Impact of weather and climate change with indoor and outdoor air quality in asthma: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee

Examining the impact of air pollution, climate change, and social determinants of health on asthma and environmental justice

PURPOSE OF REVIEW

In this review, we discuss the current literature examining the impact air pollution and climate change has on asthma onset, control, and exacerbation. This review also addresses the risk of exposure to specific disproportionately affected communities, highlighting health disparities in exposure and asthma outcomes.

RECENT FINDINGS

Recent studies have shifted from highlighting the associations between asthma exacerbations and indoor and outdoor air pollution. Studies are now focused on confirming the association of asthma incidence from these same exposures. Many studies have linked particulate matter to adverse asthma outcomes, however, the pollutant exposures that pose the greatest risk and the effect of natural disasters fueled by climate change are under current study. Some studies have observed that the true burden that pollutant exposures have on asthma outcomes occurs at the intersection of exposure and vulnerability. Future studies in this area will address social determinants of health, societal factors such as redlining and other systemic racism practices.

SUMMARY

Although decades of research support the causal link between gaseous and particulate air pollution and the exacerbation of preexisting asthma, recent studies suggest air pollution can cause incident (new onset) asthma. Studies have started to focus on the underlying drivers of poor outcomes in asthma. Many of the structural impediments to high quality asthma care at the society level (e.g. poverty, redlining, systemic racism) also are risk factors for worsened climate events and air pollution exposure. The individuals in these disproportionately affected groups are doubly affected by worsened exposure and worsened access to care for the resultant asthma exacerbations or incident asthma. More research is needed to understand the specific climate and air pollution mitigation efforts where disproportionately affected communities would derive the most benefit.

Development of a Unified IoT Platform for Assessing Meteorological and Air Quality Data in a Tropical Environment

In developing nations, outdated technologies and sulfur-rich heavy fossil fuel usage are major contributors to air pollution, affecting urban air quality and public health. In addition, the limited resources hinder the adoption of advanced monitoring systems crucial for informed public health policies. This study addresses this challenge by introducing an affordable internet of things (IoT) monitoring system capable of tracking atmospheric pollutants and meteorological parameters. The IoT platform combines a Bresser 5-in-1 weather station with a previously developed air quality monitoring device equipped with Alphasense gas sensors. Utilizing MQTT, Node-RED, InfluxDB, and Grafana, a Raspberry Pi collects, processes, and visualizes the data it receives from the measuring device by LoRa. To validate system performance, a 15-day field campaign was conducted in Santa Clara, Cuba, using a Libelium Smart Environment Pro as a reference. The system, with a development cost several times lower than Libelium and measuring a greater number of variables, provided reliable data to address air quality issues and support health-related decision making, overcoming resource and budget constraints. The results showed that the IoT architecture has the capacity to process measurements in tropical conditions. The meteorological data provide deeper insights into events of poorer air quality.

Prenatal Exposure to Air Pollutants Associated with Allergic Diseases in Children: Which Pollutant, When Exposure, and What Disease? A Systematic Review and Meta-analysis

This systematic review aims to identify the association between prenatal exposure to air pollutants and allergic diseases in children, focusing on specific pollutants, timing of exposure, and associated diseases. We searched PubMed, Scopus, and Web of Science for English articles until May 1, 2023, examining maternal exposure to outdoor air pollutants (PM1, PM2.5, PM10, NO, NO2, SO2, CO, and O3) during pregnancy and child allergic diseases (atopic dermatitis (AD), food allergy (FA), asthma (AT) and allergic rhinitis (AR)/hay fever (HF)). The final 38 eligible studies were included in the meta-analysis. Exposure to PM2.5 and NO2 during pregnancy was associated with the risk of childhood AD, with pooled ORs of 1.34 (95% confidence interval (CI), 1.10-1.63) and 1.10 (95%CI, 1.05-1.15) per 10 µg/m3 increase, respectively. Maternal exposure to PM1, PM2.5, and NO2 with a 10 µg/m3 increase posed a risk for AT, with pooled ORs of 1.34 (95%CI, 1.17-1.54), 1.11 (95%CI, 1.05-1.18), and 1.07 (95%CI, 1.02-1.12), respectively. An increased risk of HF was observed for PM2.5 and NO2 with a 10 µg/m3 increase, with ORs of 1.36 (95%CI, 1.17-1.58) and 1.26 (95%CI, 1.08-1.48), respectively. Traffic-related air pollutants (TRAP), particularly PM2.5 and NO2, throughout pregnancy, pose a pervasive risk for childhood allergies. Different pollutants may induce diverse allergic diseases in children across varying perinatal periods. AT is more likely to be induced by outdoor air pollutants as a health outcome. More research is needed to explore links between air pollution and airway-derived food allergies.

Investigating the impact of air pollution and temperature changes on emergency admissions (cardiovascular + respiratory) disease in the city of Bojnord, northeastern Iran

Cardiovascular (CVD) + Respiratory diseases are recognized as the main cause of death worldwide. Fluctuations in temperature and air pollution have been reported as one of the most important causes of cardiovascular & respiratory diseases. Therefore, in the current study, we assessed the relationship between ambient air temperature and pollution on the number of total emergency hospital admission due to cardiovascular and respiratory conditions in the City of Bojnord, northeastern Iran. The meteorological data, including daily temperature, relative humidity and concentrations of five air pollutants CO, NO2, NOX SO2, and PM10 were obtained from online electronic sensors at the Bojnurd meteorological station from 21th March 2018 to 20th March 2020. Statistical analysis, penalized distributed lag non-linear method was applied using R Software. Also, sensitivity analysis test was calculated by using appropriate application. The results of the study revealed that the effect of higher and lower temperatures was observed immediately from the first day and the second week, respectively. Also result showed with increase and decrease temperature, significantly increased the risk of hospitalization by 36% (RR, 1.36; 95% CI (1), 0.95 to 1.95) and 17% (RR, 1.17; 95% CI (1), 0.88 to 1.55) until the lag 25th day, respectively. Based on the results, increasing temperature significantly increased the hospitalization rate of cardiopulmonary patients, but the effect of cold was not significant on the population as well as age and gender subgroups. Study have also proved that there is no significance correlation between air pollutant and Cardiovascular & respiratory diseases.

