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The prevalence of allergic diseases is increasing worldwide with the rapid industrialization
and urbanization. Globally, 300 million people suffer from asthma, 400 million from rhinitis
[1]. Air pollution, climate change, and reduced biodiversity are major threats to human
health with detrimental effects on a variety of chronic diseases in particular respiratory and
cardiovascular diseases. The extent of air pollution both outdoor and indoor is increasing
to alarming proportions particularly in the rapidly industrializing countries. According to
the World Health Organization (WHO) every year 3 million people die prematurely due to
outdoor air pollution, which is heaviest in major cities of Asia, Africa, and Latin America.
In recent years, Asia has experienced rapid economic growth and a deteriorating
environment coupled with an increase in allergic diseases to epidemic proportions. In
the Asia-Pacific region, 2.3 billion people are exposed to levels of air pollution several
times higher than the WHO guideline for safe air especially in China and India. Moreover,
industrial, traffic-related, and household biomass combustion, indoor pollutants from
chemicals, phthalates, and tobacco are major sources of air pollutants, with increasing
burden on respiratory allergies.
Epidemiological and experimental studies have shed light on the relationship between various environmental factors and climate change on respiratory allergies [2-9] such as rhinitis and asthma. Increased exposure to outdoor pollutants like carbon dioxide (CO2), sulfur dioxide (SO2), ozone (O3), and indoor pollutants like tobacco smoke and chemicals leading tolimited plant, animal and microbial life lead to immune dysfunction and impaired tolerancein humans [5, 6]. Urbanization, high levels of vehicle emissions and westernized lifestyle correlate with an increase in the frequency of pollen-induced respiratory allergy in people living in urban areas in comparison with those living in rural areas [10]. Ozone has been reported to cause respiratory symptoms by inducing increase in airway responsiveness, airway injury and inflammation and systemic oxidative stress [11] Furthermore, pollen collected along high-traffic roads showed a higher allergen city and children living closer to high traffic roads has been shown to have greater symptoms of respiratory allergies. in this context, it is important to point out that air pollution can interact with allergen-carrying submicronic and paucimicronic particles derived from pollen or other part of the plants [12, 13]. These allergens are able to reach peripheral airways with inhaled air, inducing asthma in sensitized subjects.
Weather changes like wind patterns, precipitation timing and intensity, increase of temperature may have an effect on the severity and frequency of air pollution. One of the effects of climate change and global warming that can threaten respiratory health is
“Thunderstorm related asthma.” Thunderstorms occurring during the pollen season have
been observed to induce severe asthma attacks and also deaths in pollen-allergic patients.
The thunderstorm asthma of Melbourne in 2016, with the involvement of more than 9,000
persons and 10 deaths, was a major event in the Asia-Pacific region [13]. The thunderstorm
in a pollen season led to a major rise in concentration of pollen grains, hydration and
rupture of pollens by osmotic shock with release of allergen-carrying paucimicronic particles
of respirable size such as starch granules and other cytoplasmic components into the
atmosphere. This resulted in the inhalation of these particles by those who had seasonal
allergic rhinitis to the pollen with or without comorbid asthma and resulted in the onset of
asthma epidemics [3, 14, 15]
A third of the world's population uses solid fuel derived from plant material (biomass) or coal
for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple
stove with incomplete combustion, and result in a large amount of household air pollution.
Volatile organic compounds (VOCs) are a group of carbon-based chemicals that easily
evaporate at room temperature. Many common household materials and products, such as
paints and cleaning products, give off VOCs [3]. Common VOCs include acetone, benzene,
ethylene glycol, formaldehyde, methylene chloride, perchloroethylene, toluene, and xylene.
Several studies suggest that exposure to VOCs may worsen symptoms in asthmatics or are
those particularly sensitive to chemicals.
A global study of 9–23 million and 5–10 million annual asthma Emergency room visits
(ERVs) globally in 2015 was shown to be attributable to O3 and particulate matter (PM2.5),
respectively, representing 8%–20% and 4%–9% of the annual number of global visits,
respectively. Anthropogenic emissions were responsible for ∼37% and 73% of O3 and PM2.5 impacts, respectively [16]. Remaining impacts were attributable to naturally occurring O3 precursor emissions (e.g., from vegetation, lightning) and PM2.5 (e.g., dust, sea salt), though several of these sources are also influenced by humans. The largest impacts were estimated in China and India. The top 3 countries for both asthma incidence and prevalence in Asia were India, China, and Indonesia. Nearly half (48%) of estimated O3-attributable and over half (56%) of PM2.5-attributable asthma ERVs were estimated in Southeast Asia (includes India), and western Pacific regions (includes China). The percentage of national pediatric asthma incidence that may be attributable to anthropogenic PM2.5 was estimated to be 57% in India, 51% in China, and over 70% in Bangladesh.
Furthermore, changes in the environment and human activities have caused an alteration in
the biodiversity [17, 18]. Metagenomic and other studies of healthy and diseased individuals
reveal that reduced biodiversity and alterations in the composition of the gut and skin
microbiota are associated with various inflammatory conditions, including asthma and
allergic diseases.
Asia-Pacific comprises over half of the world's population. There is an urgent need to
highlight the key components of outdoor and indoor air pollutants and their impact on
respiratory allergies like asthma and allergic rhinitis, increase public awareness, highlight
targets for interventions, increase awareness amongst patients and physicians on the
importance of diagnosis and evidence-based treatment with safe and efficacious drugs,
public advocacy and a call to action to policy makers to implement policy changes towards
reducing air pollution with strategic interventions at a population-based level.
