Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group

BACKGROUND

 Allergic rhinitis (AR) has a significant impact on the community as a whole with regard to quality of life and its relationship to allergic multi-morbidities. Appropriate diagnosis, treatment and review of the efficacy of interventions can ameliorate these effects. Yet, the importance of AR is often overlooked, and appropriate therapy is neglected. The availability of effective medications and knowledge as to management are often lacking in both public and private health systems.

METHODS

 This review is based on a comprehensive literature search and detailed discussions by the South African Allergic Rhinitis Working Group (SAARWG).

RESULTS

 The working group provided up-to-date recommendations on the epidemiology, pathology, diagnosis and management of AR, appropriate to the South African setting.

CONCLUSION

 Allergic rhinitis causes significant, often unappreciated, morbidity. It is a complex disease related to an inflammatory response to environmental allergens. Therapy involves education, evaluation of allergen sensitisation, pharmacological treatment, allergen immunotherapy (AIT) and evaluation of the success of interventions. Regular use of saline; the important role of intranasal corticosteroids, including those combined with topical antihistamines and reduction in the use of systemic steroids are key. Practitioners should have a thorough knowledge of associated morbidities and the need for specialist referral.Contribution: This review summarises the latest developments in the diagnosis and management of AR such that it is a resource that allows easy access for family practitioners and specialists alike.

Associations of particulate matter, gaseous pollutants, and road traffic noise with the prevalence of asthma in children

The purposes of this study were to elucidate the associations between exposure to particulate matter, gaseous pollutants, and road traffic noise and asthma prevalence and to determine the interaction between exposure to multiple pollutants and asthma in children. A total of 3,246 children were recruited from 11 kindergartens in New Taipei City, Taiwan. Land use regression (LUR) was used to establish predictive models for estimating individual exposure levels of particulate matter, gaseous pollutants, and the 24 h A-weighted equivalent sound pressure level (LAeq,24). Multiple logistic regression was performed to test the associations between exposure to these environmental factors and asthma prevalence in children. Multiple-exposure models revealed that an interquartile-range (IQR) increase in PM2.5 (1.17 μg/m3) and PM10 (10.69 μg/m3) caused a 1.34-fold (95% confidence interval [CI] = 1.05-1.70) and 1.17-fold (95% CI = 1.01-1.36) increase in risk of asthma prevalence in children after adjusting for LAeq,24 and NO2. Co-exposure to PM2.5, LAeq,24, and O3, SO2, or CO, as well as co-exposure to PM10, LAeq,24, and CO produced similar findings. Only exposure to one IQR of SO2 (0.15 ppb) was observed a significant association (odds ratio = 1.16, 95% CI = 1.00-1.34) with the asthma prevalence in children after adjusting for PM10 and LAeq,24. Exposure to PM2.5, PM10, and SO2 may be associated with a higher asthma prevalence in children, while other gaseous pollutants and road traffic noise did not demonstrate significant associations. The interaction of exposure to air pollutants and road traffic noise on asthma prevalence in children was not observed in this study.

Filter blot method: A simple method for measuring 3-nitrotyrosine in proteins of atmospheric particulate matter

Air pollutants, such as nitrogen dioxide (NO₂), ozone (O₃), and particulate matter (PM), have been epidemiologically reported to contribute to the onset and exacerbation of asthma. We have previously shown that several proteins in atmospheric PM are allergenic in mouse asthma models and that these proteins are nitrated by atmospheric NO₂ and O₃ in chemical reactions. Based on these results, the amount of 3-nitrotyrosine (3-NT) in atmospheric PM could be an air pollution marker integrating NO₂, O₃, and PM. We established a method to measure 3-NT by high-performance liquid chromatography electrochemical detection (HPLC-ECD). Although this method is accurate, it requires a filter treatment process, which is time-consuming and costly for an environmental monitoring tool, in which many samples are measured simultaneously. Therefore, in this study, we investigated a simple immunoblotting method in which atmospheric PM proteins were directly transferred to a polyvinylidene fluoride (PVDF) membrane and measured using an anti-3-NT antibody (the filter blot method). The 3-NT value obtained from this method was significantly correlated (r = 0.809, p < 0.001) with that of the HPLC-ECD method, with a detection power of 0.1 μg/mL for tyrosine nitrated bovine serum albumin equivalents. Multiple regression analysis using the filter blot method showed that the amount of 3-NT in atmospheric PM was significantly associated with the published environmental measurements of O₃ and PM in the region. Therefore, the filter blot method may be useful for the environmental monitoring of 3-NT in atmospheric PM.

