EAACI Guidelines on Environmental Science for Allergy and Asthma-Recommendations on the Impact of Indoor Air Pollutants on the Risk of New-Onset Asthma and on Asthma-Related Outcomes

Ioana Agache¹, Isabella Annesi-Maesano², Lorenzo Cecchi³, Benedetta Biagioni⁴, Fan Chung⁵, Gennaro D'Amato^{6

7}, Athanasios Damialis⁸, Stefano Del Giacco⁹, Javier Dominguez Ortega¹⁰, Carmen Galán¹¹, Stefanie Gilles^{12

13}, Stephen Holgate¹⁴, Mohamed Jeebhay¹⁵, Stelios Kazadzis¹⁶, Kari Nadeau¹⁷, Nikos G Papadopoulos^{18

19}, Santiago Quirce¹⁰, Joaquin Sastre¹³, Claudia Traidl-Hoffmann^{12

20}, Jolanta Walusiak-Skorupa²¹, Magdalena Zemelka-Wiacek²², Marek Jutel^{22

23}, Cezmi A Akdis²⁴

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France.
³ Allergology and Clinical Immunology, S Giovanni di Dio Hospital, Florence, Italy.
⁴ Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Florence, Italy.
⁵ Imperial College, London, UK.
⁶ Respiratory Disease Department, Hospital Cardarelli, Naples, Italy.
⁷ Medical School of Respiratory Diseases, University of Naples Federico II, Naples, Italy.
⁸ Terrestrial Ecology and Climate Change, Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
¹⁰ Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain.
¹¹ Inter-University Institute for Earth System Research (IISTA), international Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain.
¹² Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
¹³ Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain.
¹⁴ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁵ Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa.
¹⁶ Physikalisch-Meteorologisches Observatorium Davos, World Radiation Center, Davos, Switzerland.
¹⁷ 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.
¹⁸ Department of Allergy, second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Lydia Becker Institute, University of Manchester, Manchester, UK.
²⁰ Insitute of Environmental Medicine, Helmholtz Munich, German Research Center for Environmental Health, Neuherberg, Germany.
²¹ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²² Department of Clinical Immunology, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.

PMID: 40018799
DOI: 10.1111/all.16502

Practice Guideline

EAACI Guidelines on Environmental Science for Allergy and Asthma-Recommendations on the Impact of Indoor Air Pollutants on the Risk of New-Onset Asthma and on Asthma-Related Outcomes

Ioana Agache et al. Allergy. 2025 Mar.

. 2025 Mar;80(3):651-676.

doi: 10.1111/all.16502. Epub 2025 Feb 28.

Authors

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France.
³ Allergology and Clinical Immunology, S Giovanni di Dio Hospital, Florence, Italy.
⁴ Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Florence, Italy.
⁵ Imperial College, London, UK.
⁶ Respiratory Disease Department, Hospital Cardarelli, Naples, Italy.
⁷ Medical School of Respiratory Diseases, University of Naples Federico II, Naples, Italy.
⁸ Terrestrial Ecology and Climate Change, Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
¹⁰ Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain.
¹¹ Inter-University Institute for Earth System Research (IISTA), international Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain.
¹² Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
¹³ Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain.
¹⁴ Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁵ Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa.
¹⁶ Physikalisch-Meteorologisches Observatorium Davos, World Radiation Center, Davos, Switzerland.
¹⁷ 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.
¹⁸ Department of Allergy, second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Lydia Becker Institute, University of Manchester, Manchester, UK.
²⁰ Insitute of Environmental Medicine, Helmholtz Munich, German Research Center for Environmental Health, Neuherberg, Germany.
²¹ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²² Department of Clinical Immunology, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.

PMID: 40018799
DOI: 10.1111/all.16502

Abstract

The EAACI Guidelines used the GRADE approach to evaluate the impact of major indoor air pollutants (dampness and mould, cleaning agents, volatile organic compounds and pesticides) on the risk of new-onset asthma and on asthma-related outcomes. The guideline also acknowledges the synergies among indoor air pollutants and other components of the indoor exposome (allergens, viruses, endotoxins). Very low to low certainty of evidence was found for the association between exposure to indoor pollutants and increased risk of new-onset asthma and asthma worsening. Only for mould exposure there was moderate certainty of evidence for new-onset asthma. Due to the quality of evidence, conditional recommendations were formulated on the risk of exposure to all indoor pollutants. Recommendations are provided for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management. For policymakers and regulators this evidence-informed guideline supports setting legally binding standards and goals for indoor air quality at international, national and local levels. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but community and governmental measures for improved indoor air quality are needed to achieve significant impact.

Keywords: asthma; environmental science; guidelines; indoor air pollutants; indoor environment.

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References

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1. D. W. Cockcroft, “Environmental Causes of Asthma,” Seminars in Respiratory and Critical Care Medicine 39, no. 1 (2018): 12–18.
1. B. Biagioni, L. Cecchi, G. D'Amato, and I. Annesi‐Maesano, “Environmental Influences on Childhood Asthma: Climate Change,” Pediatric Allergy and Immunology 34, no. 5 (2023): e13961.
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EAACI Guidelines on Environmental Science for Allergy and Asthma-Recommendations on the Impact of Indoor Air Pollutants on the Risk of New-Onset Asthma and on Asthma-Related Outcomes

Affiliations

EAACI Guidelines on Environmental Science for Allergy and Asthma-Recommendations on the Impact of Indoor Air Pollutants on the Risk of New-Onset Asthma and on Asthma-Related Outcomes

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

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LinkOut - more resources

Full Text Sources

Medical