Impact of climate change on non-communicable diseases due to increased ambient air pollution.

Background: The impacts of air pollutants on health range from short-term health impairments to hospital admissions and deaths. Climate change is leading to an increase in air pollution. Methods: This article addresses, based on selected literature, the relationship between climate change and air pollutants, the health effects of air pollutants and their modification by air temperature, with a focus on Germany. Results: Poor air quality increases the risk of many diseases. Climate change is causing, among other things, more periods of extreme heat with simultaneously increased concentrations of air pollutants. The interactions between air temperature and air pollutants, as well as their combined effects on human health, have not yet been sufficiently studied. Limit, target, and guideline values are of particular importance for health protection. Conclusions: Measures to reduce air pollutants and greenhouse gases must be more strictly implemented. An essential step towards improving air quality is setting stricter air quality limit values in Europe. Prevention and adaptation measures should be accelerated in Germany, as they contribute to climate-resilient and sustainable healthcare systems.

Heat in Germany: Health risks and preventive measures.

Background: Climate change has already led to a significant temperature increase in Germany. The average temperature in the past decade was approximately 2°C above the pre-industrial level and eight of the ten hottest summers since the beginning of systematic weather records in 1881 were recorded in the last 30 years. Methods: Based on a selective literature search and authors' own results, the article summarises the current state of knowledge on heat and its health impacts for Germany, addresses adaptation measures, and gives an outlook on implementation and research questions. Results: Heat can aggravate pre-existing conditions such as diseases of the cardiovascular system, the respiratory tract, or the kidneys and trigger potentially harmful side effects for numerous medications. A significant increase in mortality is regularly observed during heat events. Previous approaches to mitigate the health impact of high temperatures include, for example, the heat alerts of the German Meteorological Service and recommendations for the preparation of heat-health action plans. Conclusions: Evidence on health impacts of heat and awareness of the need for heat-related health protection have grown in recent years, but there is still a need for further action and research.

Heat-Related Mortality in Germany From 1992 to 2021.

BACKGROUND: 2018-2020 were unusually warm years in Germany, and the summer of 2018 was the second warmest summer since record-keeping began in 1881. Higher temperatures regularly lead to increased mortality, particularly among the elderly. METHODS: We used weekly data on all-cause mortality and mean temperature from the period 1992-2021 and estimated the number of heat-related deaths in all of Germany, and in the northern, central, and southern regions of Germany, employing a generalized additive model (GAM). To characterize long-term trends, we compared the effect of heat on mortality over the decades. RESULTS: Our estimate reveals that the unusually high summer temperatures in Germany between 2018 and 2020 led to a statistically significant number of deaths in all three years. There were approximately 8700 heat-related deaths in 2018, 6900 in 2019, and 3700 in 2020. There was no statistically significant heat-related increase in deaths in 2021. A comparison of the past three decades reveals a slight overall decline in the effect of high temperatures on mortality. CONCLUSION: Although evidence suggests that there has been some adaptation to heat over the years, the data from 2018-2020 in particular show that heat events remain a significant threat to human health in Germany.

Management of patients with seasonal allergic rhinitis: Diagnostic consideration of sensitization to non-frequent pollen allergens.

BACKGROUND: Diagnosis of pollen allergies is mainly based on test allergens for skin prick testing. In the minimum battery of test inhalant allergens recommended by the Global Allergy and Asthma European Network 10 pollen allergens are included. Complementary other pollen allergens may need to be considered; however, respective awareness may not always be granted. Furthermore, at least in Germany, the situation may be even more complicated by the fact that test allergens need regulatory approval. A decline in commercially available test allergens may result in a diagnostic gap regarding patients with non-frequent allergies. How many patients with non-frequent pollen allergies would be affected by this gap? The data presented here partly answer this question. METHODS: The study consisted of a descriptive and an analytical part. In the descriptive part, sensitization to frequent pollen allergens (alder, hazel, birch, sweet grasses; according to the German Therapy Allergen Ordinance) and to respective non-frequent pollen allergens (cypress, Japanese cedar, ash, plane tree, olive, Bermuda grass, wall pellitory, plantain, goosefoot, mugwort, ragweed, and saltwort) was measured in adult patients with physician-diagnosed allergic rhinitis from two German federal states, namely North-Rhine Westphalia (n = 360) and Bavaria (n = 339), using skin prick testing and/or ISAC technology. Furthermore, respective regional pollen data were assessed. In the analytical part, sensitization data were correlated with each other and with anamnestic data on symptom periods. RESULTS: Sensitization to frequent pollen allergens ranged from 45% (sIgE to Aln g 1/Alder, NRW) to 72% (prick test reactivity to birch, NRW). Sensitization to non-frequent pollen allergens ranged from 0% (sIgE to Amb a 1/ragweed, NRW) to 41% (prick test reactivity to olive, Bavaria). Sensitization data partly correlated with each other and in connection with symptom periods showed a partly similar seasonal pattern as pollen data. CONCLUSIONS: Sensitization to non-frequent pollen allergens have to be considered when examining patients with respective seasonal symptoms, and test (and respective therapy) allergens for non-frequent pollen allergies need to be available. Further prerequisites for adequate patient management would be a nationwide pollen monitoring system giving continuous pollen data and a systematic sensitization monitoring at patient level.

