Air pollution and respiratory allergic diseases in schoolchildren

Basis of preventive and non-pharmacological interventions in asthma

Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.

Factors associated with allergy traits around the 2nd year of life: a brazilian cohort study

BACKGROUND

Allergic status has been strongly influenced by early exposures; however, allergic diseases are hard to measure in early life. Thus, this study proposed a latent variable allergy traits around the second year of life and analyzed pre- and perinatal factors associated with this phenomenon.

METHODS

The study used data from the BRISA birth cohort, Ribeirão Preto, Brazil (n = 3644). The theoretical model included: family allergy (history of allergic rhinitis, atopic dermatitis, and asthma); gestational period variables (socioeconomic status, mother's skin color, pregestational body mass index - BMI, smoking, gestational diabetes, and hypertension); birth variables (gestational age, 5-minute Apgar score, birth weight, type of delivery), and early life factor (exclusive breast feeding). The outcome was allergy traits around the 2nd year of life, a latent variable deduced from the shared variance among medical diagnosis of allergic rhinitis, atopic dermatitis, and food allergy. The model was analyzed by structural equation modeling.

RESULTS

Higher socioeconomic status (SC = 0.256; p < 0.001) and higher family allergy values (SC = 1.224; p < 0.001) were associated with higher allergy trait values. Hypertension during pregnancy was associated with higher values (SC = 0.170; p = 0.022) and exclusive breast feeding (SC = -0.192; p < 0.001) with low allergy trait values.

CONCLUSION

Although socioeconomic and environmental factors were associated with allergy traits around the 2nd year of life, the family component of allergy was the exposure that best explained this outcome.

Health Outcomes in Children Associated with Prenatal and Early-Life Exposures to Air Pollution: A Narrative Review

(1) Background: The developmental origins of health and disease (DOHaD) hypothesis links adverse fetal exposures with developmental mal-adaptations and morbidity later in life. Short- and long-term exposures to air pollutants are known contributors to health outcomes; however, the potential for developmental health effects of air pollution exposures during gestation or early-childhood have yet to be reviewed and synthesized from a DOHaD lens. The objective of this study is to summarize the literature on cardiovascular and metabolic, respiratory, allergic, and neuropsychological health outcomes, from prenatal development through early childhood, associated with early-life exposures to outdoor air pollutants, including traffic-related and wildfire-generated air pollutants. (2) Methods: We conducted a search using PubMed and the references of articles previously known to the authors. We selected papers that investigated health outcomes during fetal or childhood development in association with early-life ambient or source-specific air pollution exposure. (3) Results: The current literature reports that prenatal and early-childhood exposures to ambient and traffic-related air pollutants are associated with a range of adverse outcomes in early life, including cardiovascular and metabolic, respiratory and allergic, and neurodevelopmental outcomes. Very few studies have investigated associations between wildfire-related air pollution exposure and health outcomes during prenatal, postnatal, or childhood development. (4) Conclusion: Evidence from January 2000 to January 2022 supports a role for prenatal and early-childhood air pollution exposures adversely affecting health outcomes during development. Future studies are needed to identify both detrimental air pollutants from the exposure mixture and critical exposure time periods, investigate emerging exposure sources such as wildfire, and develop feasible interventional tools.

DEP-induced ZEB2 promotes nasal polyp formation via epithelial-to-mesenchymal transition

BACKGROUND

Diesel exhaust particles (DEPs) are associated with the prevalence and exacerbation of allergic respiratory diseases, including allergic rhinitis and allergic asthma. However, DEP-induced mechanistic pathways promoting upper airway disease and their clinical implications remain unclear.

OBJECTIVE

We sought to investigate the mechanisms by which DEP exposure contributes to nasal polyposis using human-derived epithelial cells and a murine nasal polyp (NP) model.

METHODS

Gene set enrichment and weighted gene coexpression network analyses were performed. Cytotoxicity, epithelial-to-mesenchymal transition (EMT) markers, and nasal polyposis were assessed. Effects of DEP exposure on EMT were determined using epithelial cells from normal people or patients with chronic rhinosinusitis with or without NPs. BALB/c mice were exposed to DEP through either a nose-only exposure system or nasal instillation, with or without house dust mite, followed by zinc finger E-box-binding homeobox (ZEB)2 small hairpin RNA delivery.

