Elevated atmospheric carbon dioxide concentrations amplify Alternaria alternata sporulation and total antigen production

Fungal diversity differences in the indoor dust microbiome from built environments on earth and in space

Human occupied built environments are no longer confined to Earth. In fact, there have been humans living and working in low-Earth orbit on the International Space Station (ISS) since November 2000. With NASA's Artemis missions and the age of commercial space stations set to begin, more human-occupied spacecraft than ever will be in Earth's orbit and beyond. On Earth and in the ISS, microbes, especially fungi, can be found in dust and grow when unexpected, elevated moisture conditions occur. However, we do not yet know how indoor microbiomes in Earth-based homes and in the ISS differ due to their unique set of environmental conditions. Here we show that bacterial and fungal communities are different in dust collected from vacuum bags on Earth and the ISS, with Earth-based homes being more diverse (465 fungal OTUs and 237 bacterial ASVs) compared to the ISS (102 fungal OTUs and 102 bacterial ASVs). When dust from these locations were exposed to varying equilibrium relative humidity conditions (ERH), there were also significant fungal community composition changes as ERH and time elevated increased (Bray Curtis: R2 = 0.35, P = 0.001). These findings can inform future spacecraft design to promote healthy indoor microbiomes that support crew health, spacecraft integrity, and planetary protection.

Effects of CO2 in fungi

Carbon dioxide supplies carbon for photosynthetic species and is a major product of respiration for all life forms. Inside the human body where CO2 is a by-product of the tricarboxylic acid cycle, its level reaches 5% or higher. In the ambient atmosphere, ∼.04% of the air is CO2. Different organisms can tolerate different CO2 levels to various degrees, and experiencing higher CO2 is toxic and can lead to death. The fungal kingdom shows great variations in response to CO2 that has been documented by different researchers at different time periods. This literature review aims to connect these studies, highlight mechanisms underlying tolerance to high levels of CO2, and emphasize the effects of CO2 on fungal metabolism and morphogenesis.

HLA gene variations and mycotoxin toxicity: Four case reports

Mycotoxins are produced by certain molds that can cause many health effects. We present four human cases of prolonged consistent mycotoxins exposure linked to genetic variations in human leukocyte antigen (HLA) alleles. The HLA-DR/DQ isotype alleles are linked to mycotoxins susceptibility due to the lack of proper immune response; individuals with these alleles are poor eliminators of mycotoxins from their system. Four subjects with variations in their HLA-DR alleles were exposed to mycotoxins from living in mold-infested houses and experienced persistent mold-related symptoms long after moving out from the mold-infested houses and only exposed to the levels of molds found in the ambient air. From one of the subjects, two urine samples were collected ~ 18 months apart after the cessation of exposure. Urinary elimination rate was extremely slow for two of the mycotoxins (ochratoxin A [OTA] and mycophenolic acid [MPA]) detected in both samples. In 18 months, decline in OTA level was only ~ 3-fold (estimated t½ of ~ 311 days) and decline in MPA level was ~ 11-fold (estimated t½ of ~ 160 days), which was ~ 10- and ~ 213-fold slower than expected in individuals without HLA-DR alleles, respectively. We estimated that ~ 4.3 and ~ 2.2 years will be required for OTA and MPA to reach < LLQ in urine, respectively. Three other subjects with variations in HLA-DR alleles were members of a family who lived in a mold-infested house for 4 years. They kept experiencing mold-related issues >2 years after moving to a non-mold-infested house. Consistent exposure was confirmed by the presence of several mycotoxins in urine >2 years after the secession of higher than background (from outdoor ambient air) exposure. This was consistent with the extremely slow elimination of mycotoxins from their system. Variations in HLA-DR alleles can, consequently, make even short periods of exposure to chronic exposure scenarios with related adverse health effects. It is, therefore, important to determine genetic predisposition as a reason for prolonged/lingering mold-related symptoms long after the cessation of higher than background exposure. Increased human exposure to mycotoxins is expected from increased mold infestation that is anticipated due to rising CO2, temperature, and humidity from the climate change with possibly increased adverse health effects, especially in individuals with genetic susceptibility to mold toxicity.

Going over Fungal Allergy: Alternaria alternata and Its Allergens

Fungal allergy is the third most frequent cause of respiratory pathologies and the most related to a poor prognosis of asthma. The genera Alternaria and Cladosporium are the most frequently associated with allergic respiratory diseases, with Alternaria being the one with the highest prevalence of sensitization. Alternaria alternata is an outdoor fungus whose spores disseminate in warm and dry air, reaching peak levels in temperate summers. Alternaria can also be found in damp and insufficiently ventilated houses, causing what is known as sick building syndrome. Thus, exposure to fungal allergens can occur outdoors and indoors. However, not only spores but also fungal fragments contain detectable amounts of allergens and may function as aeroallergenic sources. Allergenic extracts of Alternaria hyphae and spores are still in use for the diagnosis and treatment of allergic diseases but are variable and insufficiently standardised, as they are often a random mixture of allergenic ingredients and casual impurities. Thus, diagnosis of fungal allergy has been difficult, and knowledge about new fungal allergens is stuck. The number of allergens described in Fungi remains almost constant while new allergens are being found in the Plantae and Animalia kingdoms. Given Alt a 1 is not the unique Alternaria allergen eliciting allergy symptoms, component-resolved diagnosis strategies should be applied to diagnose fungal allergy. To date, twelve A. alternata allergens are accepted in the WHO/IUIS Allergen Nomenclature Subcommittee, many of them are enzymes: Alt a 4 (disulfide isomerase), Alt a 6 (enolase), Alt a 8 (mannitol de-hydrogenase), Alt a 10 (aldehyde dehydrogenase), Alt a 13 (glutathione-S-transferase) and Alt a MnSOD (Mn superoxide dismutase), and others have structural and regulatory functions such as Alt a 5 and Alt a 12, Alt a 3, Alt a 7. The function of Alt a 1 and Alt a 9 remains unknown. Other four allergens are included in other medical databases (e.g., Allergome): Alt a NTF2, Alt a TCTP, and Alt a 70 kDa. Despite Alt a 1 being the A. alternata major allergen, other allergens, such as enolase, Alt a 6 or MnSOD, Alt a 14 have been suggested to be included in the diagnosis panel of fungal allergy.

