Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases

Interactions among Cupressaceae pollen, air pollutants and meteorology in the urban and suburban areas of Beijing, China

Atmospheric pollutants alter the physicochemical properties of pollen allergens, and raise a high risk of co-exposure to more aeroallergens in the allergic population. It is necessary to reveal the relationships between them and the impacts of meteorology on them both. Herein, synchronous data of aerobiology, pollution and meteorology at the same location are used to investigate the correlation between Cupressaceae pollen (major allergen in Norther China) and atmospheric pollutants, and their association with meteorological factors at different timescales in the urban and suburban areas of Beijing, China. In this research, the correlation between allergenic pollen, air pollutants and meteorological factors may display distinct patterns at daily and hourly timescales. Daily concentration of Cupressaceae pollen was positively correlated with PM2.5 and O3. Hourly pollen concentration exhibited positive correlation with NOx and PM2.5 during high-pollen episodes. Increasing temperature and decreasing relative humidity after sunrise facilitate pollination, causing hourly pollen peak. Temperature exhibited a strong positive correlation with daily and hourly O3 concentrations. Highly humid conditions largely decreased allergenic pollen and O3 concentrations but increased NOx and PM2.5 concentrations. In the urban area, local winds considerably impacting on hourly pollen peaks were associated with high levels of NOx and PM2.5. Concentration weighted trajectory (CWT) results indicated that allergenic pollen and O3 may have some common potential source areas. This research will help us to get a better understanding of the linkage between allergenic pollen and air pollutants, and their dynamics under varying meteorological conditions, and provide effective support on addressing respiratory allergies on the risk of co-exposure for allergenic pollen and air pollutants in the urban and suburban areas of Beijing city.

Mitigation potential of urban greening during heatwaves and stormwater events: a modeling study for Karlsruhe, Germany

Climate change is increasing the frequency and intensity of urban heat islands and stormwater flooding. In order to mitigate these threats cities are turning toward green infrastructure to restore the hydrologic cycle in a way that increases the ecosystem services provided by trees. Strategically designed green infrastructure can mitigate runoff volume by rainfall interception through tree canopies and redirect impervious runoff into bioswales that promote infiltration. In addition, urban greens mitigate extreme heat via evapotranspiration and shading. Here we applied the i-Tree HydroPlus model to the German city of Karlsruhe and its twenty-seven districts with varying initial conditions of tree cover to analyze the potential for both runoff and heat mitigation during dry and wet periods throughout a 5-year period. After analyzing initial tree cover and drainage conditions, we used the model to simulate a green infrastructure scenario for each district with restored hydrology and tree cover at 30%. Regarding trade-offs between runoff and heat mitigation, the results confirm that dry soils before storm events lead to greater runoff reduction by 10%, and wet soils prior to heatwaves resulted in a greater evaporative cooling. Compared to current conditions, the green infrastructure scenarios resulted in decreasing the number of extreme heat hours (Heat Index > 31 °C) per year on average by 64.5%, and to reduce runoff in average by 58% across all city districts. Thus, our simulation results show that investing into a greener infrastructure, has positive impacts on microclimate and hydrology. Finally, we discuss synergies and trade-offs of the investigated management options as well as the transferability of results to other cities.

Alteration of the health effects of bioaerosols by chemical modification in the atmosphere: A review

Bioaerosols are a subset of important airborne particulates that present a substantial human health hazard due to their allergenicity and infectivity. Chemical reactions in atmospheric processes can significantly influence the health hazard presented by bioaerosols; however, few studies have summarized such alterations to bioaerosols and the mechanisms involved. In this paper, we systematically review the chemical modifications of bioaerosols and the impact on their health effects, mainly focusing on the exacerbation of allergic diseases such as asthma, rhinitis, and bronchitis. Oxidation, nitration, and oligomerization induced by hydroxyl radicals, ozone, and nitrogen dioxide are the major chemical modifications affecting bioaerosols, all of which can aggravate allergenicity mainly through immunoglobulin E pathways. Such processes can even interact with climate change including the greenhouse effect, suggesting the importance of bioaerosols in the future implementation of carbon neutralization strategies. In summary, the chemical modification of bioaerosols and the subsequent impact on health hazards indicate that the combined management of both chemical and biological components is required to mitigate the health hazards of particulate air pollution.

Brain response in asthma: the role of "lung-brain" axis mediated by neuroimmune crosstalk

In addition to typical respiratory symptoms, patients with asthma are frequently accompanied by cognitive decline, mood disorders (anxiety and depression), sleep disorders, olfactory disorders, and other brain response manifestations, all of which worsen asthma symptoms, form a vicious cycle, and exacerbate the burden on families and society. Therefore, studying the mechanism of neurological symptoms in patients with asthma is necessary to identify the appropriate preventative and therapeutic measures. In order to provide a comprehensive reference for related research, we compiled the pertinent literature, systematically summarized the latest research progress of asthma and its brain response, and attempted to reveal the possible "lung-brain" crosstalk mechanism and treatment methods at the onset of asthma, which will promote more related research to provide asthmatic patients with neurological symptoms new hope.

Chemical modification by peroxynitrite enhances TLR4 activation of the grass pollen allergen Phl p 5

The chemical modification of aeroallergens by reactive oxygen and nitrogen species (ROS/RNS) may contribute to the growing prevalence of respiratory allergies in industrialized countries. Post-translational modifications can alter the immunological properties of proteins, but the underlying mechanisms and effects are not well understood. In this study, we investigate the Toll-like receptor 4 (TLR4) activation of the major birch and grass pollen allergens Bet v 1 and Phl p 5, and how the physiological oxidant peroxynitrite (ONOO-) changes the TLR4 activation through protein nitration and the formation of protein dimers and higher oligomers. Of the two allergens, Bet v 1 exhibited no TLR4 activation, but we found TLR4 activation of Phl p 5, which increased after modification with ONOO- and may play a role in the sensitization against this grass pollen allergen. We attribute the TLR4 activation mainly to the two-domain structure of Phl p 5 which may promote TLR4 dimerization and activation. The enhanced TLR4 signaling of the modified allergen indicates that the ONOO--induced modifications affect relevant protein-receptor interactions. This may lead to increased sensitization to the grass pollen allergen and thus contribute to the increasing prevalence of allergies in the Anthropocene, the present era of globally pervasive anthropogenic influence on the environment.

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.

Air Quality Prediction Using the Fractional Gradient-Based Recurrent Neural Network

In this study, the air quality index (AQI) of Indian cities of different tiers is predicted by using the vanilla recurrent neural network (RNN). AQI is used to measure the air quality of any region which is calculated on the basis of the concentration of ground-level ozone, particle pollution, carbon monoxide, and sulphur dioxide in air. Thus, the present air quality of an area is dependent on current weather conditions, vehicle traffic in that area, or anything that increases air pollution. Also, the current air quality is dependent on the climate conditions and industrialization in that area. Thus, the AQI is history-dependent. To capture this dependency, the memory property of fractional derivatives is exploited in this algorithm and the fractional gradient descent algorithm involving Caputo's derivative has been used in the backpropagation algorithm for training of the RNN. Due to the availability of a large amount of data and high computation support, deep neural networks are capable of giving state-of-the-art results in the time series prediction. But, in this study, the basic vanilla RNN has been chosen to check the effectiveness of fractional derivatives. The AQI and gases affecting AQI prediction results for different cities show that the proposed algorithm leads to higher accuracy. It has been observed that the results of the vanilla RNN with fractional derivatives are comparable to long short-term memory (LSTM).

