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He BX, Ma JJ, Lai H, Li CG, Huang LX, Huang HN, Liu XQ, Zhou ZR, Xie YC, Kuang PP, Ou CQ, Fu QL. Association between daily 1-km resolution levels of ambient air pollution and hospital visits for allergic diseases. Allergy 2024; 79:1336-1338. [PMID: 37787017 DOI: 10.1111/all.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Bi-Xin He
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Jun Ma
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - He Lai
- Department of Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chan-Gu Li
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long-Xin Huang
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao-Neng Huang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiao-Qing Liu
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Rou Zhou
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying-Chun Xie
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peng-Peng Kuang
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qing-Ling Fu
- Otorhinolaryngology Hospital and Department of Allergy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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2
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Kim BE, Hui-Beckman JW, Nevid MZ, Goleva E, Leung DYM. Air pollutants contribute to epithelial barrier dysfunction and allergic diseases. Ann Allergy Asthma Immunol 2024; 132:433-439. [PMID: 38006973 DOI: 10.1016/j.anai.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Air pollution is a global problem associated with various health conditions, causing elevated rates of morbidity and mortality. Major sources of air pollutants include industrial emissions, traffic-related pollutants, and household biomass combustion, in addition to indoor pollutants from chemicals and tobacco. Various types of air pollutants originate from both human activities and natural sources. These include particulate matter, pollen, greenhouse gases, and other harmful gases. Air pollution is linked to allergic diseases, including atopic dermatitis, allergic rhinitis, allergic conjunctivitis, food allergy, and bronchial asthma. These pollutants lead to epithelial barrier dysfunction, dysbiosis, and immune dysregulation. In addition, climate change and global warming may contribute to the exacerbation and the development of allergic diseases related to air pollutants. Epigenetic changes associated with air pollutants have also been connected to the onset of allergic diseases. Furthermore, these changes can be passed down through subsequent generations, causing a higher prevalence of allergic diseases in offspring. Modulation of the aryl hydrocarbon receptor could be a valuable strategy for alleviating air pollutant-induced epidermal barrier dysfunction and atopic dermatitis. A more effective approach to preventing allergic diseases triggered by air pollutants is to reduce exposure to them. Implementing public policies aimed at safeguarding individuals from air pollutant exposure may prove to be the most efficient solution. A pressing need exists for global policy initiatives that prioritize efforts to reduce the production of air pollutants.
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Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | | | | | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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3
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Hwang SH, Lee YJ, Choi YH, Huh DA, Kang MS, Moon KW. Long-term effects of the Hebei Spirit oil spill on the prevalence and incidence of allergic disorders. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168801. [PMID: 38008335 DOI: 10.1016/j.scitotenv.2023.168801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
The Hebei Spirit oil spill accident occurred in December 2007, approximately 10 km off the coast of Taean, South Korea, a location notably close to residential areas. Crude oil substances have been detected in various environmental mediums since the accident, yet previous studies have primarily focused on the acute effects of oil exposure due to the short latency period of allergic diseases. Therefore, this study evaluated the long-term effects of oil spill exposure on allergic disorders. Our study included adult residents who had participated in the Health Effects Research on Hebei Spirit Oil Spill (HEROS) study up to five years post-incident, which was a prospective cohort to monitor the health status of Taean residents. We used two indicators to assess oil spill exposure, namely the distance from the initial contaminated coastline to each participant's residence and the number of days participants had engaged in oil clean-up work. Current symptoms such as asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and multimorbidity were considered allergic disorders. In the baseline survey, the prevalence of asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and allergic multimorbidity symptoms was associated with both exposure indicators; however, these associations were not observed in the two consecutive surveys. Significant longitudinal associations between oil spill exposure indicators and the four allergic disorders, as well as multimorbidity incidences, were observed during a five-year follow-up period. Our results suggest that oil spill exposure can affect acute and long-term allergic symptoms in residents near the accident site.
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Affiliation(s)
- Se Hyun Hwang
- Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yong-Jin Lee
- Regional Environmental Health Center, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea; Department of Occupational & Environmental Medicine, Soonchunhyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Yun-Hee Choi
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea; BK21 FOUR R & E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Da-An Huh
- Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea.
| | - Min-Sung Kang
- Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Kyong Whan Moon
- Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea; BK21 FOUR R & E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
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4
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Wu CY, Wu CY, Li MC, Ho HJ, Ao CK. Association of air quality index (AQI) with incidence of atopic dermatitis in Taiwan: A nationwide population-based cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00207-X. [PMID: 38311242 DOI: 10.1016/j.jaad.2024.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Air pollutants may aggravate atopic dermatitis (AD). However, the association between Air Quality Index (AQI) and incidence of AD remains unknown. OBJECTIVE To investigate association between AQI and incidence of AD, using the nationwide cohort in the Taiwan National Health Insurance Research Database (NHIRD). METHODS We included 21,278,938 participants from the NHIRD not diagnosed with AD before 2008. Long-term average AQI value, obtained from the Taiwan Air Quality Monitoring System Network, before AD diagnosis was calculated and linked for each participant. RESULTS 199,205 incident cases of AD were identified from 2008 to 2018. Participants were classified into 4 quantiles (Q) by AQI value. With the lowest quantile, Q1, as reference, the AD risk increased significantly in the Q2 group (adjusted hazard ratio [aHR]: 1.29, 95% confidence interval [CI]: 1.04-1.65), Q3 group (aHR: 4.71, 95% CI: 3.78-6.04), and was highest in the Q4 group (aHR: 13.20, 95% CI: 10.86-16.60). As AQI treated as a continuous variable, an increase of 1 unit of AQI value added 7% of AD risk (aHR, 1.07, 95% CI: 1.07-1.08). LIMITATIONS The NHIRD lacks detailed information on individual subjects. CONCLUSIONS The results demonstrated a significant positive association between AQI and incidence of AD with a clear dose-response relationship.