"Air That Once Was Breath" Part 1: Wildfire-Smoke-Induced Mechanisms of Airway Inflammation - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023

BACKGROUND

Wildfires are a global concern due to their wide-ranging environmental, economic, and public health impacts. Climate change contributes to an increase in the frequency and intensity of wildfires making smoke exposure a more significant and recurring health concern for individuals with airway diseases. Some of the most prominent effects of wildfire smoke exposure are asthma exacerbations and allergic airway sensitization. Likely due to the delayed recognition of its health impacts in comparison with cigarette smoke and industrial or traffic-related air pollution, research on the composition, the mechanisms of toxicity, and the cellular/molecular pathways involved is poor or non-existent.

SUMMARY

This review discusses potential underlying pathological mechanisms of wildfire-smoke-related allergic airway disease and asthma. We focused on major gaps in understanding the role of wildfire smoke composition in the development of airway disease and the known and potential mechanisms involving cellular and molecular players of oxidative injury at the epithelial barrier in airway inflammation. We examine how PM2.5, VOCs, O3, endotoxin, microbes, and toxic gases may affect oxidative stress and inflammation in the respiratory mucosal barrier. We discuss the role of AhR in mediating smoke's effects in alarmin release and IL-17A production and how glucocorticoid responsiveness may be impaired by IL-17A-induced signaling and epigenetic changes leading to steroid-resistant severe airway inflammation.

KEY MESSAGE

Effective mitigation of wildfire-smoke-related respiratory health effects would require comprehensive research efforts aimed at a better understanding of the immune regulatory effects of wildfire smoke in respiratory health and disease.

Climate Change and Children's Health: Building a Healthy Future for Every Child

Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.

Extreme Weather Events and Asthma

The objective of this article is to review recent literature on the implications of extreme weather events such as thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes in relationship to asthma symptoms. Several studies have shown worsening of asthma symptoms with thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes. In particular, thunderstorm asthma can be exacerbated by certain factors such as temperature, precipitation, and allergen sensitization. Therefore, it is imperative that the allergy and immunology community be aware of the health effects associated with these extreme weather events in order to educate patients and engage in mitigation strategies.

Impact of Climate Change on Dietary Nutritional Quality and Implications for Asthma and Allergy

Asthma and allergic disorders are common in childhood with genetic and environmental determinants of disease that include prenatal nutritional exposures such as long-chain polyunsaturated fatty acids and antioxidants. Global climate change is implicated in asthma and allergic disorder morbidity with potential mechanisms including perturbations of ecosystems. There is support that environmental and climatic changes such as increasing global temperate and carbon dioxide levels affect aquatic and agricultural ecosystems with subsequent alterations in long-chain polyunsaturated fatty acid availability and nutrient quality and antioxidant capacity of certain crops, respectively. This article discusses asthma epidemiology and the influence of global climate change.

Impact of Climate Change on Indoor Air Quality

Climate change may affect the quality of the indoor environment through heat and mass transfer between indoors and outdoors: first by a direct response to global warming itself and related extreme weather phenomena and second by indirect actions taken to reduce greenhouse gas emissions that can lead to increased concentrations of indoor air contaminants. Therefore, both indoor and outdoor air pollution contribute to poor indoor air quality in this context. Exposures to high concentrations of these pollutants contribute to inflammatory respiratory diseases. Climate change adaptation and mitigation measures could minimize these risks and bring associated health benefits.

Machine Learning Approaches to Predict Asthma Exacerbations: A Narrative Review

The implementation of artificial intelligence (AI) and machine learning (ML) techniques in healthcare has garnered significant attention in recent years, especially as a result of their potential to revolutionize personalized medicine. Despite advances in the treatment and management of asthma, a significant proportion of patients continue to suffer acute exacerbations, irrespective of disease severity and therapeutic regimen. The situation is further complicated by the constellation of factors that influence disease activity in a patient with asthma, such as medical history, biomarker phenotype, pulmonary function, level of healthcare access, treatment compliance, comorbidities, personal habits, and environmental conditions. A growing body of work has demonstrated the potential for AI and ML to accurately predict asthma exacerbations while also capturing the entirety of the patient experience. However, application in the clinical setting remains mostly unexplored, and important questions on the strengths and limitations of this technology remain. This review presents an overview of the rapidly evolving landscape of AI and ML integration into asthma management by providing a snapshot of the existing scientific evidence and proposing potential avenues for future applications.

Agency in the Anthropocene: education for planetary health

Collective action is essential to address planetary health as current and future environmental challenges are socioecological and require coordinated, informed, and sustained action from all societal sectors. Education that engages intergenerational communities is a crucial means of building collective action as it provides opportunities to develop an informed citizenry capable of making the necessary decisions to work towards planetary health. Schools are valuable sites of community learning and action, and will benefit from a new orientation towards and commitment to educator training, curriculum development, and youth agency. This orientation is supported by the Organisation for Economic Co-operation and Development's Programme for International Student Assessment's (PISA) 2025 Science Framework, which measures the competence (skills and knowledge) of 15-year-old students. This Personal View describes a new concept, Agency in the Anthropocene, a contributing element of the 2025 Science Framework that defines the way science education could develop agency and hope in this era of socioecological challenges that are impacting planetary health.

Long-term PM2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

BACKGROUND

Exhaled nitric oxide concentration (FENO) is a marker of airway inflammation. This study aimed to evaluate the association of air pollution exposure with FENO levels and asthma prevalence with respiratory symptoms in school children.

METHODS

We analyzed 4736 school children who reside in six townships near industrial areas in central Taiwan. We evaluated asthmatic symptoms, FENO, and conducted the environmental questionnaire. The personal exposure of PM2.5, NO, and SO2 was estimated using land-use regression models data on children's school and home addresses.

RESULTS

Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma (OR = 1.595), exercise-induced wheezing (OR = 1.726), itchy eyes (OR = 1.417), and current nasal problems (OR = 1.334) (P < 0.05). FENO levels in the absence of infection were positively correlated with age, previous wheezing, allergic rhinitis, atopic eczema, near the road, and for children with high exposure to PM2.5 (P < 0.05). An increase of 1 μg/m3 PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels for children after adjusting for potential confounding variables, including exposures to NO and SO2.