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

Specific aeroallergen sensitization associated with current rhinitis among adults in southwestern Saudi Arabia

Data about allergic sensitization to rhinitis among adults are limited. The objectives were to explore the prevalence of current rhinitis (CR) and associated specific allergen sensitizations in southwestern Saudi Arabia. A cross-sectional study was conducted on 969 adults in southwestern regions of Saudi Arabia, namely Aseer, Jazan, and Al Baha. From each region, 5 primary health care centers were chosen. The validated Arabic Version of the International Study of Asthma and Allergies in Childhood questionnaire was used. Total immunoglobulin E (IgE) enzyme-linked immunosorbent assay, cytokine enzyme-linked immunosorbent assay (interleukin [IL]-4, IL-10, IL-13, and interferon-γ), aeroallergen-specific IgE immunoassay (a panel of 30 common aeroallergens; 9 indoor and 21 outdoors), and eosinophilic count were assessed. A prevalence of CR of 35.8% (95% confidence interval: 32.8%-38.9%) was found. Regarding outdoor aeroallergens, Mesquite-positive IgE antibodies were higher among CR adults (odds ratio = 1.52, 95% confidence interval: 1.02-2.21) compared to those without CR. The same significant pattern was found with Chenopodium, Ragweed, Pigweed, Russian thistle, Bermuda grass, Timothy grass, and Rye. All indoor aeroallergens were not significantly associated with CR. Total IgE and eosinophil count were significantly higher among adults with CR. In conclusion, CR in southwestern regions of Saudi Arabia is common and of significant public health importance. Aeroallergens that associate with adult sensitization to CR tend to be of the outdoor variety particularly the herbaceous grass and their pollens. The magnitude of CR and its association with exposure to outdoor aeroallergens should be taken into account by health policy decision makers, clinicians, and medical practitioners when diagnosing and treating related conditions.

Place of residence, gender, month of birth and age influence on the concentration of specific IgE antibodies in serum. The Epidemiology of Allergic Diseases in Poland (ECAP survey): part three

Introduction

Specific immunoglobulins E (sIgE) are important parameters to estimate the severity of allergic diseases.

Aim

To determine the influence of gender, age and place of residence on the concentration of specific IgE antibodies in serum.

Material and methods

The concentration of sIgE antibodies against allergens of Dermatophagoides pteronyssinus, cat dander, timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 8 regions (ECAP study). The positive results of sIgE (≥ 0.35 IU/ml) were correlated with answers to ECAP questionnaires.

Results

IgE antibodies are less frequently detected in respondents living in the country (p < 0.05 to p < 0.005); and they are less frequently detected in respondents living in cities of hardly industrialised regions than in respondents living in cities of industrialised regions (D. pteronyssinus p < 0.05, cat dander p < 0.01). IgE antibodies are more frequently detected in men (p < 0.005 to p < 0.001). IgE antibodies are more frequently detected in respondents born in May-July (timothy grass p < 0.005, Alternaria alternata p < 0.005) and less frequently detected in respondents born in August-October (timothy grass p < 0.005, Alternaria alternata p < 0.05).

Conclusions

Characteristics of the urban environment, non-specific factors and gender affect the concentration of specific IgE antibodies in serum. Influence of seasonal allergens within the first months of life and/or in the course of the foetal period alters the production of specific IgE antibodies.

Association Between Air Pollutants and Pediatric Respiratory Outpatient Visits in Zhoushan, China

OBJECTIVE

This study aimed to explore the time-series relationship between air pollutants and the number of children's respiratory outpatient visits in coastal cities.

METHODS

We used time series analysis to investigate the association between air pollution levels and pediatric respiratory outpatient visits in Zhoushan city, China. The population was selected from children aged 0-18 who had been in pediatric respiratory clinics for eight consecutive years from 2014 to 2020. After describing the population and weather characteristics, a lag model was used to explore the relationship between outpatient visits and air pollution.

RESULTS

We recorded annual outpatient visits for different respiratory diseases in children. The best synergy lag model found a 10 μg/m3 increase in PM2.5 for every 4-10% increase in the number of pediatric respiratory outpatient visits (P < 0.05). The cumulative effect of an increase in the number of daily pediatric respiratory clinics with a lag of 1-7 days was the best model.

CONCLUSIONS

PM2.5 is significantly related to the number of respiratory outpatient visits of children, which can aid in formulating policies for health resource allocation and health risk assessment strategies.

Fabrication and Characterization of Alveolus-Like Scaffolds with Control of the Pore Architecture and Gas Permeability

The micrometer scale sac-like alveoli are the most important and essential unit for gas exchange in the lung. Thus, design and fabrication of scaffolds for alveoli regeneration by tissue engineering approach should meet a few topography and functional requests such as large surface area, flexibility, and high gas permeability to their native counterpart. Testing the gas permeability of scaffolds through a fast and simple technique is also highly demanded to assist new scaffold development. This study fabricated alveolus-like scaffolds with regular pore shape, high pore connectivity, and high porosity produced by inverse opal technique alongside randomly distrusted porous scaffolds by salt leaching technique from two different materials (polyurethane and poly(L-lactic acid)). The scaffold surface was modified by immobilization of VEGF. A facile and new technique based on the bubble meter principle enabling to measure the gas permeability of porous scaffolds conveniently has been developed specifically. The cellular response of the scaffolds was assessed by culturing with bone marrow mesenchymal stem cells and coculturing with lung epithelial NL20 and endothelial HUVECs. Our results showed that the newly designed gas permeability device provided rapid, nondestructive, reproducible, and accurate assessment of gas permeability of different scaffolds. The porous polyurethane scaffolds made by inverse opal method had much better gas permeability than other scaffolds used in this study. The cellular work indicated that with VEGF surface modification, polyurethane inverse opal scaffolds induced alveolus-like tissues and have promising application in lung tissue engineering.

Allergy and Household Living Conditions among Adolescents Living near Gold Mine Tailing Dumps in the Gauteng and North West Provinces of South Africa

This quantitative exploratory baseline study aimed to investigate whether allergy among adolescents was associated with household living conditions, including living near gold mine tailing dumps in South Africa. A questionnaire based on the International Study of Asthma and Allergies was used to collect information on allergy and household risk factors among adolescents (n = 5611). A chi-square test was applied to determine the relationship between community (exposed/unexposed) and confounding variables. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using univariate and multiple logistic regression analysis (LRA) to estimate the likelihood of having doctor-diagnosed allergies. The overall prevalence of doctor-diagnosed allergies was 25.5%. The exposed communities had a higher prevalence of doctor-diagnosed allergies (26.97%) compared with the unexposed (22.69%) communities. The study found an association between doctor-diagnosed allergy and having fungus in the house, being female, currently having pets in and around the house, residing in the community for more than three years and living in communities located close to gold mine tailing dumps. Actions to implement buffer zones between gold mine tailing dumps and communities would support Sustainable Development Goals 3 (health) and 11 (sustainable cities and communities), while failing to address the current potential identified risk factors may pose a significant public health challenge. Local policymakers should also apply the precautionary principle to protect the health of children, especially with the location of human settlements relative to air pollution sources.

Investigation on puncture mechanical performance of tracheal tissue

This paper investigated the mechanical behavior of the contact between the oblique tip puncture needle and the tracheal tissue during pathological examination for the diagnosis of respiratory diseases. By analyzing the force of the oblique tip puncture needle, this paper established a theoretical model of the contact mechanics between the needle and the tracheal tissue. With the material characteristics, needle diameter and puncture angle of trachea tissue as the loading conditions, the biomechanical simulation of piercing process was carried out by using the finite element simulation method, and realistic puncture experiments on isolated porcine tracheal tissue were performed by electronic universal testing machine. The results showed that the puncture needle was mainly subjected to the combined effect of cutting force, clamping force and frictional force on the needle shaft. When the needle diameter was 22G, penetrating the tracheal tissue vertically, the force on the needle was minimal. Meanwhile, it was found that the error between the experimental and theoretical values of the puncture force did not exceed 10%, thus verifying the feasibility of the hypothetical model of the puncture force in the tracheal tissue rupture stage. It provided a theoretical basis for the intervention of surgical instruments and reduced surgical risks.

