopharyngeal and tracheobronchial secretions. (5) Quantitative and qualitative analysis of the pollen in certain zones. Our clinical material is represented by 136 patients who were investigated and followed up by us at the Institute of Internal Medicine over a period of 1-4 years. Mention should also be made of a paper, already published, by SEROPIAN 1 For the Poaceae (Gramineae)we gave up testing every species; since we had the same results for five species, we gathered them into a total extract (prepared by Dr. Marcela ZamfirescuGheorghiu). 56

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et al. (1963), which refers to another group of 75 cases ofpollenoses from the legion of Bucharest who were investigated at about the same period.

DISCUSSION

The frequency of disturbances due to pollen among patients suffering from allergie~ varied greatly in the variou~ zones of the territory investigated: 1-25~o, or an average of 9 . 5 ~ (POPESCUand MOLNER,1965; QUARLES VAN UFFORD, 1958). In the administrative region of Bucharest the number of confirmed patients (23) was very small, especially if we compare it to the number of allergic diseases caused by house dust, fungi, animal hair, or to occupational allergens such as the castor bean. Their actual number could be larger, but as they did not come for consultation it may be assumed that their disturbances were slight or transient. In contrast, in the city of Bucharest, patients were much more numerous (Table I). Compared to the total population the incidence of pollen allergy is negligible in the administrative region of Bucharest, rather slight in the city of Bucharest (less than 1 per 10,000) and more important in District C (0.25~ in some localities). In addition, in the latter district, pollen allergy accounts for one fourth of the allergic patients. The hypothesis of LAROCHEet al. (1919) and of SPOUJITCH(1958), according to which long exposure to pollen in rural environments brings about a spontaneous hyposensitization, seems, therefore, very likely. For town people, contact with pollen is accidental. In our opinion the origin of the pollen is likewise very important (Table I). Indeed, in the region of Bucharest, allergy is due to the pollen of Poaceae, while in the city of Bucharest and in District C, a lesser but not negligible part is played by the pollen of trees such as Populus nigra, Populus alba, and Tilia cordata, and of bushes such as Sambucus (pure sensitization or associated with that of Poaceae). In opposition to other authors, we consider that sensitization to Tilia pollen is as frequent as that to Populus pollen. In two of our asthmatics the sensitization to lime-tree pollen was indisputable. SPOUJITCH(1958) mentions similar findings made by S. Pujevic in Belgrade where, as in our country, the boulevards and the avenues TABLE

I

NUMBER OF POLLEN-ALLERGY

CASES A C C O R D I N G

Geographical zone

Grasses

Region of Bucharest City of Bucharest District C

23 35 43

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TO GEOGRAPHICAL

Trees

0 7 9

ZONES AND ORIGIN OF THE POLLEN

Bushes

0 3 0

Mixed origin

0 7 6

Total

23 52 60 57

in public gardens are bordered with lime trees and poplars. In District C we found pollen of trees and grasses present at the same time in spring, while in Bucharest there was only tree pollen. In the forme~ district lime-tree pollen mixed with that of weeds was found during all of July. As for the pollen of Asteraceae found in Bucharest toward autumn by BULLA et al. (1963), we doubt the possibility of its playing a part in the etiology of hay fever and of bronchial asthma. The problem was raised especially with respect to three patients living in District C. The pollen of pine trees is also very abundant in the atmosphere, but seemingly without allergenic properties (except in the case of one patient who, however, lived in another part of the countryl. Finally we have doubts about the allergenic faculty in Rumania of the pollen of "parietair", which is known to be pathogenic in countries distant from the Mediterranean region. Among bushes, only Sambucus, cultivated on a large scale in gardens, can be incriminated in the pollen allergies. On the other hand, no allergenic role can be ascribed to ambrosia in Rumania. At present we are continuing our investigations on the pollen of oak trees, ash trees, willows, elms, etc. The provisional results show that their role (as well as the extent of forest surface covered by these species) is no more important than that of pines. The results of chromatographic analyses of Poaceae pollen (for which we are indebted to Miss Ileana Apostolescu) are similar in all respects to those published by DUCHA1NE (1964); the following amino acids were revealed: lysine, histidine, glycocol, arginine, cysteine, serinine, glutamine, alanine, proline, tyrosine, valine, leucine, and a nonidentified fraction. The disturbances were of the hay fever type in half of the patients, ranging from the mildest to the most severe forms (with psychological effects in some patients), and of the bronchial asthma type, either pure or associated with chronic rhinitis. The onset and the end of bronchial asthma are generally sudden. The duration is usually 2-6 weeks, but in some of our patients it stretched out over a period of 4-6 months, probably owing to alternate and associated sensitizations (trees, grasses). Indeed, by skin tests and cultures inseminated in the houses of asthmatics in District C, during the pollen period of the year, we have isolated, in collaboration with Mrs. E. Capetti, fungi such as Cladosporium, Alternaria, Mueor, Fusarium, Penicillium, and Pullularia, whose part in bronchial asthma must be estimated to 8 ~ . Maximum incidence of sensitization to pollen occurred in individuals 21-40 years old. In one third of the cases it occurred in children 5-7 years old. In most of the patients the pollen was inhaled accidentally. In two of the patients the onset of bronchial asthma was caused by pollen ingested on the advice of a village healer and in another two cases by pollen associated with cosmetic products. Three patients were florists especially sensitized to Chrysanthemum pollen. Apart from sensitization with the hydrosoluble fraction, we have 58

