Gentowa

The nose is an organ with two basic functions:

● olfactory

● respiratory

The main respiratory (breathing) function of the nose and the nasal cavity is to provide the transport of the air to the lungs. In addition to that, other important functions include:

● processes of the inhaled air (warming-cooling, humectation)

● enables the resistance against the strong air

● filters the inhaled air

● provides the immunology barrier

In order to provide these “services” the nasal cavity is fit out with the complex structure. The nasal mucosa is able to make itself thinner and rougher hence it has an important influence on the air rate of flow resistance. The nasal resistance can alter from the slight to complex obstruction. The changes of the nasal mucosa thickness are influenced by the vascular system, too. The nasal mucosa contains a large amount of the mucous glands, which humidify the inhaled air. The nose noticeably prevents the lungs from the flow of the inhaled parts. It is able to remove the pollen grains of 15-30μm almost complex and enables the reduction the mites allergens of approximately 5μm up to 50%. The soluble chemicals can be removed from the inhaled air by being dissolved in the mucous.

The nose plays its role in the defensive line of the immune mechanisms, as well. By the collecting and the phagocytic process it liquidates a part of the microorganisms. The mucosa consists of lyzozymes; there is also immunoglobulin, especially the phlegmy IgA together with the phagocytes, there. On the other hand it is full of mastocytes, which play a negative role in allergic people lives.

What is a common cold (runny nose)?

The common cold (rhinitis) is defined as the nasal mucosa inflammation, which is characterised by one or more symptoms:

● nasal obstruction

● secretion

● sneezing

● nasal itch

While taking the symptoms into consideration, it can be difficult to distinguish the infectious cold from the allergic one. No diagnosis can be usually made only from the clinical count without anamnestic data and a special allergist examination. Similar problems can be brought about by polyps, anatomic mechanic factors, swellings and tumours and in the case of small children by foreign bodies (beans, bullets, peas).

The nasal cavities, which enable the air circulation, relate anatomically to the nose. When somebody suffers an allergy, they are usually affected by the allergic inflammation, as well. Sinusitis itself, as this disease is called, is usually a symptom of an allergy.

The skin tests are necessary supplements of all basic allergist examinations. The allergic hypersensitiveness proof was discovered by Charlie Blackley already in 1865. The technique

was later on improved by Grant Lewis, Pepyes and others, who introduced the prick test (stinger) usage. Nowadays the standardized method introduced by the European allergist and clinical immunology academy.

The skin test in based on the fact, that sensitive allergic patient has specific antibodies against the allergens not only in the particular organ, in which the clinical symptoms are active, but also in the cell membrane – mastocyte which are in the skin. While testing, the suspect allergen is injected into the patients´ skin near the forearm. The allergen choice is made according to the patients´ data on the clinical symptoms period. The standard group of allergens, which includes the following, is used:

● trees pollen

● grass pollen

● rye

● worm wood

● ambrosia

● mould

● feather

● mites

● positive control (histamine)

● negative control (usually a solution with dissolved allergens)

According to the seasonality, others allergens are added. If the patient is in the contact with the animals, the animal allergens (dog, cat, etc) are tested, as well. Before the testing the patient should cease the anti allergic treatment (the antihistamines for at least one week), but others, as well. For example many preparations used by the psychiatrists relieve even the skin reaction at the skin tests.

When possible, the patient should be tested even off pollen season. It is not appropriate to test somebody during or right after the infection since it can cover the reaction, as well. For checking the skin test realisation correctness beside the allergens, the positive and the negative control is injected. As the positive control histamine is used – a chemical, which is released during the allergic reaction in general, i.e. test with this chemical can be positive even in the case of the health people. If this reaction after the testing is negative, the test is not valid, since some of the processes or the medications relieved all reactions.

The negative checking is, on the contrary, is injected in order to exclude the reaction, which is only mechanical – the injury or the injection itself, or the allergic reaction to the solution, eventually to the conservative chemical in the allergen solution. The skin tests allergens are made commercially. Their content and dilution are standardised.

How the allergy is diagnosed by the doctor

The diagnosis procedure is not easy. The clinical symptoms of the different origin illness are often similar. For instance the symptoms of the allergic fever – red stuffy nose, sneezing, nose secretion are the same as while having the cold (it is usually caused by a simple viral inflammation). But the treatment approach is different. Therefore the diagnosis procedure requires besides the judgement of the current health conditions further information, too.

