Alternaria spore exposure in Bavaria, Germany, measured using artificial intelligence algorithms in a network of BAA500 automatic pollen monitors

Aerosol Measurements and Decadal Changes: The Role of Climatic Changes and How It Reflects in Respiratory Allergies and Asthma

The causative agents of respiratory allergies are bioaerosols, such as house dust mite feces, pollen grains, and fungal spores. Climate change and urbanization are considered to lead to an increase in the load of allergenic bioaerosols due to impacts on plant phenophases and allergenicity. Continuous and efficient monitoring of the atmospheric composition worldwide is essential, given the major changes involved and their impact on climate change. The complexity of the exposome, evolving from single to multiple complex exposures, is explored in this work. Acquiring information from interdisciplinary scientific disciplines, such as aerobiology (for airborne particles of biological origin), aerosol science (for airborne particles of chemical or inorganic material), and integrating this with the actual reactome of patients with respiratory diseases, we aim to provide evidence of the multifactorial nature of this interaction in real life. The objective of this review is to present how we can monitor aerosols and mostly monitor the exposome, especially the biological one, i.e., pollen and fungal spores, and what their impact is, or could be, on respiratory allergies. A huge technological advancement has been required, as traditional methods of particle collection and identification have been based on tedious laboratory procedures, with delays of more than a week. This has limited their practical use to allergic patients and their treating physicians. Automation, real-time high temporal resolution, and the use of artificial intelligence are being increasingly used in medicine. Likewise, this overview summarizes the current aerosol measurement and modeling capabilities and discusses the classification of various aerosol particles and their impact on respiratory allergies. Satellite remote sensing is highlighted as a solution to the gaps in global aerosol representation by examining aerosol load in the atmospheric column in major cities worldwide. We also discuss potential novel threats, such as pioneer bioaerosols and the respiratory epithelial barrier, as well as future insights into the impact of climate change on allergy and asthma. We conclude with a discussion of emerging co-exposures and co-diseases resulting from the ongoing climate change.

Full consideration of the pollen exposure effect in clinical trial design for pollen-induced allergic rhinitis

INTRODUCTION

Allergic rhinitis (AR) is global health concern with an increasing prevalence. Among them, pollen-induced AR (PIAR) exhibits more severe and intense symptoms, decreased quality of life, prominent local inflammation, and is thus more challenging to control. Due to the difficulties in disease control, in recent years, an increasing number of treatment methods, including pharmacotherapy, allergen-specific immunotherapy, and newly developed biologics, have focused on PIAR. It has been shown that the pollen exposure has a significant impact on the symptoms of PIAR and the efficacy of intervention. From this perspective, clinical trials for PIAR need to take full account of pollen exposure, especially when assessing efficacy.

AREAS COVERED

This review summarized the effect of pollen exposure on PIAR, including immune responses, symptoms and clinic visits. Current definitions for the pollen season (PS) and the peak pollen season (PPS) are discussed. Based on the previous PIAR-related clinical studies and the available recommendations for clinical trial design, a detailed account of trial protocols which fully considered pollen exposure is provided.

EXPERT OPINION

Pollen exposure has a significant impact on PIAR. With fully considering the pollen exposure in the clinical trial design for PIAR, future protocols for PIAR-related studies may be more objective and better harmonized and, therefore, comparable.

Climate change, airborne allergens, and three translational mitigation approaches

One of the important adverse impacts of climate change on human health is increases in allergic respiratory diseases such as allergic rhinitis and asthma. This impact is via the effects of increases in atmospheric carbon dioxide concentration and air temperature on sources of airborne allergens such as pollen and fungal spores. This review describes these effects and then explores three translational mitigation approaches that may lead to improved health outcomes, with recent examples and developments highlighted. Impacts have already been observed on the seasonality, production and atmospheric concentration, allergenicity, and geographic distribution of airborne allergens, and these are projected to continue into the future. A technological revolution is underway that has the potential to advance patient management by better avoiding associated increased exposures, including automated real-time airborne allergen monitoring, airborne allergen forecasting and modelling, and smartphone apps for mitigating the health impacts of airborne allergens.