Heat Extremes, Public Health Impacts, and Adaptation Policy in Germany.

Global warming with increasing weather extremes, like heat events, is enhancing impacts to public health. This essay focuses on unusual extreme summer heat extremes occurring in Germany at higher frequency, longer duration, and with new temperature records. Large areas of the country are affected, particularly urban settlements, where about 77% of the population lives, which are exposed to multiple inner-city threats, such as urban heat islands. Because harm to public health is directly released by high ambient air temperatures, local and national studies on heat-related morbidity and mortality indicate that vulnerable groups such as the elderly population are predominantly threatened with heat-related health problems. After the severe mortality impacts of the extreme summer heat 2003 in Europe, in 2008, Germany took up the National Adaptation Strategy on Climate Change to tackle and manage the impacts of weather extremes, for example to protect people's health against heat. Public health systems and services need to be better prepared to improve resilience to the effects of extreme heat events, e.g., by implementing heat health action plans. Both climate protection as well as adaptation are necessary in order to be able to respond as adequate as possible to the challenges posed by climate change.

[Health protection against heat extremes in Germany: What has been done in federal states and municipalities?] / Gesundheitsschutz bei Hitzeextremen in Deutschland: Was wird in Ländern und Kommunen bisher unternommen?

BACKGROUND: Heat extremes are one of the most perceptible health risks of climate change. In the field of prevention, Germany relies on recommendations for heat health action plans and on programs to support such measures. OBJECTIVES: To give an overview of measures and projects for the prevention of heat-related mortality and morbidity that have been established in Germany. MATERIALS AND METHODS: Activities and projects covering heat and human health since 2003 were identified by database and Internet search. Projects just indirectly related to human health were excluded. We recorded federal states and funding agencies, and which of the eight core elements of the Federal Ministry for the Environment recommendations for action are addressed by the measure. RESULTS: Of the 190 projects, 19 can be assigned the keyword "heat health action plan", although these are very heterogeneous activities. The individual measures partly covered several criteria of the recommendations for action: 70.0% concern urban planning and construction, 37.4% information and communication, 24.2% vulnerable groups, 17.9% reducing indoor heat, 15.3% the use of a heat warning system, 13.7% each for central coordination, interdisciplinary cooperation, and the preparation of health and social systems, and 5.3% refer to monitoring and evaluation of measures. DISCUSSION: The number of measures and projects in Germany is considerable. However, it remains unclear whether these actions meet the criteria for effective medium- and short-term protection.

"New" inhalant plant allergens.

Specific IgE measurements obtained from patients suffering from respiratory allergy (n = 952) show that, despite similar climatic conditions, there are clear regional differences in pollen sensitization between North Rhine-Westphalia and Bavaria. The data on sensitization levels and pollen concentration was taken from the research and development project Ufoplan 3710 61 228 of the German Environment Agency for North Rhine-Westphalia and Bavaria (2011 - 2014). Most poly-sensitized patients have already shown sensitization, both in the form of cross-reactivity and species-specific sensitization, to "new" pollen allergens, such as Bermuda grass and olive tree. These plants are currently not common in Germany, but may become considerably more widespread due to the increase in average yearly temperatures caused by the global warming. The other "new" aeroallergens discussed here are plants that can be found throughout Germany, such as nettle, cypress, and pine. Their current sensitization levels are higher than 8%; however, their clinical impact appears to be underestimated. For clinical practice it is important to identify when patients' symptoms are typically severe and which regional plants might be responsible for the patients' complaints in this period of time, as this affects further diagnostic strategy. Allergens having an immune effect can then be targeted by specific immunotherapies. The information on complaints of the patients should be regularly recorded in symptom diaries. Recording this information for at least 1 year may allow to discover a correlation between specific types of pollen and allergy symptoms.

[Climate change - physical and mental consequences]. / Klimawandel ­ physische und psychische Folgen.

Climate change has already had a large influence on the human environmental system and directly or indirectly affects physical and mental health. Triggered by extreme meteorological conditions, for example, storms, floods, earth slides and heat periods, the direct consequences range from illnesses to serious accidents with injuries, or in extreme cases fatalities. Indirectly, a changed environment due to climate change affects, amongst other things, the cardiovascular system and respiratory tract, and can also cause allergies and infectious diseases. In addition, increasing confrontation with environmental impacts may cause negative psychological effects such as posttraumatic stress disorders and anxiety, but also aggression, distress and depressive symptoms. The extent and severity of the health consequences depend on individual pre-disposition, resilience, behaviour and adaptation.

Spatial distribution of allergenic pollen through a large metropolitan area.