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Affiliation(s)
- Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Public Health and Department of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chun-Ying Wu
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Translational Research and Center of Excellence for Cancer Research, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Meng-Chieh Li
- Department of Medical Education, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chon-Kit Ao
- Department of Economics, National Cheng Kung University, Tainan, Taiwan.
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5
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Stefanovic N, Irvine AD. Filaggrin and beyond: New insights into the skin barrier in atopic dermatitis and allergic diseases, from genetics to therapeutic perspectives. Ann Allergy Asthma Immunol 2024; 132:187-195. [PMID: 37758055 DOI: 10.1016/j.anai.2023.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Atopic dermatitis (AD) is the most common inflammatory skin disease worldwide, affecting 20% of children and 5% of adults. One critical component in the pathophysiology of AD is the epidermal skin barrier, with its outermost layer, the stratum corneum (SC), conferring biochemical properties that enable resilience against environmental threats and maintain homeostasis. The skin barrier may be conceptualized as a key facilitator of complex interactions between genetics, host immunity, the cutaneous microbiome, and environmental exposures. The key genetic risk factor for AD development and persistence is a loss-of-function mutation in FLG, with recent advances in genomics focusing on rare variant discovery, establishment of pathogenic mechanisms, and exploration of the role of other epidermal differentiation complex gene variants in AD. Aberrant type 2 inflammatory responses down-regulate the transcription of key epidermal barrier genes, alter the composition of SC lipids, and induce further injury through a neurocutaneous feedback loop and the itch-scratch cycle. The dysbiotic epidermis exhibits reduced bacterial diversity and enhanced colonization with Staphylococcus and Malassezia species, which contribute to both direct barrier injury through the action of bacterial toxins and perpetuation of the inflammatory cascades. Enhanced understanding of each of the pathogenic mechanisms underpinning barrier disruption has led to the development of novel topical and systemic molecules, including interleukin (IL)-4Ra, IL-13, PDE4, and Janus-associated kinase inhibitors, whose clinical effectiveness exceeds conventional treatment modalities. In this narrative review, we aim to summarize the current understanding of the above-mentioned pathophysiological and therapeutic mechanisms, with a focus on the genetic, cellular, and molecular mechanisms underpinning AD development.
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Affiliation(s)
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
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6
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Luo M, Su HC, Lin JE, Zhu CH, Lin LH, Han Y. A Retrospective Analysis of Risk Factors for Atopic Dermatitis Severity. Dermatitis 2024; 35:S81-S90. [PMID: 37126941 DOI: 10.1089/derm.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background: Atopic dermatitis (AD) has the highest burden of any skin disease; however, the severity-associated factors remain unclear. Objective: To evaluate potential severity-associated factors of AD and to design and validate a severity prediction model to inform the management of AD patients. Methods: A cross-sectional study of 900 AD patients was conducted from December 2021 to October 2022 at our hospital. The primary outcome was disease severity, categorized as mild, moderate, or severe using the scoring atopic dermatitis index. Ordinal logistic regression and bootstrapped validation were used to derive and internally validate the model. Results: Increasing age, elevated eosinophil level, higher economic status, and urban residence were associated with severe AD. Breastfeeding, disinfectants and topical emollients use, and short duration of bathing were associated with mild AD. In the prediction model, predictors included age, eosinophil and economic status, residence, feeding, disinfectants and emollients use, and duration of bathing. Prediction models demonstrated good discrimination (bias-corrected concordance index [c-index] = 0.72) and good calibration. Conclusion: Risk factors for the severity of AD were identified that could aid the early prediction of AD progression. The predictive model included variables that are easily evaluated and could inform personalized prevention and therapy.