CONCLUSIONS

Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

IMPACT

Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma and nasal problems and itchy eyes. Long-term exposures to PM2.5 were significantly associated with FENO levels after adjusting for potential confounding variables. This is first study to assess the association between FENO levels and long-term air pollution exposures in children near coal-based power plants. An increase of 1 μg/m3 annual PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels. Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

Health-based strategies for overcoming barriers to climate change adaptation and mitigation

Climate change poses an unequivocal threat to the respiratory health of current and future generations. Human activities-largely through the release of greenhouse gases-are driving rising global temperatures. Without a concerted effort to mitigate greenhouse gas emissions or adapt to the effects of a changing climate, each increment of warming increases the risk of climate hazards (eg, heat waves, floods, and droughts) that that can adversely affect allergy and immunologic diseases. For instance, wildfires, which release large quantities of particulate matter with a diameter of less than 2.5 μm (an air pollutant), occur with greater intensity, frequency, and duration in a hotter climate. This increases the risk of associated respiratory outcomes such as allergy and asthma. Fortunately, many mitigation and adaptation strategies can be applied to limit the impacts of global warming. Adaptation strategies, ranging from promotions of behavioral changes to infrastructural improvements, have been effectively deployed to increase resilience and alleviate adverse health effects. Mitigation strategies aimed at reducing greenhouse gas emissions can not only address the problem at the source but also provide numerous direct health cobenefits. Although it is possible to limit the impacts of climate change, urgent and sustained action must be taken now. The health and scientific community can play a key role in promoting and implementing climate action to ensure a more sustainable and healthy future.

Impact of Air Pollution on Atopic Dermatitis: A Comprehensive Review

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.

Assessing the Effect of Precipitation on Asthma Emergency Department Visits in New York State From 2005 to 2014: A Case-Crossover Study

The Earth's precipitation patterns are changing, and regional precipitation is expected to continue to increase in New York State (NYS). Heavy precipitation may negatively affect asthma prevalence through its effect on seasonally varying allergens. We employed a threshold analysis using a time-stratified semi-symmetric bi-directional case-crossover study design to assess the effect of increase in precipitation on asthma (ICD-9 code 493.xx, N = 970,903) emergency department (ED) visits between 2005 and 2014 during non-winter months in NYS. Spatially contiguous gridded meteorological data from North American Land Data Assimilation System (NLDAS) were utilized. We used conditional logistic regression models and stratified the analyses by seasons. During non-winter months, we found a small, statistically significant risk of asthma ED visits for precipitation levels above 50 mm, with differences by season. These results suggest that heavy precipitation may be related to an increased risk of asthma ED visits. Gridded meteorological estimates provide a means of addressing the gaps in exposure classification, and these findings provide opportunities for further research on interactions with aeroallergens and meteorological conditions in the context of climate and health.

The Impact of Climate Change on Asthma and Allergic-Immunologic Disease

PURPOSE OF REVIEW

This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources.

RECENT FINDINGS

Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.

Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.

Climate Change and Child Health Equity

The climate crisis is a major public health threat for children, disproportionately affecting the most vulnerable populations. Climate change causes a myriad of health issues for children, including respiratory illness, heat stress, infectious disease, the effects of weather-related disasters, and psychological sequelae. Pediatric clinicians must identify and address these issues in the clinical setting. Strong advocacy from pediatric clinicians is needed to help prevent the worst effects of the climate crisis and to support the elimination of use of fossil fuels and enactment of climate-friendly policies.

A Review of Artificial Neural Network Models Applied to Predict Indoor Air Quality in Schools

BACKGROUND

Indoor air quality (IAQ) in schools can affect the performance and health of occupants, especially young children. Increased public attention on IAQ during the COVID-19 pandemic and bushfires have boosted the development and application of data-driven models, such as artificial neural networks (ANNs) that can be used to predict levels of pollutants and indoor exposures.

METHODS

This review summarises the types and sources of indoor air pollutants (IAP) and the indicators of IAQ. This is followed by a systematic evaluation of ANNs as predictive models of IAQ in schools, including predictive neural network algorithms and modelling processes. The methods for article selection and inclusion followed a systematic, four-step process: identification, screening, eligibility, and inclusion.

RESULTS

After screening and selection, nine predictive papers were included in this review. Traditional ANNs were used most frequently, while recurrent neural networks (RNNs) models analysed time-series issues such as IAQ better. Meanwhile, current prediction research mainly focused on using indoor PM2.5 and CO2 concentrations as output variables in schools and did not cover common air pollutants. Although studies have highlighted the impact of school building parameters and occupancy parameters on IAQ, it is difficult to incorporate them in predictive models.

CONCLUSIONS

This review presents the current state of IAQ predictive models and identifies the limitations and future research directions for schools.

Effects of climate change on patients with respiratory and cardiovascular conditions

Climate change is one of the most significant global challenges and is already having detrimental effects on people's health. Pollution levels and ambient temperatures continue to increase, resulting in higher levels of humidity and pollen production. These environmental threats can affect many vulnerable patients, particularly those with respiratory and cardiovascular conditions, and nurses have a crucial role in raising awareness of the health implications of climate change. This article explores the pathophysiological effects of climate change on patients with asthma, chronic obstructive pulmonary disease and cardiovascular disease, and aims to enhance nurses' understanding of the health challenges of climate change.

Updated assessment of occupational safety and health hazards of climate change

Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.

Effects of Climate Change and Air Pollution on Perinatal Health

Climate change is often framed as an environmental concern; however, the burning of fossil fuels both directly and indirectly impacts air quality and, thus, human health. Gas byproducts of combustion lead to increased levels of atmospheric ozone and carbon dioxide, which in turn elevate surface temperatures of the earth. This process exposes individuals to respiratory irritants and contributes to increased frequency of natural disasters such as wildfires, negatively impacting respiratory health. Normal physiologic changes in the respiratory system make pregnant people particularly vulnerable to the effects of air pollution. Asthma and allergic rhinitis are 2 common respiratory diseases that can be triggered by poor air quality. Solutions to limit the impact of climate change on respiratory disease include risk mitigation and reduction of fossil fuel consumption on individual, organization, and community levels. Midwives are well positioned as clinicians to educate people about individual strategies to reduce environmental exposure to respiratory irritants and advocate for policy changes to limit future health effects of climate change.