The basis of all allergic examination is the detailed anamnesis. It is actually the list of all factors, which relate (sometimes only seemingly for the patients) to the illnesses.

The family anamnesis is an information on the illnesses appeared in the patient family. Naturally, the blood relations, not he wife or the brother-in-law, are important. The allergic reaction, their ancestors – father, grandmother, siblings or children-suffered from, indicates the relation to the current illness of the patient. The allergy predisposition is inherited. While the child of the parents, who do not suffer any allergy, inclines to the allergy at the odds of approximately 20%, the odds of the allergy increases up to 50% concerning the child of at least one allergic parent. If the mother suffers any allergy, the odds will increase even more and in the case of both allergic parents, it is almost 100% certain, that their child will suffer the allergy (especially if both parents are allergic to the same allergens).

Personal anamnesis includes the facts, which precedes the particular current illness. In the anamnesis, all the previous illnesses, we have undergone, are listened. The eczemas in the childhood, serious allergic reaction suffered years ago, or the repeated infections – all these are information, which indicate the possible immune system disorder or direct the allergic “before-period”. Concerning the women the important information is the number of the deliveries and

the development of the pregnancy, concerning the children, the time until they were nursed,

when they started to eat the baby food, is of the greatest importance.

The working anamnesis is the information on the surroundings, where we spend the main part of our day. The important facts refer not only to conditions of the building (cleanness, humidity, thermo regime) but also all things we come into contact with – the production, administration, special operations and chemicals. The significant information are the protection regime against the potential harmful chemicals at the workplace and our approach to it. The information about how we spend our spare time – our hobbies, the sport, etc, places where we have the chance of the contact with the factors initiating or starting the allergy, should be a part of this analysis, too.

The current illness – its description is the most important part of the “testimony” and no basic information can be omitted in it.

● illness start and description

● your own symptoms descriptions

● seasonal presence of the clinical effects (per year, during the summer, etc)

● allergic (not allergic) initiating factor – if we know it or if it seems to be assumed

● lifestyle influence

* the symptoms occurrence frequency and the seriousness symptoms

* influence on the occupation ( study)

* extra working activities (sport, hobby)

* sleep

● environmental allergens – surroundings allergens – (at home, work)

● existing treatment – ( if already treated)

* effect (little, significant; stopped to be effective after a period of time)

* side-effects

* satisfaction and the willingness to undergo this type of treatment.

The information on the further potential illnesses we have, especially on medications we take, is important. Many can influence not only the diagnosis, but also the particular allergic reaction itself – and not only in the negative sense – worsen of the clinical condition or on the contrary- covering of the particular typical symptoms.

The physical examination is the basis in all cases. The doctor examines all systems. He or she examines the skin al over the body, where the symptoms – even not the most serious and hence hidden, which the patient himself does not have to notice – inflammation, reaction to any mechanic irritation, dryness or wetness of the skin, nails, hair, are looked for. The oral cavity reveals the potential inflammation- infectious, but allergic, as well.

The nasal mucosa swelling and congestion, nasal discharge, red skin around the nostrils caused by the mechanic irritation are the symptoms of the common cold. The patients with the nasal congestion breathe through the mouth, which are open all the time. The nasal congestion As far as the children are concerned, the nasal congestion is revealed by the line on the top, especially the so called allergic salute (greeting), it is started with. It is a “gesture” of pushing the top of the nose up with the palm, while the nasal cavity is being released.

The auscultatory examination – examination with the phonendoscope – enables to hear the breathing sound. Unlike the healthy lungs, the patients with the clinical asthma make crunching, bubbling or whistling sounds while breathing. They do not have to be loud so that only the experienced ear of the doctor can hear and identify them. The palpating and percussing of the rib cage and the abdomen provides further information.

The entire examination, especially the first visit to the specialised doctor is necessary. Therefore even while examining the patients, who are think that they have “only” a common cold, we should expect the complex examination.

How does the skin test reaction look like?

The applied allergens are bound on the antibodies molecules IgE - on the outside part of the mastocytes and through the transfer of the signal their degranulation and the allergic reaction mediators release occur. These initiate the reaction through the affect on the surrounding blood vessels, the symptoms of which are the flush, the itch and the swelling with the diameter of several millimetres in the place of the injection. On the reaction, which starts approximately after 5 minutes from the allergen application, takes part also the so called substance P, which is released from the sensitive nerve ending, after the histamine stimulation. The reaction culminates in the period of 15-20 minutes, when the doctor subtracts it, after this time the reaction decreases.