India's Opportunities and Challenges in Establishing a Twin Registry: An Unexplored Human Resource for the World's Second-Most Populous Nation

Nature and nurture have always been a prerogative of evolutionary biologists. The environment's role in shaping an organism's phenotype has always intrigued us. Since the inception of humankind, twinning has existed with an unsettled parley on the contribution of nature (i.e. genetics) versus nurture (i.e. environment), which can influence the phenotypes. The study of twins measures the genetic contribution and that of the environmental influence for a particular trait, acting as a catalyst, fine-tuning the phenotypic trajectories. This is further evident because a number of human diseases show a spectrum of clinical manifestations with the same underlying molecular aberration. As of now, there is no definite way to conclude just from the genomic data the severity of a disease or even to predict who will get affected. This greatly justifies initiating a twin registry for a country as diverse and populated as India. There is an unmet need to set up a nationwide database to carefully curate the information on twins, serving as a valuable biorepository to study their overall susceptibility to disease. Establishing a twin registry is of paramount importance to harness the wealth of human information related to the biomedical, anthropological, cultural, social and economic significance.

Allergic Rhinitis: A Clinical and Pathophysiological Overview

Allergic rhinitis (AR) represents a global health concern where it affects approximately 400 million people worldwide. The prevalence of AR has increased over the years along with increased urbanization and environmental pollutants thought to be some of the leading causes of the disease. Understanding the pathophysiology of AR is crucial in the development of novel therapies to treat this incurable disease that often comorbids with other airway diseases. Hence in this mini review, we summarize the well-established yet vital aspects of AR. These include the epidemiology, clinical and laboratory diagnostic criteria, AR in pediatrics, pathophysiology of AR, Th2 responses in the disease, as well as pharmacological and immunomodulating therapies for AR patients.

Environmental Influences and Allergic Diseases in the Asia-Pacific Region: What Will Happen in Next 30 Years?

Asia-Pacific is a populous region with remarkable variations in socioeconomic development and environmental exposure among countries. The prevalence rates of asthma and allergic rhinitis appear to have recently reached a plateau in Western countries, whereas they are still increasing in many Asian countries. Given the large population in Asia, even a slight increase in the prevalence rate will translate into an overwhelming number of patients. To reduce the magnitude of the increase in allergic diseases in next few decades in Asia, we must understand the potential factors leading to the occurrence of these disorders and the development of potential preventive strategies. The etiology of allergic disorders is likely due to complex interactions among genetic, epigenetic, and environmental factors for the manifestations of inappropriate immune responses. As urbanization and industrialization inevitably progress in Asia, there is an urgent need to curtail the upcoming waves of the allergy epidemic. Potentially modifiable risk exposure, such as air pollution, should be minimized through timely implementation of effective legislations. Meanwhile, re-introduction of protective factors that were once part of the traditional farming lifestyle might give new insight into primary prevention of allergy.

Comparison of the characterization of allergenic protein 3 (Pla a3) released from Platanus pollen grains collected in Shanghai during the spring of 2019 and 2020

Due to the COVID-19 pandemic in early 2020, large-scale industrial production has been stagnant and reduced, the urban air quality has been greatly improved. It provided an excellent opportunity to explore the effects of air pollutants on the sensitization of pollen allergen proteins in the environment. Platanus pollen grains sampled in the spring of 2019 and 2020 were used for detailed characterization and analysis. Scanning electron microscopy, Fourier transform infrared, X-ray spectroscopy (XPS), trypan blue staining, and western blot analysis were employed to characterize Platanus pollen protein released from pollen grains. Our data showed that the viability of the pollen grains in 2019 was lower compared that in 2020, and the pollen grains collected in 2019 had a higher absorption peak of protein functional groups. The XPS spectra assay result demonstrated that the binding energy of the high-resolution components had not variation on the surface of pollen grains, but relative content of nitrogen and peptide chain in the pollen grains sampled in 2019 were higher than in 2020. These results suggested that more protein in the pollen grains was released onto the surface of pollen grains. In addition, western blot assay showed that the expression of Pla a3 protein in pollen grains sampled in 2019 was significantly higher than that in 2020, revealing that air pollutants could enhance the expression of Pla a3 proteins in Platanus pollen.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10453-021-09731-6.

The role of the environment in shaping the trends of childhood asthma - An Asian perspective

Asthma has now become one of the most common atopic disorders not only in developed countries but also in many developing countries. The etiology is likely due to a complex interaction between genetic and environmental factors. In many Asian countries, the prevalence of asthma has also been documented by validated instruments to be increasing rapidly over the past two decades. However, studies in rural areas in Asia with a traditional farming environment revealed markedly lower asthma prevalence when compared with residents in nearby cities despite having similar genetic background. Among the environmental factors implicated in the pathogenesis of asthma, air pollution, dietary patterns, viral infections, and early microbial exposure have been studied extensively around the world. Asia provides many opportunities to study these potential factors as there are many ethnic groups living in distinctly different environments. The understanding of the roles of these factors in affecting the early immune system and subsequent development of asthma will enable us to develop potential primary preventive strategies against a disease which affects millions worldwide.

Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis

Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%-89% of the chronic rhinitis cases, affecting 1%-50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%-67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.

The effect of air pollution on drivers' safety performance

Numerous studies have determined the adverse effects of air pollution on the health, welfare, and comfort of humans. More recently, the effects of air pollution on cognitive performance of humans are also focused. However, as a group in direct exposure to air pollution, drivers are rarely studied. The present study aims to evaluate the effect of air pollution on the performance of drivers. Their performance is evaluated by observing the number of recorded accidents. The effect of pollutant concentration (primarily PM_2.5) on the number of accidents is investigated in a case study in Tehran. The temperature inversion phenomenon is used as an instrumental variable in a two-stage least squares method. The results indicate that temperature inversion had a significant positive correlation with the concentration of pollutants. Considering temperature inversion as an instrumental variable for these pollutants, it is observed that 1 μg/m³ increase in concentration of PM_2.5, increased the number of accidents approximately by 4% in 1 day, for the range of parameters studied. No significant relationship was observed regarding the effect of NO₂ and CO on accidents during the study period.

Impact of Particulate Matter on the Clinical Characteristics of Rhinitis

OBJECTIVES/HYPOTHESIS

To investigate the association between PM₁₀ concentration and the severity of rhinitis symptoms.

STUDY DESIGN

Retrospective cohort study.

METHODS

Retrospective analysis of the data of 590 participants prospectively enrolled in a regional population-based cohort study was performed. The ambient PM₁₀ concentrations were measured at 12 different observatories located in three cities. All participants were screened for allergic sensitization by skin prick tests and asked to complete questionnaires regarding their rhinitis symptoms. The severity and duration of rhinitis were analyzed and compared at different levels of PM₁₀ concentration_. RESULTS: On multivariate analysis, the PM₁₀ concentration significantly correlated with the severity of symptoms when adjusting for age, sex, presence of sensitized allergen, region, and the time of enrolment (β = 0.102, P = .021). Positive correlation was found between PM₁₀ concentration and the duration of allergic rhinitis symptoms (β = 0.082, P = .077). In the stratified analysis on the atopic status, there was a significant correlation between PM₁₀ concentration and the severity and duration of rhinitis symptoms in those without allergic sensitization (β = 0.104; P = .032 and β = 0.104; P = .011, respectively).

CONCLUSIONS

The significant correlation between the annual PM10 concentration and severity and duration of rhinitis symptoms suggests the necessity of intensive management of rhinitis patients exposed to elevated levels of ambient PM10 concentration.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:E1753-E1759, 2021.

Short-term effects of air pollution on exacerbations of allergic asthma in Užice region, Serbia

Introduction

Many time-series studies have shown a positive association between air pollution and asthma exacerbation. However, till now only one study in Serbia has examined this relationship.

Aim

To examine the associations between air pollution and asthma emergency department (ED) visits in the Užice region, Serbia.

Material and methods

A time-stratified case-crossover design was applied to 424 ED visits for asthma exacerbation that occurred in the Užice region, Serbia, in 2012–2014. Data about ED visits were routinely collected in the Užice Health Centre. The daily average concentrations of particulate matter (PM_2.5 and PM₁₀), sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and black carbon (BC) were measured by automatic ambient air quality monitoring stations. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity and air pressure).

Results

Statistically significant associations were observed between ED visits for asthma and 3-day lagged exposure to BC (OR = 3.23; 95% CI: 1.05–9.95), and between ED visits for asthma with coexisting allergic rhinitis and 0-day lag exposure to NO₂ (OR = 1.57; 95% CI: 0.94–2.65), 2-day lag exposure to SO₂ (OR = 1.97; 95% CI: 1.02–3.80), and 3-day lag exposure to PM₁₀ (OR = 2.38; 95% CI: 1.17–4.84).

Conclusions

Exposure to ambient air pollution in the Užice region increases the risk of ED visits for asthma, particularly during the heating season.

The Effects of Short-Term and Very Short-Term Particulate Matter Exposure on Asthma-Related Hospital Visits: National Health Insurance Data

PURPOSE

The purpose of this study was to investigate the effects of short-term and very short-term exposure to particulate matter (PM) exceeding the daily average environmental standards for Korea (≤100 μg/m³ for PM10 and ≤50 μg/m³ for PM2.5) on on asthma-related hospital visits.

