EAACI guidelines on environmental science for allergy and asthma: The impact of short-term exposure to outdoor air pollutants on asthma-related outcomes and recommendations for mitigation measures.

The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

Contemporary Concise Review 2023: Environmental and occupational lung diseases.

Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.

Pollution evaluation and health risk assessment of airborne toxic metals in both indoors and outdoors of the Pearl River Delta, China.

BACKGROUND: Industries deveploped cities in the Pearl River Delta (PRD) are suffering serious atmospheric metals pollution, in which, people's health risks after inhaling particulate matter (PM) with airborne toxic metals might be rising. This study provides the latest and comprehensive pollution profiles of toxic metals both from indoors and outdoors in PRD. METHOD: Total 22 pairs of indoor and outdoor total suspended particulates (TSP), PM10 and PM2.5 samples in residential area were synchronously sampled and investigated in detail within 9 main cities of the PRD, China. The concentrations of the Zn, Pb, Mn, Ni, As, V, Sb and Cd in the samples were measured by inductively coupled plasma mass spectrometry (ICP-MS). Health risk assessment via inhalation of residents was estimated by EPA recommended model with exposure parameters of Chinese population indoor and outdoor activity pattern. RESULTS: The trends followed as Zn > Pb ≈ Mn > Ni > As > V > Sb ≈ Cd for both indoors and outdoors. Investigated metals were found to be dominantly distributed in PM2.5 for both indoors and outdoors. The concentrations of outdoor PM and the most of metals were significantly higher than those of indoors. The results concluded that toxic metals might be from regional emission, such as Pb from ceramic factory, Ni from motor factory and V from oil combustion of ship. In health risk assessments, LCR is higher than 1.00E-06 for adults, while contrary to children in the PRD. Among four carcinogenic metals, LCR of As and Cd are higher than 1.00E-06 in some cities. In addition, HI below one for both adults and children in the PRD. CONCLUSIONS: Outdoor metals concentrations are related to local industry types, while indoor metals are mainly from outdoor. Health risk assessments indicated that adults suffered unsafe cancer risk from metals, especially As and Cd in some cities, while both adults and children did not suffer non-carcinogenic risks.

Self-reported history of stroke and long-term living conditions near air pollution sources: results of a national epidemiological study in Lebanon.

Stroke is a disease related to high mortality and morbidity, particularly in developing countries. Some studies have linked self-reported indoor and outdoor pollution to stroke and mini-stroke, while some others showed no association. Our objective was to assess this association in Lebanon, a Middle Eastern developing country. A national cross-sectional study was conducted all over Lebanon. In addition to self-reported items of pollution exposure, we assessed potential predictors of stroke and mini-stroke, including sociodemographic characteristics, self-reported health information, and biological measurements. Moreover, we assessed dose-effect relationship of pollution items in relation with stroke. Self-reported indoor pollution exposure was associated with stroke and mini-stroke, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease, but this effect did not reach statistical significance after adjustment for sociodemographics and biological characteristics. No association was found for any outdoor pollution item. Although additional studies would be necessary to confirm these findings, sensitizing the population about the effect of pollution on chronic diseases, working on reducing pollution, and improving air quality should be implemented to decrease the burden of the disease on the population and health system.

Children's food allergy: Effects of environmental influences and antibiotic use across critical developmental windows.