The skin test realisation is not painful for the patient. On the palm side of the forearm the drops of the examining allergens are applied. In every drop a gentle puncture with the plastic or metal tool with the small sharp top is made. The skin is punctured only on the top skin layer so that the place does not have to bleed at all. After 20 minutes the reaction is judged. Places, which are either red or swollen in the same way as after applying the histamine, indicate that the reaction is positive. The patient can react to one or ore allergens. Beside the reaction when the small papule with the diameter of several millimetres appear, which is the most common reaction, the more extensive local reaction – of several centimetres, in rare cases even the swelling of the hand come about. These reactions cease to occur spontaneously after several hours.

In addition to the immediate reaction the patient can react in the so called later phase, when the papules appear after several hours. The patient deducts and informs the doctor of the reaction by himself/herself. The skin tests represent the allergist diagnosis basis. Together with the detailed taken anamnesis they are sufficient for the majority of the patients sensitive to common inhalation allergens for the typical symptoms of the diagnosis. Their role in the diagnosis is hence important, which relates to the fact that their preparation and realisation should be paid attention to.

The skin tests can be characterised as indirect provoking tests. They are called indirect, since their positives and negatives prove the sensitization of the human body. The presence of the specific IgE antibodies to applied allergen is proved on the skin without giving the information on the reactivity of the particular target organ (unless the target organ is the skin itself). Standard prick tests are used. They are made by the pharmaceutical companies, which prepare them according to the strict formulas. The content of all solutions with the allergens is diluted exactly together with the known analysed components of the particular chemical. The food allergens to the prick tests are chosen similar according to the patients. In the basic scale the eggs, nuts, milk and hesperidium should not be omitted. As far as the patient has not only a food allergy, but also the inhalational allergy, we add the cross reacting foodstuffs (birch-apple, Artemisia-celery, mites-crabs, latex-banana, etc.).

The professional airways allergic illnesses have increasing tendency. The allergens are represented by the whole range of various factors of both, the vegetable and animal origin, but also by the chemical agents. Besides the pharmacotherapy, which does not differ from the common recommended procedures, the fundamental step is the immediate transfer of the patient from the exposition of the cause, which is necessary to be defined. To the testing process the chemicals, which are not tested with the traditional patients, are added, as well.

The contact allergy diagnosis skin tests are made by putting the analysed chemical on the skin. More information is provided in the chapter about the contact allergy.

The laboratory tests are the necessary part of the diagnosis procedure, in the case that the previous examinations were not sufficient for the unambiguous conclusion. The important restriction of these tests is the fact that the patient’s allergic reaction includes different cells in different tissues of the high degree of the variability. Even in the case of the same patient the ability to react can change in a short period of time. For the sake of the laboratory examination the blood is necessary. The blood collecting is usually made in the morning. If we undergo the blood collecting, we will have to take into consideration that it will contain the small amount of the elements, which are influences by the food we have eaten. Hence the blood collecting should be undertaken not only on an empty stomach, but even in during the last evening before the collecting, the patients do not have to eat a fair amount of the fatty meals.

The leukocyte differential calculus belongs to the basic laboratory examination. The medical finding of the eosinophilia is typical as for the allergic patients. To the standard examinations belongs the total IgE level examination. The values above 100 IU/ml state the allergic reaction (illness). A reliable source of information is provided in the newborn umbilical cord examination, where the higher level above 10IU/ml reflects the higher risk of the allergic illness during the life.

The specific examination, which proves the allergy and analyses the initialising allergen, is the specific IgE antibodies examination. Here, the antibodies, which react against the particular allergen, are looked for and determined.

All the IgE determining methods are demanding and require special devices, hence are made only in bigger centres. They are not made to all patients. They are needed in cases, when the previous examinations did not prove the clear diagnosis. Moreover, even more simple methods using the testing slips of paper similar to the litmus paper are used in order to diagnose the IgE antibodies quantitatively.

Before the allergist examination all allergic patients should have examined the basic biochemical parameters, which are necessary for the therapeutic preparations. When needed, if we suspect the nasal cavity inflammation or the asthma, sometimes the X-ray examination is made. The X-ray pictures of the head, eventually of the lungs, where inflammation changes can be observed, are judged. The lungs and nose function is judged through the spirometric examination.