Risk factors for current wheeze among school children (6–7 and 13–14 years old) in Khuzestan, Iran

Objectives

In recent years, there has been a clear trend of increasing allergic diseases especially in children, and developing countries are no exception. Thepresentstudy sought to determine the risk factors associated with wheezing among school children aged 6–7 and 13–14 years living in Khuzestan Province, Iran.

Study design

Cross-sectional.

Methods

Data for this cross-sectional study is the history of wheeze in the last 12 months. The participants included 6-7- and 13-14-year-old girls and boys studying in urban schools in Khuzestan Province in 2019. We collected the data using the multi stage sampling technique as suggested in the International Study of Asthma and Allergies in Childhood (ISAAC). The research reviewed the literature and consulted experts to collect the risk factors for demographic and clinical information, environmental exposure and lifestyle.

Results

Eight thousand questionnaires were handed out to both age groups, of which 7344 were completed. Two hundred ninety-nine (4.1 %) of the participants had current wheeze. Three-point four percent (124 individuals) in the 6–7 year age group and 4.8 % in the 13–14-year-old age group had current wheezing. The results of the logistic regression model suggest that the most significant risk factors associated with the chance of developing current wheeze in the both age groups are: being male (OR: 1.46, 95 % CI: 1.12–1.88), being from employed mother families (OR: 1.50, 95 %, CI:1.05–2.08), property ownership (OR:1.36, 95 %, CI:1.04–1.79) bugs in the property (OR: 1.29, 95 %, CI:0.99–1.70) mold in the property (OR: 1.75, 95 %, CI:1.12–2.76), pet(s) in the student's bedroom (OR: 1.75, 95 %, CI: 0.97–3.14), a family history of asthma and allergic diseases (OR: 2.20, 95 %, CI: 1.69–2.87), tobacco smoke exposures in the property (OR: 1.43, 95 %, CI:1.04–1.96), having allergic rhinitis (OR: 7.86, 95 % CI: 5.89–10.50) and eczema (OR: 3.85, 95 % CI: 2.10–7.08).

Conclusions

Families are suggested to adopt strategies to reduce exposure to outdoor air pollutants and contain indoor allergens. More studies are necessary to further explore the effects of modifying and changing these risk factors.

•

3.4 % in the 6–7 year age group and 4.8 % in the 13–14 year age group had current wheezing.

•

In both age groups, current wheeze is more common in boys than girls.

•

Mold in the home, pet in the bedroom and tobacco smoke exposures are the most important risk factors for current wheeze.

Climate Change and Global Issues in Allergy and Immunology

The steady increase in global temperatures, resulting from the combustion of fossil fuels and the accumulation of greenhouse gases (GHG), continues to destabilize all ecosystems worldwide. Although annual emissions must halve by 2030 and reach net-zero by 2050 to limit some of the most catastrophic impacts associated with a warming planet, the world's efforts to curb GHG emissions fall short of the commitments made in the 2015 Paris Agreement (1). To this effect, July 2021 was recently declared the hottest month ever recorded in 142 years (2). The ramifications of these changes on global temperatures are complex and further promote outdoor air pollution, pollen exposure, and extreme weather events. Besides worsening respiratory health, air pollution, promotes atopy and susceptibility to infections. The GHG effects on pollen affect the frequency and severity of asthma and allergic rhinitis. Changes in temperature, air pollution, and extreme weather events exert adverse multisystemic health effects and disproportionally affect disadvantaged and vulnerable populations. This article is an update for allergists and immunologists about the health impacts of climate change, already evident in our daily practices. It is also a call to action and advocacy, including integrating climate change-related mitigation, education, and adaptation measures to protect our patients and avert further injury to our planet.

A systematic review of the effects of temperature and precipitation on pollen concentrations and season timing, and implications for human health

Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to "wash out" effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals.

Oligomerization and Nitration of the Grass Pollen Allergen Phl p 5 by Ozone, Nitrogen Dioxide, and Peroxynitrite: Reaction Products, Kinetics, and Health Effects

The allergenic and inflammatory potential of proteins can be enhanced by chemical modification upon exposure to atmospheric or physiological oxidants. The molecular mechanisms and kinetics of such modifications, however, have not yet been fully resolved. We investigated the oligomerization and nitration of the grass pollen allergen Phl p 5 by ozone (O₃), nitrogen dioxide (NO₂), and peroxynitrite (ONOO^-). Within several hours of exposure to atmospherically relevant concentration levels of O₃ and NO₂, up to 50% of Phl p 5 were converted into protein oligomers, likely by formation of dityrosine cross-links. Assuming that tyrosine residues are the preferential site of nitration, up to 10% of the 12 tyrosine residues per protein monomer were nitrated. For the reaction with peroxynitrite, the largest oligomer mass fractions (up to 50%) were found for equimolar concentrations of peroxynitrite over tyrosine residues. With excess peroxynitrite, the nitration degrees increased up to 40% whereas the oligomer mass fractions decreased to 20%. Our results suggest that protein oligomerization and nitration are competing processes, which is consistent with a two-step mechanism involving a reactive oxygen intermediate (ROI), as observed for other proteins. The modified proteins can promote pro-inflammatory cellular signaling that may contribute to chronic inflammation and allergies in response to air pollution.

Effect of Different Pollution Parameters and Chemical Components of PM2.5 on Health of Residents of Xinxiang City, China

The present study was planned to explore the pollution characteristics, health risks, and influence of atmospheric fine particulate matter (PM2.5) and its components on blood routine parameters in a typical industrial city (Xinxiang City) in China. In this study, 102 effective samples 28 (April-May), 19 (July-August), 27 (September-October), 28 (December-January) of PM2.5 were collected during different seasons from 2017 to 2018. The water-soluble ions and metal elements in PM2.5 were analyzed via ion chromatography and inductively coupled plasma-mass spectrometry. The blood routine physical examination parameters under different polluted weather conditions from January to December 2017 and 2018, the corresponding PM2.5 concentration, temperature, and relative humidity during the same period were collected from Second People's Hospital of Xinxiang during 2017-2018. Risk assessment was carried out using the generalized additive time series model (GAM). It was used to analyze the influence of PM2.5 concentration and its components on blood routine indicators of the physical examination population. The "mgcv" package in R.3.5.3 statistical software was used for modeling and analysis and used to perform nonparametric smoothing on meteorological indicators such as temperature and humidity. When Akaike's information criterion (AIC) value is the smallest, the goodness of fit of the model is the highest. Additionally, the US EPA exposure model was used to evaluate the health risks caused by different heavy metals in PM2.5 to the human body through the respiratory pathway, including carcinogenic risk and non-carcinogenic risk. The result showed that the air particulate matter and its chemical components in Xinxiang City were higher in winter as compared to other seasons with an overall trend of winter > spring > autumn > summer. The content of nitrate (NO3-) and sulfate (SO42-) ions in the atmosphere were higher in winter, which, together with ammonium, constitute the main components of water-soluble ions in PM2.5 in Xinxiang City. Source analysis reported that mobile pollution sources (coal combustion emissions, automobile exhaust emissions, and industrial emissions) in Xinxiang City during the winter season contributed more to atmospheric pollution as compared to fixed sources. The results of the risk assessment showed that the non-carcinogenic health risk of heavy metals in fine particulate matter is acceptable to the human body, while among the carcinogenic elements, the order of lifetime carcinogenic risk is arsenic (As) > chromium(Cr) > cadmium (Cd) > cobalt(Co) > nickel (Ni). During periods of haze pollution, the exposure concentration of PM2.5 has a certain lag effect on blood routine parameters. On the day when haze pollution occurs, when the daily average concentration of PM2.5 rises by 10 μg·m-3, hemoglobin (HGB) and platelet count (PLT) increase, respectively, by 9.923% (95% CI, 8.741-11.264) and 0.068% (95% CI, 0.067-0.069). GAM model analysis predicted the maximum effect of PM2.5 exposure concentration on red blood cell count (RBC) and PLT was reached when the hysteresis accumulates for 1d (Lag0). The maximum effect of exposure concentration ofPM2.5 on MONO is reached when the lag accumulation is 3d (Lag2). When the hysteresis accumulates for 6d (Lag5), the exposure concentration of PM2.5 has the greatest effect on HGB. The maximum cumulative effect of PM2.5 on neutrophil count (NEUT) and lymphocyte (LMY) was strongest when the lag was 2d (Lag1). During periods of moderate to severe pollution, the concentration of water-soluble ions and heavy metal elements in PM2.5 increases significantly and has a significant correlation with some blood routine indicators.

