Aeroallergens, air pollutants, and chronic rhinitis and rhinosinusitis

Air Quality, Allergic Rhinitis, and Asthma

This review article highlights air pollution as a critical global health concern with emphasis on its effects and role in the development and exacerbation of upper airway and lower airway disease with a focus on allergic rhinitis and asthma. This review underscores the World Health Organization's recognition of air pollution as the biggest environmental threat to human health. It discusses the various components and categories of air pollutants and the evidence-based effects they have on asthma and allergic rhinitis, ranging from pathogenesis to exacerbation of these conditions across various age groups in different geographic locations.

Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study

Background

The prevalence of allergic rhinitis (AR) has been increasing steadily worldwide, especially in countries with increasing industrialization such as China. However, available evidence regarding AR prevalence among Chinese adults is scarce and limited to regional data collected in earlier years. We therefore aimed to provide a more recent and robust estimate of AR prevalence using a nationwide representative cross-sectional study in China.

Methods

Data of 184 326 participants aged 18 years or older were obtained from the China Chronic Disease and Risk Factor Surveillance conducted in 2018-2019. AR was determined by self-reported sneezing, nasal itching, obstruction, or rhinorrhea symptoms for at least 1 h in the absence of a cold or flu within the last 12 months. Multivariable logistic model was used to examine the risk factors of AR, and a possible non-linear relationship was further tested by restricted cubic spline. Potential additive interactions of risk factors with sex, residence, and geographic region were assessed by relative excess risk due to interaction (RERI).

Results

The weighted prevalence of AR was 8.1% (95% confidence interval [CI], 7.4%-8.7%), of whom 23.7% (95% CI, 21.3%-26.0%) were aware of their diagnosis. Increased odds of AR were associated with younger age, men, living in urban area or north region, more education, smoking, underweight, and higher income. Despite the nonsignificant linear trend, the spline regression demonstrated a non-linear association between AR and sleep duration, with higher odds at both ends. Additionally, the observed associations were generally stronger among men and people living in urban area and north region, with significant RERI ranging from 0.07 (95% CI, 0.00-0.14) to 0.40 (95% CI, 0.12-0.67).

Conclusions

AR is prevalent in China and the associated factors and interactions are helpful to design targeted preventive strategies towards certain subpopulations. The low awareness of AR calls for a national effort on AR screening.

[Phage therapy in overcoming antibiotic resistance in chronic rhinosinusitis]

The relevance of the study is due to the observed increase in antibiotic resistance of the main pathogens of chronic rhinosinusitis.

OBJECTIVE

To evaluate the effectiveness of phage therapy in the complex treatment of exacerbations of chronic rhinosinusitis.

MATERIAL AND METHODS

The study included 55 patients with a verified diagnosis of chronic rhinosinusitis and a history of periodic exacerbations throughout the year, hospitalized at the St. Petersburg State Budgetary Institution «Elizabeth Hospital» from January 2022 to February 2023.Depending on the antimicrobial treatment received, patients were divided into groups that received an antibiotic or a bacteriophage.All patients underwent puncture of the maxillary sinuses. All patients in the first group taking an antibiotic, underwent sinus rinse with saline, and in the second group, a bacteriophage sinus rinse was used. Material from the first puncture of the maxillary sinuses was used to determine sensitivity to antibiotics and bacteriophages.

RESULTS AND DISCUSSION

The average duration of treatment to positive outcome in the group receiving antibiotic therapy was 8±1.59 days, whereas in the group receiving bacteriophage therapy 7.69±1.35 days (p=0.3008). There were no significant differences between groups in the average duration of treatment until a favorable outcome was achieved.

CONCLUSION

The high efficiency of phage therapy, the absence of its effect on the growth of antibiotic resistance allows us to recommend the use of bacteriophages in the treatment of chronic rhinosinusitis.