BACKGROUND: Increasing studies linked outdoor air pollution (OAP), indoor environmental factors (IEFs), and antibiotics use (AU) with the first wave of allergies (i.e., asthma, allergic rhinitis, and eczema), yet the role of their exposures on children's second wave of allergy (i.e., food allergy) are unknown. OBJECTIVES: To investigate the association between exposure to OAP and IEFs and childhood doctor-diagnosed food allergy (DFA) during the pre-pregnancy, prenatal, early postnatal, and current periods, and to further explore the effect of OAP and IEFs on DFA in children co-exposed to antibiotics. METHODS: A retrospective cohort study involving 8689 preschoolers was carried out in Changsha, China. Data on the health outcomes, antibiotic use, and home environment of each child were collected through a questionnaire. Temperature and air pollutants data were obtained from 8 and 10 monitoring stations in Changsha, respectively. Exposure levels to temperature and air pollutants at individual home addresses were calculated by the inverse distance weighted (IDW) method. Multiple logistic regression models were employed to assess the associations of childhood DFA with exposure to OAP, IEF, and AU. RESULTS: Childhood ever doctor-diagnosed food allergy (DFA) was linked to postnatal PM10 exposure with OR (95% CI) of 1.18 (1.03-1.36), especially for CO and O3 exposure during the first year with ORs (95% CI) = 1.08 (1.00-1.16) and 1.07 (1.00-1.14), as well as SO2 exposure during the previous year with OR (95% CI) of 1.13 (1.02-1.25). The role of postnatal air pollution is more important for the risk of egg, milk and other food allergies. Renovation-related IAP (new furniture) and dampness-related indoor allergens exposures throughout all time windows significantly increased the risk of childhood DFA, with ORs ranging from 1.23 (1.03-1.46) to 1.54 (1.29-1.83). Furthermore, smoke-related IAP (environmental tobacco smoke [ETS], parental and grandparental smoking) exposure during pregnancy, first year, and previous year was related to DFA. Additionally, exposure to pet-related indoor allergens (cats) during first year and total plant-related allergens (particularly nonflowering plants) during previous year were associated with DFA. Moreover, exposure to plant-related allergy during first and previous year was specifically associated with milk allergy, while keeping cats during first year increased the risk of fruits/vegetables allergy. Life-time and early-life AU was associated with the increased risk of childhood DFA with ORs (95% CI) = 1.57 (1.32-1.87) and 1.46 (1.27-1.67), including different types food allergies except fruit/vegetable allergy. CONCLUSIONS: Postnatal OAP, life-time and early-life IEFs and AU exposure played a vital role in the development of DFA, supporting the "fetal origin of childhood FA" hypothesis.

Cellular mechanisms linking to outdoor and indoor air pollution damage during pregnancy.

Pregnancies are a critical window period for environmental influences over the mother and the offspring. There is a growing body of evidence associating indoor and outdoor air pollution exposure to adverse pregnancy outcomes such as preterm birth and hypertensive disorders of pregnancy. Particulate matter (PM) could trigger oxi-inflammation and could also reach the placenta leading to placental damage with fetal consequences. The combination of strategies such as risk assessment, advise about risks of environmental exposures to pregnant women, together with nutritional strategies and digital solutions to monitor air quality can be effective in mitigating the effects of air pollution during pregnancy.

Health impact assessment of Delhi's outdoor workers exposed to air pollution and extreme weather events: an integrated epidemiology approach.

This study is an assessment of the effects of outdoor air pollution and extreme weather events on the health of outdoor workers in Delhi, including auto rickshaw drivers, street vendors, and sweepers. To carry it out, a cross-sectional and perception-based epidemiological research design was used, and the primary tool used for data collection was a questionnaire. Two hundred twenty-eight people participated in the survey, and a pulmonary function test (PFT) was performed on 63 participants. Most of the respondents from different occupational groups complained about headaches/giddiness, nausea, and muscular cramps during extreme heat events due to the physically demanding nature of their jobs in the outdoor environment. Furthermore, autorickshaw drivers reported the highest prevalence of ophthalmic symptoms, such as eye redness (44%) and eye irritation (36%). In comparison, vendors reported a higher prevalence of headaches (43%) and eye redness (40%) due to increased exposure to vehicular emissions. Among sweepers, musculoskeletal problems like joint pain (40%), backache (38%), and shoulder pain (35%) were most prevalent due to occupation-related ergonomic factors. In addition, the majority of autorickshaw drivers (47%), vendors (47%), and sweepers (48%) considered that air quality had a severe impact on their health. PFT results showed that most respondents had restricted lung function. Binary logistic regression analysis showed that lung function impairment had a significant association with smoking (p = 0.023) and age (0.019). The odds ratio for smoking, which was around 4, indicated that respondents who smoked had a nearly four times greater risk of developing lung impairment. The study also highlighted the need for using personal protective equipment and developing guidelines to reduce their exposure level.

Allergic rhinitis aggravated by air pollutants in Latin America: A systematic review.

