Climate change and our environment: the effect on respiratory and allergic disease

Low-Dose Occupational Exposure to Nickel and Thyroid Hormones

INTRODUCTION

The aim of this study was to evaluate the effects of a low-dose exposure to nickel, as it is present in urban air, on thyroid hormones and on thyrotropin in outdoor workers exposed to urban pollutants.

MATERIALS AND METHODS

A total of 164 outdoor workers were studied and divided by sex and smoking habit. Each worker underwent measurement of urinary nickel and of blood triiodothyronine, L-thyroxine, and thyrotropin levels. The statistical analysis was performed.

RESULTS

Statistical analysis shows a significant and positive correlation between urinary nickel and L-thyroxine, both in total sample and in males.

DISCUSSION AND CONCLUSION

The study suggests that occupational exposure to a low dose of nickel may affect thyroid function in municipal police workers. These data may provide information on other categories of outdoor workers with similar exposure.

Interaction effect of prenatal and postnatal exposure to ambient air pollution and temperature on childhood asthma

BACKGROUND

Although mounting evidence has associated air pollution and environmental temperature with children's health problems, it is unclear whether there is an interaction between these factors on childhood asthma.

OBJECTIVES

To explore the effects of temperature-pollution interactions during pre- and post-natal periods on asthma among pre-schoolers.

METHODS

A retrospective cohort study of 39,782 pre-schoolers was performed during 2010-2012, in seven cities in China. Exposure to three temperature indicators (TI) and three critical ambient air pollutants, including particulate matter with aerodynamic diameter ≤ 10 μm (PM₁₀), sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) as proxies of industrial and vehicular air pollution, was estimated by an inverse distance weighted (IDW) method. Two-level logistical regression analysis was used to examine the association between both pre- and post-natal exposure and childhood asthma in terms of odds ratio (OR) and 95 % confidence interval (CI).

RESULTS

Asthma prevalence in pre-schoolers at age of 3-6 years (6.9 %) was significantly associated with traffic-related air pollutant (NO₂) exposure, with ORs (95 % CI) of 1.17 (1.06, 1.28), 1.19 (1.05-1.34) and 1.16 (1.03-1.31) for an IQR increase in NO₂ exposure during lifetime, pregnancy, and entire postnatal period respectively. Furthermore, childhood asthma was positively associated with exposure to increased temperature during lifetime, pregnancy, and entire postnatal period with ORs (95 % CI) = 1.89 (1.66, 2.16), 1.47 (1.34, 1.61), and 1.15 (1.11, 1.18) respectively, while was negatively associated with decreased temperatures. Childhood asthma was positively related with exposure to extreme heat days (EHD) during postnatal period particularly in first year of life respectively with ORs (95 % CI) = 1.23 (1.04, 1.46) and 1.26 (1.07, 1.47), but was not related with extreme cold days (ECD) exposure. A combination of high air pollutant levels and high temperatures significantly increased the risk of asthma during both pre- and post-natal periods. Strikingly, we found a significantly positive interaction of temperature and PM₁₀ or SO₂ on asthma risk among boys and younger children.

CONCLUSIONS

Prenatal and postnatal exposure to ambient air pollution and high temperatures are independently and jointly associated with asthma risk in early childhood.

Air- and dustborne fungi in repositories of the National Archive of the Republic of Cuba

This study has as objectives to determine the concentration and diversity of the air- and dustborne mycobiota in seven National Archive of the Republic of Cuba repositories, and to assess the potential risk of biodeterioration that isolated taxa may have. In the indoor and outdoor environmental microbiological samplings a SAS biocollector was used and the indoor/outdoor (I/O) ratio was determined for each repository. The settled dust was collected during six months. Sørensen's coefficient of similarity (QS) was calculated to compare the isolated taxa among the three studied niches (indoor air, dust, outdoor air). The biodegradation potential of the isolated taxa was determined by semi-quantitative tests. The concentrations in the air of repositories with natural cross-ventilation ranged from 225.2-750.3 CFU m-3, while in the Map library with air-conditioning the concentration was significantly lower. The I/O ratios ranged from 0.1-1.7 revealing different environmental qualities. The maximum settled dust load was 22.8 mg/m2/day with a top fungal concentration of 6000 CFU g-1. 14 and eleven genera were detected in the air and dust respectively with predominance of the genera Aspergillus, Cladosporium and Penicillium. A QS of 0.8 was obtained between the indoor and the outdoor environments with eleven taxa similar evidencing the incidence of outdoors on the indoor mycobiota. The isolated taxa showed several biodeteriogenic attributes highlighting twelve and 14 taxa from indoor air and dust respectively with positive results for the five tests performed. This demonstrates the potential risk that fungal environmental represent for the preserved documentary heritage.