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Affiliation(s)
- Min Luo
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Huichun C Su
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Jinger E Lin
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Changhua H Zhu
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Lihang H Lin
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Yue Han
- From the Department of Dermatology, the Union Hospital, Fujian Medical University, Fuzhou, P.R. China
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7
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Feng C, Shao Y, Ye T, Cai C, Yin C, Li X, Liu H, Ma H, Yu B, Qin M, Chen Y, Yang Y, Xu W, Zhu Q, Jia P, Yang S. Associations between long-term exposure to PM 2.5 chemical constituents and allergic diseases: evidence from a large cohort study in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166755. [PMID: 37659545 DOI: 10.1016/j.scitotenv.2023.166755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/12/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Exposure to air pollutants may cause immune responses and further allergic diseases, but existing studies have mostly, if not all, focused on effects of short-term exposure to PM2.5 on allergic diseases. OBJECTIVES We estimated associations of long-term exposure to PM2.5 chemical constituents with allergic disease risks and effect modification. METHODS We used the baseline of a newly established, provincially representative cohort of 51,480 participants in southwest China. The presence of allergic rhinitis, allergic asthma, urticaria, and allergic conjunctivitis was self-reported by following a formed questionnaire in face-to-face interviews. The average concentrations of PM2.5 chemical constituents (NO3-, SO42-, NH4+, organic matter [OM], and black carbon [BC]) over participants' residence were estimated using machine learning models. Logistic regression with double robust estimator and weighted quantile sum regression were used to estimate the effects of PM2.5 chemical constituents on allergic disease risks, as well as relative importance of each PM2.5 chemical constituent. RESULTS Per interquartile range increase in the concentration of all PM2.5 chemical constituents was associated with the elevated risks for allergic asthma (OR = 1.79 [1.41-2.26]), allergic conjunctivitis (1.54 [1.19-2.00]), urticaria (1.36 [1.25-1.48]), and allergic rhinitis (1.18 [1.11-1.26]). NO3- contributed more to risks for allergic asthma (weight = 46.05 %), urticaria (72.29 %), and allergic conjunctivitis (47.65 %), while NH4+ contributed more to allergic rhinitis (78.07 %). OM contributed most to the risks for allergic asthma (30.81 %) and allergic conjunctivitis (31.40 %). BC was also associated with allergic rhinitis, urticaria, and allergic conjunctivitis, only with a considerable weight for urticaria (24.59 %). Joint effects of PM2.5 chemical constituents on risks for allergic rhinitis and urticaria were stronger in minorities and farmers than their counterparts. CONCLUSION Long-term exposure to PM2.5 chemical constituents was associated with the increased allergic disease risks, with NO3- and NH4+ accounting for the largest variance of the associations. Our findings would serve as scientific evidence for developing more explicit strategies of air pollution control.
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Affiliation(s)
- Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ying Shao
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Tingting Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Changwei Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chun Yin
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Xiaobo Li
- Respiratory department, Chengdu Seventh People's Hospital, Chengdu, China
| | - Hongyun Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Mingfang Qin
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yang Chen
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yongfang Yang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Wen Xu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Qiuyan Zhu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China.
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8
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Hui-Beckman JW, Leung DYM. Physical influences on the skin barrier and pathogenesis of allergy. Curr Opin Pediatr 2023; 35:656-662. [PMID: 37650580 DOI: 10.1097/mop.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW As the incidence of allergic conditions has increased in recent decades, the effects of climate change have been implicated. There is also increased knowledge on the effects of other physical influences, such as scratching and Staphylococcus aureus . The skin barrier is the first line of defense to the external environment, so understanding the ways that these factors influence skin barrier dysfunction is important. RECENT FINDINGS Although the impact on environmental exposures has been well studied in asthma and other allergic disorders, there is now more literature on the effects of temperature, air pollution, and detergents on the skin barrier. Factors that cause skin barrier dysfunction include extreme temperatures, air pollution (including greenhouse gases and particulate matter), wildfire smoke, pollen, scratching, S. aureus, and detergents. SUMMARY Understanding the ways that external insults affect the skin barrier is important to further understand the mechanisms in order to inform the medical community on treatment and prevention measures for atopic conditions.
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9
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Seastedt H, Nadeau K. Factors by which global warming worsens allergic disease. Ann Allergy Asthma Immunol 2023; 131:694-702. [PMID: 37689112 PMCID: PMC10873081 DOI: 10.1016/j.anai.2023.08.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/11/2023]
Abstract
Increased use of fossil fuels has led to global warming with concomitant increases in the severity and frequency of extreme weather events such as wildfires and sand and dust storms. These changes have led to increases in air pollutants such as particulate matter and greenhouse gases. Global warming is also associated with increases in pollen season length and pollen concentration. Particulate matter, greenhouse gases, and pollen synergistically increase the incidence and severity of allergic diseases. Other indirect factors such as droughts, flooding, thunderstorms, heat waves, water pollution, human migration, deforestation, loss of green space, and decreasing biodiversity (including microbial diversity) also affect the incidence and severity of allergic disease. Global warming and extreme weather events are expected to increase in the coming decades, and further increases in allergic diseases are expected, exacerbating the already high health care burden associated with these diseases. There is an urgent need to mitigate and adapt to the effects of climate change to improve human health. Human health and planetary health are connected and the concept of One Health, which is an integrated, unifying approach to balance and optimize the health of people, animals, and the environment needs to be emphasized. Clinicians are trusted members of the community, and they need to take a strong leadership role in educating patients on climate change and its adverse effects on human health. They also need to advocate for policy changes that decrease the use of fossil fuels and increase biodiversity and green space to enable a healthier and more sustainable future.