Stress Response to Climate Change and Postharvest Handling in Two Differently Pigmented Lettuce Genotypes: Impact on Alternaria alternata Invasion and Mycotoxin Production

Many species of Alternaria are important pathogens that cause plant diseases and postharvest rots. They lead to significant economic losses in agriculture and affect human and animal health due to their capacity to produce mycotoxins. Therefore, it is necessary to study the factors that can result in an increase in A. alternata. In this study, we discuss the mechanism by which phenol content protects from A. alternata, since the red oak leaf cultivar (containing higher phenols) showed lower invasion than the green one, Batavia, and no mycotoxin production. A climate change scenario enhanced fungal growth in the most susceptible cultivar, green lettuce, likely because elevated temperature and CO₂ levels decrease plant N content, modifying the C/N ratio. Finally, while the abundance of the fungi was maintained at similar levels after keeping the lettuces for four days at 4 °C, this postharvest handling triggered TeA and TEN mycotoxin synthesis, but only in the green cultivar. Therefore, the results demonstrated that invasion and mycotoxin production are cultivar- and temperature-dependent. Further research should be directed to search for resistant cultivars and effective postharvest strategies to reduce the toxicological risk and economic losses related to this fungus, which are expected to increase in a climate change scenario.

Climate change, the environment, and rhinologic disease

BACKGROUND

The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases.

METHODS

Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed.

RESULTS

The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected.

CONCLUSIONS

We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs.

Divergent Trends in the Prevalence of Children's Asthma, Rhinitis and Atopic Dermatitis and Environmental Influences in the Urban Setting of Zagreb, Croatia

BACKGROUND

Previous studies have reported that the allergy epidemic in developed countries has reached its plateau, while a rise is expected in developing ones. Our aim was to compare the prevalence of allergic diseases among schoolchildren from the city of Zagreb, Croatia after sixteen years.

METHODS

Symptoms of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) and risk factors were assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. An allergic profile was determined by a skin prick test.

RESULTS

The prevalence of current, ever-in-a-lifetime and diagnosed AR of 35.7%, 42.5% and 14.9% and AD of 18.1%, 37.1% and 31.1% demonstrated a significant increase. The asthma prevalence has remained unchanged. The allergen sensitivity rate has remained similar, but pollens have become dominant. Mould and dog exposure are risks for asthma (OR 14.505, OR 2.033). Exposure to cat allergens is protective in AR (OR 0.277). Parental history of allergies is a risk factor in all conditions.

CONCLUSION

Over sixteen years, the prevalence of AR and AD, but not of asthma, have increased. The proportion of atopy has remained high. The AR/AD symptom rise is probably a consequence of increased pollen sensitisation united with high particulate matter concentrations. The stable asthma trend could be a result of decreasing exposures to indoor allergens.

Dry eye disease and risks of urban air pollution – literature review

Air pollution has a major impact on health, and it particularly affects the mucous membranes of the respiratory tract and the eyes. The ocular effects of chronic, long-term exposure to high levels of air pollution are still unclear. The increase in air pollution levels can be associated with an increase in the instability of the tear film. The aim of this paper is to evaluate and discuss the available data about chronic eye diseases in regions with high air pollution. Furthermore, the review also offers a certain understanding of the link between chronic dry eye disease (DED) and air pollution. Materials and methods: Specific keywords (dry eye, air pollution, and urban) were used to search the medical databases of PubMed and Medline. This research technique led to obtaining 103 papers, dating from 1995 to 2021. Out of those, 15 were used as the basis of this paper. Results: The pathophysiological mechanisms of oxidative stress and ocular surface inflammation involve the selective binding of environmental agents to ocular surface membrane receptors, leading to the activation of proinflammatory signaling pathways with changes in the extracellular stromal matrix and consequent occurrence of inflammation of the ocular surface with epithelial defects. Conclusions: Dry eye disease, pollution, and eye allergy overlap, but their presentations can be different. Future advancements in monitoring technology and the development of modern, non-invasive diagnostic methods will help prove the link between air pollutants and  DED. The points should be aimed at preventing the global risks of antigenic stimulation of "urban eye".