Anaphylaxis: Epidemiology and Differential Diagnosis

Anaphylaxis-related emergency department (ED) visits and hospitalizations are increasing. Triggers for anaphylaxis include food, medications, and stinging insects. Idiopathic anaphylaxis accounts for 30% to 60% of cases of anaphylaxis in adults and up to 10% of cases in children with novel allergens such as galactose-α-1,3 galactose reclassifying these cases. Recent practice guidelines have recommended against the routine use of systemic corticosteroids and antihistamines for the prevention of biphasic reactions and recommend an extended observation, up to 6 hours, for those with risk factors for biphasic anaphylaxis and those with lack of access to epinephrine and to emergency medical services.

Aeroallergens and Climate Change in Tulsa, Oklahoma: Long-Term Trends in the South Central United States

Climate change is having a significant effect on many allergenic plants resulting in increased pollen production and shifts in plant phenology. Although these effects have been well-studied in some areas of the world, few studies have focused on long-term changes in allergenic pollen in the South Central United States. This study examined airborne pollen, temperature, and precipitation in Tulsa, Oklahoma over 25 to 34 years. Pollen was monitored with a Hirst-type spore trap on the roof of a building at the University of Tulsa and meteorology data were obtained from the National Weather Service. Changes in total pollen intensity were examined along with detailed analyses of the eight most abundant pollen types in the Tulsa atmosphere. In addition to pollen intensity, changes in pollen season start date, end date, peak date and season duration were also analyzed. Results show a trend to increasing temperatures with a significant increase in annual maximum temperature. There was a non-significant trend toward increasing total pollen and a significant increase in tree pollen over time. Several individual taxa showed significant increases in pollen intensity over the study period including spring Cupressaceae and Quercus pollen, while Ambrosia pollen showed a significant decrease. Data from the current study also indicated that the pollen season started earlier for spring pollinating trees and Poaceae. Significant correlations with preseason temperature may explain the earlier pollen season start dates along with a trend toward increasing March temperatures. More research is needed to understand the global impact of climate change on allergenic species, especially from other regions that have not been studied.

Urinary Nickel and Progesterone in Workers Exposed to Urban Pollutants

OBJECTIVE

The aim of this study is to evaluate whether the exposure to a low dose of nickel could determinate a variation in levels of progesterone in outdoor workers.

MATERIALS AND METHODS

Two hundred sixty one subjects were divided by sex, task, age, seniority, and cigarette smoking habit. For each workers was evaluated the dose of blood progesterone and urinary nickel.The statistical analysis was performed.

RESULTS

The Pearson correlation showed a statistically significant correlation between urinary nickel levels and progesterone. The multiple linear regression showed a significant correlation between progesterone and urinary nickel in the total sample and in the subgroups of smokers and workers with tasks of traffic direction.

CONCLUSIONS

The results of our study suggest that occupational exposure to low doses of nickel present in urban pollution may influence to progesterone levels in outdoor workers.

Effect modification of greenness on temperature-mortality relationship among older adults: A case-crossover study in China

BACKGROUND

Climate change exacerbates temperature-related mortality, but effects may vary by geographic characteristics. We hypothesize that higher greenness may mitigate temperature-related mortality, and that the effect may vary in different areas.

OBJECTIVE

We examined how mortality among older adults in China was associated with temperature for 2000-2014, and how geolocation and residential greenness may modulate this association.