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Affiliation(s)
- Hana Seastedt
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Kari Nadeau
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
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10
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Trinh P, Allerup JA, Li S, Ko J, Chen J, Linos E, Chiou AS. Association between yearlong air pollution and moderate-severe atopic dermatitis: A United States cross-sectional claims analysis. JAAD Int 2023; 13:4-6. [PMID: 37592975 PMCID: PMC10430148 DOI: 10.1016/j.jdin.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Pavin Trinh
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Johan A.C. Allerup
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Justin Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Jennifer Chen
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Albert S. Chiou
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
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11
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Çelebi Sözener Z, Treffeisen ER, Özdel Öztürk B, Schneider LC. Global warming and implications for epithelial barrier disruption and respiratory and dermatologic allergic diseases. J Allergy Clin Immunol 2023; 152:1033-1046. [PMID: 37689250 PMCID: PMC10864040 DOI: 10.1016/j.jaci.2023.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Global warming has direct and indirect effects, as well as short- and long-term impacts on the respiratory and skin barriers. Extreme temperature directly affects the airway epithelial barrier by disrupting the structural proteins and by triggering airway inflammation and hyperreactivity. It enhances tidal volume and respiratory rate by affecting the thermoregulatory system, causing specific airway resistance and reflex bronchoconstriction via activation of bronchopulmonary vagal C fibers and upregulation of transient receptor potential vanilloid (TRPV) 1 and TRPV4. Heat shock proteins are activated under heat stress and contribute to both epithelial barrier dysfunction and airway inflammation. Accordingly, the frequency and severity of allergic rhinitis and asthma have been increasing. Heat activates TRPV3 in keratinocytes, causing the secretion of inflammatory mediators and eventually pruritus. Exposure to air pollutants alters the expression of genes that control skin barrier integrity and triggers an immune response, increasing the incidence and prevalence of atopic dermatitis. There is evidence that extreme temperature, heavy rains and floods, air pollution, and wildfires increase atopic dermatitis flares. In this narrative review, focused on the last 3 years of literature, we explore the effects of global warming on respiratory and skin barrier and their clinical consequences.
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Affiliation(s)
- Zeynep Çelebi Sözener
- Division of Immunology and Allergic Diseases, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Elsa R Treffeisen
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Betül Özdel Öztürk
- Division of Immunology and Allergic Diseases, Bolu Izzet Baysal Training and Research Hospital, Bolu, Turkey
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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12
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Pan Z, Dai Y, Akar-Ghibril N, Simpson J, Ren H, Zhang L, Hou Y, Wen X, Chang C, Tang R, Sun JL. Impact of Air Pollution on Atopic Dermatitis: A Comprehensive Review. Clin Rev Allergy Immunol 2023; 65:121-135. [PMID: 36853525 DOI: 10.1007/s12016-022-08957-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 03/01/2023]
Abstract
Air pollution is associated with multiple health problems worldwide, contributing to increased morbidity and mortality. Atopic dermatitis (AD) is a common allergic disease, and increasing evidence has revealed a role of air pollution in the development of atopic dermatitis. Air pollutants are derived from several sources, including harmful gases such as nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO), as well as particulate matter (PM) of various sizes, and bioaerosols. Possible mechanisms linking air pollution to atopic dermatitis include damage to the skin barrier through oxidative stress, increased water loss, physicochemical injury, and an effect on skin microflora. Furthermore, oxidative stress triggers immune dysregulation, leading to enhanced sensitization to allergens. There have been multiple studies focusing on the association between various types of air pollutants and atopic dermatitis. Since there are many confounders in the current research, such as climate, synergistic effects of mixed pollutants, and diversity of study population, it is not surprising that inconsistencies exist between different studies regarding AD and air pollution. Still, it is generally accepted that air pollution is a risk factor for AD. Future studies should focus on how air pollution leads to AD as well as effective intervention measures.
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Affiliation(s)
- Zhouxian Pan
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yimin Dai
- Eight-Year Clinical Medicine System, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Nicole Akar-Ghibril
- Division of Immunology, Allergy and Rheumatology, Joe DiMaggio Children's Hospital, Memorial Healthcare System, Hollywood, FL, 33021, USA
| | - Jessica Simpson
- Division of Immunology, Allergy and Rheumatology, Joe DiMaggio Children's Hospital, Memorial Healthcare System, Hollywood, FL, 33021, USA
| | - Huali Ren
- Department of Allergy, Beijing Electric Power Hospital of State Grid Company of China, Electric Power Teaching Hospital of Capital Medical University, Beijing, 100073, China
| | - Lishan Zhang
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yibo Hou
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xueyi Wen
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Christopher Chang
- Division of Immunology, Allergy and Rheumatology, Joe DiMaggio Children's Hospital, Memorial Healthcare System, Hollywood, FL, 33021, USA.
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, 95616, USA.
| | - Rui Tang
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jin-Lyu Sun
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Allergy Department, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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13
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Mazur M, Dyga W, Czarnobilska E. The Prevalence of Atopic Dermatitis and Food Allergy in Children Living in an Urban Agglomeration-Is There a Current Relationship? J Clin Med 2023; 12:5982. [PMID: 37762923 PMCID: PMC10531722 DOI: 10.3390/jcm12185982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Atopic dermatitis (AD) prevalence in Poland is more frequent in individuals who live in a city. There are more studies demonstrating that long-term exposure to air pollutants is an independent risk factor for developing AD. The aim of the study was to assess the epidemiology of AD and food allergy (FA) in school children and adolescents living in Krakow, and to find a potential relationship between the incidence of atopic dermatitis with exposure to polluted air. In this paper, we presented the incidence of AD and FA between 2014 and 2018. We analyzed data collected from nearly 30,000 children aged 7-8 and adolescents aged 16-17 from the population of children and youth in Krakow. We correlated it with annual mean concentrations of PM10 and PM2.5, which indicated a gradual improvement in the air quality in Krakow. As our research results show that the prevalence of atopic dermatitis decreased with food allergy prevalence depending on the age group. We can suspect that this is the result of children growing out of a food allergy. It may be also influenced by more consequential eating habits in a group of adolescents and the elimination of allergenic foods from the diet. The decreasing incidence of atopic dermatitis appears to be also related to improvement in air quality.
