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Background: Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of nonpharmacologic interventions to reduce allergic symptoms. Methods: PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, 2 of 13 | SCHUTZMEIER ET al. | INTRODUC TI ONAllergic rhinitis (AR) and asthma pose a worldwide health issue. 1 International studies like the European Community RespiratoryHealth Survey and the International Study of Asthma and Allergies in Childhood showed that AR and asthma are prevalent in most countries. 2,3 The global prevalence of AR is between 10% and 30% in adults and at least 40% in children. 4 AR is associated with immunoglobulin-E type antibody (IgE)mediated immune response to allergens causing inflammations. The most common symptoms are rhinorrhea, blocked nose, nasal itching, sneezing, and ocular symptoms. 5 AR is associated with the development of asthma. 6,7 Both AR and asthma can be triggered by airborne pollen. 8 Apart from allergenspecific immunotherapy as the only causal treatment, 9,10 there is a variety of effective medication and guidelines to control symptoms, for example, second-generation antihistamine or intranasal glucocorticoids. Bousquet et al. 11 showed that symptoms of AR are under control in only about one third of the patients who received optimal pharmacological treatment. The objective of this paper is to review studies on the effectiveness of non-pharmacologic interventions (NPI) to reduce allergic symptoms due to pollen. | ME THODSThe "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) checklist has been used to carry out this systematic review (Appendix S1: ESM 1). [12][13][14] The review was prepared in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. 15 The review is registered in the "International Prospective Register of Systematic Reviews" (PROSPERO: CRD42019106131). | Search strategyThe search strategy was conducted by using PECOs (Tables 1 and 2):Studies that investigated the efficacy of NPI in people with allergic and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included.Results: Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filt...

Background Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children’s exposure to second-hand smoke (SHS) before and after the ban, its effect on children’s health and prevalence of active smoking in adults. Methods Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children’s intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking. Results The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95% 1.01–1.35), 1.65 (CI95% 1.39–1.95), 2.85 (CI95% 2.32–3.51), 2.24 (CI95% 1.84–2.72) and 3.66 (CI95% 2.89–4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95% 1.03–1.24)) and S8 (OR = 1.24 (CI95% 1.13–1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95% 1.06–1.40) for S2 and 1.57 (CI95% 1.33–1.86) for S8 compared to S1. Adverse health effects related to children’s exposure to SHS are significantly less in S8 compared to S1. Conclusion After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.

Background: Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children’s exposure to second-hand smoke (SHS) before and after the ban, its effect on children’s health and prevalence of active smoking in adults. Methods: Six cross-sectional surveys (n=32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariate logistic regression, we analysed change in children’s SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking. Results: Odds of parents never smoking at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI 95% 1.01 – 1.35), 1.65 (CI 95% 1.39 – 1.95), 2.85 (CI 95% 2.32 – 3.51), 2.24 (CI 95% 1.84 – 2.72) and 3.66 (CI 95% 2.89 – 4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents not actively smoking is significantly higher in S7 (OR= 1.13 (CI 95% 1.03 – 1.24)) and S8 (OR= 1.24 (CI 95% 1.13 – 1.36)). Adverse health effects related to children’s exposure to SHS are significantly less in S8 compared to S1. Conclusion: Smoking displacement to homes after the ban in Bavaria was disproved. Number of parents quitting smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.