Three Consecutive Episodes of Thunderstorm Asthma in Ahvaz, Iran: the Possible Role of Conocarpus Pollen

Background

The aim of this study is to evaluate the clinical pattern of thunderstorm asthma (TA) and the possible environmental hypotheses involved in the escalation of these epidemics.

Materials and Methods

This retrospective descriptive study examined patients with respiratory problems referred to the clinics and emergency departments in Ahvaz, Iran during 2013-2016 periods following the first episodes of rainfall in autumn. The seasonal profile of airborne pollens and fungal spores in Ahvaz were characterized and clinical and spirometry findings of 443 patients were evaluated.

Results

Of 56,000 people referred to the emergency department due to respiratory problems associated with the first rainfall in Khuzestan province, 91.4% displayed asthma-like symptoms and 71.3% had a history of allergic rhinitis. According to the results of spirometry test 38%, 52.9%, and 9.1% of patients had normal, obstructive, and restrictive patterns, respectively. Our results highlight the importance of allergic rhinitis as risk factors of TA epidemics. In terms of pollen, seasonal pollen integral was much higher in autumn than in winter.

Conclusion

Our results highlight the importance of seasonal allergy and rhinitis as risk factors for thunderstorm asthma epidemics.

Impact of Annual Exposure to Polycyclic Aromatic Hydrocarbons on Acute Exacerbation Frequency in Asthmatic Patients

Purpose

Exposure to polycyclic aromatic hydrocarbons (PAHs) associated with ambient air particulate matter (PM) poses significant health concerns. Increased acute exacerbation (AE) frequency in asthmatic patients has been associated with ambient PAHs, but which subgroup of patients are particularly susceptible to ambient PAHs is uncertain. We developed a new model to simulate grid-scale PM_2.5-PAH levels in order to evaluate whether the severity of asthma as measured by the Global Initiative of Asthma (GINA) levels of treatment is related to cumulative exposure of ambient PAHs.

Methods

Patients with asthma residing in the northern Taiwan were reviewed retrospectively from 2014 to 2017. PM_2.5 were sampled and analysed for PAHs twice a month over a 72-hour period, in addition to collecting the routinely monitored air pollutant data from an established air quality monitoring network. In combination with correlation analysis and principal component analysis, multivariate linear regression models were performed to simulate hourly grid-scale PM_2.5-PAH concentrations (ng/m³). A geographic information system mapping approach with ordinary kriging interpolation method was used to calculate the annual exposure of PAHs (ng/m).

Results

Among the 387 patients with asthma aged 18 to 93 (median 62), 97 subjects were treated as GINA step 5 (24%). Asthmatics in GINA 5 subgroup with high annual PAHs exposure were likely to have a higher annual frequency of any AE (1 (0–12), p<0.0001). Annual PAHs exposure was correlated with the annual frequency of any exacerbation (r=0.11, p=0.02). This was more significant in the GINA 5 subgroup (r=0.29, p=0.005) and in the GINA 5 subgroup with severe acute exacerbations (r=0.51, p=0.002). Annual PAHs exposure, severe acute exacerbation and GINA steps were independent variables that predict annual frequency of any exacerbation.

Conclusion

Asthmatic patients in the GINA 5 subgroup with acute exacerbations were more susceptible to the effect of environmental PAHs on their exacerbation frequency. Reducing environmental levels of PAHs will have the greatest impact on the more severe asthma patients.

Air pollution aggravating COVID-19 lethality? Exploration in Asian cities using statistical models

The present work estimates the increased risk of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 by establishing the linkage between the mortality rate in the infected cases and the air pollution, specifically Particulate Matters (PM) with aerodynamic diameters ≤ 10 µm and ≤ 2.5 µm. Data related to nine Asian cities are analyzed using statistical approaches, including the analysis of variance and regression model. The present work suggests that there exists a positive correlation between the level of air pollution of a region and the lethality related to COVID-19, indicating air pollution to be an elemental and concealed factor in aggravating the global burden of deaths related to COVID-19. Past exposures to high level of PM_2.5 over a long period, is found to significantly correlate with present COVID-19 mortality per unit reported cases (p < 0.05) compared to PM₁₀, with non-significant correlation (p = 0.118). The finding of the study can help government agencies, health ministries and policymakers globally to take proactive steps by promoting immunity-boosting supplements and appropriate masks to reduce the risks associated with COVID-19 in highly polluted areas.

Network pharmacology-based study of the protective mechanism of conciliatory anti-allergic decoction on asthma

BACKGROUND

This study aimed to explore the underlying anti-asthma pharmacological mechanisms of conciliatory anti-allergic decoction (CAD) with a network pharmacology approach.

METHODS

Traditional Chinese medicine related databases were utilized to screen the active ingredients of CAD. Targets of CAD for asthma treatment were also identified based on related databases. The protein-protein interaction network, biological function and KEGG pathway enrichment analysis, and molecular docking of the targets were performed. Furthermore, an asthma mouse model experiment involving HE staining, AB-PAS staining, and ELISA was also performed to assess the anti-asthma effect of CAD.

RESULTS

There were 77 active ingredients in CAD, including quercetin, kaempferol, stigmasterol, luteolin, cryptotanshinone, beta-sitosterol, acacetin, naringenin, baicalin, and 48 related targets for asthma treatment, mainly including TNF, IL4, IL5, IL10, IL13 and IFN-γ, were identified with ideal molecular docking binding scores by network pharmacology analysis. KEGG pathway analysis revealed that these targets were directly involved in the asthma pathway, Th1 and Th2 cell differentiation, and signaling pathways correlated with asthma (NF-κB, IL17, T cell receptor, TNF, JAK-STAT signaling pathways, etc.). Animal experiments also confirmed that CAD could attenuate inflammatory cell invasion, goblet cell hyperplasia and mucus secretion. The levels of the major targets TNF-α, IL4, IL5, and IL13 can also be regulated by CAD in an asthma mouse model.

CONCLUSION

The anti-asthma mechanism of CAD possibly stemmed from the active ingredients targeting asthma-related targets, which are involved in the asthma pathway and signaling pathways to exhibit therapeutic effects.

Early-life exposure to air pollution and childhood allergic diseases: an update on the link and its implications

INTRODUCTION

Although mounting evidence has linked environmental factors with childhood allergies, some specific key issues still remain unclear: what is the main environmental factor? what is the critical timing window? And whether these contribute to the development of disease?