METHODS

We used health data from the China Longitudinal Healthy Longevity Survey (CLHLS), and meteorological data from the Global Surface Summary of Day (GSOD) product by National Climate Data Center. We used a case-crossover study design with distributed nonlinear modeling to estimate mortality risks in relation to temperature, and stratified analysis by quartile of greenness. Greenness was estimated by Normalized Difference Vegetation Index (NDVI) from remote-sensed imagery. In addition to the national analysis, we also assessed three provinces (Jiangsu, Guangdong, and Liaoning) to examine differences by climatic regions.

RESULTS

Extreme temperatures had a significant association with higher mortality, with regional differences. Findings from the national analysis suggest that individuals in the lowest quartile of greenness exposure had a ratio of relative risks (RRR) of 1.38 (0.79, 2.42) for mortality risk on extreme hot days at the 95th percentile compared to those at the 50th percentile, compared to those in the highest quartile, which means those residing in the lowest quartile of greenness had a 38% higher RR than those residing in the highest quartile of greenness, where RR refers to the risk of mortality on days at the 95th percentile of temperature compared to days at the 50th percentile. The RRR for the highest to lowest quartiles of greenness for mortality risk on extreme cold days at the 5th percentile compared to the 50th percentile was 2.08 (0.12, 36.2). In Jiangsu and Guangdong provinces, both the heat effects and cold effects were the lowest in the highest greenness quartile, and the results in Liaoning province were not statistically significant, indicating different regional effects of greenness on modulating the temperature-mortality relationship.

DISCUSSION

We elucidated one pathway through which greenness benefits health by decreasing impact from extreme high temperatures. The effects of greenness differed by climatic regions. Policymakers should consider vegetation in the context of climate change and health.

An Overview of Rising CO₂ and Climatic Change on Aeroallergens and Allergic Diseases

There are a number of implications of climate change in regard to human health. Among these, the role of rising carbon dioxide (CO₂) and temperature in aeroallergen exposure and associated changes in the start, duration and intensity of the pollen season, and associated consequences in aeroallergens and allergic disease are a primary concern. This review is intended to provide a synopsis of CO₂ and climate factors associated with likely changes in aeroallergen biology (indoor and outdoor), including changes in the demography of flowering plants, pollen seasonality, aeroallergen production, and potential biotic and abiotic interactions. These factors, in turn, are compared to clinical trials that have linked aeroallergens to allergic disease and associated health impacts. Finally, suggestions to address unmet needs and critical knowledge gaps are offered. Such recommendations are not meant to be inclusive, but to serve as a spur for the additional research and resources that will be necessary to acquire a better understanding of climate change, CO₂, aeroallergens and associated allergic diseases. Such resources will be critical to derive time-relevant scientific and policy solutions that will minimize public health consequences in a changing climate.

Demographic Inequities in Health Outcomes and Air Pollution Exposure in the Atlanta Area and its Relationship to Urban Infrastructure

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

Chronic lifestyle diseases display seasonal sensitive comorbid trend in human population evidence from Google Trends