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Affiliation(s)
| | | | - Ewa Czarnobilska
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Botaniczna St. 3, 31-501 Krakow, Poland
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14
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Bocheva G, Slominski RM, Slominski AT. Environmental Air Pollutants Affecting Skin Functions with Systemic Implications. Int J Mol Sci 2023; 24:10502. [PMID: 37445680 PMCID: PMC10341863 DOI: 10.3390/ijms241310502] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The increase in air pollution worldwide represents an environmental risk factor that has global implications for the health of humans worldwide. The skin of billions of people is exposed to a mixture of harmful air pollutants, which can affect its physiology and are responsible for cutaneous damage. Some polycyclic aromatic hydrocarbons are photoreactive and could be activated by ultraviolet radiation (UVR). Therefore, such UVR exposure would enhance their deleterious effects on the skin. Air pollution also affects vitamin D synthesis by reducing UVB radiation, which is essential for the production of vitamin D3, tachysterol, and lumisterol derivatives. Ambient air pollutants, photopollution, blue-light pollution, and cigarette smoke compromise cutaneous structural integrity, can interact with human skin microbiota, and trigger or exacerbate a range of skin diseases through various mechanisms. Generally, air pollution elicits an oxidative stress response on the skin that can activate the inflammatory responses. The aryl hydrocarbon receptor (AhR) can act as a sensor for small molecules such as air pollutants and plays a crucial role in responses to (photo)pollution. On the other hand, targeting AhR/Nrf2 is emerging as a novel treatment option for air pollutants that induce or exacerbate inflammatory skin diseases. Therefore, AhR with downstream regulatory pathways would represent a crucial signaling system regulating the skin phenotype in a Yin and Yang fashion defined by the chemical nature of the activating factor and the cellular and tissue context.
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Affiliation(s)
- Georgeta Bocheva
- Department of Pharmacology and Toxicology, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Radomir M. Slominski
- Department of Genetics, Informatics Institute in the School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Andrzej T. Slominski
- Department of Dermatology, Cancer Chemoprevention Program, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Veteran Administration Medical Center, Birmingham, AL 35294, USA
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15
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Belzer A, Parker ER. Climate Change, Skin Health, and Dermatologic Disease: A Guide for the Dermatologist. Am J Clin Dermatol 2023:10.1007/s40257-023-00770-y. [PMID: 37336870 DOI: 10.1007/s40257-023-00770-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 06/21/2023]
Abstract
Climate change has a pervasive impact on health and is of clinical relevance to every organ system. Climate change-related factors impact the skin's capacity to maintain homeostasis, leading to a variety of cutaneous diseases. Stratospheric ozone depletion has led to increased risk of melanoma and keratinocyte carcinomas due to ultraviolet radiation exposure. Atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoaging are all associated with rising levels of air pollution. Elevated temperatures due to global warming induce disruption of the skin microbiome, thereby impacting atopic dermatitis, acne vulgaris, and psoriasis, and high temperatures are associated with exacerbation of skin disease and increased risk of heat stroke. Extreme weather events due to climate change, including floods and wildfires, are of relevance to the dermatologist as these events are implicated in cutaneous injuries, skin infections, and acute worsening of inflammatory skin disorders. The health consequences as well as the economic and social burden of climate change fall most heavily on vulnerable and marginalized populations due to structural disparities. As dermatologists, understanding the interaction of climate change and skin health is essential to appropriately manage dermatologic disease and advocate for our patients.
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Affiliation(s)
- Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | - Eva Rawlings Parker
- Department of Dermatology, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 26-300, Nashville, TN, 37204, USA.
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16
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Bellinato F, Adami G, Furci A, Cattani G, Schena D, Girolomoni G, Gisondi P. Association between short-term exposure to environmental air pollution and atopic dermatitis flare in patients treated with dupilumab. JAAD Int 2023; 11:72-77. [PMID: 36937029 PMCID: PMC10020116 DOI: 10.1016/j.jdin.2023.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 02/12/2023] Open
Abstract
Background The magnitude of short/medium-term air pollution exposure on atopic dermatitis (AD) flare has not been fully investigated. The aim of the study was to investigate the association of short/medium-term exposure to airborne pollution on AD flares in patients treated with dupilumab. Methods Observational case-crossover study. Patients with moderate-to-severe AD under treatment with dupilumab were included. The exposure of interest was the mean concentrations of coarse and fine particulate matter (PM10, PM2.5), nitrogen dioxide, and oxides (NO2, NOx). Different intervals were considered at 1 to 60 days before the AD flare and control visit, defined as the visit with the highest Eczema Area and Severity Index scores >8 and ≤7, respectively. A conditional logistic regression analysis adjusted for systemic treatments was employed to estimate the incremental odds (%) of flare every 10 μg/m3 pollutant concentration. Results Data on 169 of 528 patients with AD having 1130 follow-up visits and 5840 air pollutant concentration measurements were retrieved. The mean age was 41.4 ± 20.3 years; 94 (55%) men. The incremental odds curve indicated a significant positive trend of AD flare for all pollutants in all time windows. At 60 days, every 10 μg/m3 PM10, PM2.5, NOx, and NO2 increase concentration was associated with 82%, 67%, 28%, and 113% odds of flare, respectively. Conclusions In patients treated with dupilumab, acute air pollution exposure is associated with an increased risk for AD flare with a dose-response relationship.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology
- Correspondence and reprint requests to: Francesco Bellinato, MD, Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy, Piazzale A. Stefani 1, 37126 Verona, Italy.
