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

Ioana Agache¹, Carlos Canelo-Aybar², Isabella Annesi-Maesano³, Lorenzo Cecchi⁴, David Rigau², L Yesenia Rodríguez-Tanta², Wendy Nieto-Gutierrez², Yang Song², Yahveth Cantero-Fortiz^{2

5}, Marta Roqué^{2

5}, Juan Carlos Vasquez², Ivan Sola⁵, Benedetta Biagioni⁶, Fan Chung⁷, Gennaro D'Amato⁸, Athanasios Damialis⁹, Stefano Del Giacco¹⁰, Leticia de Las Vecillas¹¹, Javier Dominguez-Ortega¹¹, Carmen Galàn¹², Stefanie Gilles¹³, Mattia Giovannini^{14

15}, Stephen Holgate¹⁶, Mohamed Jeebhay¹⁷, Kari Nadeau¹⁸, Nikolaos Papadopoulos^{19

20}, Santiago Quirce¹¹, Joaquin Sastre²¹, Claudia Traidl-Hoffmann^{22

23

24}, Jolanta Walusiak-Skorupa²⁵, Bernardo Sousa-Pinto²⁶, Pablo Alonso-Coello^{2

5}, Josefina Salazar², Marek Jutel²⁷, Cezmi A Akdis²⁸

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
³ Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France.
⁴ Centre of Bioclimatology, University of Florence, Florence, Italy.
⁵ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital, Florence, Italy.
⁷ Imperial College, London, UK.
⁸ Medical School of Respiratory Diseases, University of Naples Federico II, Naples, Italy.
⁹ Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
¹⁰ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
¹¹ Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
¹² Department of Botany, Ecology and Plant Physiology, International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain.
¹³ Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
¹⁴ Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
¹⁵ Department of Health Sciences, University of Florence, Florence, Italy.
¹⁶ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁷ Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Rondebosch, South Africa.
¹⁸ John Rock Professor of Climate and Population Studies; Chair, Department of Environmental Health, Interim Director, Center for Climate, Health, and The Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁹ Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK.
²¹ Instituto Carlos III, Ministry of Science and Innovation, Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Madrid, Spain.
²² Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
²³ Institute of Environmental Medicine, Helmholtz Center Munich-German Research Center for Environmental Health, Augsburg, Germany.
²⁴ Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.
²⁵ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁶ MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
²⁷ Department of Clinical Immunology, ALL-MED Medical Research Institute, Wrocław Medical University, Wroclaw, Poland.
²⁸ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.

PMID: 38311978
DOI: 10.1111/all.16041

Meta-Analysis

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

Ioana Agache et al. Allergy. 2024 Jul.

. 2024 Jul;79(7):1725-1760.

doi: 10.1111/all.16041. Epub 2024 Feb 4.

Authors

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
³ Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France.
⁴ Centre of Bioclimatology, University of Florence, Florence, Italy.
⁵ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital, Florence, Italy.
⁷ Imperial College, London, UK.
⁸ Medical School of Respiratory Diseases, University of Naples Federico II, Naples, Italy.
⁹ Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
¹⁰ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
¹¹ Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
¹² Department of Botany, Ecology and Plant Physiology, International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain.
¹³ Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
¹⁴ Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
¹⁵ Department of Health Sciences, University of Florence, Florence, Italy.
¹⁶ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁷ Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Rondebosch, South Africa.
¹⁸ John Rock Professor of Climate and Population Studies; Chair, Department of Environmental Health, Interim Director, Center for Climate, Health, and The Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁹ Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK.
²¹ Instituto Carlos III, Ministry of Science and Innovation, Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Madrid, Spain.
²² Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
²³ Institute of Environmental Medicine, Helmholtz Center Munich-German Research Center for Environmental Health, Augsburg, Germany.
²⁴ Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.
²⁵ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁶ MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
²⁷ Department of Clinical Immunology, ALL-MED Medical Research Institute, Wrocław Medical University, Wroclaw, Poland.
²⁸ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.

PMID: 38311978
DOI: 10.1111/all.16041

Abstract

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).

Keywords: GRADE; asthma; extreme temperatures; outdoor pollution; systematic review.

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References

REFERENCES

1. WHO factsheet: Asthma 2017 Available from: https://www.who.int/news‐room/fact‐sheets/detail/asthma
1. Global Asthma Network. The Global Asthma Report. Auckland; 2018.
1. Raulf M, Buters J, Chapman M, et al. Monitoring of occupational and environmental aeroallergens‐EAACI position paper. Concerted action of the EAACI IG occupational allergy and Aerobiology & air Pollution. Allergy. 2014;69(10):1280‐1299.
1. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383:1581‐1592.
1. Annesi‐Maesano I, Forastiere F, Balmes J, et al. The clear and persistent impact of air pollution on chronic respiratory diseases: a call for interventions. Eur Respir J. 2021;57(3):2002981.

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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

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

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LinkOut - more resources

Full Text Sources

Medical

Research Materials