Seasonal and human physiological changes are important factors in the development of many diseases. But, the study of genuine seasonal impact on these diseases is difficult to measure due to many other environment and lifestyle factors which directly affect these diseases. However, several clinical studies have been conducted in different parts of the world, and it has clearly indicated that certain groups of population are highly subjected to seasonal changes, and their maladaptation can possibly lead to several disorders/diseases. Thus, it is crucial to study the significant seasonal sensitive diseases spread across the human population. To narrow down these disorders/diseases, the study hypothesized that high altitude (HA) associated diseases and disorders are of the strong variants of seasonal physiologic changes. It is because, HA is the only geographical condition for which humans can develop very efficient physiological adaptation mechanism called acclimatization. To study this hypothesis, PubMed was used to collect the HA associated symptoms and disorders. Disease Ontology based semantic similarity network (DSN) and disease-drug networks were constructed to narrow down the benchmark diseases and disorders of HA. The DSN which was further subjected to different community structure analysis uncovered the highly associated or possible comorbid diseases of HA. The predicted 12 lifestyle diseases were assumed to be “seasonal (sensitive) comorbid lifestyle diseases (SCLD)”. A time series analyses on Google Search data of the world from 2004–2016 was conducted to investigate whether the 12 lifestyle diseases have seasonal patterns. Because, the trends were sensitive to the term used as benchmark; the temporal relationships among the 12 disease search volumes and their temporal sequences similarity by dynamic time warping analyses was used to predict the comorbid diseases. Among the 12 lifestyle diseases, the study provides an indirect evidence in the existence of severe seasonal comorbidity among hypertension, obesity, asthma and fibrosis diseases, which is widespread in the world population. Thus, the present study has successfully addressed this issue by predicting the SCLD, and indirectly verified them among the world population using Google Search Trend. Furthermore, based on the SCLD seasonal trend, the study also classified them as severe, moderate, and mild. Interestingly, seasonal trends of the severe seasonal comorbid diseases displayed an inverse pattern between USA (Northern hemisphere) and New Zealand (Southern hemisphere). Further, knowledge in the so called “seasonal sensitive populations” physiological response to seasonal triggers such as winter, summer, spring, and autumn become crucial to modulate disease incidence, disease course, or clinical prevention.

Making the Case for "Whole System" Approaches: Integrating Public Health and Housing

Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and "place" where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the "triple win" of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the "triple win." This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.

Impact of Climate Change on Pollen and Respiratory Disease

PURPOSE OF REVIEW

A warming world will impact everyone and everything. The practice of allergic and respiratory disease will not be excepted. All the impacts will be impossible to anticipate. This review is intended to discuss significant factors related to individuals with allergic and respiratory disease.

RECENT FINDINGS

Recent findings include the increased growth of allergenic plants in response to higher carbon dioxide levels and warmer temperatures. This also contributes to the increased production of pollen as well as the appearance of allergenic species in new climactic areas. Stinging insects will extend their ranges into northern areas where they have not previously been a problem. The shift and extension of pollen seasons with warmer springs and later frosts have already been observed. Recent severe hurricanes and flooding events may be just the harbinger of increasing damp housing exposure related to sea level rise. Evidence is accumulating that indicates the expected higher number of ozone alert days and increased pollution in populated areas is bringing increases in pollen potency. Finally, increased exposure to smoke and particles from wild fires, resulting from heat waves, will contribute to the general increase in respiratory disease. The practice of allergy being closely aligned with environmental conditions will be especially impacted. Allergists should consider increasing educational activities aimed at making patients more aware of air quality conditions.

A Closer Look at the Bivariate Association between Ambient Air Pollution and Allergic Diseases: The Role of Spatial Analysis

Although previous ecological studies investigating the association between air pollution and allergic diseases accounted for temporal or seasonal relationships, few studies address spatial non-stationarity or autocorrelation explicitly. Our objective was to examine bivariate correlation between outdoor air pollutants and the prevalence of allergic diseases, highlighting the limitation of a non-spatial correlation measure, and suggesting an alternative to address spatial autocorrelation. The 5-year prevalence data (2011⁻2015) of allergic rhinitis, atopic dermatitis, and asthma were integrated with the measures of four major air pollutants (SO₂, NO₂, CO, and PM₁₀) for each of the 423 sub-districts of Seoul. Lee's L statistics, which captures how much bivariate associations are spatially clustered, was calculated and compared with Pearson's correlation coefficient for each pair of the air pollutants and allergic diseases. A series of maps showing spatiotemporal patterns of allergic diseases at the sub-district level reveals a substantial degree of spatial heterogeneity. A high spatial autocorrelation was observed for all pollutants and diseases, leading to significant dissimilarities between the two bivariate association measures. The local L statistics identifies the areas where a specific air pollutant is considered to be contributing to a type of allergic disease. This study suggests that a bivariate correlation measure between air pollutants and allergic diseases should capture spatially-clustered phenomenon of the association, and detect the local instability in their relationships. It highlights the role of spatial analysis in investigating the contribution of the local-level spatiotemporal dynamics of air pollution to trends and the distribution of allergic diseases.