Naso (the nose) manometry (blood pressure) is an examination, which measures the flow of rate of the nose. The measure principle is similar to the spirometry. Even the spirometer, to which a special attachment is added, is used.

A healthy nose is clear and a healthy person breathes usually through it (unless he exerts him/herself). If some illness process obstructs or restricts the flow of nasal rate, the patient breathes through the mouth even while resting, which brings many disadvantages (filtration restrictions and humidifying air, mucosa drying, etc.). Detailed information is provided in the chapter on common cold. The nasometry examination enables to objectify the seriousness of the measured numbers and the nasal obstruction. The patient himself does not have to know about the extent of the obstruction and the one, whose nose is obstructed for a longer period of time, usually does not know about it for sure, since he/she is used to it and thinks that everything is all right in the way it is.

While the nasal examination of both nostrils, two small devices with small hollows are inserted into the nostrils. The devices are connected to a tube, which the air flows in both ways, in and out, through. On the other hand, in comparison with the spirometry, the examined person has closed mouth and breathes only through the nose. One device (it looks like a small olive) is bunged up so that it does not allow breathing through the nostril the device is put in. The rate of flow of both nostrils is measured hence after the half time the devices are exchanged. In the same was as during the spirometry, the device records the air rate of flow of both nostrils and judges the congestion values. The examination is used not only for the common cold obstruction diagnosis, but also for the effect of the treatment evaluation. On more time, the patient himself often does not estimate the health improvement extent (“I can breathe through the nose easier”)

The medical finding of the total obstruction is not rare although the examined person does not know about it.

The first examination should be undergone without the medical treatment.

The therapy of the asthma has gone through relatively long development. It can be stated, that until recent times the patients suffering from the severe illness, dyspnoea (breathlessness) and choking, have been regarded quite common. The modern medication arsenal enables the patients – if it is used, disciplined and diagnosed correctly, to live the life with minimal or no troubles. The therapy must start on time! Delayed or neglected therapy relates to the continuing inflammation, to the gradual change and rebuild of the airways structure. It is more difficult to treat the anatomically changed windpipes and the therapy effect will not result in the absolute normalisation of the clinical conditions.

The asthma clinical symptoms are basically caused by two factors – the windpipes obstruction and the inflammation. The therapy is concentrated against those two processes, as well:

● bronchus dilatative (windpipes are expanding)

● antiphlogistic

The bronchus dilatative (bronchus – windpipes, dilatation – expanding) is a process of expanding (opening, enlarging) of the windpipes, which enables a better breathing. The medications used for this purpose belong to the basic asthma medications, yet they are taken even while suffering other windpipes contraction diseases. The medications are dosed according to the patient’s seriousness of the health conditions. They can be taken perorally (pills, syrup), injected or inhaled. Clinically they suppress the cough, the breathlessness and the whistling sounds. If they are dosed correctly, they enable the patients with contracted windpipes to breathe normally, without feeling sick. The medications are divided into – according to the effects principle several groups:

The basic group is the so called beta2 mimetics, also called betaagonists, which stimulate (irritate) the part of the autonomous vegetative nerve system with the result of released windpipes fibre muscles i.e. the windpipes extension.

The following side effects can occur, as well, although as for the modern medications they are rare:

● heartbeat and faster action

● short ague (especially hands)

● headache

● nervousness

The side effects result from the total medication influence, which effect in addition to the airways even other, especially cardiovascular system. The development of this type of medications is concentrated on the fact that the preparation should affect the airways the most and the other systems only minimal.

The best way to take the betamimetics is the inhalation. Hence many devices used to transfer the effective chemical to the needed place – the airways have been developed. If the preparation is liquid, the “small device”, which makes the aerosol from the liquid with the help of the driving gas, will be used. In this way the small medication particles get into the windpipes and the ronchus after the inhalation.

The second form is the powdered. The effective chemical is adjusted into the bin in the form of the powder and with the help of the ingenious mechanism while inhaling it is transferred into the particular target place. Both mentioned systems have their pluses and minuses.

The modern therapy uses two types of the beta2mimetics – effective for a longer or shorter period of time.