Allergic diseases in India - Prevalence, risk factors and current challenges

Epidemiological studies have shown a rise in the prevalence of allergic diseases in India during the last two decades. However, recent evidence from the Global Asthma Network study has observed a decrease in allergic rhinitis, asthma and atopic dermatitis in children. Still, with a population over 1.3 billion, there is a huge burden of allergic rhinitis, asthma and atopic dermatitis, and this is compounded by an unmet demand for trained allergy specialists and poor health service framework. There is wide variation in the prevalence of allergic diseases between different geographical locations in India, and the reasons are unclear at present. This may at least in part be attributable to considerable heterogeneity in aero-biology, weather, air pollution levels, cultural and religious factors, diet, socioeconomic strata and literacy. At present, factors enhancing risks and those protecting from development of atopy and allergic diseases have not been well delineated, although there is some evidence for the influence of genetic factors alongside cultural and environmental variables such as diet, exposure to tobacco smoke and air pollution and residence in urban areas. This narrative review provides an overview of data from India regarding epidemiology, risk factors and genetics and highlights gaps in evidence as well as areas for future research.

Prediction of effect of wind speed on air pollution level using machine learning technique

Air pollution is one of the most challenging issues poses serious threat to human health and environment. The increasing influx of population in metropolitan cities has further worsened the situation. Quantifying the air pollution experimentally is quite a challenging task as it depends on many parameters viz., wind speed, wind temperature, relative humidity, temperature etc. It requires the investment of huge money and manpower for controlling air pollution. Machine learning technique-based computer modelling reduces both of the parameters. In the present work, the dependence of air pollution level on wind speed and temperature has been taken up using machine learning in the form of ANN and LSTM model. The recorded data of air pollution level (PM2.5) is collected from a measurement station of Lucknow city situated at Central School, CPCB. The data is used in an Artificial Neural based network and in an LSTM model to predict suitably the level of air pollution for a known value of average wind speed and temperature without experimental measurements. LSTM model is found to predict the pollution level better than ANN for the developed ANN networks.

Identification of prominent airborne pollen in a city situated in foot-hills of Himalayas, Chandigarh, India

Pollen allergy is considered one of the important critical thrust areas, as 20-30% of the world population suffers from allergic rhinitis. The increase in global surface temperature directly affects pollen physiological (e.g., pollen production) and morphological parameters and indirectly affects the distribution pattern, the allergenic potential of pollen, and plant species. Therefore, periodic sampling and pollen studies of a region have become necessary to assess the status of change in species and its morphological characteristics of different taxa. The current study is conducted to identify the airborne pollen based on studying their unique and distinctive morphological characters to serve as a reference pollen guide for future research. The airborne pollens were trapped using the Burkard volumetric sampler at three different locations in Chandigarh from 2018 to 2020 and analyzed under Leica DM5500B-Automated Upright Microscope System. The study investigated various pollen features such as shape, size, aperture type, and exine/surface pattern for taxonomic classification of plant groups. The majority of LM-analyzed pollen grains were prolate-spheroidal or oblate, whereas the aperture types were 3-zonocolporate, 3-colpate, and 3-zonocolporate. Exine patterns were predominantly psilate, reticulate, and straite and were easily discernible. Nonetheless, the vast majority of airborne pollen belonging to both arboreal and non-arboreal was quite small and fall into small pollen size classes, i.e., 10-24 μm. The exine pattern was readily apparent and were predominantly psilate, reticulate, and straight. The current study improved the knowledge on airborne pollen biodiversity, which will help to understand the regional distribution, long-range transport, and construct the current status of morphological features of species/taxa.

The effects of NLRP3 and MAVS gene polymorphisms on the risk of asthma: A case-control study

Genetic factors are important risk factors for asthma. Nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) is closely associated with asthma. Mitochondrial antiviral signaling protein (MAVS) mediates the recruitment of NLRP3 to the mitochondria and activation of the NLRP3 inflammasome. The purpose of this study was to analyze the effects of NLRP3 and MAVS polymorphisms on the risk of asthma and the interactions between them. Children with asthma (n = 127) and healthy children (n = 100) were recruited between August, 2020 and July, 2021. Multiplex polymerase chain reaction and sequencing was used to analyze genotypes of single nucleotide polymorphisms. The multifactor dimensionality reduction statistical method was used to detect and model epistasis of gene-gene interactions. There were significant differences in the distribution of MVAS rs6515831 and NLRP3 rs10925023 genotypes between the asthma and healthy groups. Compared with rs6515831 TT genotype, the results showed that rs6515831CT genotype increased the risk of asthma (odds ratio: 2.243, 95% CI: 1.221-4.122, P = .009). Compared with rs10925023 GG genotype, the results showed that the risk of asthma in the population with rs10925023 TT genotype was lower (odd ratio: 0.643, 95% CI: 0.423-0.979, P = .039). In the genotype of the NLRP3 rs12048215 locus, the IgE level of asthma patients with genotype AG was lower than that of patients with genotype AA. The dendrogram model showed the strongest interaction between rs7272495 and rs10925023, which was expressed in a synergistic manner. Haplotype analysis revealed that rs10925023T/rs7272495G and rs10925023T/rs3272495A were statistically different in distribution between the two groups. The MAVS rs6515831 and NLRP3 rs10925023 polymorphisms were associated with the risk of asthma in children. There may be interactions between NLRP3 and MAVS polymorphisms in the risk of asthma.