RESULTS

Bioinformatics analyses revealed that DEP exposure triggered EMT features in airway epithelial cells. Similarly, DEP-exposed human nasal epithelial cells exhibited EMT characteristics, which were dependent on ZEB2 expression. Human nasal epithelial cells derived from patients with chronic rhinosinusitis presented more prominent EMT features after DEP treatment, when compared with those from control subjects and patients with NPs. Coexposure to DEP and house dust mite synergistically increased the number of NPs, epithelial disruptions, and ZEB2 expression. Most importantly, ZEB2 inhibition prevented DEP-induced EMT, thereby alleviating NP formation in mice.

CONCLUSIONS

Our data show that DEP facilitated NP formation, possibly via the promotion of ZEB2-induced EMT. ZEB2 may be a therapeutic target for DEP-induced epithelial damage and related airway diseases, including NPs.

Influence of the seasonality and of urban variables in the BTEX and PM2.5 atmospheric levels and risks to human health in a tropical coastal city (Fortaleza, CE, Brazil)

The International Agency for Research on Cancer (IARC) classifies benzene in group 1 (carcinogenic to humans). Particulate matter (PM) has recently also been classified in this category. This was an advance toward prioritizing the monitoring of particles in urban areas. The aim of the present study was to assess levels of PM_2.5 and BTEX (benzene, toluene, ethylbenzene, and xylene), the influence of meteorological variables, the planetary boundary layer (PBL), and urban variables as well as risks to human health in the city of Fortaleza, Brazil, in the wet and dry periods. BTEX compounds were sampled using the 1501 method of NIOSH and determined by GC-HS-PID/FID. PM_2.5 was monitored using an air sampling pump with a filter holder and determined by the gravimetric method. Average concentrations of BTEX ranged from 1.6 to 45.5 μg m^-3, with higher values in the wet period, which may be explained by the fact that annual distribution is influenced by meteorological variables and the PBL. PM_2.5 levels ranged from 4.12 to 33.0 μg m^-3 and 4.18 to 86.58 μg m^-3 in the dry and wet periods, respectively. No seasonal pattern was found for PM_2.5, probably due to the influence of meteorological variables, the PBL, and urban variables. Cancer risk ranged from 2.46E^-04 to 4.71E^-03 and 1.72E^-04 to 2.01E^-03 for benzene and from 3.07E^-06 to 7.04E^-05 and 3.08E^-06 to 2.85E^-05 for PM_2.5 in the wet and dry periods, respectively. Cancer risk values for benzene were above the acceptable limit established by the international regulatory agency in both the dry and wet periods. The results obtained of the noncarcinogenic risks for the compounds toluene, ethylbenzene, and xylene were within the limits of acceptability. The findings also showed that the risk related to PM is always greater among smokers than nonsmokers.

Allergic rhinitis aggravated by air pollutants in Latin America: A systematic review

The aim of this systematic review (SR) was to evaluate the most frequent pollutants and their effect on allergic rhinitis in Latin American countries. Observational studies up to December 2020 and comparing different indoor and outdoor pollutants that had allergic rhinitis (AR) as an outcome were included in the systematic review. Random-effect meta-analyses were conducted for the presence of allergic rhinitis. Estimates were presented as pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs). Twenty-two publications comprised this review according to the inclusion and exclusion criteria and 12 had data that could be analyzed statistically. The most frequent pollutant was PM10, followed by NO2 /O3 and PM2.5 in studies conducted in Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, and Peru. The OR of an exposed subject experiencing allergic rhinitis was 1.43 (95% CI 1.026; 1.980). The OR of children and adolescents experiencing of allergic rhinitis was 1.359 (95% CI 1.051; 1.759). Asymmetry and great variability in the effect estimated from the selected studies were observed. The publication bias was quantified by Kendall's correlation and Egger's test resulted in 0.152 (p-value = 0.493). Egger's test provided an intercept equal to 2.511 and a p-value = 0.398. The I2 statistic was 89.3% and reinforces the hypothesis of heterogeneity. This first systematic review conducted in Latin America confirmed the chance of a person exposed to pollutants and experiencing allergic rhinitis is 43% greater than that of a non-exposed person, reinforcing the importance of policies to reduce pollutant exposure and the use of protection systems for workforces exposed to occupational pollutants in work environments.