The short-term effective mimetics with the fast start are called the releasers. Their task is the windpipes spasm (cramp releasing). They are used if the patients can not breathe or if the health conditions get worse, since they are effective after several minutes. These medications are taken by the patients suffering from the intermittent asthma, since if the symptoms occur only once in a time (less than once a week), it will be the only therapy needed. If the breathlessness attacks appear oftener, the therapy has to be combined. Naturally, if needed, the patients suffering the severe disease undergo it, as well. Our market offers many preparations: salbutamol (SALAMOL, ECOSAL, VENTOLIN, and VENTODISKS), terbutaline (BRICANYL), fenoterole (BEROTEC also combined with the DITEC).

The long lasting betamimetics release the effective chemical gradually; hence they permanently affect the windpipes, which are extended under their influence. It is sufficient to take them twice a day. Together with the corticoids they are taken by the patients suffering from medium or severe asthma. Their effect start varies. There are salmeterol (SEREVEBT) and formoterol OXIS, FORADIL) used on our marketplace. The peroral betamimetics – either the pills or the syrup (terbitalin, prokaterol, bambuterol, klenbuterol) are used according to their systems side effects only rarely.

The anti-inflammatory therapy is based on the glucose-corticoids (cortisonides) taking, which are the hormonal preparations produced by the adrenal gland cortex (nowadays they are produces synthetically). They influence many levels and factors, which take part in the inflammation process. The best solution offers their local use – in the form of inhalation. The same devices as in the case of the betamimetics are used. In general, either injected or as pills, they are taken only in the most serious states of health. The doses are adapted to the seriousness of the illness. The informed patient can control their therapy to certain extent alone i.e. increase or reduce the doses according to their health conditions. The patient has to follow the criteria stated by his/her doctor.

We use: beclometozone (BECLAZONE, BECLOMET, BECODISKS, BECOTIDE, ECOBEC), budesonide (INFLAMMIDE, MILFONID, PULMICORT) fluzolide (BRONILIDE), flutikazone (FLIXOTIDE, FLIXOTIDE DISKUS), triamcinolone (AZMACORT).

From the point of the comfortableness and the effectiveness (anti-inflammatory and bronchodilative function) the combined preparations belong to the newest preparations. They are usually taken twice in a day. The corticoid element doses are taken according to the seriousness of the clinical health conditions. The Slovak market has two anti inflammatory and bronchodilative preparations at disposal: SERETIDE DISKUS and SYMBICORT. The modern preparations are the so called antileucotriens – the medications, which influence the molecular structure of the allergic inflammation process. These include sappirelukast (ACCOLATE) and montelukast (SINGULAIR), which are applied orally. In additions to these, the rommoglycolates in the inhalation form are used while treating the asthma. As for their advantage, they hardly have any side effects; their disadvantage is the often application (4-6 times a day). Considering the children they are very effective, their influence is restricted concerning the adults. There can be CROMOBENE, CROMOLYN, INTALCROMOGEN and nedopfromol (TILADE) found in our pharmacies.

Additional therapy is provided with the parasympatoliticums – the ipratrophiumbromid (ATROVENT combined with the COMBIVENT). The antihistamines, especially if the asthma is combined with other allergic symptoms, will be used, as well. After the allergen is defined, the allergen vaccination follows (detailed information in next chapter).

The teopfyline preparations (Syntophiline and so on), can not be used in the modern therapy except for the preparations with slow releasing (UNI-DUR, THEO-DUR, TEOTARD)

The allergic reaction, which appears in the eyes, is relatively common. It usually occurs together with the allergic common cold; through it rarely appears in the exe area only. Not for all the symptoms, which are regarded as the “red eyes”, the term allergy is correct. In addition to the reaction to the external irritation – the contact with the essential matter or dust, the infections and autoimmune disease can be taken into consideration, as well. The most common eye allergic disease is the allergic conjunctivitis – i.e. the pinkeye, which cover 25% of the population.

The conjunctiva is a thin phlegmy membrane, which covers the eye (the front side), the eyelash from the inner side hence it forms the so called eye conjunctiva bag. Since it is “stuffed” by the lymphocytes, eosinofilms and mastocytes it is a tissue, which the allergic reaction can appear in.

What are the allergic pink eye symptoms?