Fungal communities in soils under global change

Soil fungi play indispensable roles in all ecosystems including the recycling of organic matter and interactions with plants, both as symbionts and pathogens. Past observations and experimental manipulations indicate that projected global change effects, including the increase of CO₂ concentration, temperature, change of precipitation and nitrogen (N) deposition, affect fungal species and communities in soils. Although the observed effects depend on the size and duration of change and reflect local conditions, increased N deposition seems to have the most profound effect on fungal communities. The plant-mutualistic fungal guilds - ectomycorrhizal fungi and arbuscular mycorrhizal fungi - appear to be especially responsive to global change factors with N deposition and warming seemingly having the strongest adverse effects. While global change effects on fungal biodiversity seem to be limited, multiple studies demonstrate increases in abundance and dispersal of plant pathogenic fungi. Additionally, ecosystems weakened by global change-induced phenomena, such as drought, are more vulnerable to pathogen outbreaks. The shift from mutualistic fungi to plant pathogens is likely the largest potential threat for the future functioning of natural and managed ecosystems. However, our ability to predict global change effects on fungi is still insufficient and requires further experimental work and long-term observations. Citation: Baldrian P, Bell-Dereske L, Lepinay C, Větrovský T, Kohout P (2022). Fungal communities in soils under global change. Studies in Mycology 103: 1-24. doi: 10.3114/sim.2022.103.01.

Importance of allergen–environment interactions in epidemic thunderstorm asthma

Australia is home to one of the highest rates of allergic rhinitis worldwide. Commonly known as ‘hay fever’, this chronic condition affects up to 30% of the population and is characterised by sensitisation to pollen and fungal spores. Exposure to these aeroallergens has been strongly associated with causing allergic reactions and worsening asthma symptoms. Over the last few decades, incidences of respiratory admissions have risen due to the increased atmospheric concentration of airborne allergens. The fragmentation and dispersion of these allergens is aided by environmental factors like rainfall, temperature and interactions with atmospheric aerosols. Extreme weather parameters, which continue to become more frequent due to the impacts of climate change, have greatly fluctuated allergen concentrations and led to epidemic thunderstorm asthma (ETSA) events that have left hundreds, if not thousands, struggling to breathe. While a link exists between airborne allergens, weather and respiratory admissions, the underlying factors that influence these epidemics remain unknown. It is important we understand the potential threat these events pose on our susceptible populations and ensure our health infrastructure is prepared for the next epidemic.

Impact of Fungal Spores on Asthma Prevalence and Hospitalization

Despite making up a significant proportion of airborne allergens, the relationship between fungal spores and asthma is not fully explored. Only 80 taxa of fungi have so far been observed to exacerbate respiratory presentations, with Cladosporium spp., Aspergillus spp., Penicillium spp., and Alternaria spp. found to comprise the predominant allergenic airborne spores. Fungal spores have been found in indoor environments, such as hospitals and housing due to poor ventilation. Meanwhile, outdoor fungal spores exhibit greater diversity, and higher abundance and have been associated with hospitalizations from acute asthma presentations. In addition, fungal spores may be the underlying, and perhaps the “missing link”, factor influencing the heightened rate of asthma presentations during epidemic thunderstorm asthma events. To improve our knowledge gap on fungal spores, airborne allergen monitoring must be improved to include not only dominant allergenic fungi but also provide real-time data to accurately and quickly warn the general public. Such data will help prevent future asthma exacerbations and thus save lives. In this review, we examine the health risks of prominent allergenic fungal taxa, the factors influencing spore dispersal and distribution, and why improvements should be made to current sampling methods for public health and wellbeing.

Climate, Carbon Dioxide, and Plant-Based Aero-Allergens: A Deeper Botanical Perspective

There is global evidence of a general increase in the incidence and prevalence of respiratory diseases including allergic rhinitis and associated asthma. This increase in turn, has been related, in part, to concurrent increases in carbon dioxide (CO₂) and temperature on pollen production and allergic disease generated from plant-based sources of pollen. Such links to anthropogenic climate change has suggested three significant and interrelated consequences associated with respiratory allergies or disease. First, warmer temperatures and a longer frost-free growing season can influence pollen season length and temporal exposure to airborne aeroallergens. Second, both warmer temperatures and additional CO₂ can increase the amount of pollen, the seasonal intensity, from spring through fall. Thirdly, there is evidence from oak and ragweed that rising levels of CO₂ could increase the allergen concentration of the pollen and symptom severity. However, while these outcomes are of obvious consequence, they do not fully encompass all of the plant derived changes that could, directly or indirectly, influence aeroallergen production, exposure, and consequences for public health. In this overview, I will delve deeper into other plant-based links to climate/CO₂ that are consequential either directly or indirectly to allergic rhinitis and associated disease. Such interactions range from pollen morphology to fire occurrence, from volatile organic compounds to potential changes in pesticide usage. The goal in doing so is to provide a broader context and appreciation for the interactions between plant biology and climate that can also affect allergen production and human impact but which, to date, have received little recognition or research.

Current and future threats to human health in the Anthropocene

It has been widely recognised that the threats to human health from global environmental changes (GECs) are increasing in the Anthropocene epoch, and urgent actions are required to tackle these pressing challenges. A scoping review was conducted to provide an overview of the nine planetary boundaries and the threats to population health posed by human activities that are exceeding these boundaries in the Anthropocene. The research progress and key knowledge gaps were identified in this emerging field. Over the past three decades, there has been a great deal of research progress on health risks from climate change, land-use change and urbanisation, biodiversity loss and other GECs. However, several significant challenges remain, including the misperception of the relationship between human and nature; assessment of the compounding risks of GECs; strategies to reduce and prevent the potential health impacts of GECs; and uncertainties in fulfilling the commitments to the Paris Agreement. Confronting these challenges will require rigorous scientific research that is well-coordinated across different disciplines and various sectors. It is imperative for the international community to work together to develop informed policies to avert crises and ensure a safe and sustainable planet for the present and future generations.

