Microplastics exposure and immunologic response.

OBJECTIVE: To assess the impact of microplastics (MPs) on human health. DATA SOURCE: The authors conducted a non-systematic review of articles published in English, Portuguese, French, and Spanish in the last decade in the following databases: PubMed, Google Scholar, EMBASE, and SciELO. The keywords used were: microplastics OR nanoplastics OR marine litter OR toxicology OR additives AND human health OR children OR adults. DATA SUMMARY: MPs are a group of emerging contaminants that have attracted scientific interest and societal attention in the last decade due to their ubiquitous detection in all environments. Humans can primarily be exposed to MPs and nanoplastics via oral and inhalation routes, but dermal contact cannot be overlooked, especially in young children. The possible toxic effects of plastic particles are due to their potential toxicity, often combined with that of leachable additives and adsorbed contaminants. CONCLUSIONS: Unless the plastic value chain is transformed over the next two decades, the risks to species, marine ecosystems, climate, health, economy, and communities will be unmanageable. However, along with these risks are the unique opportunities to help transition to a more sustainable world.

Manifesto on inhaled triple therapy in asthma: an Interasma (Global Asthma Association - GAA) document.

Objective: The optimal use of drug combinations for the management of asthma is providing significant results. This has prompted Interasma (Global Asthma Association) to take a position on inhaled triple therapy in asthma.Methods: We performed an extensive literature research to clinical trials, meta-analyses, randomized controlled trials and systematic reviews.Results: Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto, developed by Interasma scientific network (INES) members.Conclusions: The manifesto describes the evidence gathered to date and states, advocates, and proposes issues on inhaled corticosteroid (ICS) plus long-acting beta 2 agonist (LABA) and long-acting muscarinic antagonists (LAMA) with the aim of challenging assumptions, fostering commitment, and bringing about change.

Climate change and allergic diseases in children and adolescents.

INTRODUCTION: The Anthropocene is used to describe the most recent period where major disruptions in Earth's system processes have resulted from humanity's increasing ecological footprint. Climate change affects the social and environmental determinants of good health, such as clean air, stable ecosystems, safe drinking water, and sufficient and safe food, and they seem to be closely related to air pollution. OBJECTIVES: This article aims to review the evidence of how extreme weather events and indoor and outdoor pollution are associated with insufficient lung growth in early life, changes in lung function, and the increase in respiratory infections, favoring the development of allergic respiratory diseases. MATERIAL AND METHODS: Non-systematic review of English, Spanish, and Portuguese articles published in the last ten years in databases such as PubMed, EMBASE, and SciELO. The terms used were air pollution OR climate changes OR smoke, AND health OR allergic disease. RESULTS: Climate change and air pollution are the leading contributors to health emergencies around the world. On a global scale, those most at risk of adverse health effects associated with climate change include children, the elderly, and other vulnerable groups. Climate change and air pollution have adverse impacts on respiratory allergies, and the mechanisms are complex and interactive. CONCLUSION: Health professionals must receive information and education necessary to establish effective mitigation and adaptation strategies to minimize the effects of climate changes on the respiratory health of their patients.

Household pollution and COVID-19: irrelevant association?

Evidence supports the link between air pollution and coronavirus disease 2019 (COVID-19). Therefore, exposure to indoor pollution (IDP) is likely to be associated with the disease. The poor, refugees, and migrant workers who live in feeble conditions are the most vulnerable. The pandemic has caused many people to remain indoors, especially at-risk individuals (e.g., the elderly, diabetics, obese, cardiac, and chronic lung disease patients). Home isolation may be an underlying factor to other health problems among these populations if the place where they are socially isolating is not adequately ventilated. Therefore, understanding the consequences of the relationship between IDP and the COVID-19 pandemic is essential.

Dust from the Sahara to the American Continent: Health impacts.

The Saharan Air Layer is a mass of hot, dry air laden with dust that forms over the Sahara and moves towards the Atlantic Ocean. This air mass contains soil dust particles emitted by the action of winds on the African continent. Between June and August, the large-scale patterns of wind circulation transport dust from the Sahara across the tropical North Atlantic Ocean, affecting parts of the Caribbean, Central America, Mexico, even some regions of the United States, and the Mediterranean and Southern Europe. Between December and April, wind circulation patterns facilitate dust transportation from the Sahara to the northern parts of South America and the Amazon. This dust transportation a phenomenon of interest to geosciences and public health because of the potential health impacts of dust dispersion and circulation in the atmosphere. Thus, we assessed the relationship between exposure to Saharan dust (SahD) and its implications for human health in the Americas. We performed a nonsystematic review in the PubMed, Google Scholar, EMBASE, and Scielo databases of studies published between 2000 and 2020 in Portuguese, English, French, or Spanish using the search words "Saharan dust," or "mineral dust," or "desert dust," and "human health." The available direct air pollutants measurements indicate that the pollution level in the cities affected on a constant and prolonged basis is high versus acceptable standards. Further, this review also showed that the negative health effects of SahD are sparsely studied in the Americas.