For nearly a decade, the majority of the world's population has been living in cities, including a considerable percentage of people suffering from pollen allergy. The increasing concentration of people in cities results in larger populations being exposed to allergenic pollen at the same time. There is almost no information about spatial distribution of pollen within cities as well as a lack of information about the possible impact to human health. To obtain this increasing need for pollen exposure studies on an intra-urban scale, a novelty screening network of 14 weekly changed pollen traps was established within a large metropolitan area-Berlin, Germany. Gravimetric pollen traps were placed at a uniform street-level height from March until October 2014. Three important allergenic pollen types for Central Europe-birch (Betula), grasses (Poaceae), and mugwort (Artemisia)-were monitored. Remarkable spatial and temporal variations of pollen sedimentation within the city and the influences by urban local sources are shown. The observed differences between the trap with the overall highest and the trap with the overall lowest amount of pollen sedimentation were in the case of birch pollen 245%, grass pollen 306%, and mugwort pollen 1962%. Differences of this magnitude can probably lead to different health impacts on allergy sufferers in one city. Therefore, pollen should be monitored preferably in two or more appropriate locations within large cities and as a part of natural air quality regulations.

Potential health risk of allergenic pollen with climate change associated spreading capacity: Ragweed and olive sensitization in two German federal states.

BACKGROUND: Global climate changes may influence the geographical spread of allergenic plants thus causing new allergen challenges. OBJECTIVE: Allergy patients from two German federal states were compared for their status quo sensitization to ragweed, an establishing allergen, olive, a non-established allergen, and the native allergens birch, mugwort, and ash. METHODS: Between 2011 and 2013, 476 adult allergy patients per region were recruited. Patients completed a questionnaire, participated in a medical interview, and underwent skin prick testing and blood withdrawal for analysis of specific IgE to allergen components (ISAC technology). Data on regional pollen load from 2006 to 2011 were acquired from the German Pollen Information Service Foundation. RESULTS: Prick test reactivity to ragweed and ash, respectively, was lower in Bavaria than in NRW (ragweed: p=0.001, aOR=0.54; ash: p=0.001, aOR=0.59), whereas prick test reactivity to olive was higher (p=0.000, aOR=3.09). Prick test reactivity to birch and mugwort, respectively, did not significantly differ. 1% (1/127) of patients with prick test reactivity to ragweed showed sIgE to Amb a 1, and 65% (86/132) of olive-but-not-ash reactive patients showed sIgE to Ole e 1 (NRW: 67%, Bavaria: 65%; p=0.823, OR=0.91). Regional differences in sensitization pattern were neither explainable by cross-reactivity to pollen pan-allergens nor non-exposure variables nor by reported plant population or pollen data. CONCLUSIONS: Spread of ragweed and particularly olive may result in prompt occurrence of allergic symptoms. Early identification of invasive allergens due to climate change does need time and spatial close meshed measurement of respective indicator allergens and sensitization pattern.

Air quality management in the WHO European Region--results of a quality assurance and control programme on air quality monitoring (1994-2004).

Since the last decade the WHO Collaborating Centre for Air Quality Management and Air Pollution Control, Berlin, Germany, operates a quality assurance and control (QA/QC) programme on air quality monitoring in the WHO European Region. As main activity Intercomparison workshops have been established for air monitoring network laboratories on a regular basis to harmonise air quality measurements, analysis and calibration techniques. 36 air hygiene laboratories of public health and environmental institutions of 24 countries participated in twelve Intercomparisons between 1994 and 2004. The majority was carried out for NO, NO(2), SO(2) and O(3). The results were predominantly satisfactory for automatic methods. The results of manual methods were mainly in a good, and for several concentration levels partly very good accordance with the data obtained by the monitors.

Apheis: Health impact assessment of long-term exposure to PM(2.5) in 23 European cities.

INTRODUCTION: Apheis aims to provide European decision makers, environmental-health professionals and the general public with up-to-date and easy-to-use information on air pollution (AP) and public health (PH). In the Apheis-3 phase we quantified the PH impact of long-term exposure to PM(2.5) (particulate matter < 2.5 microm) in terms of attributable number of deaths and the potential gain in life expectancy in 23 European cities. METHODS: We followed the World Health Organization (WHO) methodology for Health Impact Assessment (HIA) and the Apheis guidelines for data collection and analysis. We used the programme created by PSAS-9 for attributable-cases calculations and the WHO software AirQ to estimate the potential gain in life expectancy. For most cities, PM(2.5) levels were calculated from PM10 measurements using a local or European conversion factor. RESULTS: The HIA estimated that 16,926 premature deaths from all causes, including 11,612 cardiopulmonary deaths and 1901 lung-cancer deaths, could be prevented annually if long-term exposure to PM(2.5 )levels were reduced to 15 microg/m3 in each city. Equivalently, this reduction would increase life expectancy at age 30 by a range between one month and more than two years in the Apheis cities. CONCLUSIONS: In addition to the number of attributable cases, our HIA has estimated the potential gain in life expectancy for long-term exposure to fine particles, contributing to a better quantification of the impact of AP on PH in Europe.