| | - Giovanni Adami
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Giorgio Cattani
- Italian Institute for Environmental Protection and Research, Rome, Italy
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17
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Kayode OA, Mokoatle CM, Rathebe PC, Mbonane TP. Factors Associated with Atopic Dermatitis among Children Aged 6 to 14 Years in Alimosho Local Government, Lagos, Nigeria. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050893. [PMID: 37238441 DOI: 10.3390/children10050893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
There has been a rise in the prevalence of atopic dermatitis (AD) globally, especially in low-and middle-income countries such as Nigeria. The condition has been linked to genetic predisposes, living conditions, and environmental factors. Environmental factors are considered a significant contributor to AD in low- and middle-income countries. This study determined the prevalence of AD in south-western Nigeria and identified risk factors in home and school environments that children aged 6 to 14 years are exposed to. A cross-sectional study was adopted, and the total sample size was 349. Four randomly selected health facilities were used for the study. A questionnaire was used to determine the risk factors in the population. Data analysis was performed using the latest version of Statistical Package for Social Science (SPSS). The prevalence of atopic dermatitis in this study is 25%. Atopic dermatitis was found to be common in females (27%). According to the univariate analysis, children who lived where trucks pass on the street almost daily had the highest cases of atopic dermatitis (28%). Children with rugs in their houses (26%) and those whose houses are surrounded by bushes (26%) had higher cases of atopic dermatitis. Children who played on school grass (26%), attended creche with rubber toys (28%), and attended school where wooden chairs (28%) and chalkboards (27%) are used had a higher number of AD. Bivariate analysis showed an association between AD with a mother's monthly income (p = 0.012) and eating potatoes (p = 0.005), fruits (p = 0.040), and cereal (p = 0.057). In the multivariate analysis, the consumption of fruits (p = 0.02), potatoes (p < 0.001), and cereal (p = 0.04) were identified as risk factors associated with AD. It is envisaged that the study will serve as a basis for possible research on evidence-based and primary prevention options. Hence, we recommend health education activities to empower communities to protect themselves against environmental risk factors that are preventable.
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Affiliation(s)
- Olubunmi A Kayode
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
| | - Charlotte M Mokoatle
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
| | - Phoka C Rathebe
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
| | - Thokozani P Mbonane
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
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18
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Schuler CF, Billi AC, Maverakis E, Tsoi LC, Gudjonsson JE. Novel insights into atopic dermatitis. J Allergy Clin Immunol 2023; 151:1145-1154. [PMID: 36428114 PMCID: PMC10164702 DOI: 10.1016/j.jaci.2022.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Recent research into the pathophysiology and treatment of atopic dermatitis (AD) has shown notable progress. An increasing number of aspects of the immune system are being implicated in AD, including the epithelial barrier, TH2 cytokines, and mast cells. Major advances in therapeutics were made in biologic cytokine and receptor antagonists and among Janus kinase inhibitors. We focus on these areas and address new insights into AD epidemiology, biomarkers, endotypes, prevention, and comorbidities. Going forward, we expect future mechanistic insights and therapeutic advances to broaden physicians' ability to diagnose and manage AD patients, and perhaps to find a cure for this chronic condition.
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Affiliation(s)
- Charles F Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Allison C Billi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Emanual Maverakis
- Department of Dermatology, University of California-Davis, Sacramento, Calif
| | - Lam C Tsoi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Johann E Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
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19
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Kam S, Hwang BJ, Parker ER. The impact of climate change on atopic dermatitis and mental health comorbidities: a review of the literature and examination of intersectionality. Int J Dermatol 2023; 62:449-458. [PMID: 36639925 DOI: 10.1111/ijd.16557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/19/2022] [Accepted: 11/30/2022] [Indexed: 01/15/2023]
Abstract
Climate change, fueled by increasing concentrations of greenhouse gases, is associated with rising temperatures, extreme weather events, increased aeroallergen production, and air pollution. Our understanding that many inflammatory cutaneous diseases carry important mental health comorbidities is expanding. Simultaneously, the detrimental impacts of climate change on human health are now widely recognized as a global public health crisis. Importantly, these climate-associated phenomena exacerbate the environmental triggers of atopic dermatitis (AD) and are also associated with amplification of comorbid mental health conditions in AD including depression, anxiety, trauma-related disorders, and psychotic spectrum disorders. This review is the first to examine the nexus of climate change, atopic dermatitis, and mental health comorbidities and emphasizes the disproportionate impacts of climate change in vulnerable and marginalized populations.