Hospital admission for symptoms exacerbation in 2,075 infants suffering from recurrent asthma-like symptoms: (EISL-3 South America).

BACKGROUND: Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known. METHODS: This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12-18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis. RESULTS: The prevalence of admission for wheezing was 29.7% (95% CI 27.7-31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93-5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33-2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38-2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR: 1.69; 95% CI: 1.19-2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02-1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54-0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51-0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18-0.67, p = 0.002), were protective factors. CONCLUSIONS: Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms.

Air pollution and rhinitis.

Rhinitis arises from either allergic or non-allergic inflammation of the nasal mucosa, characterized by the infiltration of inflammatory cells into the tissue and nasal secretions, along with structural alterations in the nasal mucosa. The pathways through which air pollution affects rhinitis may diverge from those affecting asthma. This article aims to review the effects of diverse air pollutants on the nose, the correlation of climate change and pollution, and how they aggravate the symptoms of patients with rhinitis.

[Food allergy and environmental contamination]. / Alergia alimentaria y contaminación ambiental.

The interaction between genetic potential and the environment, especially increased urbanization and inadequate waste management, contributes to the manifestation of allergic diseases. Pediatric patients are the most vulnerable, due to the immaturity of the respiratory and immune systems. Prenatal and postnatal exposure to air pollutants, both indoors and outdoors, accelerates or aggravates morbidity and mortality from allergic diseases. The "exposome," which encompasses all environmental exposures throughout life, influences health. Biological and chemical attacks alter the epithelial barrier, triggering inflammatory responses and favoring allergic diseases, such as food allergies. The uncontrolled use of toxic fuels, particulate matter, detergents and other factors contribute to the continuous deterioration of the intestinal epithelial barrier, increasing the risk of allergic diseases. It is important to take urgent action to address these issues and protect the health of the planet.

La interacción entre el potencial genético y el medio ambiente, especialmente el aumento de la urbanización y la gestión inadecuada de residuos contribuye con la manifestación de enfermedades alérgicas. Los pacientes pediátricos son los más vulnerables, debido a la inmadurez de los sistemas respiratorio e inmunológico. La exposición prenatal y posnatal a contaminantes del aire, tanto en exteriores como interiores, acelera o agrava la morbilidad y mortalidad por enfermedades alérgicas. El "exposoma", que abarca todas las exposiciones ambientales a lo largo de la vida, influye en la salud. Las agresiones biológicas y químicas alteran la barrera epitelial, desencadenando respuestas inflamatorias y favoreciendo enfermedades alérgicas, como alergias alimentarias. El uso descontrolado de combustibles tóxicos, material particulado, detergentes y otros factores contribuyen con el deterioro continuo de la barrera epitelial intestinal, aumentando el riesgo de enfermedades alérgicas. Es importante tomar medidas urgentes para abordar estos problemas y proteger la salud del planeta.

Environmental impact of inhaler devices on respiratory care: a narrative review.

Climate change is a huge and present threat to human health. This article aims to deepen the knowledge about the environmental impact of inhaler devices on their carbon footprint for patients and health professionals, providing information that allows a better choice of the type of device to be prescribed for the treatment of asthma and COPD. This narrative and nonsystematic review was carried out by searching databases (PubMed, Google Scholar, SciELO, and EMBASE) for articles published between 2017 and 2022, written in Portuguese or in English, using the search words "inhalation device" OR "environmental." The review showed that global warming cannot be addressed by focusing only on inhaler devices. However, the devices that we use to treat respiratory diseases such as asthma and COPD, which are diseases that are aggravated by climate change, are also causing that change. Therefore, health professionals, patient organizations, and industries should take a lead in health policies to offer affordable alternatives to inhalers containing hydrofluoroalkane.

Radon exposure: a major cause of lung cancer in nonsmokers.