The aim of this systematic review (SR) was to evaluate the most frequent pollutants and their effect on allergic rhinitis in Latin American countries. Observational studies up to December 2020 and comparing different indoor and outdoor pollutants that had allergic rhinitis (AR) as an outcome were included in the systematic review. Random-effect meta-analyses were conducted for the presence of allergic rhinitis. Estimates were presented as pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs). Twenty-two publications comprised this review according to the inclusion and exclusion criteria and 12 had data that could be analyzed statistically. The most frequent pollutant was PM10, followed by NO2 /O3 and PM2.5 in studies conducted in Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, and Peru. The OR of an exposed subject experiencing allergic rhinitis was 1.43 (95% CI 1.026; 1.980). The OR of children and adolescents experiencing of allergic rhinitis was 1.359 (95% CI 1.051; 1.759). Asymmetry and great variability in the effect estimated from the selected studies were observed. The publication bias was quantified by Kendall's correlation and Egger's test resulted in 0.152 (p-value = 0.493). Egger's test provided an intercept equal to 2.511 and a p-value = 0.398. The I2 statistic was 89.3% and reinforces the hypothesis of heterogeneity. This first systematic review conducted in Latin America confirmed the chance of a person exposed to pollutants and experiencing allergic rhinitis is 43% greater than that of a non-exposed person, reinforcing the importance of policies to reduce pollutant exposure and the use of protection systems for workforces exposed to occupational pollutants in work environments.

What is the impact of outdoor pollution on children's asthma?

Outdoor pollution is a complex mix of more than 200 air contaminants. Among these pollutants, ozone, nitrogen dioxide and fine particles may generate bronchial inflammation and hyperreactivity. The hypothesis that pollution contributes to the development of asthma in children is based on epidemiological, clinical and experimental data. Many risk factors during the in utero and postnatal period have been identified in the aetiology of childhood asthma. During pregnancy, outdoor pollution was identified as a causal factor of respiratory disease in neonatal cohort studies. Several epidemiological studies also demonstrate that outdoor pollution is a trigger of asthma exacerbations. This review aims to highlight the current knowledge on outdoor pollution and asthma.

Chlorinated paraffins in the indoor and outdoor atmospheric particles from the Pearl River Delta: Characteristics, sources, and human exposure risks.

Chlorinated paraffins (CPs) are ubiquitously present in the environment due to their abundant production and consumption. Information on CPs as part of indoor particles is very limited although a significant amount of time is spent in indoor environments. Seventy-two indoor and 66 outdoor TSP/PM10/PM2.5 samples (particulate matters with aerodynamic diameter <100, 10, and 2.5µm) from 24 homes of the Pearl River Delta (PRD), China, were analyzed for CPs. PM2.5 were found to be the dominant particles both indoors and outdoors. CPs were mainly distributed in PM2.5 that accounted for 89.1% and 93.0% of the total particles indoors and outdoors, respectively. The geometric mean (GM) concentrations of medium-chain CPs (MCCPs) exceeded those of short-chain CPs (SCCPs) (22.0 vs. 9.2ng/m3) in all particle samples. Both SCCPs and MCCPs in the indoor particles (GM: 13.4 and 30.9ng/m3) were approximately twice as high as in the outdoor environment (GM: 6.1 and 15.2ng/m3). C11 and C14 carbon chains as well as six and seven chlorine homologues were found to be predominant in all samples with average percentages of 43.0% and 55.4%, respectively. The estimated daily CP intakes via PM2.5 inhalation were 8.1-24.6 and 25.1-76.0ng/kg·bw/day for all age subgroups based on both mean and 95th percentile concentrations of CPs. However, the estimated daily uptakes decreased to 4.4-16.4 and 13.5-50.6ng/kg·bw/day, respectively, when the deposition fractions of PM2.5 in the human lung were considered. Indoor PM2.5 attributed to 93.8% exposure of CPs based on both total estimated daily intakes (EDIs) and estimated daily uptakes (EDUs), indicating that the indoor PM2.5 exposure was very important. Infants and toddlers suffered higher exposure risks of CPs compared to other subgroups, indicating higher potential health risks; however, based on the margin of the exposure analysis these risks could be ignored.

