Severe chronic allergic (and related) diseases:a uniform approach - A MeDALL - GA(2)LEN - ARIA position paper

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies

The cycling of pollutants in nonurban forested environments

Forests are complex ecosystems which respond to external inputs of pollutants in a variety of ways. Quantifying changes in the storage of pollutants within ecosystem pools and the biogeochemical fluxes between them provides a means of calculating the overall pollutant balance of a forest ecosystem as an indicator of its sustainability and health. This chapter focuses on pollutant cycling in nonurban forest ecosystems with specific attention on quantification of external inputs, pollutant fluxes and pools within forests and exports to adjacent systems (Fig. 34.1). Selected case studies are used to exemplify the approach and illustrate the importance of location, forest type, management practices such as harvesting and soil conditions. Direct pollutant impacts on forest ecosystem functioning, the effects of intensified biomass utilization, and interactions between climate and pollutant cycling are also discusse