Independent associations of short- and long-term air pollution exposure with COVID-19 mortality among Californians

The growing literature demonstrating air pollution associations on COVID-19 mortality contains studies predominantly examining long-term exposure, with few on short-term exposure, and rarely both together to estimate independent associations. Because mechanisms by which air pollution may impact COVID-19 mortality risk function over timescales ranging from years to days, and given correlation among exposure time windows, consideration of both short- and long-term exposure is of importance. We assessed the independent associations between COVID-19 mortality rates with short- and long-term air pollution exposure by modeling both concurrently. Using California death certificate data COVID-19-related deaths were identified, and decedent residential information used to assess short- (4-week mean) and long-term (6-year mean) exposure to particulate matter <2.5µm (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃). Negative binomial mixed models were fitted on weekly census tract COVID-19 mortality adjusting for potential confounders with random effects for county and census tract and an offset for population. Data were evaluated separately for two time periods March 16, 2020-October 18, 2020 and October 19, 2020-April 25, 2021, representing the Spring/Summer surges and Winter surge. Independent positive associations with COVID-19 mortality were observed for short- and long-term PM_2.5 in both study periods, with strongest associations observed in the first study period: COVID-19 mortality rate ratio for a 2-μg/m³ increase in long-term PM_2.5 was 1.13 (95%CI:1.09,1.17) and for a 4.7-μg/m³ increase in short-term PM_2.5 was 1.05 (95%CI:1.02,1.08). Statistically significant positive associations were seen for both short- and long-term NO₂ in study period 1, but short-term NO₂ was not statistically significant in study period 2. Results for long-term O₃ indicate positive associations, however, only marginal significance is achieved in study period 1. These findings support an adverse effect of long-term PM_2.5 and NO₂ exposure on COVID-19 mortality risk, independent of short-term exposure, and a possible independent effect of short-term PM_2.5.

Prevalence, determinants of chronic rhinosinusitis and its impact on quality of life among students in Karachi, Pakistan

Background

Chronic rhinosinusitis (CRS) is a common public health issue among students.

Methodology

 A total of 300 undergraduate students were selected through multistage cluster sampling from three public-sector universities. Sino-nasal Outcome Test (SNOT-22) and Rhinosinusitis Disability Index (RSDI) were used for determining the quality of life. Chi-square and independent t-test were used.

Results

About 46% and 54% (p = 0.001) of social science and health science students were suffering from CRS, respectively. Around 7% and 9% of CRS patients had poor quality of life according to SNOT-22 and RSDI, respectively (p = 0.042 and p = 0.032, respectively).

Conclusion

Quality of life was affected in all domains of SNOT-22 and RSDI.

Air Pollution Exposure and the Development of Chronic Rhinosinusitis in the Active Duty Population

INTRODUCTION

It has been shown that combat environment exposure, including burn pits that produce particulate matter 2.5 (PM2.5), is associated with lower respiratory tract disease in the military population with increased hypothetical risk of upper respiratory disease, but no study has been done that examines the effects of non-combat environmental exposures on the development of chronic rhinosinusitis (CRS) in the active duty population. The primary goal of this study is to evaluate how air pollution exposure correlates to the development of CRS in active duty service members in the United States.

METHODS

The military electronic medical record was queried for active duty service members diagnosed with CRS by an otolaryngologist between January 2016 and January 2018, who have never deployed, stationed in the United States from 2015 to 2018 (n = 399). For each subject, the 1-year mean exposure of PM2.5, particulate matter 10 (PM10), nitrogen dioxide (NO2), and ozone was calculated. The control group was comprised of the same criteria except these patients were diagnosed with cerumen impaction and matched to the case group by age and gender (n = 399). Pollution exposure was calculated based on the Environmental Protection Agency's data tables for each subject. Values were calculated using chi-square test for categorical variables and the Mann-Whitney U-test for continuous variables.