MATERIALS AND METHODS

This was a population-based, case-crossover study using National Health Insurance and air pollution data between January 1, 2014 and December 31, 2016. The event day was defined as a day when PM exceeded the daily average environmental standard (short-term exposure) or daily average environmental standard for 2 hours (very short-term exposure). The control day was defined as the same day of the week at 1 week prior to the event day.

RESULTS

Compared with control days, asthma-related hospital visits on the 24-hr event days and 2-hr event days increased by 4.10% and 3.45% for PM₁₀ and 5.66% and 3.74% for PM_2.5, respectively. Asthma-related hospital visits increased from the 24-hr event day for PM₁₀ to 4 days after the event day, peaking on the third day after the event day (1.26, 95% confidence interval, 1.22-1.30). Hospitalizations also increased on the third day after the event. While there was a difference in magnitude, PM_2.5 exposure showed similar trends to PM₁₀ exposure.

CONCLUSION

We found a significant association between short-term and very short-term PM exposure exceeding the current daily average environmental standards of Korea and asthma-related hospital visits. These results are expected to aid in establishing appropriate environmental standards and relevant policies for PM.

Health Effects of Ambient Air Pollution in Developing Countries

The deleterious effects of ambient air pollution on human health have been consistently documented by many epidemiologic studies worldwide, and it has been calculated that globally at least seven million deaths are annually attributable to the effects of air pollution. The major air pollutants emitted into the atmosphere by a number of natural processes and human activities include nitrogen oxides, volatile organic compounds, and particulate matter. In addition to the poor ambient air quality, there is increasing evidence that indoor air pollution also poses a serious threat to human health, especially in low-income countries that still use biomass fuels as an energy resource. This review summarizes the current knowledge on ambient air pollution in financially deprived populations.

Allergic disease associations with regional and localized estimates of air pollution

BACKGROUND

Exposure to multiple types of air pollution may contribute to and exacerbate allergic diseases including asthma and wheezing. However, few studies have examined chronic air pollution exposure and allergic disease outcomes among an adult population. Associations between potential estimates of annual average fine particulate matter (PM2.5), traffic related air pollution, and industrial source air emissions and three allergic disease outcomes (asthma, allergies and wheezing) were examined in a state-wide general population of adults.

METHODS

The study includes a representative sample of 3381 adult Wisconsin residents who participated in the 2008-2013 Survey of the Health of Wisconsin (SHOW) program. Participant data were geographically linked to The United States Environmental Protection Agency (USEPA) Baysian space-time downscaler air pollution model for PM2.5, the United States Census roadway, and USEPA's Toxic Release Inventory data. Self-report and lung function (FEV1) estimates were used to define prevalence of asthma, allergies and wheezing symptoms.

RESULTS

Annual mean exposure to fine particulate matter (PM2.5) was between 6.59 and 15.14μg/m3. An increase of 5μg/m3 in the annual mean PM2.5 resulted in a 3.58 (2.36, 5.43) increase in the adjusted odds (95% CI) of having asthma. Exposure to vehicle traffic increased the odds of both current allergies [OR (95% CI)=1.35 (1.07, 1.35)] and current asthma [OR (95% CI)=1.51 (1.14, 2.00)]. Living within 300m of an Interstate roadway was associated with a 3-fold increase in the odds of asthma. Those living within 800m of an industrial site were 47% more likely to have asthma. No significant associations were seen with wheezing.

CONCLUSIONS

Within this population exposed to overall annual average levels of estimated low level chronic exposure to fine particulate matter (PM2.5) at or near 12μg/m3, the USEPA standard for air quality, significant association between both modeled PM2.5 exposure and proximity to roadways with asthma and allergies but not wheezing were found. Industrial source emissions were not associated with any allergic disease outcomes.

Dose- and time- effect responses of DNA methylation and histone H3K9 acetylation changes induced by traffic-related air pollution

As an important risk factor of respiratory disorders, traffic-related air pollution (TRAP) has caused extensive concerns. Epigenetic change has been considered a link between TRAP and respiratory diseases. However, the exact effects of TRAP on epigenetic changes are still unclear. Here we investigated the dose- and time- effect responses of TRAP on DNA methylations and H3K9 acetylation (H3K9ac) in both blood and lung tissues of rats. The findings showed that every 1 μg/m³ increase of TRAP components were associated with changes in %5 mC (95% CI) in LINE-1, iNOS, p16^CDKN2A, and APC ranging from −0.088% (−0.150, −0.026) to 0.102 (0.049, 0.154), as well as 0.276 (0.053, 0.498) to 0.475 (0.103, 0.848) ng/mg increase of H3K9ac. In addition, every 1 more day exposure at high level of TRAP (in tunnel) also significantly changed the levels of DNA methylation (ranging from −0.842% to 0.248%) and H3K9ac (16.033 and 15.718 ng/mg pro in PBMC and lung tissue, respectively) changes. Season and/or sex could interact with air pollutants in affecting DNA methylation and H3K9ac. The findings showed that TRAP exposure is dose- and time- dependently associated with the changes of DNA methylation and H3K9ac.