Impact of Climate Change on Indoor Air Quality: A Review

Climate change can affect the indoor environment due to heat and mass transfers between indoor and outdoor environments. To mitigate climate change impacts and adapt buildings to the changing environment, changes in building characteristics and occupants' behavior may occur. To characterize the effects of climate change on indoor air quality (IAQ), the present review focused on four aspects: (1) experimental and modeling studies that relate IAQ to future environmental conditions, (2) evolution of indoor and outdoor air concentrations in the coming years with regard to temperature rise, (3) climate change mitigation and adaptation actions in the building sector, and (4) evolution of human behavior in the context of climate change. In the indoor environment, experimental and modeling studies on indoor air pollutants highlighted a combined effect of temperature and relative humidity on pollutant emissions from indoor sources. Five IAQ models developed for future climate data were identified in the literature. In the outdoor environment, the increasing ambient temperature may lead directly or indirectly to changes in ozone, particle, nitrogen oxides, and volatile organic compound concentrations in some regions of the world depending on the assumptions made about temperature evolution, anthropogenic emissions, and regional regulation. Infiltration into buildings of outdoor air pollutants is governed by many factors, including temperature difference between indoors and outdoors, and might increase in the years to come during summer and decrease during other seasons. On the other hand, building codes in some countries require a higher airtightness for new and retrofitted buildings. The building adaptation actions include the reinforcement of insulation, implementation of new materials and smart building technologies, and a more systematic and possibly longer use of air conditioning systems in summer compared to nowadays. Moreover, warmer winters, springs, and autumns may induce an increasing duration of open windows in these seasons, while the use of air conditioning in summer may reduce the duration of open windows.

Climate change and allergic diseases: An overview

Climate change has been regarded as a threat to the human species on the earth. Greenhouse gasses are leading to increased temperatures on Earth besides impacting the humanity. These atmospheric conditions have shown to alter the release pattern of pollens and can change the timing and magnitude of pollen release with flowering plants. As pollen is responsible for respiratory allergies in humans, so climate change can adversely affect human health in susceptible individuals. In this review, we highlight the association between climate change, increased prevalence and severity of asthma, and related allergic diseases. Increased air pollution can alter the production of local and regional pollen. This altered pattern depends on bioclimatic parameters. As simulated with a pollen-release model and future bioclimatic data, warmer temperatures lead to an increased pollen count in some specific locations and for longer periods. Thus, anticipation of a future allergic disease burden can help public health agencies in planning to develop strategies in mitigating the unprecedented health challenges expected in future years.

The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children

BACKGROUND

While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children.

METHODS

We investigated 1- (n = 1108) and 6-year-old (n = 675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1 year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers.

RESULTS

Grass pollen at lag 0-3 (every 20 grains/m³ increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only.

CONCLUSION

Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.

Occupational exposure to airborne pollen and associated health risks among gardeners: a perception-based survey

Airborne pollen are considered a major trigger of respiratory diseases that causes morbidity and subsequently affects a person's quality of life (QOL). Outdoor workers, such as gardeners, florists, etc., are at greater risk of allergies due to continuous exposure to the high concentration of allergens. The current study aims to assess the associated health risks among gardeners due to occupational exposure to airborne pollen. A semi-structured questionnaire-based survey was conducted among gardeners (496) in Chandigarh, covering their socio-demographic status, occupational and environmental history, and respiratory and other health-related problems. Out of 496 respondents from 26 gardens in the city, 72.58% fall under the category of plantsman (mali), followed by 15.72% of grass cutters and 3.02% of headmali/supervisor. The majority of gardeners were males (95.76%) and a maximum number of respondents were in the age group of 29-38 years (27.41%). Among all, 4.2%, 3.6%, and 3.2% of respondents perceived the problem of shortness of breath and breathing problems. At the same time, 3.2% of respondents perceived that their breathing is never wholly satisfactory and surprisingly, all of them are plantsman (mali). Moreover, 18.9% of the respondents covered their faces with a cloth and only 0.5% of the respondents wore both spectacles and covered their faces with a cloth. Out of all respondents, 6.5% reported irritation in the eyes without wearing any personal protective device. The results show that a large proportion of gardeners are illiterate and unaware of occupational hazards and pollen allergies in their workplaces. Moreover, the regulatory authorities conduct no formal health awareness and training/education sessions to minimize the exposure and associate risk. The findings of the study will aid in a better understanding of the working conditions and health status of occupational gardeners, as well as the development of appropriate methods to improve their working conditions.

Joint association between ambient air pollutant mixture and pediatric asthma exacerbations

Exposure to air pollutants is known to exacerbate asthma, with prior studies focused on associations between single pollutant exposure and asthma exacerbations. As air pollutants often exist as a complex mixture, there is a gap in understanding the association between complex air pollutant mixtures and asthma exacerbations. We evaluated the association between the air pollutant mixture (52 pollutants) and pediatric asthma exacerbations.

Method

This study focused on children (age ≤ 19 years) who lived in Douglas County, Nebraska, during 2016-2019. A seasonal-scale joint association between the outdoor air pollutant mixture adjusting for potential confounders (temperature, precipitation, wind speed, and wind direction) in relation to pediatric asthma exacerbation-related emergency department (ED) visits was evaluated using the generalized weighted quantile sum (qWQS) regression with repeated holdout validation.

Results

We observed associations between air pollutant mixture and pediatric asthma exacerbations during spring (lagged by 5 days), summer (lag 0-5 days), and fall (lag 1-3 days) seasons. The estimate of the joint outdoor air pollutant mixture effect was higher during the summer season (adjusted-β_WQS = 1.11, 95% confidence interval [CI]: 0.66, 1.55), followed by spring (adjusted-β_WQS = 0.40, 95% CI: 0.16, 0.62) and fall (adjusted-β_WQS = 0.20, 95% CI: 0.06, 0.33) seasons. Among the air pollutants, PM_2.5, pollen, and mold contributed higher weight to the air pollutant mixture.

Conclusion

There were associations between outdoor air pollutant mixture and pediatric asthma exacerbations during the spring, summer, and fall seasons. Among the 52 outdoor air pollutant metrics investigated, PM_2.5, pollen (sycamore, grass, cedar), and mold (Helminthosporium, Peronospora, and Erysiphe) contributed the highest weight to the air pollutant mixture.

Nano-silica particles synergistically IgE-mediated mast cell activation exacerbating allergic inflammation in mice

Background

Allergic respiratory diseases have increased dramatically due to air pollution over the past few decades. However, studies are limited on the effects of inorganic components and particulate matter with different particle sizes in smog on allergic diseases, and the possible molecular mechanism of inducing allergies has not been thoroughly studied.