Exploring the economy-wide effects of agriculture on air quality and health: Evidence from Europe.

Agricultural emissions strongly contribute to fine particulate matter pollution (PM2.5) and associated effects on human health. Environmentally-extended input-output models and a regional atmospheric chemistry model (WRF-Chem) were combined to conduct an economy-wide assessment of air pollution and pre-mature mortality in the European Union (EU), associated with a 20% increase in the final demand for the output of the agricultural sector. Model results revealed significant differences in air pollution originating from agricultural growth across the 28 EU countries (EU-28). The highest impact of agricultural growth on PM2.5 concentrations occur over the Northern Balkan countries (Bulgaria and Romania) and northern Italy. However, the highest excess mortality rates in the EU-28 due to changes in emissions and enhanced PM2.5 concentrations are observed in Malta, Greece, Spain and Cyprus. The least affected countries are mostly located in the northern part of Europe, with the exception of the Scandinavian Countries, which have relatively good air quality under current conditions. Our integrated modelling framework results highlight the importance of capturing both the direct and indirect air pollution emissions of economic sectors via upstream supply chains and underscore the non-linear response of surface PM2.5 levels and their health impacts to emission fluxes.

Exposure to ambient PM2.5 concentrations and cognitive function among older Mexican adults.

BACKGROUND: Recent epidemiological research has shown that exposure to fine particulate pollution (PM2.5) is associated with a reduction in cognitive function in older adults. However, primary evidence comes from high-income countries, and no specific studies have been conducted in low and middle-income countries where higher air pollution levels exist. OBJECTIVES: To estimate the association between the exposure to PM2.5 and cognitive function in a nationally representative sample of older Mexican adults and the associated effect modifiers. METHODS: Data for this study were taken from the National Survey of Health and Nutrition in Mexico carried out in 2012. A total of 7986 older adults composed the analytical sample. Cognitive function was assessed using two tests: semantic verbal fluency and three-word memory. The annual concentration of PM2.5 was calculated using satellite data. Association between exposure to PM2.5 and cognitive function was estimated using two-level logistic and linear regression models. RESULTS: In adjusted multilevel regression models, each 10 µg/m3 increase in ambient PM2.5 raised the odds of a poorer cognitive function using the three-word memory test (OR = 1.37, 95% CI: 1.08, 1.74), and reduced the number of valid animal named in the verbal fluency test (ß = -0.72, 95% CI: -1.05, -0.40). Stratified analyses did not yield any significant modification effects of age, sex, indoor pollution, urban/rural dwelling, education, smoking and other factors. CONCLUSIONS: This study supports an association between exposure to PM2.5 concentrations and cognitive function in older adults. This is particularly relevant to low- and middle-income countries, which are marked by a rapid growth of their aging population and high levels of air pollution.

End-user perspective of low-cost sensors for outdoor air pollution monitoring.

Low-cost sensor technology can potentially revolutionise the area of air pollution monitoring by providing high-density spatiotemporal pollution data. Such data can be utilised for supplementing traditional pollution monitoring, improving exposure estimates, and raising community awareness about air pollution. However, data quality remains a major concern that hinders the widespread adoption of low-cost sensor technology. Unreliable data may mislead unsuspecting users and potentially lead to alarming consequences such as reporting acceptable air pollutant levels when they are above the limits deemed safe for human health. This article provides scientific guidance to the end-users for effectively deploying low-cost sensors for monitoring air pollution and people's exposure, while ensuring reasonable data quality. We review the performance characteristics of several low-cost particle and gas monitoring sensors and provide recommendations to end-users for making proper sensor selection by summarizing the capabilities and limitations of such sensors. The challenges, best practices, and future outlook for effectively deploying low-cost sensors, and maintaining data quality are also discussed. For data quality assurance, a two-stage sensor calibration process is recommended, which includes laboratory calibration under controlled conditions by the manufacturer supplemented with routine calibration checks performed by the end-user under final deployment conditions. For large sensor networks where routine calibration checks are impractical, statistical techniques for data quality assurance should be utilised. Further advancements and adoption of sophisticated mathematical and statistical techniques for sensor calibration, fault detection, and data quality assurance can indeed help to realise the promised benefits of a low-cost air pollution sensor network.