The Association between Ambient Air Pollution and Allergic Rhinitis: Further Epidemiological Evidence from Changchun, Northeastern China

With the continuous rapid urbanization process over the last three decades, outdoors air pollution has become a progressively more serious public health hazard in China. To investigate the possible associations, lag effects and seasonal differences of urban air quality on respiratory health (allergic rhinitis) in Changchun, a city in Northeastern China, we carried out a time-series analysis of the incidents of allergic rhinitis (AR) from 2013 to 2015. Environmental monitoring showed that PM_2.5 and PM₁₀ were the major air pollutants in Changchun, followed by SO₂, NO₂ and O₃. The results also demonstrated that the daily concentrations of air pollutants had obvious seasonal differences. PM₁₀ had higher daily mean concentrations in spring (May, dust storms), autumn (October, straw burning) and winter (November to April, coal burning). The mean daily number of outpatient AR visits in the warm season was higher than in the cold season. The prevalence of allergic rhinitis was significantly associated with PM_2.5, PM₁₀, SO₂ and NO₂, and the increased mobility was 10.2% (95% CI, 5.5%–15.1%), 4.9% (95% CI, 0.8%–9.2%), 8.5% (95% CI, −1.8%–19.8%) and 11.1% (95% CI, 5.8%–16.5%) for exposure to each 1-Standard Deviation (1-SD) increase of pollutant, respectively. Weakly or no significant associations were observed for CO and O₃. As for lag effects, the highest Relative Risks (RRs) of AR from SO₂, NO₂, PM₁₀ and PM_2.5 were on the same day, and the highest RR from CO was on day 4 (L4). The results also indicated that the concentration of air pollutants might contribute to the development of AR. To summarize, this study provides further evidence of the significant association between ambient particulate pollutants (PM_2.5 and PM₁₀, which are usually present in high concentrations) and the prevalence of respiratory effects (allergic rhinitis) in the city of Changchun, located in Northeastern China. Environmental control and public health strategies should be enforced to address this increasingly challenging problem.

Particularities of allergy in the Tropics

Allergic diseases are distributed worldwide and their risk factors and triggers vary according to geographical and socioeconomic conditions. Allergies are frequent in the Tropics but aspects of their prevalence, natural history, risk factors, sensitizers and triggers are not well defined and some are expected to be different from those in temperate zone countries. The aim of this review is to investigate if allergic diseases in the Tropics have particularities that deserve special attention for research and clinical practice. Such information will help to form a better understanding of the pathogenesis, diagnosis and management of allergic diseases in the Tropics. As expected, we found particularities in the Tropics that merit further study because they strongly affect the natural history of common allergic diseases; most of them related to climate conditions that favor permanent exposure to mite allergens, helminth infections and stinging insects. In addition, we detected several unmet needs in important areas which should be investigated and solved by collaborative efforts led by the emergent research groups on allergy from tropical countries.

Characteristics of traditional Chinese medicine users and prescription analysis for pediatric atopic dermatitis: a population-based study

Background

Atopic dermatitis among children is an important issue due to relapses and skin manifestations. Traditional Chinese medicine (TCM) is commonly used to treat children with atopic dermatitis. The aim of this study was to investigate the characteristics and TCM prescriptions of patients with atopic dermatitis using a nationwide database.

Methods

Children younger than 12 years of age diagnosed with atopic dermatitis, defined as ICD-9-CM codes 691.8 and 692.x, were identified from the database. Data on age, diagnosis codes, area of residence and use of corticosteroids of the TCM users were recorded. Association rule mining was used to analyze the prescriptions used for atopic dermatitis.

Results

We identified 13,646 children with atopic dermatitis using TCM in 2007. Female gender (OR: 0.83 for male gender), adolescence (OR: 10.0, 95 % CI: 8.88–11.15) and allergic rhinitis (OR: 2.44, 95 % CI: 2.10–2.85) were associated with the use of TCM. Fewer of the TCM users were prescribed with corticosteroids (35.8 % of all TCM users), but the TCM users had a higher rate of long-term topical corticosteroid therapy (10.6 % for TCM users versus 2.0 % for those who did not use TCM). Chinese herbal medicine (CHM) was used by 93.7 % of all TCM users in 36,398 prescriptions. On average, 5.6 kinds of CHM were used in combination. The relationship between the CHMs constituted a network, in which Xiao-Feng-San was the core treatment for atopic dermatitis.