Methods

Four common mineral elements with different particle sizes in smog particles were selected, including Al₂O₃, TiO₂, Fe₂O₃, and SiO₂. We studied the relationship and molecular mechanism of smog particle composition, particle size, and allergic reactions using mast cells, immunoglobulin E (IgE)-mediated passive cutaneous anaphylaxis (PCA) model, and an ovalbumin (OVA)-induced asthmatic mouse model in vitro and in vivo, combined with transmission electron microscopy, scanning transmission X-ray microscopy analysis, and transcriptome sequencing.

Results

Only 20 nm SiO₂ particles significantly increased β-hexosaminidase release, based on dinitrophenol (DNP)-human serum albumin (HSA) stimulation, from IgE-sensitized mast cells, while other particles did not. Meanwhile, the PCA model showed that Evan’s blue extravasation in mice was increased after treatment with nano-SiO₂ particles. Nano-SiO₂ particles exposure in the asthmatic mouse model caused an enhancement of allergic airway inflammation as manifested by OVA-specific serum IgE, airway hyperresponsiveness, lung inflammation injury, mucous cell metaplasia, cytokine expression, mast cell activation, and histamine secretion, which were significantly increased. Nano-SiO₂ particles exposure did not affect the expression of FcϵRI or the ability of mast cells to bind IgE but synergistically activated mast cells by enhancing the mitogen-activated protein kinase (MAPK) signaling pathway, especially the phosphorylation levels of the extracellular signal-regulated kinase (ERK)1/2. The ERK inhibitors showed a significant inhibitory effect in reducing β-hexosaminidase release.

Conclusion

Our results indicated that nano-SiO₂ particles stimulation might synergistically activate IgE-sensitized mast cells by enhancing the MAPK signaling pathway and that nano-SiO₂ particles exposure could exacerbate allergic inflammation. Our experimental results provide useful information for preventing and treating allergic diseases.

Climate Change Related Catastrophic Rainfall Events and Non-Communicable Respiratory Disease: A Systematic Review of the Literature

Climate change is increasing the frequency and intensity of extreme precipitation events, the impacts of which disproportionately impact urban populations. Pluvial flooding and flooding related sewer backups are thought to result in an increase in potentially hazardous human-pathogen encounters. However, the extent and nature of associations between flooding events and non-communicable respiratory diseases such as chronic bronchitis, asthma, and chronic obstructive pulmonary disease (COPD) are not well understood. This research seeks to characterize the state of research on flooding and NCRDs through a systematic review of the scientific literature. We conducted a systematic search of PubMed, Web of Science, and Scopus for published scholarly research papers using the terms flooding, monsoon, and tropical storm with terms for common NCRDs such as asthma, COPD, and chronic bronchitis. Papers were included if they covered research studies on individuals with defined outcomes of flooding events. We excluded review papers, case studies, and opinion pieces. We retrieved 200 articles from PubMed, 268 from Web of Science and 203 from Scopus which comprised 345 unique papers. An initial review of abstracts yielded 38 candidate papers. A full text review of each left 16 papers which were included for the review. All papers except for one found a significant association between a severe weather event and increased risk for at least one of the NCRDs included in this research. Our findings further suggest that extreme weather events may worsen pre-existing respiratory conditions and increase the risk of development of asthma. Future work should focus on more precisely defining measure of health outcomes using validated tools to describe asthma and COPD exacerbations. Research efforts should also work to collect granular data on patients’ health status and family history and assess possible confounding and mediating factors such as neighborhood water mitigation infrastructure, housing conditions, pollen counts, and other environmental variables.

Legal implications of the climate-health crisis: A case study analysis of the role of public health in climate litigation

Background

Strong scientific evidence affirms that climate change is now a public health emergency. Increasingly, climate litigation brought against governments and corporations utilizes international human rights, environmental and climate laws and policies to seek accountability for climate-destructive and health-harming actions. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems. Yet there is scant documentation in the literature of the role that public health has played in climate litigation and the legal weight public health narratives are given in such contexts. Therefore, we assessed to what extent courts of law have used public health harm in legal adjudication and sought to provide practical recommendations to address barriers to positioning legal arguments in public health-centric frames.

Methods

We reviewed legal databases to identify all publicly reported, documented, cases of climate litigation filed in any country or jurisdiction between 1990 and September 2020. For the 1641 cases identified, we quantified the frequency of cases where health concerns were explicitly or implicitly raised.

Findings

Case numbers are trending upwards, notably in high income countries. Resolution remains pending in over half of cases as the majority were initiated in the past three years. Cases were primarily based in climate and human rights law and brought by a wide range of groups and individuals predominantly against governments. About half of the decided cases found in favour for the plaintiffs. Based on this, we selected the 65 cases that were directly linked to public health. We found economic forces and pricing of health risks play a key role, as courts are challenged by litigants to adjudicate on the responsibility for health impacts.

Conclusions

While courts of law are receptive to public health science, significant legal reform is needed to enhance leveraging of public health evidence in legal judgements of climate litigation cases. The integration of a public health mandate into a new eco-centric legal paradigm will optimize its potential to promote human well-being—the core objective underpinning both international law, human rights, and public health. Existing legal doctrines and practices can be enhanced to increase the weight of public health arguments in climate legal action and consequently ensure legal rulings in climate litigation prioritize, protect and promote public health.

Transcriptomic and ultrastructural evidence indicate that anti-HMGB1 antibodies rescue organic dust-induced mitochondrial dysfunction

Exposure to organic dust (OD) in agriculture is known to cause respiratory symptoms including loss of lung function. OD exposure activates multiple signaling pathways since it contains a variety of microbial products and particulate matter. Previously, we have shown how OD exposure leads to the secretion of HMGB1 and HMGB1-RAGE signaling, and how this can be a possible therapeutic target to reduce inflammation. Cellular mitochondria are indispensable for homeostasis and are emerging targets to curtail inflammation. Recently, we have also observed that OD exposure induces mitochondrial dysfunction characterized by loss of structural integrity and deficits in bioenergetics. However, the role of HMGB1 in OD-induced mitochondrial dysfunction in human bronchial epithelial (NHBE) cells remains elusive. Therefore, we aimed to study whether decreased levels of intracellular HMGB1 or antibody-mediated neutralization of secreted HMGB1 would rescue mitochondrial dysfunction. Single and repeated ODE exposure showed an elongated mitochondrial network and cristolysis whereas HMGB1 neutralization or the lack thereof promotes mitochondrial biogenesis evidenced by increased mitochondrial fragmentation, increased DRP1 expression, decreased MFN2 expression, and increased PGC1α expression. Repeated 5-day ODE exposure significantly downregulated transcripts encoding mitochondrial respiration and metabolism (ATP synthase, NADUF, and UQCR) as well as glucose uptake. This was reversed by the antibody-mediated neutralization of HMGB1. Our results support our hypothesis that, in NHBE cells, neutralization of ODE-induced HMGB1 secretion rescues OD-induced mitochondrial dysfunction.