[Outdoor aeroallergens and climate change]

INTRODUCTION

Pollen and fungal spore concentrations in outdoor air are partly dependent on atmospheric conditions. Since the climate is changing, there is a growing body of research on the effects of climate change on aeroallergens. The present article provides a rapid review of this literature, highlighting the points of agreement, but also drawing attention to the main mistakes to be avoided.

STATE OF ART

For pollen, the prevailing view is that rising temperatures lead to an earlier start to the pollen season, a longer season, increased allergenic potential and higher concentrations. However, there are exceptions: what is true for one taxon, in one place and at one time, can almost never be generalised. For fungal spores, it is even more difficult to state universal rules.

PERSPECTIVES

Four priorities can be set for future research: (1) to look for trends only on sufficiently long series and not to neglect possible trend reversals; (2) to give priority to the local scale and the separate consideration of the various pollen and mycological taxa; (3) not to limit oneself to temperature as an element of explanation, but also to consider the other elements of the climate; (4) not to try to explain any evolution in the abundance or seasonality of aeroallergens by climate change alone.

CONCLUSIONS

Many more analytical studies giving precedence to observation over reasoning are still required, without any preconceptions, before it is possible to synthesise the impacts of climate change on pollen and, even more so, on fungal spores.

Elevated carbon dioxide reduces a common soybean leaf endophyte

Free-air CO2 enrichment (FACE) experiments have elucidated how climate change affects plant physiology and production. However, we lack a predictive understanding of how climate change alters interactions between plants and endophytes, critical microbial mediators of plant physiology and ecology. We leveraged the SoyFACE facility to examine how elevated [CO2 ] affected soybean (Glycine max) leaf endophyte communities in the field. Endophyte community composition changed under elevated [CO2 ], including a decrease in the abundance of a common endophyte, Methylobacterium sp. Moreover, Methylobacterium abundance was negatively correlated with co-occurring fungal endophytes. We then assessed how Methylobacterium affected the growth of co-occurring endophytic fungi in vitro. Methylobacterium antagonized most co-occurring fungal endophytes in vitro, particularly when it was more established in culture before fungal introduction. Variation in fungal response to Methylobacterium within a single fungal operational taxonomic unit (OTU) was comparable to inter-OTU variation. Finally, fungi isolated from elevated vs. ambient [CO2 ] plots differed in colony growth and response to Methylobacterium, suggesting that increasing [CO2 ] may affect fungal traits and interactions within the microbiome. By combining in situ and in vitro studies, we show that elevated [CO2 ] decreases the abundance of a common bacterial endophyte that interacts strongly with co-occurring fungal endophytes. We suggest that endophyte responses to global climate change will have important but largely unexplored implications for both agricultural and natural systems.

The Clinical Relevance of Pollen Versus Fungal Spores in Allergic Diseases

Pollen and fungal spores are associated with seasonal and perennial allergies. However, most scientific literature thus far suggests that pollen allergy is more clinically relevant than fungal allergy. Several environmental and biological factors and the difficulty in producing reliable fungal extracts account for this. Biodiversity, taxonomy, and meteorology are responsible for the types and levels of pollen and fungal spores, their fragments, and the presence of free airborne allergens. Therefore, it is difficult to accurately measure both pollen and fungal allergen exposure. In addition, understanding the enzymatic nature of fungal and some pollen allergens, the presence of allergenic and nonallergenic substances that may modulate the allergic immune response, and allergen cross-reactivity are all necessary to appropriately evaluate both sensitivity and exposure. The raw materials and manufacturing processes used to prepare pollen versus fungal extracts differ, further increasing the complexity to properly determine allergic sensitivity and degrees of exposure. The pollen extracts used for diagnosis and treatment are relatively consistent, and some have been standardized. However, obtaining clinically relevant fungal extracts is more difficult. Doing so will allow for the proper selection of such extracts to more appropriately diagnose and treat both pollen- and fungal-induced allergic diseases.

Update on Climate Change: Its Impact on Respiratory Health at Work, Home, and at Play

Climate change is a crisis of vast proportions that has serious implications for pulmonary health. Increasing global temperatures influence respiratory health through extreme weather events, wildfires, prolonged allergy seasons, and worsening air pollution. Children, elderly patients, and patients with underlying lung disease are at elevated risk of complications from these effects of climate change. This paper summarizes the myriad ways in which climate change affects the respiratory health of patients at home and in outdoor environments and outlines measures for patients to protect themselves.

Diversity, Concentration and Dynamics of Culturable Fungal Bioaerosols at Doha, Qatar

This research was conducted to investigate the dynamics of airborne fungi using viable culture collection and in respect to different abiotic variables, including seasonal and intra-diurnal variations. A gravimetric method was used to sample airborne fungal deposition on potato dextrose agar plates on alternate days, for a year between April 2015 to March 2016. From 176 settle plate exposures, a total of 1197 mould and 283 yeast colony-forming units (CFU), 21 genera and 62 species were retrieved. The highest fungal spore count was recorded in February 2016, whereas the lowest count occurred in August 2015. The main constituents of the fungal airspora were attributed to Cladosporium (60.2%), Aspergillus (10.4%), Fusarium (9.4%), Alternaria (8.5%), and Ganoderma spp. (2.3%). Temperature was negatively correlated with total colony count (r = −0.231, p ≤ 0.05) or species richness (r = −0.267, p ≤ 0.001), while wind speed was positively correlated with total colony count (r = 0.484, p ≤ 0.001) or species richness (r = 0.257, p ≤ −0.001). The highest dispersal of fungal spores was obtained at 18:00, whereas the lowest fungal spores release was recorded at 00:00 (midnight). There were no significant differences in species composition and richness of the airborne fungal population between two study sites, the Industrial area and Qatar University Campus. The count of Alternaria spp. and Fusarium spp. were significantly higher at the Industrial area site, which corresponds to a higher CO₂ level than the Qatar University site. This study lays the foundation for future work to assess the implications of such aeromycological data on public health.