Awareness of Environmental Change, Climate Variability, and Their Role in Prevalence of Mosquitoes among Urban Dwellers in Southern Ghana

This study evaluates the extent to which urban residents of Accra and Sekondi-Takoradi (all of southern Ghana) were aware of environment and climate-related variability. A total of 150 questionnaires were given to adults of 40 years and above who lived in the cities for at least 35 years. SPSS version 16 was used to process the data. Results show that all respondents in Accra Metropolitan Area (AMA) and 96% of them in Sekondi-Takoradi Metropolitan Area (STMA) noted the deteriorating vegetation cover over the cities. Similarly, 93% and 83% of them in AMA and STMA, respectively, observed that land use pattern of the two cities has changed considerably. There was positive and statistically significant correlation between respondents' educational attainment and their awareness of changes in land use/land cover (r = 0.18, n = 140, p = 0.03). Also, 71% in AMA and 89% in STMA stated that temperature of the cities had been increasing over the years. In all, 82.9% of the respondents mentioned that they had problem with the increasing population of mosquitoes. Respondents demonstrated ample knowledge of environment and climate variability and should be engaged in preventing further environmental degradation. The top-down approach to environmental issues has failed; the bottom-up approach to environmental maintenance is needed.

Relationships between aeroallergen levels and hospital admissions for asthma in the Brussels-Capital Region: a daily time series analysis

BACKGROUND

Outdoor pollen grain and fungal spore concentrations have been associated with severe asthma exacerbations at the population level. The specific impact of each taxon and the concomitant effect of air pollution on these symptoms have, however, still to be better characterized. This study aimed to investigate the short-term associations between ambient concentrations of various aeroallergens and hospitalizations related to asthma in the Brussels-Capital Region (Belgium), an area recording especially high rates of admissions.

METHODS

Based on administrative records of asthma hospitalizations and regular monitoring of 11 tree/herbaceous pollen taxa and 2 fungal spore taxa, daily time series analyses covering the 2008-2013 period were performed. Effects up to 6 days after exposure were captured by combining quasi-Poisson regression with distributed lag models, adjusting for seasonal and long-term trends, day of the week, public holidays, mean temperature and relative humidity. Effect modification by age and air pollution (PM, NO₂, O₃) was tested.

RESULTS

A significant increase in asthma hospitalizations was observed for an interquartile range increase in grass (5.9%, 95% CI: 0.0, 12.0), birch (3.2%, 95% CI: 1.1, 5.3) and hornbeam (0.7%, 95% CI: 0.2, 1.3) pollen concentrations. For several taxa including grasses, an age modification effect was notable, the hospitalization risk tending to be higher in individuals younger than 60 years. Air pollutants impacted the relationships too: the risk appeared to be stronger for grass and birch pollen concentrations in case of high PM₁₀ and O₃ concentrations respectively.

CONCLUSIONS

These findings suggest that airborne grass, birch and hornbeam pollen are associated with severe asthma exacerbations in the Brussels region. These compounds appear to act in synergy with air pollution and to more specifically affect young and intermediate age groups. Most of these life-threatening events could theoretically be prevented with improved disease diagnosis/management and targeted communication actions.

Climate Change and the Impact on Respiratory and Allergic Disease: 2018

PURPOSE OF REVIEW

The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?

RECENT FINDINGS

Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases. This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities.

Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II

We studied dampness and mold in homes in relation to climate, building characteristics and socio-economic status (SES) across Europe, for 7127 homes in 22 centers. A subsample of 3118 homes was inspected. Multilevel analysis was applied, including age, gender, center, SES, climate, and building factors. Self-reported water damage (10%), damp spots (21%), and mold (16%) in past year were similar as observed data (19% dampness and 14% mold). Ambient temperature was associated with self-reported water damage (OR=1.63 per 10°C; 95% CI 1.02-2.63), damp spots (OR=2.95; 95% CI 1.98-4.39), and mold (OR=2.28; 95% CI 1.04-4.67). Precipitation was associated with water damage (OR=1.12 per 100 mm; 95% CI 1.02-1.23) and damp spots (OR=1.11; 95% CI 1.02-1.20). Ambient relative air humidity was not associated with indoor dampness and mold. Older buildings had more dampness and mold (P<.001). Manual workers reported less water damage (OR=0.69; 95% CI 0.53-0.89) but more mold (OR=1.27; 95% CI 1.03-1.55) as compared to managerial/professional workers. There were correlations between reported and observed data at center level (Spearman rho 0.61 for dampness and 0.73 for mold). In conclusion, high ambient temperature and precipitation and high building age can be risk factors for dampness and mold in homes in Europe.

A model to predict the incidence of allergic rhinitis based on meteorological factors

Meteorological factors have been shown to affect the physiology, distribution, and amounts of inhaled allergens. The aim of this study was to develop a model to predict the trends for onset of allergic rhinitis (AR) patients. A total of 10,914 consecutive AR outpatients were assessed for the number of daily patient visits over a period of 4 years. Meteorological data were used to assess the relationship between meteorological factors and AR incidence by time-series data and regression analysis. Predictive models for incidence of AR were established in pollen-, dust mite- and mould-sensitive groups of patients, and the predictive performances of meteorological factors on the incidence of AR were estimated using root mean squared errors (RMSEs). The incidence of pollen-, dust mites- and mould-sensitive AR patients was significantly correlated with minimum temperature, vapour pressure, and sea-level pressure, respectively. The correlation between comprehensive meteorological parametric (CMP) and incidence of AR was higher than the correlation between the individual meteorological parameters and AR incidence. CMP had higher performance than individual meteorological parameters for predicting the incidence of AR patients. These findings suggest that the incidence of pollen-, dust mites- and mould-sensitive AR can be predicted employing models based on prevailing meteorological conditions.

Effects of temperature variation between neighbouring days on daily hospital visits for childhood asthma: a time-series analysis

OBJECTIVES

To identify the relationship between temperature variation between neighbouring days (TVN) and hospital visits for childhood asthma in age- and sex-specific groups.

STUDY DESIGN

An ecological design was used to explore the effect of TVN on hospital visits for childhood asthma.

METHODS

A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to analyse the association between TVN and hospital visits for childhood asthma. All hospital visits for childhood asthma from June 2010 to July 2013 were included (n = 17,022). Daily climate data were obtained from Hefei Meteorological Bureau.

RESULTS

A significant correlation was found between TVN and hospital visits for childhood asthma in age- and sex-specific groups. For different gender groups, the effect of TVN on childhood asthma was the greatest at 3 and 5 days lag for males and females. For different age groups, the effect of TVN on childhood asthma was the greatest at 1 and 5 days lag for 0-4 years and 5-14 years children, respectively. A 1 °C increase in TVN was associated with a 4.2% (95% confidence interval 0.9-7.6%) increase in hospital visits for childhood asthma.

CONCLUSIONS

TVN is associated with hospital visits for childhood asthma. Once the temperature change rapidly, guardians will be urged to pay more attention to their children's health, which may reduce the morbidity of childhood asthma.

Pollen used to produce allergen extracts

OBJECTIVE

To review the use of pollen for the production of allergen extracts to diagnose and treat allergic diseases, examine the associated regulations, and highlight candidate areas for improvement.

DATA SOURCES

A PubMed search was performed using focused keywords combined with a review of regulatory documents and industry guidelines.

STUDY SELECTIONS

The information obtained through literature, documents, and industry was scrutinized and used with personal experience and expertise to write this article.

RESULTS

Both genetic and environmental factors affect the allergenic composition of pollen because it is a biologically active pharmaceutical ingredient obtained from nature. The potential effect of airborne contaminants in pollen requires major attention but can be properly addressed through careful collection practices, combined with a proper interpretation of the data on purity obtained for each pollen lot. The regulations associated with pollen used to manufacture allergen extracts in the United States and Europe and the numbers of pollen allergen extracts commercially available in both areas of the world differ. A critical parameter to select the appropriate extracts for diagnosis and allergen immunotherapy is to understand the phenomenon of cross-reactivity among pollen families, genera, and species.