Conclusions

In this study, we described the characteristics of children with atopic dermatitis who use TCM in Taiwan. and identified the core CHM treatment. Further research on the safety and efficacy of this treatment are still needed.

H3K9 acetylation change patterns in rats after exposure to traffic-related air pollution

Traffic-related air pollution (TRAP) has been acknowledged as a potential risk factor for numerous respiratory disorders including lung cancer; however, the exact mechanisms involved are still unclear. Here we investigated the effects of TRAP exposure on the H3K9 acetylation in rats. The exposure was performed in both spring and autumn with identical study procedures. In each season, 48 healthy Wistar rats were exposed to different levels of TRAP for 4 h, 7 d, 14 d, and 28 d, respectively. H3K9 acetylation levels in both the peripheral blood mononuclear cells (PBMCs) and lung tissues were quantified. Multiple linear regression was applied to assess the influence of air pollutants on H3K9 acetylation levels. The levels of PM2.5, PM10, and NO2 in the tunnel and crossroad groups were significantly higher than in the control group. The H3K9 acetylation levels were not significantly different between spring and autumn. When spring and autumn data were analyzed together, no significant association between the TRAP and H3K9 acetylation was found in 4h exposure window. However, in the 7 d exposure window, PM2.5 and PM10 exposures were associated with changes in H3K9 acetylation ranging from 0.276 (0.053, 0.498) to 0.475 (0.103, 0.848) per 1 μg/m(3) increase in the pollutant concentration. In addition, prolonged exposure of the rats in the tunnel showed that both PM2.5 and PM10 concentrations were positively associated with H3k9 acetylation in both PBMCs and lung tissues. The findings showed that 7-d and prolonged TRAP exposure could effectively increase the H3K9 acetylation level in both PBMCs and lung tissues of rats.

Allergens, air pollutants, and childhood allergic diseases

BACKGROUND

The synergistic effect of allergens and air pollutants on the risk of allergic diseases is unclear.

OBJECTIVE

To evaluate the joint effect of outdoor pollutants and indoor allergens on the risk of allergic diseases.

METHODS

We enrolled 2661 kindergarten children from the CEAS cohort. Data on allergic diseases and environmental exposure were collected. Skin prick tests were performed. Individual exposure to air pollution was estimated using a geographic information system with the mean concentration of air pollutants. Multiple logistic regression analysis was performed to estimate the association between air pollutants, allergen exposure and the risk of allergic diseases with adjustments for potential confounders.

RESULTS

Overall, 12.6% of the children had asthma, 30.0% had allergic rhinitis (AR), and 14.4% had atopic dermatitis (AD). Mite sensitization significantly increased the risk of AD, AR, and asthma (OR (95%CI) 2.15 (1.53-3.03), 1.94 (1.46-2.58), and 2.31 (1.63-3.29), respectively). Exposure to PM10, PM(2.5), CO, and O(3) was associated with asthma (OR (95% CI) 1.39 (1.03-1.87), 1.45 (1.07-1.97), 1.36 (1.01-1.83), and 0.68 (0.51-0.92), respectively). PM(2.5) may have increased the risk of AR (OR (95% CI) 1.54 (1.03-2.32). Mite sensitization showed a synergistic effect with PM(2.5) on the development of asthma (p < 0.001). Moreover, mite allergens may modify the effect of air pollutants on allergic diseases.

CONCLUSION

Dust mites and PM(2.5) play an important role on the risk of asthma and AR. Exposure to PM(2.5) and mite allergens had a synergistic effect on the development of asthma. Avoiding co-exposure to allergens and air pollutants is important.

Effect of nitrogen dioxide and sulfur dioxide on viability and morphology of oak pollen

BACKGROUND

Nitrogen dioxide (NO2) and sulfur dioxide (SO2) generated by excessive coal combustion and motor vehicle emissions are major air pollutants in the large cities of China. The objective of our study was to determine the effects of the exposure of oak pollens (Quercusmongolica) to several concentrations of NO2 or SO2.

METHODS

Pollen grains were exposed to 0.5 ppm to 5.0 ppm NO2 or SO2 for 4 hours and assessed for morphological damage by field emission scanning electron microscopy and for viability using the trypan blue stain. Morphological changes in pollen grains were also examined after contact with acid solutions at pH 4.0 to pH 7.0.