Exposure to radon can impact human health. This is a nonsystematic review of articles written in English, Spanish, French, or Portuguese published in the last decade (2013-2023), using databases such as PubMed, Google Scholar, EMBASE, and SciELO. Search terms selected were radon, human health, respiratory diseases, children, and adults. After analyzing the titles and abstracts, the researchers initially identified 47 studies, which were subsequently reduced to 40 after excluding reviews, dissertations, theses, and case-control studies. The studies have shown that enclosed environments such as residences and workplaces have higher levels of radon than those outdoors. Moreover, radon is one of the leading causes of lung cancer, especially in nonsmokers. An association between exposure to radon and development of other lung diseases, such as asthma and COPD, was also observed. It is crucial to increase public awareness and implement governmental control measures to reduce radon exposure. It is essential to quantify radon levels in all types of buildings and train professionals to conduct such measurements according to proven efficacy standards. Health care professionals should also be informed about this threat and receive adequate training to deal with the effects of radon on human health.

Prevalence of rhinitis and associated factors in adolescents and adults: a Global Asthma Network study.

OBJECTIVE: To determine the prevalence of allergic rhinitis and associated factors in adolescents and in their parents/guardians. METHODS: A cross-sectional study, applying a standardized and validated written questionnaire. Adolescents (13-14 years old; n=1,058) and their parents/guardians (mean age=42.1 years old; n=896) living in the city of Uruguaiana, southern Brazil, responded to the Global Asthma Network standard questionnaires. RESULTS: The prevalence of allergic rhinitis in adolescents was 28.0%, allergic rhinoconjunctivitis, 21.3%, and severe forms of allergic rhinitis, 7.8%. In the adults, the prevalence of allergic rhinitis was 31.7%. Some associated factors with allergic rhinitis in adolescents include low physical exercise (OR 2.16; 95%CI 1.15-4.05), having only one older sibling (OR 1.94; 95CI 1.01-3.72) and daily meat consumption (OR 7.43; 95% CI 1.53-36.11). In contrast, consuming sugar (OR 0.34; 95%CI 0.12-0.93) or olive oil (OR 0.33; 95%CI 0.13-0 .81) once or twice a week, and eating vegetables daily (OR 0.39; 95%CI 0.15-0.99) were considered factors negatively associated. In adults, exposure to fungi at home (OR 5.25; 95%CI 1.01-27.22) and consumption of meat once or twice a week (OR 46.45; 95CI 2.12-1020.71) were factors associated with the medical diagnosis of allergic rhinitis, while low education (OR 0.25; 95%CI 0.07-0.92) was found to be a factor negatively associated. CONCLUSIONS: The prevalence of allergic rhinitis in adolescents is high, as well as its medical diagnosis in adults living in Uruguaiana. Environmental factors, especially food habits, were associated with findings in both groups.

Environmental history-taking as part of pediatric consultations: a pilot study. / Anamnesis ambiental como parte de la consulta pediátrica: estudio piloto.

Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental historytaking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study.

Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Climate changes, air pollution and allergic diseases in childhood and adolescence.

OBJECTIVE: To analyze the impacts of climate change on the development of immature respiratory and immune systems in children. SOURCE OF DATA: The authors of the present study performed a non-systematic review of English, Spanish, and Portuguese articles published in the last five years in databases such as PubMed, EMBASE, and SciELO. The terms used were air pollution OR climate changes OR smoke, AND children OR health. SYNTHESIS OF DATA: The increase in the prevalence of some diseases, such as allergic ones, is attributed to the interactions between genetic potential and the environment. However, disordered growth combined with inadequate waste management has caused problems for the planet, such as heatwaves, droughts, forest fires, increased storms and floods, interference in food crops and their nutritional values, changes in the infectious disease pattern, and air pollution resulting from the continuous use of fossil fuels. Children, beings still in the development stage with immature respiratory and immune systems, are the primary victims of the climate crisis. CONCLUSIONS: The authors documented that prenatal and postnatal exposure to ambient air pollutants will accelerate or worsen the morbidity and mortality of many health conditions, including allergic diseases. Ambient air pollutants change the microbiota, interfere with the immune response, and take direct action on the skin and respiratory epithelium, which facilitates the penetration of allergens. Understanding how the children and adolescent health and well-being are affected by climate change is an urgent matter.

Association between exposure to pesticides and allergic diseases in children and adolescents: a systematic review with meta-analysis.

OBJECTIVE: The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. METHOD: A systematic review and meta-analysis were performed using the PRISMA method with the question "What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?" MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. RESULTS: Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). CONCLUSIONS: Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.

Environmental contributions to the interactions of COVID-19 and asthma: A secondary publication and update.