AREAS COVERED

This selective review summarizes recent epidemiological studies on the association between early-life exposure to indoor/outdoor air pollution and childhood allergic diseases. A literature search was conducted in the PubMed and Web of Science for peer-reviewed articles published until April 2020. Exposure to the traffic-related air pollutant, NO₂, exposure during pregnancy and early postnatal periods is found to be associated with childhood allergies, and exposure during different trimesters causes different allergic diseases. However, exposure to classical air pollutants (PM₁₀ and SO₂) also contributes to childhood allergy in developing countries. In addition, early-life exposure to indoor renovation and mold/dampness significantly increases the risk of allergy in children. A synergistic effect between indoor and outdoor air pollution is found in the development of allergic diseases.

EXPERT OPINION

Early-life exposure to outdoor air pollution and indoor environmental factors plays an important role in the development of childhood allergic diseases, and the synergy between indoor and outdoor exposures increases allergy risk. The available findings support the hypothesis of the 'fetal origins of childhood allergy,' with new implications for the effective control and early prevention of childhood allergies.

Summer storms and their effects on the spectrum and quantity of airborne bioparticles in Bratislava, Central Europe

A thunderstorm is a risk factor for severe respiratory allergy or asthma attacks in patients suffering from pollen/spore allergy. This study aimed to investigate the changes in the spectrum and quantity of pollen and fungal spores in the air of Bratislava during summer storms as well as the impact of selected environmental parameters on these changes. Pollen/spore samples were collected using a Burkard volumetric aerospore trap during summer 2016. To identify those types of pollen/spores that may harm human health during the storm episodes, we analysed how the concentration of individual bioparticles in the air changed during pre-storm/storm/post-storm periods. The effect of environmental variables on the concentration of selected pollen/spore types was evaluated through Spearman's correlation analysis. The results of our study suggest that thunderstorm-related respiratory allergy symptoms in the study area may be caused by (1) spores of Myxomycetes, the airborne concentration of which increases due to an increase in wind speed during the pre-storm period; (2) ruptured pollen and Diatripaceae spores, the concentration of which increases due to increase in precipitation and relative air humidity, respectively, during the storm period; and (3) spores of Fusarium and Leptosphaeria, the concentration of which increases due to increase in precipitation and air temperature, respectively, during the post-storm period.

The effect of atmospheric pressure on oxygen saturation and dyspnea: the Tromsø study

A drop in atmospheric pressure, as observed at high altitudes, leads to decreased oxygen saturation. The effect of regular changes in barometric pressure at sea level has never been studied in a general population. A cohort of adults aged 40 years were examined with pulse oximetry at two separate visits, and the local barometric pressure was available from the local weather station. The study aimed at determining the effect of atmospheric pressure on oxygen saturation also called SpO₂, as well as on shortness of breath. Based on spirometry, the participants were divided into two groups, with normal and decreased lung function. Decreased lung function was defined as forced expiratory volume in 1 s (FEV₁) below lower limit or normal (LLN) or FEV₁/FVC (FVC, forced vital capacity) below LLN, with GLI 2012 reference values. The statistical analysis included uni/multivariable linear and logistic regression. A total of 7439 participants of the Tromsø 7 cohort study were included. There was a significant association between barometric pressure and SpO₂ < 96%, and we found that a reduction of 166.67 hPa was needed to get a 1% reduction in SpO₂. The change in atmospheric pressure was not significantly associated with shortness of breath, also not in subjects with reduced lung function.

The Role of Th17 Cells and IL-17 in Th2 Immune Responses of Allergic Conjunctivitis

Allergic conjunctivitis (AC) is a common allergic disease that is often associated with the onset of rhinitis or asthma. The incidence of AC has increased significantly in recent years possibly due to air pollution and climate warming. AC seriously affects patients' quality of life and work efficiency. Th (T-helper) 2 immune responses and type I hypersensitivity reactions are generally considered the basis of occurrence of AC. It has been found that new subpopulations of T-helper cells, Th17 cells that produce interleukin-17 (IL-17), play an important role in the Th2-mediated pathogenesis of conjunctivitis. Studies have shown that Th17 cells are involved in a variety of immune inflammation, including psoriasis, rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and asthma. However, the role of Th17 and IL-17 in AC is unclear. This paper will focus on how T-helper 17 cells and interleukin-17 are activated in the Th2 immune response of allergic conjunctivitis and how they promote the Th2 immune response of AC.

Linking green infrastructure to urban heat and human health risk mitigation in Oslo, Norway

The predicted extreme temperatures of global warming are magnified in cities due to the urban heat island effect. Even if the target for average temperature increase in the Paris Climate Agreement is met, temperatures during the hottest month in a northern city like Oslo are predicted to rise by over 5 °C by 2050. We hypothesised that heat-related diagnoses for heat-sensitive citizens (75+) in Oslo are correlated to monthly air temperatures, and that green infrastructure such as tree canopy cover reduces extreme land surface temperatures and thus reduces health risk from heat exposure. Monthly air temperatures were significantly correlated to the number of skin-related diagnoses at the city level, but were unrelated to diagnoses under circulatory, nervous system, or general categories. Satellite-derived spatially-explicit measures revealed that on one of the hottest days during the summer of 2018, landscape units composed of paved, midrise or lowrise buildings gave off the most heat (39 °C), whereas units composed of complete tree canopy cover, or mixed (i.e. tree and grass) vegetation maintained temperatures of between 29 and 32 °C. Land surface temperatures were negatively correlated to tree canopy cover (R² = 0.45) and vegetation greenness (R² = 0.41). In a scenario in which each city tree was replaced by the most common non-tree cover in its neighbourhood, the area of Oslo exceeding a 30 °C health risk threshold during the summer would increase from 23 to 29%. Combining modelling results with population at risk at census tract level, we estimated that each tree in the city currently mitigates additional heat exposure of one heat-sensitive person by one day. Our results indicate that maintaining and restoring tree cover provides an ecosystem service of urban heat reduction. Our findings have particular relevance for health benefit estimation in urban ecosystem accounting and municipal policy decisions regarding ecosystem-based climate adaptation.

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

1. Epidemiological studies show that indoor and outdoor pollutions affect respiratory health, including an increased prevalence of asthma and allergic diseases. Global warming will increase the effects of outdoor air pollution on health.

2. The Asia-Pacific is the most populated region in the world, with a huge burden of both outdoor and indoor pollutants, including PM_2.5, PM₁₀, SPM, CO, O₃, NO₂, SO₂, NO and household pollutants including biomass and tobacco.

3. The risk factors for the epidemic rise of allergic diseases in the Asia-Pacific are due to the increasing urbanization, environmental factors of air pollution and climate changes in recent decades than in the other parts of the world.

4. In light of the different environmental exposures in different countries of the Asia-Pacific region, strategies to combat allergic disease in this region should be focused on active government policies to fight air pollution based on the local conditions.

5. Substantial efforts need to be implemented with a concerted strategy at legislative, administrative, and community levels to improve air quality.

6. Abatement of the main risk factors for respiratory diseases, in particular, environmental tobacco smoke, indoor biomass fuels, and outdoor air pollution, as well as better control of asthma and rhinitis will achieve huge health benefits.

A systematic review of the role of grass pollen and fungi in thunderstorm asthma

BACKGROUND

Thunderstorm asthma is defined as epidemics of asthma occurring shortly after a thunderstorm. While grass pollen has been implicated in thunderstorm asthma events, little is known about the role of fungi and studies have not been synthesised.

OBJECTIVE

This systematic review aims to evaluate whether grass pollen is necessary in thunderstorm asthma events and whether fungi also play a part in these associations.

METHODS

We conducted a systematic search using six electronic databases (i.e. CINAHL, Medline (Ovid), Web of Science, ProQuest Central, EMBASE and Google Scholar) and checked reference lists. The search terms used were pollen AND thunderstorm* AND asthma. The inclusion criteria were studies published in English with original human data relating to outdoor pollen and thunderstorm asthma.