Influence of meteorological parameters and air pollutants on the airborne pollen of city Chandigarh, India

Pollen, climatic variables and air pollutants coexist in nature with the potential to interact with one another and play a crucial role in increasing allergic diseases. The current study evaluates the influence of meteorological parameters and air pollutants on the airborne pollen in an urban city, Chandigarh, situated in the Indo-Gangetic Plains. Airborne pollen monitoring was done following Spanish Aerobiological Network guidelines and dynamics of daily total pollen and six most abundant taxa were studied from June 2018 to June 2020. Among meteorological parameters, temperature and wind were the most correlated and influential parameters to airborne pollen concentration. Annual Pollen Integral (APIn) of Cannabis sativa (r = 0.52), Parthenium hysterophorus (r = 0.27), Poaceae (r = 0.32) and total pollen concentration (r = 0.30) showed a statistically significant positive correlation with temperature. In contrast, precipitation and relative humidity negatively correlated with APIn of total pollen concentration, Eucalyptus sp. and Poaceae except for Parthenium hysterophorus and Celtis occidentalis. Similar results were found with Seasonal Pollen Integral (SPIn) of total pollen concentration, six major taxa and meteorological variables. Spearman correlation performed for NOx showed a significant positive correlation among APIn and SPIn of Celtis occidentalis and insignificant among APIn and SPIn of Eucalyptus sp. and Morus alba. In contrast, except for Eucalyptus sp., PM₁₀ and PM_2.5 were negatively correlated among APIn and SPIn of total pollen concentration and other major taxa. Spearman's correlation of APIn and SPIn for each pollen taxon, meteorological parameters and air pollutants suggests that each taxon has a different pattern in response to all parameters. The study findings suggest that pollen response must be examined at the taxon level, not the assemblage level, having long time-series data. This will help to compute future scenarios of changing environmental factors and comprehend the relationships and trends among meteorology, air pollutants and aerobiology.

Pollen allergy: Developing multi-sectorial strategies for its prevention and control in lower and middle-income countries

Pollen allergy is considered a major public health problem that causes morbidity and subsequently affects a patient's quality of life. Pollen due to their large size cannot enter the thoracic regions of the respiratory tract but can affect the nasopharyngeal mucous membrane. At the same time, the submicronic-pollen particles can act as respirable particles reaching deeper into the upper airways leading to exacerbation of asthma, chronic obstructive pulmonary disease (COPD) and other allergic reactions. Based on the existing literature, expanding evidence shows that climate change and air pollutants could affect the pollen number, morphology, season, allergen content, and distribution pattern. Hence, this will influence the prevalence and occurrence of allergies linked to pollen exposure. Being a part of biogenic pollutants, pollen allergens are not expected to diminish in the foreseeable future. Therefore, it is imperative that steps need to be strengthened to improve and optimize preventive/adaptive strategies. This paper aims to review the major causes of widespread allergy, identify the major gaps, and suggest key preventive/adaptive measures to address the onset and exacerbation of pollen-related allergic diseases with a major focus on lower and middle-income countries. The study also discusses how-to implement the prevention and control measures at the individual, health care communities and organizations, Local Governments, National/International Governments levels to decrease the risk of illnesses associated with pollen allergy.

Cloud-Based Decision Support System for Air Quality Management

Air quality is important for the protection of human health, the environment and our cultural heritage and it is an issue that will acquire increased significance in the future due to the adverse effects of climate change. Thus, it is important to not simply monitor air quality, but to make information immediately available to those responsible for monitoring the networks, to policy/decision makers, but also to the general population. Moreover, the development of information technologies over the last couple of decades has allowed the proliferation of real-time pollution monitoring. The work presented herein concerns the development of an effective way of monitoring environmental parameters using dedicated software. It offers a complete suite of applications that support environmental data collection management and reporting for air quality and associated meteorology. It combines modern technologies for the proper monitoring of air quality networks, which can consist of one or more measuring stations. Innovatively, it also focuses on how to effectively present the relevant information, utilizing modern technologies, such as cloud and mobile applications, to network engineers, policy/decision managers, and to the general public at large. It also has the capability of notifying appropriate personnel in the event of failures, overruns or abnormal values. The system, in its current configuration, handles information from six networks that include over 55 air pollution monitoring stations that are located throughout Greece. This practical application has shown that the system can achieve high data availability rates, even higher than 99% during the year.

AlergiaPT: A Portuguese media campaign to inspire people with allergies to make a positive change in their life

Allergic diseases comprise a significant cause of morbidity worldwide and a substantial burden on the health and medical systems of both developed and emerging economies. Although highly prevalent, relatively severe, and largely impactful on the quality of life of patients, allergic diseases are commonly trivialized. Increasing awareness of the relevance of allergic diseases as a major public health problem might lead to an improved acknowledgment by governments and health authorities. Based on the positive impact that media campaigns might have on health-related behaviors, as well as the large use of social media by different types of users, social media might be used as a powerful tool for spreading awareness and education even more effective than traditional face-to-face communication. Therefore, we aimed to develop a social media-based communication program, the AlergiaPT, reaching all stakeholders, to increase the awareness of allergic diseases tackling the causes, prevention, control, and economic impact. The AlergiaPT will provide user-generated and interactive content toward engagement, include both long-form and short-form video productions toward education, as well as stories and time-sensitive content toward empowerment. It will be targeted to all populations, engaging different stakeholders. Contents will address the 5 campaign goals: i) allergy health is promoted; ii) tolerance is actively reinforced, and avoidance reduced; iii) treatment control and guided self-management of patients of asthma, rhinitis, food allergy, and atopic eczema are strengthened; iv) recognition and treatment of severe allergy and anaphylaxis are improved, and v) indoor air quality is promoted. Engagement on the campaign will be promoted through stepwise educational takeaways meetings using different social media, and targeting all audience groups, by promoting the organization of resources for common goals and the involvement of social media to improve public awareness. The impact of AlergiaPT will be assessed through google analytics.