Allergenic Pollen Season Variations in the Past Two Decades Under Changing Climate in the United States

Prevalence of allergic diseases has been increasing due to multiple factors, among which climate change has had the most impact. Climate factors increase production of pollen, which also exhibits increased allergenicity. Also, as a result of climate change, there has been a shift in flowering phenology and pollen initiation causing prolonged pollen exposure. Various numerical models have been developed to understand the effect of climate change on pollen emission and transport and the impact on allergic airway diseases.

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.

Alternaria Leaf Spot Caused by Alternaria Species: An Emerging Problem on Ornamental Plants in Italy

Serious outbreaks of Alternaria leaf spot and plant decay have recently been recorded on several ornamental plants in the Biella Province (Northern Italy). Twenty-two fungal isolates were obtained from Alternaria infected plant tissues from 13 ornamental hosts. All the isolates were identified morphologically as small-spored Alternaria species. Multilocus sequence typing, carried out by means of ITS, rpb2, tef1, endoPG, Alt a 1, and OPA10-2, assigned 19 isolates as Alternaria alternata, two isolates as belonging to the Alternaria arborescens species complex, and one isolate as an unknown Alternaria sp. Haplotype analyses of ornamental and reference A. alternata isolates from 12 countries identified 14 OPA10-2 and 11 endoPG haplotypes showing a relatively high haplotype diversity. A lack of host specialization or geographic distribution was observed. The host range of the studied A. alternata isolates expanded in cross-pathogenicity assays, and more aggressiveness was frequently observed on the experimental plants than on the host plants from which the fungal isolates were originally isolated. High disease severity, population expansion, intraspecies diversity, and increased range of experimental hosts were seen in the emergence of Alternaria disease on ornamentals. More epidemiological and molecular studies should be performed to better understand these diseases, taking into consideration factors such as seed transmission and ongoing climate changes.

The Clinical Utility of Pollen Counts

In this review, we describe how pollen counts are performed, the health effects caused by exposure to varying amounts of pollen, the clinical utility of reporting pollen counts to the public, and how that information can be used by patients who have allergies to improve their health. The public is very interested in pollen counts, particularly if the counts provide a forecast of expected pollen exposure for the next few days. Traditional pollen counts are labor-intensive; poorly distributed; and, since the counts are usually 1-day-old, do not provide forecasts that can be acted on. New methods that provide short- and long-term pollen forecasts can provide this information to allergic individuals so that they can respond to changing outdoor conditions. Studies of the relationship between artificial and natural exposure to pollen and development of symptoms have provided improved understanding into how much pollen it takes to cause symptoms. Thresholds for pollen counts that trigger symptoms vary by pollen type, sensitivity of the population, and interactions with other atmospheric exposures. Strategies to inform the public when the pollen count poses a health risk have been proposed along with computerized systems that provide personalized pollen alerts. The best performing public notification system was a "traffic light system" that reported pollen exposure as low, 0-30; intermediate, 31-50; or high, 51-150. This system outperformed other threshold systems used in Sweden and in Britain/Denmark. Continued improvements in pollen forecasting models combined with data provided by automated pollen counters and better public reporting should permit allergic individuals and urban planners to adapt effectively to changes in outdoor aeroallergen exposures.

Environment and Host-Genetic Determinants in Early Development of Allergic Asthma: Contribution of Fungi

Asthma is a chronic debilitating airway disease affecting millions of people worldwide. Although largely thought to be a disease of the first world, it is now clear that it is on the rise in many middle- and lower-income countries. The disease is complex, and its etiology is poorly understood, which explains failure of most treatment strategies. We know that in children, asthma is closely linked to poor lung function in the first 3-years of life, when the lung is still undergoing post-natal alveolarization phase. Epidemiological studies also suggest that environmental factors around that age do play a critical part in the establishment of early wheezing which persists until adulthood. Some of the factors that contribute to early development of asthma in children in Western world are clear, however, in low- to middle-income countries this is likely to differ significantly. The contribution of fungal species in the development of allergic diseases is known in adults and in experimental models. However, it is unclear whether early exposure during perinatal or post-natal lung development influences a protective or promotes allergic asthma. Host immune cells and responses will play a crucial part in early development of allergic asthma. How immune cells and their receptors may recognize fungi and promote allergic asthma or protect by tolerance among other immune mechanisms is not fully understood in this early lung development stage. The aim of this review is to discuss what fungal species are present during early exposure as well as their contribution to the development of allergic responses. We also discuss how the host has evolved to promote tolerance to limit hyper-responsiveness to innocuous fungi, and how host evasion by fungi during early development consequentially results in allergic diseases.

Molecular study of hypersensitivity to spores in adults and children from Castile & Leon

INTRODUCTION AND OBJECTIVES

Biological aerosols play a vital role in the interactions between the atmosphere, biosphere, climate and public health and fungal spores are a component with allergic importance. We constructed a database in Castile & Leon (Spain) and carry out molecular-level component-resolved diagnosis to complete the air quality study carried out since 2006 by our aerobiological network (RACYL) to aid clinical diagnosis and treatment.