Influence of urban forest on traffic air pollution and children respiratory health

This study aimed to assess the air quality, the prevalence of child respiratory morbidity, and the association between them, in urban areas where concentrations of pollutants are expected to be below national limits. The monitoring of PM_10, NO₂ and O₃ was performed in five schools, during 9 months. Information about respiratory diseases and associated symptoms were collected from each student using a questionnaire based on the International Study of Asthma and Allergies in Childhood. The PM₁₀ and NO₂ concentrations were higher at points closer to roads and avenues with intense vehicle flow and lower at the point closer to a park, with dense vegetation. All sampling points exceeded the annual limit established by WHO for PM₁₀. Some maximum PM₁₀ concentrations recorded close to the road was six times higher than the international limit. In total, 340 answered questionnaires were collected (68% response rate). Respiratory symptoms such as wheezing, sneezing, running nose, tearing, and itchy eyes had positive and strong correlation to the primary pollutants (0.70 to 0.87), but the frequency of some symptoms was lower close to the urban forest. Therefore, our results confirm the importance of creating and maintaining green areas in urban space, considering all ecosystem services provided by them, especially the improvement of air quality. In addition, a continuous program to monitor and control atmospheric pollution is required in mid-sized counties located nearby important roads, with growing fleets of vehicles.

The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study

Objectives

The effects of air pollutants on upper airway disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ENT diseases.

Methods

We identified cases of ENT disease occurring in 2009, as recorded by the Korea National Health and Nutrition Examination Survey, and explored their associations with the levels of five air pollutants: sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO), and particulate matter (PM₁₀ particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT diseases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 7,399 subjects with ENT diseases were identified. A linear association was evident between PM₁₀ concentration and the frequency of septal deviation (Spearman coefficient, 0.507; P=0.045). After adjustment, the PM₁₀ level was associated with high odds ratios for chronic rhinosinusitis (1.22; 95% CI, 1.02 to 1.46) and septal deviation (1.43; 95% CI, 1.22 to 1.67). Both of these conditions were more prevalent in males.

Conclusion

We found that increased ambient concentrations of PM₁₀ particles were clearly associated with increased the risk of chronic rhinosinusitis and septal deviation; the exposure-response relationship was definitive.

Aeroallergens, air pollutants, and chronic rhinitis and rhinosinusitis

Chronic rhinitis and rhinosinusitis are among the most common conditions worldwide with significant morbidity and decreased quality of life. Although the pathogenesis of these conditions is multifactorial, there has been increasing evidence for the role of environmental factors such as aeroallergens and air pollutants as initiating or exacerbating factors. This review will outline the current literature focusing on the role of aeroallergens and air pollution in the pathogenesis of chronic sinonasal inflammatory conditions.

Association of traffic air pollution and rhinitis quality of life in Peruvian children with asthma

Background

Air pollution exposure may contribute to rhinoconjunctivitis morbidity in children with underlying airways disease. Prior studies have not assessed rhinoconjunctivitis-related quality of life (QOL) in children with asthma chronically exposed to air pollution.

Methods

Children ages 9–19 years with asthma from peri-urban Peru, self-reporting rhinoconjunctivitis symptoms (n = 484), were administered the Rhinoconjunctivitis QOL Questionnaire (RQLQ) at repeated intervals over one year, with scores dichotomized into bothered (>0) and not bothered (= 0). Individual weekly exposures to particulate matter<2.5μm (PM_2.5) and its black carbon (BC) component were estimated by inverse distance weighted methods. Generalized estimating equations, adjusting for covariates, estimated associations of PM_2.5 and BC with QOL.

Results

Participants were on average 13 years old, 55% female, and majority were atopic (77%). Mean (SD) PM_2.5 and BC concentrations were 21(3.2) μg/m3 and 4.4(1.5) μg/m3, respectively. In adjusted multi-pollutant models, each 10μg/m3 increase in PM_2.5 was associated with increased odds of worse rhinoconjunctivitis QOL (OR;[95% CI]: 1.83;[1.33,2.52]). A 10% increase in the BC proportion was associated with higher rhinitis burden (OR;[95% CI]: 1.80;[1.22,2.66]), while increases in the non-BC component of PM did not significantly impact rhinoconjunctivitis QOL. Associations were similar regardless of atopy.