CONCLUSION

Physicians should be aware of the factors responsible for the qualitative and quantitative composition of pollen allergen extracts and the associated regulations to produce suitable extracts to diagnose and treat allergic diseases. Collaboration and cooperation among allergen manufacturing companies and regulatory agencies are necessary.

Sensitization pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey

Variability in children's allergic sensitization has been detected not only among different countries but also among cities within the same nation but yet different climatic areas. The aim of this study was to investigate the sensitization pattern of asthmatic children who lived in different altitude areas: the two largest Turkish cities, Istanbul (sea level) and Erzurum (high altitude). Five hundred and twelve asthmatic children (6-15 years old) from Istanbul (western Turkey, at sea level) and 609 from Erzurum (eastern Turkey, at an altitude of 1800 m) were included in the study. All participants underwent skin testing with common inhalant allergens, spirometry, total IgE level, and clinical examination. The positive sensitization ratio to aeroallergens in children with asthma living at sea level was statistically higher than that in children living in the high altitude group [p = 0.001, OR (odds ratio) 4.9 (confidence interval (CI) 3.67-6.459)]. However, pollen sensitization in asthmatic children living in high altitudes was significantly higher than that in children living at sea level [p = 0.00, OR 2.6 (CI 1.79-3.87)]. Children with asthma who live at high altitudes are characterized by higher pollen but lower mite sensitization rates than those living at sea level in Turkey. Different climatic conditions and altitudes may affect aeroallergen sensitization in children with asthma.

Influences of large sets of environmental exposures on immune responses in healthy adult men

Environmental factors have long been known to influence immune responses. In particular, clinical studies about the association between migration and increased risk of atopy/asthma have provided important information on the role of migration associated large sets of environmental exposures in the development of allergic diseases. However, investigations about environmental effects on immune responses are mostly limited in candidate environmental exposures, such as air pollution. The influences of large sets of environmental exposures on immune responses are still largely unknown. A simulated 520-d Mars mission provided an opportunity to investigate this topic. Six healthy males lived in a closed habitat simulating a spacecraft for 520 days. When they exited their “spacecraft” after the mission, the scenario was similar to that of migration, involving exposure to a new set of environmental pollutants and allergens. We measured multiple immune parameters with blood samples at chosen time points after the mission. At the early adaptation stage, highly enhanced cytokine responses were observed upon ex vivo antigen stimulations. For cell population frequencies, we found the subjects displayed increased neutrophils. These results may presumably represent the immune changes occurred in healthy humans when migrating, indicating that large sets of environmental exposures may trigger aberrant immune activity.

Climate change and respiratory health

OBJECTIVE

To discuss the nature of climate change and both its immediate and long-term effects on human respiratory health.

METHODS

This review is based on information from a presentation of the American College of Chest Physicians course on Occupational and Environmental Lung Disease held in Toronto, Canada, June 2013. It is supplemented by a PubMed search for climate change, global warming, respiratory tract diseases, and respiratory health. It is also supplemented by a search of Web sites including the Environmental Protection Agency, National Oceanic and Atmospheric Administration, World Meteorological Association, National Snow and Ice Data Center, Carbon Dioxide Information Analysis Center, Inter-Governmental Panel on Climate Change, and the World Health Organization.

RESULTS

Health effects of climate change include an increase in the prevalence of certain respiratory diseases, exacerbations of chronic lung disease, premature mortality, allergic responses, and declines in lung function.

CONCLUSIONS

Climate change, mediated by greenhouse gases, causes adverse health effects to the most vulnerable patient populations-the elderly, children, and those in distressed socioeconomic strata.