The Climate Change Hypothesis for the Allergy Epidemic

The health consequences of climate change are being increasingly recognized. Herein, the climate change hypothesis is put forth as a substantial contributor to the growing global allergy epidemic. A call for deeper research and action on the impact of climate change on various aspects of allergic disease mechanisms, exacerbation, and prevalence is imperative.

Plant Stress Scenarios Differentially Affect Expression and IgE Reactivity of Grass Group-1 Allergen (β-Expansin) in Maize and Rice Pollen

Grass pollen is among the most common outdoor aeroallergens eliciting pollen allergies throughout the world. Grass group-1 allergen or β-expansin is recognized as a major pollen allergen, particularly in the grass family Poaceae. Expression of β-expansin has been shown to be dynamic and can be influenced by environmental stresses. This study evaluated the relative expression of β-expansin and IgE-binding ability of crude pollen extract protein of rice and maize under three different stress conditions: flood, salt, and drought. After 1 week of treatments, anthers containing pollen were collected followed by RNA extraction and cDNA synthesis. To evaluate relative expression, qRT-PCR was performed using specific primers for β-expansin and reference genes. Physiological characteristics of treated and untreated maize and rice: plant height; fresh weight of anthers; number of inflorescences, anthers, and pollen grains were also recorded. To assess IgE-binding ability of proteins in rice pollen extracts, soluble crude proteins were extracted and IgE immunoblot and ELISA were performed using serum samples from grass-allergic subjects and healthy control donors. Results showed that plant height, fresh weight of anthers, number of inflorescences, anthers, and pollen grains of both maize and rice decreased significantly under drought stress conditions, but not in other conditions. Expression of β-expansin in pollen of rice showed an apparent increase in all stress treatments relative to control samples. In contrast, a significant decrease of β-expansin expression was detected in maize pollen under all stress-treated conditions. IgE-reactive protein bands from rice pollen extract proteins were ~30 kDa, as expected of the grass-group 1 protein. The intensity of IgE-reactive protein bands and the level of IgE to rice pollen proteins showed significant differences among stress conditions. In conclusion, environmental stresses—flood, salt, and drought, can elicit a change of β-expansin expression and IgE reactivity to grass group-1 pollen allergens. Changes in expression level of this gene likely reflected its importance during stress. However, the response is highly dependent on different schemes employed by each plant species.

Exposome mapping in chronic respiratory diseases: the added value of digital technology

PURPOSE OF REVIEW

The development and progression of chronic respiratory diseases are impacted by a complex interplay between genetic, microbial, and environmental factors. Here we specifically summarize the effects of environmental exposure on asthma, allergic rhinitis, and chronic rhinosinusitis. We furthermore discuss how digital health technology may aid in the assessment of the environmental exposure of patients and how it may be of added value for them.

RECENT FINDINGS

It is well established that one gets allergic symptoms if sensitized and exposed to the same allergen. Viruses, bacteria, pollutants, irritants, and lifestyle-related factors modify the risk of getting sensitized and develop symptoms or may induce symptoms themselves. Understanding these processes and how the various factors interact with each other and the human body require big data and advanced statistics. Mobile health technology enables integration of multiple sources of data of the patients' exposome and link these to patient outcomes. Such technologies may contribute to the increased understanding of the development of chronic respiratory disease.

SUMMARY

Implementation of digital technologies in clinical practice may in future guide the development of preventive strategies to tackle chronic respiratory diseases and eventually improve outcomes of the patient.

The effects of air pollution, meteorological parameters, and climate change on COVID-19 comorbidity and health disparities: A systematic review

Air pollutants, especially particulate matter, and other meteorological factors serve as important carriers of infectious microbes and play a critical role in the spread of disease. However, there remains uncertainty about the relationship among particulate matter, other air pollutants, meteorological conditions and climate change and the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), hereafter referred to as COVID-19. A systematic review was conducted using PRISMA guidelines to identify the relationship between air quality, meteorological conditions and climate change, and COVID-19 risk and outcomes, host related factors, co-morbidities and disparities. Out of a total of 170,296 scientific publications screened, 63 studies were identified that focused on the relationship between air pollutants and COVID-19. Additionally, the contribution of host related-factors, co-morbidities, and health disparities was discussed. This review found a preponderance of evidence of a positive relationship between PM_2.5, other air pollutants, and meteorological conditions and climate change on COVID-19 risk and outcomes. The effects of PM_2.5, air pollutants, and meteorological conditions on COVID-19 mortalities were most commonly experienced by socially disadvantaged and vulnerable populations. Results however, were not entirely consistent, and varied by geographic region and study. Opportunities for using data to guide local response to COVID-19 are identified.

Climate Change and State of the Science for Children's Health and Environmental Health Equity

INTRODUCTION

Climate change is impacting the physical and mental health of children and families. This is a state of the science update regarding the impacts of climate change for pediatric-focused health care providers and advanced practice registered nurses.

METHOD

Using an equity lens, the authors reviewed and synthesized current literature regarding the adverse impacts of climate change.

RESULTS

The poor and communities of color are disproportionately impacted by climate change. Physical health impacts include increased vector and water-born infectious diseases, increases in asthma and respiratory infections, and undernutrition. Social disruptions lead to human trafficking. Climate change is associated with mental health concerns, including anxiety and posttraumatic stress after natural disasters.

DISCUSSION

As clinicians, pediatric-focused providers, and advanced practice registered nurses should use multipronged and interdisciplinary approaches to address or prevent the adverse impacts of climate change. Advocacy at all government levels is necessary to safeguard children and vulnerable populations.