RESULTS

Matched cases and controls (n = 399) with 33.1% male showed a statistically significant odds ratio (OR) of 5.99 (95% CI, 2.55-14.03) for exposure of every 5 µg/m3 of PM2.5 increase and the development of CRS when controlling for age, gender, and diagnosis year. When further adjusting for smoking status, the OR was still statistically significant at 3.15 (95% CI, 1.03-9.68). Particulate matter 10, ozone, and NO2 did not show any statistical significance. Odds ratios remained statistically significant when further adjusting for PM10 and ozone, but not NO2. Dose-dependent curves largely did not show a statistical significance; however, they did trend towards increased exposure of PM2.5 leading to an elevated OR.

CONCLUSION

This study showed that PM2.5 exposure is a major independent contributor to the development of CRS. Exposure to elevated levels produced statistically significant odds even among smokers and remained significant when controlling for other measured pollutants. There is still much to be understood about the genesis of CRS. From a pollution exposure perspective, a prospective cohort study would better elucidate the risk of the development of CRS among those exposed to other pollutants.

Analyzing the severity of coronavirus infections in relation to air pollution: evidence-based study from Saudi Arabia

COVID-19 is one of the major pandemics in history. It has caused various health problems to majority of countries in the world. Several researchers have examined and developed studies regarding concerns on air pollution being considered a major risk factor causing respiratory infections. Such infections are carried out by microorganisms, thus further affecting the immune system. The present study involves the relationship between air pollutants and the total COVID-19 infections along with the estimation of death rates in several regions of Saudi Arabia. The major goal of this study comprises the analysis of the relationship between air pollutants concentration, such as PM10, NO₂, CO, SO₂, and O₃, and the widespread outbreak of COVID-19. This scenario involves the transmission, number of patients, critical cases, and death rates. Results show that the estimation of recorded COVID-19 cases was in the most polluted regions; the mortality rate and critical cases were also more distinct in these regions than in other regions in Saudi Arabia. The finding of this study demonstrates a positive correlation between the mean values of PM10, NO₂, CO, and SO₂ pollutants. The results represent the significant relationship between air pollution resulting from a high concentration of NO₂ and COVID-19 infections and deaths. In addition, a null hypothesis of the relation between other pollutants and COVID-19 infections cannot be rejected. The study also indicates a significant correlation between the means of NO₂ and CO and the total number of critical cases. Negative correlations are obtained between the mean of O₃ and the total number of cases, total deaths, and critical case per cumulative days.

Long-term air pollution and COVID-19 mortality rates in California: Findings from the Spring/Summer and Winter surges of COVID-19

A growing number of studies report associations between air pollution and COVID-19 mortality. Most were ecological studies at the county or regional level which disregard important local variability and relied on data from only the first few months of the pandemic. Using COVID-19 deaths identified from death certificates in California, we evaluated whether long-term ambient air pollution was related to weekly COVID-19 mortality at the census tract-level during the first ∼12 months of the pandemic. Weekly COVID-19 mortality for each census tract was calculated based on geocoded death certificate data. Annual average concentrations of ambient particulate matter <2.5 μm (PM_2.5) and <10 μm (PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃) over 2014-2019 were assessed for all census tracts using inverse distance-squared weighting based on data from the ambient air quality monitoring system. Negative binomial mixed models related weekly census tract COVID-19 mortality counts to a natural cubic spline for calendar week. We included adjustments for potential confounders (census tract demographic and socioeconomic factors), random effects for census tract and county, and an offset for census tract population. Data were analyzed as two study periods: Spring/Summer (March 16-October 18, 2020) and Winter (October 19, 2020-March 7, 2021). Mean (standard deviation) concentrations were 10.3 (2.1) μg/m³ for PM_2.5, 25.5 (7.1) μg/m³ for PM₁₀, 11.3 (4.0) ppb for NO₂, and 42.8 (6.9) ppb for O₃. For Spring/Summer, adjusted rate ratios per standard deviation increase were 1.13 (95% confidence interval: 1.09, 1.17) for PM_2.5, 1.16 (1.11, 1.21) for PM₁₀, 1.06 (1.02, 1.10) for NO₂, and 1.09 (1.04, 1.14) for O₃. Associations were replicated in Winter, although they were attenuated for PM_2.5 and PM₁₀. Study findings support a relation between long-term ambient air pollution exposure and COVID-19 mortality. Communities with historically high pollution levels might be at higher risk of COVID-19 mortality.