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n o t i c e d that with the oily fraction o f p o l l e n some dermatites occur during July, especially in District C. T h o u g h heretofore rare, sensitization to pollen by other p a t h w a y s must n o t be neglected in a c o u n t r y like ours where p l a n t s flower everywhere.

CONCLUSIONS ( l ) The frequency o f p o l l e n allergy a m o n g allergic diseases varied a great deal a c c o r d i n g to the geographical zone: 1 - 2 5 ~ (an average o f 0.5%). (2) M o s t o f the cases can be ascribed to grasses, but in the city o f Bucharest, and to some extent in District C, trees a n d bushes p l a y an i m p o r t a n t p a r t too. (3) Besides the usual sensitization with the h y d r o s o l u b l e fraction o f pollen, the c u t a n e o u s sensitization with the oily fraction should also be mentioned. (4) The p a t h o f access is usually the r e s p i r a t o r y tract and only very seldom the digestive tract (ingestion with a therapeutic aim). (5) In District C, sensitization is m o s t often mixed: p o l l e n a n d fungi. (6) I n most o f the patients, clinical disturbances were o f the following types: hay asthma, hay fever, seasonal rhinitis a n d very frequently, after a certain time bronchial asthma.

REFERENCES BULLA, A., SARAGEM M., MOLAN, M. a IFRIM, M., 1963. Determinarea gradului de infestare cu

polen a aerului atmosferic din Bucuresti si vaioarea sensibilizant5, a unor alergene preparate din polen. Med. Interna, 15(9): 1043-1055. CHAReIN, J., WOLFROMM,R., AUBERT, J., CHARP~N, A., GUCHOT, E. et LAURIOL, E., 1965. Le calendrier pollinique de Paris. Rev. Frang. Allergie, 5: 65-75. DUCHMNE, J., 1964. Les antig6nes dans les maladies allergiques du type imm6diat. Congr. intern. Allergol., 4kme, Madrid. p.83. HAJOS, K. M., 1963. La pollinose en Hongrie. Rev. Franc. Allergie, 3:232 235. JAMAR, M. J., 1964. Fr6quences des facteurs 6tiologiques dans l'asthme bronchique en Belgique. Congr. Intern. Allergol., 40me, Madrid, p.309. LAROCHE, G., RICHET, CH. et SAINTGIRONS, F., 1919. L'Anaphylaxie alimentaire. Baill6re, Paris. MURRAY, M. A., 1960. Hay fever. In: S. J. PglNGAL(Editor), Fundamentals of Modern Allergy. Blakiston Div., McGraw-Hill, New York, N.Y., pp.189-197. PoPESCU, G. I. and MOLNER, C., 1965. The role of extrinsic allergens in the etiology of nonoccupational bronchial asthma. Med. Interna, 2(2): 103. QUARLES VAN UFFORD, W. J., 1958. (Allergic management and problems in different parts of the world,) Netherlands. In: Troisikme CongreSs International d'Allergologie. Flammarion, Paris, pp.897-913. QUARLES VAN UFFORD,W. J., 1962. The 1959 hay-fever season. Europ. Acad. Allergy, 4th Ann. Rept., pp. 10-20. SEROeIAN, E., GRECEANU, I. a BELOIU, D., 1963. Contributii [a studiul alergiei respiratorii de origine polinicfi. Med. Interna, 15(9): 1057-1063. SPOtmTCH, V., 1958. (Allergic management and problems in different parts of the world,) Yougoslavie. In: Troisikme Congrks International d'Allergologie. Flammarion, Paris, pp.881 896. Rev. Palaeobotan. PalynoL, 7 (1968) 55-59

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