As anyone living with hay fever may be a witness, days with high pollen counts can lead to sneezing, nasal congestion and other allergic symptoms. Now, a new study suggests that increasing pollen levels may also relieve pain and other symptoms in patients with urologic malignant pelvic pain syndrome (UCPPS), reports Journal of Urology®, Official Journal of the American Urological Association (AUA). The magazine is published in a Lippincott folder by Wolters Kluwer.
Our study provides evidence that shows that increased pollen numbers may cause symptoms in people living with UCPPS. If the association with pollen levels has been confirmed through future studies, it may help us to understand how flares occur in individuals with chronic urologic pelvic pain, as well as how prevent or control these unpredictable attacks. “
Siobhan Sutcliffe, PhD, ScM, MHS, Washington University School of Medicine, St. Louis
Patients with UCPPS experience flares of pelvic or bladder pain and urinary symptoms, which can be frequent and disabling. The cause of UCPPS is unknown, but talking to patients offers some interesting insights – including the fact that patients with UCPPS report higher than normal levels of allergies and asthma.
In addition, some patients find that their symptoms improve when they take allergy medications. Some drugs used for the treatment of allergies, such as antihistamines and mast cell protectors, are also used for the treatment of patients with UCPPS and other chronic pelvic pain studies. If UCPPS is linked to allergies, signal flares may be more common when pollen counts are higher.
Dr. Sutcliffe and colleagues studied this association using data on patients with enrolled UCPPS in a follow-up study (Multidisciplinary approach for the study of chronic pelvic pain, or MAPP). In 290 participants, pollen levels were compared for periods when patients did not object to receiving symptom flares. They were part of a total group of 409 patients and continued over time to assess the overall association between flame levels and pollen levels. Patients were drawn from eight study sites across the United States. Information on UCPPS flames was compared to pollen levels, based on local air quality monitoring data from each survey area.
There were no daily changes in pollen counts associated with UCPPS flames, either on a flame day or the previous three days. This was true for all participants and on an analysis of those who reported allergies or respiratory tract disorders.
However, when pollen counts rose above the mean or high level, UCPPS flames increased dramatically. One or two days after pollen counts exceeded the “moderate” level or higher, the incidence of symptomatic flares increased by 22 percent in all patients with UCPPS, and by 33 percent in the those with allergies.
Flame levels increased in the three weeks after pollen numbers exceeded medium or high thresholds, with a significant 23 percent increase in risk for patients with allergies. The results remained about the same about analysis but included patients taking UCPPS medications with anti-allergic effects.
“Our results are consistent with patients reporting higher pollen counts promoting their flames and with case series and reporting data suggesting that allergy and asthma medications relieve UCPPS symptoms,” he says. Dr. Sutcliffe and coauthors write. The findings are also supported by evidence that UCPPS and allergies share common biological factors, i.e., mast cell activation and histamine release. After histamine is released in response to allergens, levels remain high in the urine for a period of time – which can contribute to bladder-related symptoms in UCPPS.
While the findings provide new evidence about a link between allergies and UCPPS, the researchers note some limitations of their study – not all of the associations reported looked statistically significant. “If pollen actually gives flames to some patients with chronic urologic pelvic pain, that could affect further research and patient care,” adds Dr. Sutcliffe. patients may benefit from taking antihistamines on days with high pollen levels, or from allergy testing and immunotherapy. “
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Magazine Reference:
Irum, J .., et al. (2020) Are pelvic syndrome pollen flares harmful urologic pollen? Case-crossover analysis in the multidisciplinary approach for chronic pelvic pain research network analysis. Journal of Urology. doi.org/10.1097/JU.0000000000000014822.