The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence from in vitro, animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19. In vitro and in vivo studies are also strongly needed, in particular to more precisely explore the particle-virus interaction in air.

Urban Particulate Matters May Affect Endoplasmic Reticulum Stress and Tight Junction Disruption in Nasal Epithelial Cells

BACKGROUND

Exposure to airborne urban particulate matter (UPM) has been closely related to the development and aggravation of respiratory disease, including sinonasal disorders.

OBJECTIVE

The aims of this study were to investigate the effect of UPM on nasal epithelial tight junctions (TJs) and mucosal barrier function and delineate the underlying mechanism by using both in vitro and in vivo models.

METHODS

In this study, human nasal epithelial cells (hNECs) and BALB/c mice were exposed to UPMs. UPM 1648a and 1649 b were employed. TJ and endoplasmic reticulum (ER) stress marker expression was measured using western blot analysis and immunofluorescence. TJ integrity and nasal epithelial barrier function were evaluated by transepithelial electric resistance (TER) and paracellular flux. In addition, the effects of N-acetyl-L-cysteine (NAC) on UPM-induced nasal epithelial cells were investigated.

RESULTS

UPM significantly impaired the nasal epithelial barrier, as demonstrated by decreased protein expression of TJ and ER stress markers in human nasal epithelial cells. This finding was in parallel to reduced transepithelial electrical resistance and increased fluorescein isothiocyanate-dextran permeability. Pretreatment with NAC decreased the degree of UPM-mediated ER stress and restored nasal epithelial barrier disruption in human nasal epithelial cells (hNEC) and the nasal mucosa of experimental animals.

CONCLUSION

These data suggest that UPMs may induce nasal epithelial barrier dysfunction by targeting TJs and ER stress could be related in this process. Based on these results, we suggest that suppression of this process with an inhibitor targeting ER stress responses could represent a novel promising therapeutic target in UPM-induced sinonasal disease.

The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence from in vitro, animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19. In vitro and in vivo studies are also strongly needed, in particular to more precisely explore the particle–virus interaction in air.

Our review highlights that both short- and long-term exposures to air pollution may be important aggravating factors for SARS-CoV-2 transmission and COVID-19 severity and lethality through multiple mechanismshttps://bit.ly/395aS9w

Acute effects of ambient air pollution on outpatients with chronic rhinitis in Xinxiang, China

Air pollution exposure leads to increased mortality and morbidity rates of respiratory diseases. Most of the evidence was founded on acute diseases such as acute lower respiratory diseases. However, limited studies have been conducted to evaluate the effects of air pollution on chronic respiratory diseases. This time-series study was conducted to examine the acute effects of 6 criteria ambient air pollutants on hospital outpatients with chronic rhinitis (CR) in Xinxiang, China. We retrieved 223,826 outpatient records of patients with respiratory diseases, of which 62,901 were those of patients with CR. Results showed that the current 10-μg/m³ increase in fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) corresponds to 0.67% (95% confidence interval [CI]: 0.15-1.18%), 0.58% (95% CI: 0.24-0.92%), 1.89% (95% CI: 0.52-3.27%), 3.01% (95% CI: 1.66-4.35%), and 0.06% (95% CI: 0.03-0.10%) increments in outpatients with CR, respectively. In addition, the effects in the male were stronger than those in the female. Higher effect estimates were observed in the old (≥ 65 years of age) and younger (< 15 years of age) groups. Our study confirmed the association between air pollution and outpatients with CR in Xinxiang, China. More stringent air pollution control measures must be implemented.