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Affiliation(s)
- Sharon Kam
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Barrington J Hwang
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva R Parker
- Department of Dermatology and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Fadadu RP, Abuabara K, Balmes JR, Hanifin JM, Wei ML. Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2526. [PMID: 36767891 PMCID: PMC9916398 DOI: 10.3390/ijerph20032526] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Atopic dermatitis (AD) has increased in prevalence to become the most common inflammatory skin condition globally, and geographic variation and migration studies suggest an important role for environmental triggers. Air pollution, especially due to industrialization and wildfires, may contribute to the development and exacerbation of AD. We provide a comprehensive, multidisciplinary review of existing molecular and epidemiologic studies on the associations of air pollutants and AD symptoms, prevalence, incidence, severity, and clinic visits. Cell and animal studies demonstrated that air pollutants contribute to AD symptoms and disease by activating the aryl hydrocarbon receptor pathway, promoting oxidative stress, initiating a proinflammatory response, and disrupting the skin barrier function. Epidemiologic studies overall report that air pollution is associated with AD among both children and adults, though the results are not consistent among cross-sectional studies. Studies on healthcare use for AD found positive correlations between medical visits for AD and air pollutants. As the air quality worsens in many areas globally, it is important to recognize how this can increase the risk for AD, to be aware of the increased demand for AD-related medical care, and to understand how to counsel patients regarding their skin health. Further research is needed to develop treatments that prevent or mitigate air pollution-related AD symptoms.
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Affiliation(s)
- Raj P. Fadadu
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John R. Balmes
- School of Public Health, University of California, Berkeley, CA 94720, USA
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA 94143, USA
| | - Jon M. Hanifin
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Maria L. Wei
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
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21
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Chong AC, Visitsunthorn K, Ong PY. Genetic/Environmental Contributions and Immune Dysregulation in Children with Atopic Dermatitis. J Asthma Allergy 2022; 15:1681-1700. [PMID: 36447957 PMCID: PMC9701514 DOI: 10.2147/jaa.s293900] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 08/01/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common skin conditions in humans. AD affects up to 20% of children worldwide and results in morbidity for both patients and their caregivers. The basis of AD is an interplay between genetics and the environment characterized by immune dysregulation. A myriad of mutations that compromise the skin barrier and/or immune function have been linked to AD. Of these, filaggrin gene (FLG) mutations are the most evidenced. Many other mutations have been implicated in isolated studies that are often unreplicated, creating an archive of genes with potential but unconfirmed relevance to AD. Harnessing big data, polygenic risk scores (PRSs) and genome-wide association studies (GWAS) may provide a more practical strategy for identifying the genetic signatures of AD. Epigenetics may also play a role. Staphylococcus aureus is the most evidenced microbial contributor to AD. Cutaneous dysbiosis may result in over-colonization by pathogenic strains and aberrant skin immunity and inflammation. Aeroallergens, air pollution, and climate are other key environmental contributors to AD. The right climate and/or commensals may improve AD for some patients.
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Affiliation(s)
- Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Peck Y Ong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, USA
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22
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Zhang S, Fu Q, Wang S, Jin X, Tan J, Ding K, Zhang Q, Li X. Association between air pollution and the prevalence of allergic rhinitis in Chinese children: A systematic review and meta-analysis. Allergy Asthma Proc 2022; 43:e47-e57. [PMID: 36065105 DOI: 10.2500/aap.2022.43.220044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Allergic rhinitis (AR) is a common chronic inflammatory disease with bothersome symptoms. However, the effect of air pollution on the prevalence of AR in children is controversial. Objective: This study aimed to investigate the association between air pollution and the prevalence of AR in Chinese children. Methods: This study, in China, included 160,356 students ages 0-18 years who completed a questionnaire about the accuracy of the International Study of Asthma and Allergies in Childhood (ISAAC). The effect of different air pollutants on the prevalence rate were evaluated by meta-analysis. Also, it evaluated the effect of different air pollutants on the prevalence rate. Results: The differences in the effects of sulfur dioxide (SO₂) exposure (combined odds ratio [ORcombined] 1.03 [95% confidence interval {CI}, 1.01-1.05]; p = 0.010) and nitrogen dioxide (NO₂) exposure (ORcombined 1.11 [95% CI, 1.05-1.18]; p = 0.0006) on the risk of childhood AR was statistically significant. The effect of particulate matter with aerodynamic diameter of <10 μm (PM10) exposure on the risk of childhood AR was statistically significant (ORcombined 1.02 [95% CI, 1.01-1.03]; p < 0.001), the effect of particulate matter with aerodynamic diameter of <2.5 μm (PM2.5) exposure on the risk of childhood AR was statistically significant (ORcombined 1.15 [95% CI, 1.03-1.29]; p = 0.02), and the effect of ozone exposure on the risk of childhood AR was not statistically significant (ORcombined 0.98 [95% CI, 0.67-1.41]; p = 0.13). Conclusion: NO₂, SO₂, PM2.5, and PM10 were associated with the prevalence of AR in Chinese children. PM2.5 had the highest correlation with AR prevalence.
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Affiliation(s)
- Shipeng Zhang
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinwei Fu
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuting Wang
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Jin
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junwen Tan
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kaixi Ding
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinxiu Zhang
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinrong Li
- From the Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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23
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Yong SB, Gau SY, Guo YC, Wei JCC. Allergy from perspective of environmental pollution effects: from an aspect of atopic dermatitis, immune system, and atmospheric hazards-a narrative review of current evidences. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:57091-57101. [PMID: 35759095 DOI: 10.1007/s11356-022-21582-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Environmental pollution has become more diversified in recent years as technologies for urbanization is increasingly more advanced. Several environmental factors such as air and water pollutants have been linked to allergic symptoms. For instance, because of industrialization for city development in many countries, polluted soil or tiny particles in the air could result in an even more hazardous environment for people to reside. Aside from the aspects of environmental issues, other newly emerging factors such as the electromagnetic field (EMF) also require further investigation. Here, in this narrative review, we focused on allergens from atmospheric and water pollution, hygiene improvement, changes in food trend, and residential environmental pollution. Current evidences regarding the association between various pollutants and the potential clinical diseases could be induced. For people with high skin exposure to air pollutants such as PM 2.5, PM 10, or sulfur dioxide, potential onset of dermatological allergic events should be alerted. The mechanisms involved in allergic diseases are being discussed and summarized. Interactions between immunological mechanisms and clinical implications could potentially provide clearer view to the association between allergic status and pollutants. Moreover, understanding the mechanistic role of allergens can raise awareness to global environment and public health.