Analysis of correlation between pediatric asthma exacerbation and exposure to pollutant mixtures with association rule mining.

OBJECTIVES: Traditional studies on effects of outdoor pollution on asthma have been criticized for questionable statistical validity and inefficacy in exploring the effects of multiple air pollutants, alone and in combination. Association rule mining (ARM), a method easily interpretable and suitable for the analysis of the effects of multiple exposures, could be of use, but the traditional interest metrics of support and confidence need to be substituted with metrics that focus on risk variations caused by different exposures. METHODS: We present an ARM-based methodology that produces rules associated with relevant odds ratios and limits the number of final rules even at very low support levels (0.5%), thanks to post-pruning criteria that limit rule redundancy and control for statistical significance. The methodology has been applied to a case-crossover study to explore the effects of multiple air pollutants on risk of asthma in pediatric subjects. RESULTS: We identified 27 rules with interesting odds ratio among more than 10,000 having the required support. The only rule including only one chemical is exposure to ozone on the previous day of the reported asthma attack (OR=1.14). 26 combinatory rules highlight the limitations of air quality policies based on single pollutant thresholds and suggest that exposure to mixtures of chemicals is more harmful, with odds ratio as high as 1.54 (associated with the combination day0 SO2, day0 NO, day0 NO2, day1 PM). CONCLUSIONS: The proposed method can be used to analyze risk variations caused by single and multiple exposures. The method is reliable and requires fewer assumptions on the data than parametric approaches. Rules including more than one pollutant highlight interactions that deserve further investigation, while helping to limit the search field.

[Asthma, indoor and outdoor air pollution: A pilot study in Lebanese school teenagers]. / Asthme, pollutions intérieure et extérieure: étude pilote chez des adolescents libanais scolarisés.

INTRODUCTION: Many studies have demonstrated that outdoor pollution might exacerbate respiratory symptoms and childhood asthma. Our objective was to evaluate the relationship between asthma and outdoor and indoor pollution. METHODS: We undertook a survey in May-June 2012 about schoolchildren aged 12-19 years in six Lebanese schools. This combined the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire with other questions addressing outdoor and indoor exposure. RESULTS: Among 717 subjects (response rate 71.7%), 4.5% had physician-diagnosed asthma, 34.7% had probable asthma and 60.8% were asymptomatic. Exposure to indoor contaminants was positively associated to asthma. The risk for asthma was higher in those residing near heavy road traffic (ORa=4.30 [95% CI 1.45-12.71], P<0.05), those previously exposed to fire (ORa=1.84 [95% CI 1.01-3.36]), and those exposed to smog (ORa=4.15 [95% CI 1.42-12.12]). Airing the house in the morning or in case of indoor smoking had a protective effect against asthma. CONCLUSION: These results suggest that the risks of asthma or having respiratory symptoms are not only related to indoor pollution but also to outdoor pollution especially from road traffic.

Lung cancer correlates in Lebanese adults: a pilot case--control study.

BACKGROUND: Lung cancer is one of the most prevalent types of cancers. However, there are no epidemiological studies concerning lung cancer and its risk factors in Lebanon. This study was carried out to determine the association between lung cancer and its most common risk factors in a sample of the Lebanese population. METHODS: A hospital-based case-control study was conducted. Patients were recruited in a tertiary health care center. A questionnaire in Arabic was designed to assess the possible risk factors for lung cancer. RESULTS: For females, cigarette smoking (ORa=9.76) and using fuel for heating (ORa=9.12) were found to be the main risk factors for lung cancer; for males, cigarette smoking (ORa=156.98), living near an electricity generator (ORa=13.26), consuming low quantities of fruits and vegetables (ORa=10.54) and a family history of cancer (ORa=8.75) were associated with lung cancer. Waterpipe smoking was significantly correlated with lung cancer in the bivariate analysis. CONCLUSION: In this pilot study, it was found that in addition to smoking, outdoor and indoor pollution factors were potential risk factors of lung cancer. Additional studies would be necessary to confirm these findings.