RESULTS

Twenty of 2198 studies were eligible. Reported findings differed due to variation in methodological approaches and a meta-analysis was not possible. Nonetheless, of the 20 studies included, 15 demonstrated some relationship with nine demonstrating lagged effects up to four days for increasing grass pollen counts associated with increased risk of thunderstorm asthma. Of the 10 studies that examined fungi, nine demonstrated a positive relationship with thunderstorm asthma. The fungal taxa involved varied, depending on whether measurements were recorded before, during or after the thunderstorm. Nevertheless, none of the studies considered fungi as a potential effect modifier for the pollen-thunderstorm asthma association.

CONCLUSION

We found evidence to suggest that grass pollen was a necessary factor for thunderstorm asthma but there are other as yet unrecognised environmental factors that may also be important. Further research is required to examine the role of fungi and other environmental factors such as air quality as potential effect modifiers of the association.

Effects of Meteorological Factors on Hospitalizations in Adult Patients with Asthma: A Systematic Review

Background

Environmental factors such as weather variables contribute to asthma exacerbation. The impact of meteorological factors on asthma-related hospital admissions (HAs) or emergency department visits (EDVs) has been assessed in the literature. We conducted a systematic review to establish a conclusion of whether these findings from the literature are consistent and generalizable or if they vary significantly by certain subgroups.

Objective

This study aims to review the effect of meteorological variables on asthma HAs and EDVs in adults, to identify knowledge gaps and to highlight future research priorities.

Method

A systematic search was conducted in electronic databases such as PubMed, Embase, and CINAHL. All studies published in English were screened and included if they met the eligibility criteria. Two independent reviewers assessed the quality of the studies and extracted the data. The available evidence was summarized and presented using a harvest plot.

Results

Our initial search returned a total of 3887 articles. After screening titles, abstracts, and full texts, 16 studies were included. Thirty-one percent of the included studies (5/16) found that temperature was the only factor associated with asthma hospitalization or EDVs. Six studies (37%) found that both temperature and relative humidity were associated with HAs. Four studies (25%) identified thunderstorms as a possible factor associated with asthma hospitalization in adults.

Conclusion

Our review suggests that HAs and EDVs due to asthma are associated with many meteorological factors. Among the articles included in this review, changing temperature is the most commonly studied variable. We did not find studies that measured barometric pressure, weather phenomena, or the effect of tornados. To develop effective strategies to protect subjects at risk, further studies are required.

Factors Associated with Atopic Dermatitis and Allergic Rhinitis among Residents of Two Municipal Areas in South Korea

Background and Objectives: The growing burden and deleterious health consequences of allergic diseases, especially of allergic rhinitis (AR) and atopic dermatitis (AD), in developed countries remains an important public health issue. The current study aimed to assess the prevalence and to identify the risk factors of atopic dermatitis and allergic rhinitis among residents of Pohang-Si and Yeongdeok-Gun, two municipal areas in South Korea. Materials and Methods: A cross-sectional study was conducted in both municipal areas between 12 November and 13 December 2017. A total of 302 subjects were recruited from 100 households (25 apartments and 25 houses in each municipality), by system extraction according to district code numbers. Data were collected using International Study of Asthma and Allergies in Childhood (ISAAC) Standard Questionnaires for children and a health questionnaire for adults. Risk factors were identified by multivariate logistic regression analysis. Results: Of the 302 study participants, 12.9% and 25.5% had AD and AR, respectively. The significant factors associated with AD by multivariate logistic regression analysis were age ≥19 years (aOR (adjusted odds ratio) 6.9; 95% CI (confidence interval) (2.9–16.37)), residence in Pohang-Si (aOR 2.5; 95% CI (1.18–5.53)), and family history of allergic disease (aOR 2.3; 95% CI (1.09–4.9)). Similarly, the significant factors associated with AR were male gender (aOR 2.3; 95% CI (1.24–4.42)), age ≥19 years (aOR 4.4; 95% CI (2.28–8.48)), residence in Pohang-Si (aOR 2.8; 95% CI (1.51–5.37)), and family history of allergic disease (aOR 6.7; 95% CI (3.50–12.82)). Conclusion: The present study shows that age ≥19 years, residence in Pohang-Si, and family history of allergic disease are risk factors for AD and AR, and that, additionally, male gender is a risk factor of AR. Understanding the risk factors of allergic diseases can aid the design and implementation of evidence-specific strategies to reduce the long-standing problems associated with allergic disease.

Dysregulation of Gap Junction Function and Cytokine Production in Response to Non-Genotoxic Polycyclic Aromatic Hydrocarbons in an In Vitro Lung Cell Model

Polycyclic aromatic hydrocarbons (PAHs), prevalent contaminants in our environment, in many occupations, and in first and second-hand smoke, pose significant adverse health effects. Most research focused on the genotoxic high molecular weight PAHs (e.g., benzo[a]pyrene), however, the nongenotoxic low molecular weight (LMW) PAHs are emerging as potential co-carcinogens and tumor promoters known to dysregulate gap junctional intercellular communication (GJIC), activate mitogen activated protein kinase pathways, and induce the release of inflammatory mediators. We hypothesize that inflammatory mediators resulting from LMW PAH exposure in mouse lung epithelial cell lines are involved in the dysregulation of GJIC. We used mouse lung epithelial cell lines and an alveolar macrophage cell line in the presence of a binary PAH mixture (1:1 ratio of fluoranthene and 1-methylanthracene; PAH mixture). Parthenolide, a pan-inflammation inhibitor, reversed the PAH-induced inhibition of GJIC, the decreased CX43 expression, and the induction of KC and TNF. To further determine the direct role of a cytokine in regulating GJIC, recombinant TNF (rTNF) was used to inhibit GJIC and this response was further enhanced in the presence of the PAH mixture. Collectively, these findings support a role for inflammation in regulating GJIC and the potential to target these early stage cancer pathways for therapeutics.

Environmental Triggers Associated With Empty Nose Syndrome Symptoms: A Cross-Sectional Study

OBJECTIVES

Empty nose syndrome (ENS) is thought to have multiple etiologies, one of which is a postsurgical phenomenon resulting from excessive loss of nasal tissues, particularly the inferior turbinate. Given that the inferior turbinate is instrumental in maintaining nasal homeostasis in different environments, it is believed that ENS symptoms arise only in more arid regions of the world. The aim of this study was to recruit an international population of individuals with ENS to investigate the association of local climate factors on the incidence and severity of ENS-specific symptoms.

METHODS

A cross-sectional study was performed of individuals from an international ENS database. ENS status was determined on the basis of a positive ENS questionnaire score (Empty Nose Syndrome 6-Item Questionnaire) and sinus computed tomographic imaging with supporting medical documentation. Participants completed a survey encompassing demographic, geographic, and symptom indicators. Climate variables were collected from global climate databases. Participant location was classified according to the Köppen-Geiger climate system. Pearson correlation analysis was performed using α = 0.05 to determine significance.

RESULTS

Fifty-three individuals with ENS were included. Participants were distributed across 5 continents and 15 countries (representing 4 distinct Köppen-Geiger zones). Although local climate factors varied significantly within this cohort, no significant association was found between Empty Nose Syndrome 6-Item Questionnaire symptom severity and these climate factors. However, most study participants reported exacerbation of their ENS symptoms in response to dry air (94%), air conditioning (64%), changes in season and weather (60%), and transitioning between indoors and outdoors (40%). This suggests that everyday local environmental factors may influence the well-being of these patients more than global, climate-level shifts.