RESULTS

Exposure to NO2 or SO2 significantly damaged pollen grains at all concentrations investigated, compared to exposure to air; with exposure to concentrations of 0.5 ppm to 2 ppm resulting in fissures or complete breaks in the exine and a concentration of 5 ppm resulting in complete breakdown and release of pollen cytoplasmic granules. Significantly greater amounts of pollen grain were damaged after exposure to SO2 (15.5-20.4%) than after exposure to NO2 (7.1-14.7%). Similarly, exposure to NO2 or SO2 significantly decreased the viability of pollen grains, compared with exposure to air; with SO2 being slightly more detrimental than NO2. Exposure to acid solutions also induced pollen damage, which appeared to be pH-dependent (from 24.6% at pH 6.0 to 55.8% at pH 4.0; compared to 3.8% at pH 7.0).

CONCLUSION

Short-term exposure of oak pollen to high concentrations of SO2 or NO2 significantly increases their fragility and disruption, leading to subsequent release of pollen cytoplasmic granules into the atmosphere. These results suggest that heightened air pollution during the oak pollen season may possibly increase the incidence of allergic airway disease in sensitized individuals by facilitating the bioavailability of airborne pollen allergens.

Ambient air quality and the effects of air pollutants on otolaryngology in Beijing

To investigate temporal patterns, pollution concentrations and the health effects of air pollutants in Beijing we carried out time-series analyses on daily concentrations of ambient air pollutants and daily numbers of outpatient visits for otolaryngology over 2 years (2011-2012) to identify possible health effects of air pollutants. The results showed that PM10 was the major air pollutant in Beijing and that air quality was slightly better in 2012 than in 2011. Seasonal differences were apparent for SO2 and NO2. Both the background and urban areas of Beijing experienced particulate matter pollution in 2011. In addition to local air pollution, Beijing was also affected by pollutants transported from other regions, especially during heavy air pollution episodes. PM10, NO2, and SO2 concentrations showed positive associations with numbers of outpatient visits for otolaryngology during winter. NO2 and SO2 also had adverse ear, nose, and throat health effects outside of winter. The ear, nose, and throat health risks caused by air pollutants were higher during the winter than during the summer. NO2 had stronger influence on increased the likelihood of outpatient visits than SO2. The findings provide additional information about air quality and health effects of air pollution in Beijing.

Link between environmental air pollution and allergic asthma: East meets West

With the levels of outdoor air pollution from industrial and motor vehicle emissions rising rapidly in the fastly-industrializing countries of South East Asia, the prevalence of asthma and allergic diseases has also been increasing to match those in the West. Epidemiological and experimental exposure studies indicate a harmful impact of outdoor air pollution from vehicles and factories both on the development of allergic diseases and asthma and the increase in asthma symptoms and exacerbations. The level of outdoor pollution in Asia is much higher and more diverse than those encountered in Western countries. This may increase the impact of outdoor pollution on health, particularly lung health in Asia. This review discusses the constituents of air pollution in Asia with a special focus on studies in mainland China and Taiwan where the levels of pollution have reached high levels and where such high levels particularly in winter can cause a thick haze that reduces visibility. The onus remains on regulatory and public health authorities to curb the sources of pollution so that the health effects on the population particularly those with lung and cardiovascular diseases and with increased susceptibility can be mitigated.

Recent advances on diagnosis and management of childhood asthma and food allergies

The epidemic of childhood allergic disorders has been associated to the decline of infectious disease. However, exposure to many triggers (airborne viruses, tobacco smoke, pollution, indoor allergens, etc.) contribute to the disease. Breast feeding practices, nutrition, dietary and obesity also play a multifaceted role in shaping the observed worldwide trends of childhood allergies. Guidelines for treatment are available, but their implementation is suboptimal. Then developed countries are slowing learning integrating the development of suitable guidelines with implementation plans. Awareness, psychosocial and family factors strongly influence asthma and food allergy control. Moreover, monitoring tools are necessary to facilitate self-management. By taking into consideration these and many other pragmatic aspects, national public health programs to control the allergic epidemic have been successful in reducing its impact and trace the need for future research in the area.