METHODS

We reviewed a database of 19,774 patients (adults and children) with allergic respiratory disease treated in our unit during the last 12 years. We also made a component-resolved diagnosis of the molecules involved in the pathology in a randomly selected population of 150 patients.

RESULTS

The dimeric glycoprotein Alt a1 from Alternaria is the most prevalent and most useful allergen in the diagnosis of patients with allergy to fungi in our area (94.4%), followed by enolase Alt a 6 (Alternaria), ribonuclease Asp f 1 of Aspergillus and mannitol dehydrogenase from Cla h 8 (Cladosporium).

CONCLUSIONS

Our results have helped determine which spore molecules are most-closely associated with allergies. Molecular analysis will be useful to determine more accurate and useful immunotherapy in these patients.

Temporal variability in the allergenicity of airborne Alternaria spores

The concentration of fungal spores in the air is traditionally considered as a proxy of allergen exposure. However, in vitro experiments have shown that the allergenicity of Alternaria spores varies depending on ecophysiological and developmental factors. Despite the potential clinical significance of these findings, it has never been verified in outdoor environments. This study, therefore, aims to investigate variability in the amount of the major allergen (Alt a 1) released from Alternaria spores in outdoor air. During the 3-year monitoring study (2014-2016), the median seasonal allergenicity of Alternaria spores exceeded 8.6 × 10-3 pg Alt a 1/spore. The most allergenic spores were collected during the driest and the most polluted season (with respect to seasonal concentrations of ozone, sulphur dioxide, and particulate matter). Within the season, daily spore allergenicity ranged from 2.4 to 34.7 × 10-3 pg Alt a 1/spore (5th-95th percentile). No repeatable effects of weather and pollution on short-term variations in Alternaria spore allergenicity were found. However, during the episodes when high-potency spores were recorded, the air masses arrived from eastern directions. Contrary, the spores with the lowest allergenicity were related to western winds. This suggests that factors such as source area (habitat types) and species diversity could be responsible for the varying exposure to Alternaria allergens. Our findings show that high and low-potency spores are recorded in the air; therefore, the airborne concentrations of fungal spores alone may not be sufficient to provide allergy sufferers and healthcare professionals with information about allergen exposure.

Climate Change, Carbon Dioxide, and Pest Biology, Managing the Future: Coffee as a Case Study

The challenge of maintaining sufficient food, feed, fiber, and forests, for a projected end of century population of between 9–10 billion in the context of a climate averaging 2–4 °C warmer, is a global imperative. However, climate change is likely to alter the geographic ranges and impacts for a variety of insect pests, plant pathogens, and weeds, and the consequences for managed systems, particularly agriculture, remain uncertain. That uncertainty is related, in part, to whether pest management practices (e.g., biological, chemical, cultural, etc.) can adapt to climate/CO2 induced changes in pest biology to minimize potential loss. The ongoing and projected changes in CO2, environment, managed plant systems, and pest interactions, necessitates an assessment of current management practices and, if warranted, development of viable alternative strategies to counter damage from invasive alien species and evolving native pest populations. We provide an overview of the interactions regarding pest biology and climate/CO2; assess these interactions currently using coffee as a case study; identify the potential vulnerabilities regarding future pest impacts; and discuss possible adaptive strategies, including early detection and rapid response via EDDMapS (Early Detection & Distribution Mapping System), and integrated pest management (IPM), as adaptive means to improve monitoring pest movements and minimizing biotic losses while improving the efficacy of pest control.

Innate and adaptive immune responses to fungi in the airway

Fungi are ubiquitous outdoors and indoors. Exposure, sensitization, or both to fungi are strongly associated with development of asthma and allergic airway diseases. Furthermore, global climate change will likely increase the prevalence of fungi and enhance their antigenicity. Major progress has been made during the past several years regarding our understanding of antifungal immunity. Fungi contain cell-wall molecules, such as β-glucan and chitin, and secrete biologically active proteases and glycosidases. Airway epithelial cells and innate immune cells, such as dendritic cells, are equipped with cell-surface molecules that react to these fungal products, resulting in production of cytokines and proinflammatory mediators. As a result, the adaptive arm of antifungal immunity, including TH1-, TH2-, and TH17-type CD4+ T cells, is established, reinforcing protection against fungal infection and causing detrimental immunopathology in certain subjects. We are only in the beginning stages of understanding the complex biology of fungi and detailed mechanisms of how they activate the immune response that can protect against or drive diseases in human subjects. Here we describe our current understanding with an emphasis on airway allergic immune responses. The gaps in our knowledge and desirable future directions are also discussed.

Gene expression of indoor fungal communities under damp building conditions: Implications for human health

Dampness and visible mold growth in homes are associated with negative human health outcomes, but causal relationships between fungal exposure and health are not well established. The purpose of this study was to determine whether dampness in buildings impacts fungal community gene expression and how, in turn, gene expression may modulate human health impacts. A metatranscriptomic study was performed on house dust fungal communities to investigate the expression of genes and metabolic processes in chamber experiments at water activity levels of 0.5, 0.85, and 1.0. Fungi at water activities as low as 0.5 were metabolically active, focusing their transcriptional resources on primary processes essential for cell maintenance. Metabolic complexity increased with water activity where communities at 1.0 displayed more diverse secondary metabolic processes. Greater gene expression at increasing water activity has important implications for human health: Fungal communities at 1.0 a_w upregulated a greater number of allergen-, mycotoxin-, and pathogenicity-encoding genes versus communities at 0.85 and 0.5 a_w . In damp buildings, fungi may display increases in secondary metabolic processes with the potential for greater per-cell production of allergens, toxins, and pathogenicity. Assessments in wet versus dry buildings that do not account for this elevated health impact may not accurately reflect exposure.