Modifiable factors governing indoor fungal diversity and risk of asthma

Exposure to dampness and fungi in the home is a known risk factor for individuals with allergic asthma. Inadequate heating and ventilation may lead to dampness and concomitant increased exposure to spores of allergenic fungi such as Aspergillus and Penicillium. These fungi have been cultured from sputum of asthmatic and non-asthmatic individuals, and implicated in the initiation or exacerbation of asthma. Indoor environmental factors influence the presence and concentrations of fungal propagules and, in turn, risk of asthma outcomes. This review aims to identify modifiable risk factors in the built environment that have been shown to influence fungal composition indoors, and to examine this association with the risk of asthma development and/or exacerbation. A complex interaction between residential characteristics, the built environment and the behaviour of people regulate the diversity and concentrations of indoor fungi. Modifiable factors include build age, architectural design, level of maintenance, variations in construction materials, presence of pets, heating and ventilation patterns. Risk of fungal contamination and asthma outcomes are also influenced by low occupant awareness concerning potential health effects and socio-economic factors. Addressing these factors provides an opportunity to improve future housing interventions, though it is not clear how the built environment and occupant behaviours interact to modify the diversity of indoor fungi and resultant risk of asthma. A combination of housing improvements combined with awareness programmes and the alleviation of fuel poverty can be used to lower the allergen burden associated with damp homes. Further research is needed to identify factors that regulate the concentration and diversity of indoor fungi and how this may act as a modifier for asthma outcomes.

Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors

BACKGROUND

Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship.

OBJECTIVE

This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults.

METHODS

Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies.

RESULTS

Cladosporium, Alternaria, Aspergillus, and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium, Aspergillus, and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited.

CONCLUSION

Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

Environmental changes, microbiota, and allergic diseases

During the last few decades, the prevalence of allergic disease has increased dramatically. The development of allergic diseases has been attributed to complex interactions between environmental factors and genetic factors. Of the many possible environmental factors, most research has focused on the most commonly encountered environmental factors, such as air pollution and environmental microbiota in combination with climate change. There is increasing evidence that such environmental factors play a critical role in the regulation of the immune response that is associated with allergic diseases, especially in genetically susceptible individuals. This review deals with not only these environmental factors and genetic factors but also their interactions in the development of allergic diseases. It will also emphasize the need for early interventions that can prevent the development of allergic diseases in susceptible populations and how these interventions can be identified.

Fungus-associated asthma: overcoming challenges in diagnosis and treatment

With regard to fungal colonization and fungal sensitization, the goals of fungus-associated asthma management are as follows: 1) to survey fungi colonizing the airways of patients repeatedly; 2) to evaluate the tendency of the colonizing fungi to sensitize patients and the influence on clinical manifestations of asthma; 3) to follow disease development to allergic bronchopulmonary mycosis or sinobronchial allergic mycosis; and 4) to determine whether fungal eradication from the airway of patients is beneficial from the viewpoints of future risk factors. Recent developments in molecular biological analyses have facilitated the identification of basidiomycetous fungi that were not previously thought to be of concern in fungal allergy. The total control of fungus-associated asthma will be accomplished by environmental management established from the viewpoint of both the ecology and life cycle of the responsible fungi.

Urinary nickel and prolactin in workers exposed to urban stressors

The aim of our study is to verify whether the exposure to low Ni doses in urban air may have some effects on the prolactin values of outdoor workers exposed to urban pollutants. 334 workers have been included in the study and divided on the basis of gender, job, age, length of service and smoking habits. Each worker underwent urinary Ni and prolactin sampling. The t-test for independent samples, the Mann-Whitney U test for two mode variables (gender, smoking habit), the univariate ANOVA test and the Kruskal Wallis test for the variables in more than two modes (age, length of service and job duties) were performed on the total sample. Pearson's correlation coefficient (p two-tailed) among the parameters was evaluated both in the total sample and after the stratification by gender, smoking habit and job. Multiple linear regression was performed after taking account of the major confounding factors on the total sample and on the subcategories. The statistical tests showed a significant correlation between urinary Ni and prolactin both in the total sample and in the subcategories. We believe that the occupational exposure to low doses of Ni present in urban pollution may influence the prolactin values in exposed workers.