Recent advances in asthma biomarker research

Asthma is characterized by recurrent and reversible airflow obstruction, which is routinely monitored by history and physical examination, spirometry and home peak flow diaries. As airway inflammation is central to asthma pathogenesis, its monitoring should be part of patient management plans. Fractional exhaled nitric oxide level (FeNO) is the most extensively studied biomarker of airway inflammation, and FeNO references were higher in Chinese (Asians) than Whites. Published evidence was inconclusive as to whether FeNO is a useful management strategy for asthma. Other biomarkers include direct (histamine, methacholine) and indirect (adenosine, hypertonic saline) challenges of bronchial hyperresponsiveness (BHR), induced sputum and exhaled breath condensate (EBC). A management strategy that normalized sputum eosinophils among adult patients resulted in reductions of BHR and asthma exacerbations. However, subsequent adult and pediatric studies failed to replicate these benefits. Asthma phenotypes as defined by inflammatory cell populations in sputum were also not stable over a 12-month period. A recent meta-analysis concluded that induced sputum is not accurate enough to be applied in routine monitoring of childhood asthma. There is poor correlation between biomarkers that reflect different asthma dimensions: spirometry (airway caliber), BHR (airway reactivity) and FeNO or induced sputum (airway inflammation). Lastly, EBC is easily obtained noninvasively by cooling expired air. Many biomarkers ranging from acidity (pH), leukotrienes, aldehydes, cytokines to growth factors have been described. However, significant overlap between groups and technical difficulty in measuring low levels of inflammatory molecules are the major obstacles for EBC research. Metabolomics is an emerging analytical method for EBC biomarkers. In conclusion, both FeNO and induced sputum are useful asthma biomarkers. However, they will only form part of the clinical picture. Longitudinal studies with focused hypotheses and well-designed protocols are needed to establish the roles of these biomarkers in asthma management. The measurement of biomarkers in EBC remains a research tool.

Advances in adult asthma diagnosis and treatment in 2012: potential therapeutics and gene-environment interactions

In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment.

Advances in environmental and occupational disorders in 2012

The year 2012 produced a number of advances in our understanding of the effect of environmental factors on allergic diseases, identification of new allergens, immune mechanisms in host defense, factors involved in asthma severity, and therapeutic approaches. This review focuses on the articles published in the Journal in 2012 that enhance our knowledge base of environmental and occupational disorders. Identification of novel allergens can improve diagnostics, risk factor analysis can aid preventative approaches, and studies of genetic-environmental interactions and immune mechanisms will lead to better therapeutics.

Advances in pediatric asthma in 2012: moving toward asthma prevention

Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.

Iron oxide particles modulate the ovalbumin-induced Th2 immune response in mice

This study was designed to investigate the modulatory effects of submicron and nanosized iron oxide (Fe(2)O(3)) particles on the ovalbumin (OVA)-induced immune Th2 response in BALB/c mice. Particles were intratracheally administered four times to mice before and during the OVA sensitization period. For each particle type, three different doses, namely 4×100, 4×250 or 4×500 μg/mouse, were used and for each dose, four groups of mice, i.e. group saline solution (1), OVA (2), particles (3), and OVA plus particles (4), were constituted. Mice exposed to OVA alone exhibited an allergic Th2-dominated response with a consistent increase in inflammatory scores, eosinophil numbers, specific IgE levels and IL-4 production. When the mice were exposed to OVA and to high and intermediate doses of iron oxide submicron- or nanoparticles, the OVA-induced allergic response was significantly inhibited, as evidenced by the decrease in eosinophil cell influx and specific IgE levels. However, the low dose (4×100 μg) of submicron particles had no significant effect on the OVA allergic response while the same dose of nanoparticles had an adjuvant effect on the Th2 response to OVA. In conclusion, these data demonstrate that the pulmonary immune response to OVA is a sensitive target for intratracheally instilled particles. Depending on the particle dose and size, the allergic response was suppressed or enhanced.

Essential oil components from Asarum sieboldii Miquel are toxic to the house dust mite Dermatophagoides farinae

In our effort to develop novel plant-derived acaricides, we examined the contact and fumigant toxicity of Asarum heterotropoides (Asarum sieboldii Miquel) essential oil constituents to the house dust mite Dermatophagoides farinae (Acari: Pyroglyphidae). Ten constituents, including methyl eugenol (relative amount 42.18 %), were identified by gas chromatography-mass spectroscopy (GC-MS) in the A. sieboldii Miq. essential oil. In contact toxicity tests, methyl eugenol (4.2 μg/cm(2), 24 h LD50) was most toxic to D. farinae, followed by benzyl benzoate (9.1 μg/cm(2)), A. sieboldii Miq. essential oil (37.7 μg/cm(2)), and dibutyl phthalate (DBP 57.9 μg/cm(2)). The potency of methyl eugenol and A. sieboldii Miq. essential oil was higher than benzyl benzoate and DBP, with mortalities of 100, 100, 94.6, and 13.2 %, respectively, after 2.5 h of exposure. In the vapor phase mortality bioassay, methyl eugenol and A. sieboldii Miq. essential oil resulted in 100 % mortality in closed containers after 24-h exposure, but only 4.7 and 7.9 %, respectively, in open containers, indicating that the toxicity in these tests was largely due to the vapor phase. Methyl eugenol and A. sieboldii Miq. essential oil merit further study as potential D. farinae control compounds.