Conclusion

Higher PM2.5 and BC exposure is associated with worse rhinitis QOL among asthmatic children.

Air pollution and hospitalizations in the largest Brazilian metropolis

OBJECTIVE

To evaluate the impact of air pollution on hospitalizations for respiratory and cardiovascular diseases in the largest Brazilian metropolis.

METHODS

This study was carried out at the Metropolitan Region of São Paulo, Brazil. Environmental data were obtained from the network of monitoring stations of nine municipalities. Air pollution exposure was measured by daily means of PM₁₀ (particles with a nominal mean aerodynamic diameter ≤ 10 μm) per municipality, while daily counts of hospitalizations for respiratory and cardiovascular diseases within the Brazilian Unified Health System were the outcome. For each municipality a time series analysis was carried out in which a semiparametric Poisson regression model was the framework to explain the daily fluctuations on counts of hospitalizations over time. The results were combined in a meta-analysis to estimate the overall risk of PM₁₀ in hospitalizations for respiratory and cardiovascular diseases at the Metropolitan Region of São Paulo.

RESULTS

Regarding hospitalizations for respiratory diseases, the effect estimates were statistically significant (p < 0.05) for all municipalities, except Santo André and Taboão da Serra. The RR (Relative Risk) of this outcome for an increase of 10 µg/m³ in the levels of PM₁₀ ranged from 1.011 (95%CI 1.009–1.013) for São Paulo to 1.032 (95%CI 1.024–1.040) in São Bernardo do Campo. The RR of hospitalization for respiratory diseases in children for an increase of 10 µg/m3 of PM₁₀ ranged from 1.009 (95%CI 1.001–1.017) in Santo André to 1.077 (95%CI 1.056–1.098) in Mauá. Only São Paulo and São Bernardo do Campo presented positive and statistically significant results for hospitalizations for cardiovascular diseases.

CONCLUSIONS

This is the first study to estimate the risk of illness from air pollution in the set of municipalities of the Metropolitan Region of São Paulo, Brazil. Global estimates of the effect of exposure to pollution in the region indicated associations only with respiratory diseases. Only São Paulo and São Bernardo do Campo showed an association between the levels of PM₁₀ and hospitalizations for cardiovascular diseases.

Impacts of meteorological and environmental factors on allergic rhinitis in children

Meteorological and environmental factors influence the pathogenesis of allergic rhinitis (AR). An understanding of the risk factors will facilitate the development of diagnostic and preventative tools for AR children and improve their quality of life. However, research on the impact of these factors on subjective symptoms in AR children remains scarce. This study explored the relationships between subjective symptoms in pollen and dust mite positive AR children, and meteorological and environmental factors. Using a linear mixed effect model, we analyzed the correlations between monthly data on the subjective symptoms of 351 AR children (from the Shanghai Children's Medical Center) and meteorological and environmental factors during 2013. The monthly meteorological and environmental data were provided by the Shanghai Meteorological Service and Shanghai Environmental Protection Bureau. Temperature and humidity were negatively correlated with the subjective symptom score, with a 0.04 point increase observed for every 1 °C decrease in temperature (P < 0.0001) or 10 % decline in humidity (P = 0.0412). The particulate matter (PM) 10 and PM2.5 concentrations were positively correlated with the subjective symptom score, with a 10 μg/m³ increase in PM10 and PM2.5 yielding a 0.02 (P = 0.0235) and 0.03 (P = 0.0281) increase in the subjective symptom score, respectively. In conclusion, meteorological and environmental factors were correlated with subjective symptoms in AR children. Low temperatures, lower humidity, and high PM10 and PM2.5 concentrations aggravated subjective symptoms in AR children.