Usually the symptoms appear in different intensity, yet not all the symptoms appear at the same time. The common allergic conjunctivitis symptoms include the following:

● eye itch

● red eyes (red blood vessels)

● sore eyes

● lachrymation, often very intensive

● light sensitivity

The most typical symptom is the eye itch. The photophobia relates to the tingling feelings in the eyes during the increased light intensity. As for the unpleasant pinkeye side effects, the patients describe the sore eyes as having their eyes sprinkled with the sand. However, the eye does not hurt and if it does it is not the allergy. The allergic conjunctivitis can be distinguished according to the duration and season, in which it appears, into seasonal and perennial.

The seasonal is initiated by the pollen allergens and in most cases it accompanies the allergic common cold. Often the eyes symptoms appear at first, followed by the developing common cold. The symptoms can be observed on both eyes. However, their seriousness can differ – one eye can itch more than the other, and so on. While having only one inflamed eye, the disease can not be regarded as the allergic conjunctivitis.

The perennial allergic conjunctivitis is caused by the year – long appearing allergen contact – the mites, animal epithelium, moulds, which often occur together with the atopic eczema or even the asthma and sometimes is combined with the common cold. In most cases the inflammation gets worse during the pollen season. The conjunctivitis can be combined with the cornea inflammation - in this case we talk about the keratoconjunctivitis, which is more serious.

The vernal conjunctivitis has its name delivered from the fact that it appears in the spring time. Its development is regarded more serious. In addition to the common symptoms –itching, burning and shedding tears, the eye reacts with the megascopic protuberance – the capillaries. This inflammation can have complications, which can lead to the lost ob the patient’s sight. It can spread on the eye cornea and hence reduce the eye defensiveness to such a degree that the infection can start, as well.

The vernal conjunctivitis affects usually the children and the young population. The adults are affected by it only rare. The conjunctivitis is directly caused by the contact lens material, probably “in cooperation with “the mechanic eye irritation, hence as the contact lens started to be worn, the conjunctivitis has been spread. The gigantic papillary conjunctivitis – as this disease is called – is developing gradually and is a result of the intolerance of the lens, which can not be bear anymore. If we suspect any kind of illness disease in the eye, the ophthalmologic examination will be necessary. Do not try to treat these symptoms alone without an eye specialist.The allergic conjunctivitis therapy is connected with the allergic side effect therapy. It is based on the antihistamines – local and general.

Our market offers following preparations: levokabasine – LIVOSTIN, aselastine – ALLERGODIL, lodoxamide – ALOMIDE. For a long lasting therapy, even local cromoglycates – CROMMOHEXAL are used. In the case of massive inflammation, the short or long lasting corticoids can be used after the ophthalmologist´ s decision.

The pollen catcher is placed on the roof of the building. (The building should besituated representative enough for its surroundings, from which the information is given, thusnot near a factory or a chimney).The pollen catcher (pollen toils) - is a barrel with a vacuum cleaner, which draws in the airfrom the room and directs its flow with the help of the jet onto the adhesive tape.

All caught elements, which the air consists of, get caught on the adhesive tape. The tape isfixed on the inside of the barrel, which turns around slowly (360 degrees in seven days).The tape is removed from the barrel after a week, and is finally cut into seven piecesthat stand for particular days of the week. The pollen, which is caught on the rape, is colouredand finally evaluated under the microscope. Of course, these evaluations can be done only bythe experts, who can recognise and define the particular type of pollen drain according to itscolour, form and size.In addition to the type of pollen, the measurement of the pollen in the air has beenevaluated, as well.

The results are converted into 1 cubic metre. It is important, since thepatients react clinically to certain amount of the pollen in the air. The plants and flowers differin the aggressiveness from each other. To start the symptoms of the allergic reaction, 50pollen grains in 1 cubic metre are usually sufficient. While in season, the pollen count isseveral times higher.The pollen station sends the information to the centre (Štrbské Pleso in SR), whichprocesses the information and sends them to the central office in Vienna. At the same time,once in a week, it distributes the information to several doctors and public mass media.

The pollen calendar

The central office in Vienna under Dr. Siegfried Jäger processes the data fromEuropean pollen stations on the basis of the information gained. It enables to publish thepollen calendar periodically. It is a document - a map, which covers the pollen in the air indifferent European countries according to the months of the year.The calendar is important for all sufferers. The up–to-date month by month situationof the area where we are living at can be found here.We can find here the pollen situation in other countries, as well, which plays a significant rolefor everyone who is planning to travel abroad.The summary of the pollens in our country is shown in the following picture. Thevacation guideline for the allergic people can be found in the chapter Allergy on the road.