An outbreak of coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) started in Wuhan, Hubei Province, China and quickly spread around the world. Current evidence is contradictory on the association of asthma with COVID-19 and associated severe outcomes. Type 2 inflammation may reduce the risk for severe COVID-19. Whether asthma diagnosis may be a risk factor for severe COVID-19, especially for those with severe disease or non-allergic phenotypes, deserves further attention and clarification. In addition, COVID-19 does not appear to provoke asthma exacerbations, and asthma therapeutics should be continued for patients with exposure to COVID-19. Changes in the intensity of pollinization, an earlier start and extension of the pollinating season, and the increase in production and allergenicity of pollen are known direct effects that air pollution has on physical, chemical, and biological properties of the pollen grains. They are influenced and triggered by meteorological variables that could partially explain the effect on COVID-19. SARS-CoV-2 is capable of persisting in the environment and can be transported by bioaerosols which can further influence its transmission rate and seasonality. The COVID-19 pandemic has changed the behavior of adults and children globally. A general trend during the pandemic has been human isolation indoors due to school lockdowns and loss of job or implementation of virtual work at home. A consequence of this behavior change would presumably be changes in indoor allergen exposures and reduction of inhaled outdoor allergens. Therefore, lockdowns during the pandemic might have improved some specific allergies, while worsening others, depending on the housing conditions.

Impact of exposure to smoke from biomass burning in the Amazon rain forest on human health.

This review study aimed to determine the relationship between exposure to smoke from biomass burning in the Amazon rain forest and its implications on human health in that region in Brazil. A nonsystematic review was carried out by searching PubMed, Google Scholar, SciELO, and EMBASE databases for articles published between 2005 and 2021, either in Portuguese or in English, using the search terms "biomass burning" OR "Amazon" OR "burned" AND "human health." The review showed that the negative health effects of exposure to smoke from biomass burning in the Amazon have been poorly studied in that region. There is an urgent need to identify effective public health interventions that can help improve the behavior of vulnerable populations exposed to smoke from biomass burning, reducing morbidity and mortality related to that exposure.

Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study.

BACKGROUND: The Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers. METHODS: Adolescents (13-14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire. RESULTS: Although the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms. CONCLUSIONS: Adolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.

Prevalence and Determinants of Tobacco Smoking Among Low-Income Urban Adolescents.

Background: Tobacco-smoking in children is one of the most crucial public health concerns, which could be highly prevalent in underprivileged populations. Methods: A cross sectional, random sampling survey was conducted to determine the prevalence of current tobacco-smoking and related risk factors among adolescents living in a low-income area of Santiago de Chile. Results: Of the 2,747 adolescents participating in the study, 24.0% [95% confidence interval (CI) 22.3-25.5] were current smokers, with no significant difference between girls and boys. Factors associated with current smoking were as follows: positive attitude to smoking cigarettes offered by peers [odds ratio (OR) 8.0; 95% CI 5.7-11.3, P < 0.001], having smoking best friends (OR 4.0; 95% CI 2.6-6.0, P < 0.001), and passive smoking in the house (OR 1.9; 95% CI 1.2-3.1, P = 0.008). A total of 16.8% (95% CI 11.4-18.2) of children had smoked an entire cigarette at the age of ≤12, and 62.3% (95% CI, 60.5-64.1) were passive smokers at home. Regarding nonsmoking children, 52.4% (95% CI 49.74-55.06) were exposed to tobacco smoke at home. Conclusion: The prevalence of current tobacco-smoking in adolescents is high and increasing compared to previous studies undertaken in the selected low-resourced area. Two-thirds of children who started smoking before the age of 12 years were current smokers at the time of the survey, highlighting the prevalence of the powerful addiction generated and the need for better preventive strategies against tobacco-smoking for children living in low-resource communities.

Air pollution and indoor settings.

Indoor environments contribute significantly to total human exposure to air pollutants, as people spend most of their time indoors. Household air pollution (HAP) resulting from cooking with polluting ("dirty") fuels, which include coal, kerosene, and biomass (wood, charcoal, crop residues, and animal manure) is a global environmental health problem. Indoor pollutants are gases, particulates, toxins, and microorganisms among others, that can have an impact especially on the health of children and adults through a combination of different mechanisms on oxidative stress and gene activation, epigenetic, cellular, and immunological systems. Air pollution is a major risk factor and contributor to morbidity and mortality from major chronic diseases. Children are significantly affected by the impact of the environment due to biological immaturity, prenatal and postnatal lung development. Poor air quality has been related to an increased prevalence of clinical manifestations of allergic asthma and rhinitis. Health professionals should increase their role in managing the exposure of children and adults to air pollution with better methods of care, prevention, and collective action. Interventions to reduce household pollutants may promote health and can be achieved with education, community, and health professional involvement.