Eosinophils in fungal diseases: An overview

Eosinophils are the prominent cells in asthma, allergic bronchopulmonary mycosis (ABPMs), and fungal-sensitization-associated asthma, but their roles in the immunopathology of these disorders are not well understood. Moreover, the immunological mechanisms underlying the molecular direct effector interactions between fungi and eosinophils are rare and not fully known. Here, we provide an overview of eosinophil contributions to allergic asthma and ABPMs. We also revise the major general mechanisms of fungal recognition by eosinophils and consider past and recent advances in our understanding of the molecular mechanisms associated with eosinophil innate effector responses to different fungal species relevant to ABPMs (Alternaria alternata, Candida albicans, and Aspergillus fumigatus). We further examine and speculate about the therapeutic relevance of these findings in fungus-associated allergic pulmonary diseases.

[Outdoor moulds and respiratory health]

Mould spores constitute the largest portion of biologic particulate matter suspended in the outdoor atmosphere. There is no universal method for collecting airborne mould spores. The most used sampler, Hirst's apparatus, operates continuously and gives results in individual spores per cubic metre of air. Spore concentrations depend on available substrates, human activities such as agriculture, season, diurnal meteorological variations and climate changes. Under natural conditions, concentrations of over 100,000 spores per cubic metre are not exceptional. Cladosporium is the most commonly identified outdoor mould. The association between respiratory health and outdoor mould spore exposure has been assessed in clinical studies, and also by cross-sectional, and less often longitudinal, epidemiological studies. The relationship between asthma exacerbations and specific mould spores has been demonstrated in longitudinal studies. Cross sectional studies have related measurements of mould spore concentrations to severity of bronchial symptoms, drug consumption and peak-flow measurements in groups of asthmatic subjects. Ecological time-series studies use daily indicators of asthma exacerbations (emergency room visits, hospitalizations) within the general population. The moulds mainly incriminated are Cladosporium and Alternaria. They are associated with seasonal, but also perennial, asthma and rhinitis. Further studies are needed to better assess the impact of outdoor moulds on health, particularly basidiomycetes. Studies with molecular biology tools are probably a way forward.

Airway epithelial anion secretion and barrier function following exposure to fungal aeroallergens: role of oxidative stress

Aeroallergens produced by Alternaria alternata can elicit life-threatening exacerbations of asthma in patients sensitized to this fungus. In this study, the effect of Alternaria on ion transport mechanisms underlying mucociliary clearance and airway epithelial barrier function was investigated in human airway epithelial cells. Apical exposure to Alternaria induced an increase in anion secretion that was inhibited by blockers of CFTR and Ca²⁺-activated Cl^- channels. Stimulation of anion secretion was dependent on Ca²⁺ uptake from the apical solution. Alternaria exposure also produced an increase in reactive oxygen species (ROS) that was blocked by pretreatment with the oxidant scavenger glutathione (GSH). GSH and the NADPH oxidase inhibitor/complex 1 electron transport inhibitor diphenylene iodonium chloride (DPI) blocked ATP release and the increase in intracellular [Ca²⁺] evoked by AlternariaAlternaria also decreased transepithelial resistance, and a portion of this effect was dependent on the increase in ROS. However, the Alternaria-induced increase in unidirectional dextran (molecular mass = 4,000 Da) flux across the epithelium could not be accounted for by increased oxidative stress. These results support the conclusion that oxidative stress induced by Alternaria was responsible for regulating Ca²⁺-dependent anion secretion and tight junction electrical resistance that would be expected to affect mucociliary clearance.

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.

Allergic conjunctivitis in Asia

Allergic conjunctivitis (AC), which may be acute or chronic, is associated with rhinitis in 30%-70% of affected individuals, hence the term allergic rhinoconjunctivitis (AR/C). Seasonal and perennial AC is generally milder than the more chronic and persistent atopic and vernal keratoconjunctivitis. Natural allergens like house dust mites (HDM), temperate and subtropical grass and tree pollen are important triggers that drive allergic inflammation in AC in the Asia-Pacific region. Climate change, environmental tobacco smoke, pollutants derived from fuel combustion, Asian dust storms originating from central/north Asia and phthalates may also exacerbate AR/C. The Allergies in Asia Pacific study and International Study of Asthma and Allergies in Childhood provide epidemiological data on regional differences in AR/C within the region. AC significantly impacts the quality of life of both children and adults, and these can be measured by validated quality of life questionnaires on AR/C. Management guidelines for AC involve a stepped approach depending on the severity of disease, similar to that for allergic rhinitis and asthma. Topical calcineurin inhibitors are effective in certain types of persistent AC, and sublingual immunotherapy is emerging as an effective treatment option in AR/C to grass pollen and HDM. Translational research predominantly from Japan and Korea involving animal models are important for the potential development of targeted pharmacotherapies for AC.