CONCLUSIONS

ENS symptom severity does not appear to be related to climate or geographic factors. These findings deviate from the traditional dogma that ENS is experienced only in arid regions (or precluded in humid regions) and highlight the importance of recognizing this condition independent of geographic location.

The Prevalence of Allergic Rhinitis, Allergic Conjunctivitis, Atopic Dermatitis and Asthma among Adults of Tehran

BACKGROUND

Alteration of environmental factors and air pollution affects the trend of allergic diseases especially in cities such as Tehran. This study aimed to determine the prevalence of allergic rhinitis, conjunctivitis, atopic dermatitis and asthma among adults in the capital city of Iran.

METHODS

This cross-sectional study was performed between 2013 and 2016 in Tehran, Iran. The participants were adults between 18 and 45 yr of age. A specific questionnaire including demographic data and clinical symptoms was filled out by a trained interviewer. The diagnosis of allergic diseases was performed based on standard questionnaires and criteria.

RESULTS

The prevalence of allergic rhinitis, conjunctivitis, asthma and atopic dermatitis were 28.3%, 15.9%, 7.6% and 3.9%, respectively. Allergic rhinitis and conjunctivitis together were reported in 12.3% of the participants. Among patients with asthma, 47.4% had AR. Additionally, 25.7% of atopic dermatitis subjects were reported to have asthma. The subjects with at least one of these allergic diseases were 36.3%. Women showed a higher prevalence of allergic symptoms than men. There was a significant relationship between allergic symptoms and family history of atopic diseases.

CONCLUSION

The most common allergic disease was allergic rhinitis. Regarding the comorbidity of asthma and allergic rhinitis, paying more attention to controlling these allergic diseases is deemed necessary.

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.

Urban air pollution and climate change: "The Decalogue: Allergy Safe Tree" for allergic and respiratory diseases care

BACKGROUND

According to the World Health Organization, air pollution is closely associated with climate change and, in particular, with global warming. In addition to melting of ice and snow, rising sea level, and flooding of coastal areas, global warming is leading to a tropicalization of temperate marine ecosystems. Moreover, the effects of air pollution on airway and lung diseases are well documented as reported by the World Allergy Organization.

METHODS

Scientific literature was searched for studies investigating the effect of the interaction between air pollution and climate change on allergic and respiratory diseases.

RESULTS

Since 1990s, a multitude of articles and reviews have been published on this topic, with many studies confirming that the warming of our planet is caused by the "greenhouse effect" as a result of increased emission of "greenhouse" gases. Air pollution is also closely linked to global warming: the emission of hydrocarbon combustion products leads to increased concentrations of biological allergens such as pollens, generating a mixture of these particles called particulate matter (PM). The concept is that global warming is linked to the emission of hydrocarbon combustion products, since both carbon dioxide and heat increase pollen emission into the atmosphere, and all these particles make up PM10. However, the understanding of the mechanisms by which PM affects human health is still limited. Therefore, several studies are trying to determine the causes of global warming. There is also evidence that increased concentrations of air pollutants and pollens can activate inflammatory mediators in the airways. Our Task Force has prepared a Decalogue of rules addressing public administrators, which aims to limit the amount of allergenic pollen in the air without sacrificing public green areas.

CONCLUSIONS

Several studies underscore the significant risks of global warming on human health due to increasing levels of air pollution. The impact of climate change on respiratory diseases appears well documented. The last decades have seen a rise in the concentrations of pollens and pollutants in the air. This rise parallels the increase in the number of people presenting with allergic symptoms (e.g., allergic rhinitis, conjunctivitis, and asthma), who often require emergency medical care. Our hope is that scientists from different disciplines will work together with institutions, pharmaceutical companies and lay organizations to limit the adverse health effects of air pollution and global warming.

Assessment of the Cytotoxic and Immunomodulatory Effects of Substances in Human Precision-cut Lung Slices

Respiratory diseases in their broad diversity need appropriate model systems to understand the underlying mechanisms and enable development of new therapeutics. Additionally, registration of new substances requires appropriate risk assessment with adequate testing systems to avoid the risk of individuals being harmed, for example, in the working environment. Such risk assessments are usually conducted in animal studies. In view of the 3Rs principle and public skepticism against animal experiments, human alternative methods, such as precision-cut lung slices (PCLS), have been evolving. The present paper describes the ex vivo technique of human PCLS to study the immunomodulatory potential of low-molecular-weight substances, such as ammonium hexachloroplatinate (HClPt). Measured endpoints include viability and local respiratory inflammation, marked by altered secretion of cytokines and chemokines. Pro-inflammatory cytokines, tumor necrosis factor alpha (TNF-α), and interleukin 1 alpha (IL-1α) were significantly increased in human PCLS after exposure to a sub-toxic concentration of HClPt. Even though the technique of PCLS has been substantially optimized over the past decades, its applicability for the testing of immunomodulation is still in development. Therefore, the results presented here are preliminary, even though they show the potential of human PCLS as a valuable tool in respiratory research.

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.

Changes in extreme events and the potential impacts on human health

Extreme weather and climate-related events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, dust storms, flooding rains, coastal flooding, storm surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden. More information is needed about the impacts of climate change on public health and economies to effectively plan for and adapt to climate change. This paper describes some of the ways extreme events are changing and provides examples of the potential impacts on human health and infrastructure. It also identifies key research gaps to be addressed to improve the resilience of public health to extreme events in the future.

IMPLICATIONS

Extreme weather and climate events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, flooding rains, coastal flooding, surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden.

Effect of O3 and NO2 atmospheric pollutants on Platanus x acerifolia pollen: Immunochemical and spectroscopic analysis

In the present study, the effects of two important oxidizing atmospheric pollutants (O₃ and NO₂) on the allergenic properties and chemical composition of Platanus x acerifolia pollen were studied. Pollen samples were subjected to O₃ and/or NO₂ under in vitro conditions for 6h at atmospheric concentration levels (O₃: 0.061ppm; NO₂: 0.025ppm and the mixture of O₃ and NO₂: 0.060 and 0.031ppm respectively). Immunoblotting (using Pla a 1 and Pla a 2 antibodies), infrared and X-ray photoelectron spectroscopy techniques were used. Immunochemical analysis showed that pollen allergenicity changes were different according to the pollutant tested (gas or mixture of gasses) and that the same pollutant gas may interact in a different manner with each specific allergen. The spectroscopy results showed modifications in the FTIR spectral features of bands assigned to proteins, lipids, and polysaccharides of the pollen exposed to the pollutants, as well as in the XPS spectra high-resolution components C 1s, N 1s, and O 1s. This indicates that while airborne, the pollen wall suffers further modifications of its components induced by air pollution, which can compromise the pollen function.

Pollen of common ragweed (Ambrosia artemisiifolia L.): Illumina-based de novo sequencing and differential transcript expression upon elevated NO2/O3

Common ragweed (Ambrosia artemisiifolia L.) is a highly allergenic annual ruderal plant and native to Northern America, but now also spreading across Europe. Air pollution and climate change will not only affect plant growth, pollen production and duration of the whole pollen season, but also the amount of allergenic encoding transcripts and proteins of the pollen. The objective of this study was to get a better understanding of transcriptional changes in ragweed pollen upon NO₂ and O₃ fumigation. This will also contribute to a systems biology approach to understand the reaction of the allergenic pollen to air pollution and climate change. Ragweed plants were grown in climate chambers under controlled conditions and fumigated with enhanced levels of NO₂ and O₃. Illumina sequencing and de novo assembly revealed significant differentially expressed transcripts, belonging to different gene ontology (GO) terms that were grouped into biological process and molecular function. Transcript levels of the known Amb a ragweed encoding allergens were clearly up-regulated under elevated NO₂, whereas the amount of allergen encoding transcripts was more variable under elevated O₃ conditions. Moreover transcripts encoding allergen known from other plants could be identified. The transcriptional changes in ragweed pollen upon elevated NO₂ fumigation indicates that air pollution will alter the transcriptome of the pollen. The changed levels of allergenic encoding transcripts may have an influence on the total allergenic potential of ragweed pollen.