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Affiliation(s)
- Su Boon Yong
- Division of Pediatric Allergy, Immunology, Rheumatology, Lin-Shin Hospital, Taichung, Taiwan, Republic of China
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Yu-Chen Guo
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China.
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan, Republic of China.
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan, Republic of China.
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24
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Wang H, Li XB, Chu XJ, Cao NW, Wu H, Huang RG, Li BZ, Ye DQ. Ambient air pollutants increase the risk of immunoglobulin E-mediated allergic diseases: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:49534-49552. [PMID: 35595897 PMCID: PMC9122555 DOI: 10.1007/s11356-022-20447-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/21/2022] [Indexed: 05/06/2023]
Abstract
Immunoglobulin E (IgE)-mediated allergic diseases, including eczema, atopic dermatitis (AD), and allergic rhinitis (AR), have increased prevalence in recent decades. Recent studies have proved that environmental pollution might have correlations with IgE-mediated allergic diseases, but existing research findings were controversial. Thus, we performed a comprehensive meta-analysis from published observational studies to evaluate the risk of long-term and short-term exposure to air pollutants on eczema, AD, and AR in the population (per 10-μg/m3 increase in PM2.5 and PM10; per 1-ppb increase in SO2, NO2, CO, and O3). PubMed, Embase, and Web of Science were searched to identify qualified literatures. The Cochran Q test was used to assess heterogeneity and quantified with the I2 statistic. Pooled effects and the 95% confidence intervals (CIs) were used to evaluate outcome effects. A total of 55 articles were included in the study. The results showed that long-term and short-term exposure to PM10 increased the risk of eczema (PM10, RRlong = 1.583, 95% CI: 1.328, 1.888; RRshort = 1.006, 95% CI: 1.003-1.008) and short-term exposure to NO2 (RRshort = 1.009, 95% CI: 1.008-1.011) was associated with eczema. Short-term exposure to SO2 (RRshort: 1.008, 95% CI: 1.001-1.015) was associated with the risk of AD. For AR, PM2.5 (RRlong = 1.058, 95% CI: 1.014-1.222) was harmful in the long term, and short-term exposure to PM10 (RRshort: 1.028, 95% CI: 1.008-1.049) and NO2 (RRshort: 1.018, 95% CI: 1.007-1.029) were risk factors. The findings indicated that exposure to air pollutants might increase the risk of IgE-mediated allergic diseases. Further studies are warranted to illustrate the potential mechanism for air pollutants and allergic diseases.
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Affiliation(s)
- Hua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xian-Bao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xiu-Jie Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Nv-Wei Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Hong Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Rong-Gui Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Bao-Zhu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China.
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
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Chueachavalit C, Meephansan J, Payungporn S, Sawaswong V, Chanchaem P, Wongpiyabovorn J, Thio HB. Comparison of Malassezia spp. colonization between human skin exposed to high and low ambient air pollution. Exp Dermatol 2022; 31:1454-1461. [PMID: 35665543 DOI: 10.1111/exd.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/22/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The skin microbiota is essential for human health; altered skin microbiome colonization and homeostasis may be associated with several inflammatory skin conditions and other inflammatory diseases. The effects of particulate matter of diameter less than 2.5 micrometers (PM2.5) on the skin and the skin microbiome are poorly understood. Malassezia spp. are commensal fungi commonly found on the human skin, and they also play a pathogenic role in various skin diseases. It is hypothesized that the exposure of human skin to air pollution with a high concentration of PM2.5 might be associated with Malassezia spp. colonization. The aim of this study was to compare Malassezia spp. colonization on healthy human skin between people living in two major cities in Thailand with different air qualities: one city with highly polluted ambient air and the other with less polluted air. METHODS Skin microbiome samples from 66 participants were collected using swabbing and scraping techniques. The skin fungal composition was analyzed using high-throughput sequencing based on internal transcribed spacer 2 (ITS2) rDNA. RESULTS A significant difference was found in alpha and beta diversities and the relative abundance of fungal profiles between the groups. The relative abundance of Malassezia spp. was found to be significantly higher in the highly polluted area than in the less polluted area. CONCLUSION This study demonstrates that ambient air polluted with high concentrations of PM2.5 may alter Malassezia spp. colonization on healthy human skin, which could lead to dysbiosis of the cutaneous ecosystem and eventually result in some skin disorders.
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Affiliation(s)
- C Chueachavalit
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - J Meephansan
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - S Payungporn
- Research Unit of Systems Microbiology, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - V Sawaswong
- Research Unit of Systems Microbiology, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Chanchaem
- Research Unit of Systems Microbiology, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J Wongpiyabovorn
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Center of Excellence in Immunology and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - H B Thio
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherland
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