Effect of different temperatures and CO2 levels on Alternaria toxins produced on cultivated rocket, cabbage and cauliflower

Over the last 100 years, the global mean temperature has increased and has influenced several key factors that affect the occurrence and severity of fungal diseases. The effect of an increase in CO2 concentration and temperature on disease caused by four Alternaria strains and their mycotoxin production on cultivated rocket, cabbage and cauliflower plants has been investigated in this study. Six different temperature and CO2 combinations were considered: (1) 400-450 ppm CO2, 14-18 °C; (2) 800-850 ppm CO2, 14-18 °C; (3) 400-450 ppm CO2, 18-22 °C; (4) 800-850 ppm CO2, 18-22 °C; (5) 400-450 ppm CO2, 22-26 °C; and (6) 800-850 ppm CO2, 22-26 °C. Higher levels of CO2 and temperature have been found to significantly influence the disease index of the infected plants. In fact, the disease index was significantly increased at 22-26 °C and 800-850 ppm of CO2 for all of the host plants. Tenuazonic acid (TeA), alternariol, alternariol monomethyl ether and tentoxin were analysed for each climate condition using HPLC-MS/MS, and disease severity was evaluated. Higher temperature influences environmental conditions and different factors involved in plant-pathogen interaction. Temperature was the main factor involved in disease severity, while host plants and strains were found to be the factors that had the most influence on the variation of the production of mycotoxins. A large variability in the production of mycotoxins among the different host plants was observed, but TeA was always the most frequently produced mycotoxin.

Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy

Alternaria alternata spores are considered a well-known biological contaminant and a very common potent aeroallergen source that is found in environmental samples. The most intense exposure to A. alternata allergens is likely to occur outdoors; however, Alternaria and other allergenic fungi can colonize in indoor environments and thereby increase the fungal aeroallergen exposure levels. A consequence of human exposure to fungal aeroallergens, sensitization to A. alternata, has been unequivocally associated with increased asthma severity. Among allergenic proteins described in this fungal specie, the major allergen, Alt a 1, has been reported as the main elicitor of airborne allergies in patients affected by a mold allergy and considered a marker of primary sensitization to A. alternata. Moreover, A. alternata sensitization seems to be a triggering factor in the development of poly-sensitization, most likely because of the capability of A. alternata to produce, in addition to Alt a 1, a broad and complex array of cross-reactive allergens that present homologs in several other allergenic sources. The study and understanding of A. alternata allergen information may be the key to explaining why sensitization to A. alternata is a risk factor for asthma and also why the severity of asthma is associated to this mold. Compared to other common environmental allergenic sources, such as pollens and dust mites, fungi are reported to be neglected and underestimated. The rise of the A. alternata allergy has enabled more research into the role of this fungal specie and its allergenic components in the induction of IgE-mediated respiratory diseases. Indeed, recent research on the identification and characterization of A. alternata allergens has allowed for the consideration of new perspectives in the categorization of allergenic molds, assessment of exposure and diagnosis of fungi-induced allergies.

Fungi in a changing world: growth rates will be elevated, but spore production may decrease in future climates

Very little is known about the impact of climate change on fungi and especially on spore production. Fungal spores can be allergenic, thus being important for human health. The aim of this study was to investigate how climate change influences the responsive ability of fungi by simulating differing environmental regimes. Fungal species with high spore allergenic potential and atmospheric abundance were grown and experimentally examined under a variety of temperatures and different nutrient availability. Each represented the average decadal air temperature of the 1980s, 1990s and 2000s in the UK, along with an Intergovernmental Panel on Climate Change (IPCC) climate change scenario for 2100. All tests were run on six fungal species: Alternaria alternata, Aspergillus niger, Botrytis cinerea, Cladosporium cladosporioides, Cladosporium oxysporum and Epicoccum purpurascens. Mycelium growth rate and spore production were examined on each single species and competitive capacity among species combinations in pairs. All fungal species grew faster at higher temperatures, and this was more pronounced for the temperature projection in 2100. Most species grew faster when there was lower nutrient availability. Exceptions were the species with the highest growth rate (E. purpurascens) and with the highest competition capacity (A. alternata). Most species (except for E. purpurascens) produced more spores in the richer nutrient medium but fewer as temperature increased. C. cladosporioides was an exception, exponentially increasing its spore production in the temperature of the 2100 scenario. Regarding competitive capacity, no species displayed any significant alterations within the environmental range checked. It is suggested that in future climates, fungi will display dramatic growth responses, with faster mycelium growth and lower spore production, with questions risen on relevant allergen potential.

Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population.

Increased concentrations of greenhouse gases, and especially carbon dioxide (CO₂), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.

This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.

Allergenic pollen season variations in the past two decades under changing climate in the United States

Many diseases are linked with climate trends and variations. In particular, climate change is expected to alter the spatiotemporal dynamics of allergenic airborne pollen and potentially increase occurrence of allergic airway disease. Understanding the spatiotemporal patterns of changes in pollen season timing and levels is thus important in assessing climate impacts on aerobiology and allergy caused by allergenic airborne pollen. Here, we describe the spatiotemporal patterns of changes in the seasonal timing and levels of allergenic airborne pollen for multiple taxa in different climate regions at a continental scale. The allergenic pollen seasons of representative trees, weeds and grass during the past decade (2001-2010) across the contiguous United States have been observed to start 3.0 [95% Confidence Interval (CI), 1.1-4.9] days earlier on average than in the 1990s (1994-2000). The average peak value and annual total of daily counted airborne pollen have increased by 42.4% (95% CI, 21.9-62.9%) and 46.0% (95% CI, 21.5-70.5%), respectively. Changes of pollen season timing and airborne levels depend on latitude, and are associated with changes of growing degree days, frost free days, and precipitation. These changes are likely due to recent climate change and particularly the enhanced warming and precipitation at higher latitudes in the contiguous United States.