Air Pollution and Climate Change Effects on Allergies in the Anthropocene: Abundance, Interaction, and Modification of Allergens and Adjuvants

Air pollution and climate change are potential drivers for the increasing burden of allergic diseases. The molecular mechanisms by which air pollutants and climate parameters may influence allergic diseases, however, are complex and elusive. This article provides an overview of physical, chemical and biological interactions between air pollution, climate change, allergens, adjuvants and the immune system, addressing how these interactions may promote the development of allergies. We reviewed and synthesized key findings from atmospheric, climate, and biomedical research. The current state of knowledge, open questions, and future research perspectives are outlined and discussed. The Anthropocene, as the present era of globally pervasive anthropogenic influence on planet Earth and, thus, on the human environment, is characterized by a strong increase of carbon dioxide, ozone, nitrogen oxides, and combustion- or traffic-related particulate matter in the atmosphere. These environmental factors can enhance the abundance and induce chemical modifications of allergens, increase oxidative stress in the human body, and skew the immune system toward allergic reactions. In particular, air pollutants can act as adjuvants and alter the immunogenicity of allergenic proteins, while climate change affects the atmospheric abundance and human exposure to bioaerosols and aeroallergens. To fully understand and effectively mitigate the adverse effects of air pollution and climate change on allergic diseases, several challenges remain to be resolved. Among these are the identification and quantification of immunochemical reaction pathways involving allergens and adjuvants under relevant environmental and physiological conditions.

Antimony speciation as geochemical tracer for anthropogenic emissions of atmospheric particulate matter

The chemical composition of atmospheric particulate matter (PM) has been studied at the cities of Cordoba and Granada (South of Spain) between 2007 and 2013, considering urban background, traffic and industrial monitoring stations. The results of Principal Component Analysis (PCA) indicated that geochemical anomalies observed in the ambient air of Cordoba (mainly Cu, Zn, Pb and Cd) are closely related to the geochemical profile obtained from fugitive metallurgy emissions of brass industries. These findings have been confirmed performing an Sb speciation analysis of PM10 samples, which allowed to distinguish between Sb(III) and Sb(V). The percentage of Sb(V) in PM10 found in the traffic station of Granada was 64-69%. At Cordoba, the percentage of Sb(V) was found to be higher (73-77%) at both urban background and traffic stations, indicating a possible second source of Sb in the PM of this city. The PM10 samples from the industrial station of Cordoba showed a 85-86% of Sb(V). A similar percentage (84-88%) of Sb(V) was found for the fugitive emissions of the brass industries, confirming this industrial source of Sb. These results show that Sb speciation can be a useful geochemical tracer to identify anthropogenic sources (traffic and industrial) emissions of PM.

Allergic diseases in the elderly: biological characteristics and main immunological and non-immunological mechanisms

Life expectancy and the number of elderly people are progressively increasing around the world. Together with other pathologies, allergic diseases also show an increasing incidence in geriatric age. This is partly due to the growing emphasis on a more accurate and careful diagnosis of the molecular mechanisms that do not allow to ignore the real pathogenesis of many symptoms until now unknown, and partly to the fact that the allergic people from 20 years ago represent the elderly population now. Moreover, environmental pollution predisposes to the onset of allergic asthma and dermatitis which are the result of internal pathologies more than the expression of allergic manifestations. At the same time the food contamination permits the onset of allergic diseases related to food allergy. In this review we provide the state of the art on the physiological changes in the elderly responsible for allergic diseases, their biological characteristics and the major immunological and extra immunological mechanisms. Much emphasis is given to the management of several diseases in the elderly, including anaphylactic reactions. Moreover, some new features are discussed, such as management of asthma with the support of physical activity and the use of the AIT as prevention of respiratory diseases and for the purpose of a real and long lasting benefit. The mechanisms of adverse reactions to drugs are also discussed, due to their frequency in this age, especially in polytherapy regimens. Study of the modifications of the immune system is also of great importance, as regards to the distribution of the lymphocytes and also the presence of a chronic inflammatory disease related to the production of cytokines, especially in prevision of all the possible therapies to be adopted to allow an active and healthy aging.

Allergies in urban versus countryside settings in Poland as part of the Epidemiology of the Allergic Diseases in Poland (ECAP) study - challenge the early differential diagnosis

Introduction

The incidence of allergies depends on a number of factors, including adopting an urban “western” lifestyle, genetic predispositions, and different regions of residence.

Aim

To compare the prevalence of allergic conditions (seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR), bronchial asthma (BA), atopic dermatitis (AD)) in a group of countryside versus urban residents in Poland.

Material and methods

The prevalence of allergic conditions in urban versus countryside settings was assessed using the translated and approved questionnaire developed for international ECRHS II and ISAAC studies. Respondents were selected via random multistage sampling, with proportionate stratified sampling, and the Polish Resident Identification Number (PESEL) as the basis. A total of 18,617 respondents took part in the study. Subsequently, approximately 25% of the subjects underwent outpatient assessments: skin-prick, lung function, peak nasal inspiratory flow (PNIF) tests, as well as history-taking.

Results

Allergic rhinitis (AR) proved to be the most common condition in the entire study population. Children residing in the countryside were twice more likely to be diagnosed with BA (8.33% vs. 4%; p < 0.05). Conversely, in the adult subgroup, BA was more commonly observed in urban areas. Whereas reported symptom rates were much higher in AR and AD patients, symptomatic BA was proportionately lower with respect to the official diagnoses (underdiagnosed BA phenomenon). Atopic dermatitis was considerably more common in the metropolitan population. One factor that significantly correlated with allergic diseases was a positive family history.

Conclusions

Inhabitants of metropolitan areas are to a greater extent predisposed to allergic conditions. One factor significantly contributing to allergies is genetic predisposition. Given the scale of the problem, there is an urgent need to implement measures for early prevention and diagnosis of allergies to minimize distant health effects.

Urban Air Pollution in Taiwan before and after the Installation of a Mass Rapid Transit System

Urbanization causes air pollution in metropolitan areas, coupled with meteorological factors that affect air quality. Although previous studies focused on the relationships of urbanization, air pollution, and climate change in Western countries, this study evaluated long-term variations of air quality and meteorological factors in Taiwanese metropolitan areas (Taipei area, Taichung City, and Kaohsiung City) and a rural area (Hualien County) between 1993 and 2012. The influence of a mass rapid transit (MRT) system on air quality was also evaluated. Air pollutant concentrations and meteorology data were collected from Taiwan Environmental Protection Administration (TEPA) air monitoring stations and Central Weather Bureau stations in the surveyed areas, respectively. Analyses indicate that levels of air pollution in metropolitan areas were greater than in the rural area. Kaohsiung City had the highest levels of O, SO, and particulate matter 2.5 or 10 µm in diameter (PM and PM). Clear downward trends for CO, NO, PM, PM, and especially SO concentrations were found in the surveyed areas, whereas O showed no decrease. Both O and PM concentrations showed similar bimodal seasonal distributions. Taiwan's air quality has improved significantly since 1993, indicating the effectiveness of promoting air pollution strategies and policies by the TEPA. Air pollution had an obvious improvement in Taipei area after the MRT system began operations in 1996. Because global climate may potentially affect urban air pollution in Taiwan, further study to clarify the mechanisms by which air pollution may affect human health and other biological effects is warranted.