Expression of CysLTR1 and 2 in Maturating Lymphocytes of Hyperplasic Tonsils Compared to Peripheral Cells in Children

Cysteinyl-leukotriene receptors 1 and 2 (CysLTR1 and 2) are related to allergic inflammatory responses. Recent studies demonstrated their role in lymphocyte division and maturation in the bone marrow. Few data are available about CysLTRs function in lymphocyte maturation in tonsils. The objectives of this study are to compare CysLTRs expression in peripheral blood lymphocytes with expression in maturating lymphocytes of hyperplasic tonsil and to check the influence of respiratory allergies in this process. Leukocytes of peripheral blood (PL) and hyperplasic tonsils of children were immunostained for CysLTR1, CysLTR2, CD3 (T cells), and CD19 (B cells) and read in flow cytometer. Lymphocyte of tonsils were divided in differentiating small cells (SC) and mitotic large cells (LC); percentage of B and T cells expressing CysLTRs was determined, and comparison was done using ANOVA and Tukey's tests. Data were analyzed as a whole and categorizing patients according the presence of allergies. Sixty children were enrolled in this study. There was a large expression of CysLTR1 and 2 in CD3+ LC, and such expression decreased progressively in SC and PL. In B cells, the highest expression of CysLTR1 and 2 was found in PL while SC showed the lowest and LC showed the intermediate expression. This pattern kept unchanged in groups of allergic and non-allergic individuals. CysLTRs seem to be involved in lymphocyte maturation that occurs in tonsils, without influence of allergies. New studies aiming the clinic treatment of tonsil hyperplasia must be targeted to the development of drugs capable of blocking both CysLTR1 and 2.

Effects of air pollutants on upper airway disease

PURPOSE OF REVIEW

We discuss the effects of air pollutants on upper airway disease; the topic has hitherto received little attention.

RECENT FINDINGS

Several epidemiological studies have shown that air pollutants aggravate airway diseases including asthma, bronchitis, and chronic obstructive pulmonary disorder. Pollutants also have negative effects on other upper airway diseases such as allergic and nonallergic rhinitis, sinusitis, and otitis media. Traffic-related air pollutants (diesel exhaust particles and nitrogen dioxide and tobacco smoke) have been widely studied in this context. Increasing evidence suggests that particulate matter, photochemical pollutants, and ozone are associated with such conditions. Young children and the obese are more vulnerable. Work in vivo and in vitro has explored the relationships between pollutants and disease, and possible pathophysiological mechanisms. Reactive oxygen species, apoptosis, and inflammation are all in play.

SUMMARY

Traffic-derived materials and tobacco smoke are major air pollutants that aggravate upper airway disease. Novel mechanisms of action have been suggested and risk factors have been defined. However, the data are conflicting, and controlled prospective studies are required.

Traffic-related air pollution biomonitoring with Tradescantia pallida (Rose) Hunt. cv. purpurea Boom in Brazil

This study aimed to verify the capacity of Tradescantia pallida in the biomonitoring of air pollution in urban areas with different traffic intensities and under varying environmental conditions. Experiments were carried out in Ribeirão Preto, in the Southeastern Brazil, with more than 660,000 inhabitants and a fleet of more than 485,000 motor vehicles. Ten seedlings of T. pallida were exposed in three areas in the city, differing in traffic vehicle flow, in two seasons (wet and dry). At the end of each sampling period, which lasted 4 months, samples of leaves were collected, and the content of As, Ba, Ca, Cd, Cr, Cu, Fe, Hg, Mg, Mn, P, Pb, S, and Zn was determined by inductively coupled plasma mass spectroscopy (ICP-MS). The same elements were determined in soil samples for a seasonal characterization in conjunction with secondary data of environmental parameters. Additionally, micronucleus assay with early pollen tetrad cells of Tradescantia (Trad-MN) was conducted by collecting flower buds and analyzing the micronuclei frequencies in pollen mother cells. Although pollutant levels in air were below the Brazilian legal limits, plants exposed in the high-traffic flow area presented higher concentrations of elements related to vehicle emissions, especially under dry conditions, and higher micronuclei frequency in pollen mother cells. These results show the sensitivity of T. pallida to low-level urban air pollution and its suitability as bioindicator for trace elements. This alternative tool for biomonitoring can serve as a support methodology for the adoption of more restrictive public environmental policies in Brazil and extendible to other developing countries.