Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters.

This survey is anonymous.

The record of your survey responses does not contain any identifying information about you, unless a specific survey question explicitly asked for it.

If you used an identifying token to access this survey, please rest assured that this token will not be stored together with your responses. It is managed in a separate database and will only be updated to indicate whether you did (or did not) complete this survey. There is no way of matching identification tokens with survey responses.

You are invited to participate in a voluntary survey. Before participating, it is important to read this form which describes the purpose and practicalities of the survey.

Over the last few decades, the prevalence of allergies has increased considerably worldwide. In Belgium, pollen allergies are estimated to affect about 1 in 5 people.
Environmental nitrogen pollution, resulting from the burning of fossil fuels and the intensive use of pesticides in agriculture, may play an important role in the increase in the prevalence of pollen allergy and/or the aggravation of allergy symptoms, but more research is needed to understand these impacts.
By answering this questionnaire, you participate in the exploration of the relationship between nitrogen pollution and the burden of pollen allergy in Belgium and thus help to advance research in this area. We hope to include 500 respondents in this study.
The survey is organized by UCLouvain in collaboration with Sciensano.

The time required to complete the questionnaire is estimated to be between 15 and 20 minutes.

(1) My participation is voluntary and I may discontinue participation at any time, without stating a reason, even after signing the consent form. I do not have to provide a reason for withdrawing your consent to participate: however, the data collected up to the time I stop participating in the survey is part of the survey. My refusal to participate in this survey will not result in any penalty or loss of benefits to me.

(2) Any information I provide will be used only for the purposes of this study and my personal data will remain strictly confidential and anonymous. These rights are guaranteed to me by the European General Data Protection Regulation of 27 April 2016 (in force since 25 May 2018) and by the Belgian law of 30 July 2018 on the protection of privacy with regard to the processing of personal data and by the Belgian law of 22 August 2002 on patients' rights.

(3) UCLouvain and Sciensano will only use this information for general statistical purposes. Scientific publications may be created on the basis of the survey results, but my personal data will never be passed on to third parties.

(4) Anonymized data will be kept until September 2024 inclusive. During this period, there is a risk of a breach of confidentiality of the data. Following the General Data Protection Regulation (GDPR), I have the right to access, modify or delete my data during this period. If you have any questions about this, please contact the Study Center's Data Protection Officer at privacy@uclouvain.be.

(5) I understand that by participating in this survey, I will not receive any direct personal benefits. The information obtained from this survey may contribute to a better understanding of the impact of nitrogen on pollen allergies in Belgium.

(6) If I or one of my family members suffer any damage in connection with this study, this damage will be compensated by the sponsor of the study following the law relating to experiments on the human being of 7 May 2004. I do not have to prove the fault of anyone.
Name and address of the insurer: Ms Amlin insurance SE, boulevard du Roi Albert II, 37 1000 Brussels
Insurance policy number: LXX111372

(7) This survey is evaluated by an independent ethics committee, namely the Hospitalo-Faculty Ethics Committee Saint-Luc - UCLouvain, which issued a favorable opinion on the 17th of January 2023.

(8) The data protection officer of UCLouvain can be contacted for any questions on this subject at privacy@uclouvain.be .

(9) If there is a complaint about how data is processed, it can be addressed to the Belgian Data Protection Authority: rue de la Presse, 35 - 1000 Brussels - Tel: 02/274.48.00 - e-mail: contact@apd-gba.be.
Any request/question can be sent by mail to:

- Prof.Dr. DEVLEESSCHAUWER Brecht (coordinator of the study) : brecht.devleesschauwer@sciensano.be

- Prof. Dr. HOX Valérie (principal investigator of the study) : valerie.hox@saintluc.uclouvain.be

For the management of complaints not resolved by the investigator, you can contact the Ethics Committee as mediator: commision.ethique-saintluc@uclouvain.be tel: 02/764.55.14.

By clicking on "I participate", I agree to participate in this study.

We are sorry but you can't proceed without first agreeing to our survey data policy.

Consent