The Asia Pacific Association of Allergy Asthma and Clinical Immunology has developed a
white paper on the burden of air pollution in Asia Pacific and impact on respiratory allergies
and a charter of recommendations addressing this very important environmental issue that
has a wide impact on health.
REFERENCES
1. Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. WAO White book on Allergy: update 2013. Milwaukee (WI): World Allergy Organization; 2013.
2. Hegerl GC, Zwiers FW, Braconnot P, Gillett NP, Luo Y, Marengo JA, et al. Understanding and attributing climate change. In: Solomon S, Qin D, Manning M, Chen Z, Marquis M, Averyt KB, et al., editors. Climate change 2007: the physical science basis. Contribution of the Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press. 2007. p. 663-746.
3. D'Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JT, D'Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJ, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the
World Allergy Organization. World Allergy Organ J 2015;8:25.
PUBMED
4. D'Amato G, Vitale C, Lanza M, Molino A, D'Amato M. Climate change, air pollution, and allergic respiratory diseases: an update. Curr Opin Allergy Clin Immunol 2016;16:434-40.
PUBMED | CROSSREF
5. D'Amato G, Vitale C, De Martino A, Viegi G, Lanza M, Molino A, Sanduzzi A, Vatrella A, Annesi-Maesano I, D'Amato M. Effects on asthma and respiratory allergy of Climate change and air pollution. Multidiscip Respir Med 2015;10:39.
PUBMED | CROSSREF
6. Pielke RA, Cecchi L, D'Amato G, Annesi-Maesano I. Climate, urban air pollution and respiratory allergy. In: Pielke RA, editor. Climate vunerability: understanding and addressing threats to essential resources. Waltham (MA): Academic Press, 2013. p. 105-13.
7. D'Amato G, Bergmann KC, Cecchi L, Annesi-Maesano I, Sanduzzi A, Liccardi G, Vitale C, Stanziola A, D'Amato M. Climate change and air pollution: Effects on pollen allergy and other allergic respiratory diseases. Allergo J Int 2014;23:17-23.
PUBMED | CROSSREF
8. Singer BD, Ziska LH, Frenz DA, Gebhard DE. Increasing Amb a 1 content in common ragweed (Ambrosia artemisiifolia) pollen as a function of rising atmospheric CO2 concentration. Func Plant Biol 2005;32:667-70.
CROSSREF
9. Wayne P, Foster S, Connolly J, Bazzaz F, Epstein P. Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. Ann Allergy Asthma Immunol 2002;88:279-82.
PUBMED | CROSSREF
10. D'Amato G, Cecchi L. Effects of climate change on environmental factors in respiratory allergic diseases. Clin Exp Allergy 2008;38:1264-74.
PUBMED | CROSSREF
11. Islam T, Gauderman WJ, Berhane K, McConnell R, Avol E, Peters JM, Gilliland FD. Relationship between air pollution, lung function and asthma in adolescents. Thorax 2007;62:957-63.
PUBMED | CROSSREF
12. Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton R, Mace GM, Marten R, Myers SS, Nishtar S, Osofsky SA, Pattanayak SK, Pongsiri MJ, Romanelli C, Soucat A, Vega J, Yach D. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet 2015;386:1973-2028.
PUBMED | CROSSREF
13. Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, Bardin PG, Bannister T, Barnes S, Bellomo R, Byrne T, Casamento A, Conron M, Cross A, Crosswell A, Douglass JA, Durie M, Dyett J, Ebert E, Erbas B, French C, Gelbart B, Gillman A, Harun NS, Huete A, Irving L, Karalapillai D, Ku D, Lachapelle P, Langton D, Lee J, Looker C, MacIsaac C, McCaffrey J, McDonald CF, McGain F, Newbigin E, O'Hehir R, Pilcher D, Prasad S, Rangamuwa K, Ruane L, Sarode V, Silver JD, Southcott AM, Subramaniam A, Suphioglu
C, Susanto NH, Sutherland MF, Taori G, Taylor P, Torre P, Vetro J, Wigmore G, Young AC, Guest C. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health 2018;2:e255-63.
PUBMED | CROSSREF
14. D'Amato G, Cecchi L, Bonini S, Nunes C, Annesi-Maesano I, Behrendt H, Liccardi G, Popov T, van Cauwenberge P. Allergenic pollen and pollen allergy in Europe. Allergy 2007;62:976-90.
PUBMED | CROSSREF
15. D'Amato G. Airborne paucimicronic allergen-carrying particles and seasonal respiratory allergy. Allergy 2001;56:1109-11.
PUBMED | CROSSREF
16. Anenberg SC, Henze DK, Tinney V, Kinney PL, Raich W, Fann N, Malley CS, Roman H, Lamsal L, Duncan B, Martin RV, van Donkelaar A, Brauer M, Doherty R, Jonson JE, Davila Y, Sudo K, Kuylenstierna JC. Estimates of the global burden of ambient PM2.5, ozone, and NO2 on asthma incidence and emergency room visits. Environ Health Perspect 2018;126:107004.
PUBMED | CROSSREF
17. Flandroy L, Poutahidis T, Berg G, Clarke G, Dao MC, Decaestecker E, Furman E, Haahtela T, Massart S, Plovier H, Sanz Y, Rook G. The impact of human activities and lifestyles on the interlinked microbiota and health of humans and of ecosystems. Sci Total Environ 2018;627:1018-38.
PUBMED | CROSSREF
18. Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, Caraballo L, Demain J, Portnoy J, von Hertzen L; WAO Special Committee on Climate Change and Biodiversity. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J 2013;6:3.
PUBMED | CROSSREF
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