Journal List > Asia Pac Allergy > v.10(1) > 1142163

Pawankar, Wang, Wang, Thien, Chang, Latiff, Fujisawa, Zhang, Thong, Chatchatee, Leung, Kamchaisatian, Rengganis, Yoon, Munkhbayarlakh, Recto, Neo, Pham, Lan, Davies, and Oh: Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Abstract

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

References

1. Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, Caraballo L, Demain J, Portnoy J. von Hertzen LWAO Special Committee on Climate Change and Biodiversity. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J. 2013; 6:3.
crossref
2. Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss M. World Allergy Organization (WAO) White Book on Allergy: Update 2013. Milwaukee (WI): World Allergy Organization;2013.
3. Dockery DW, Stone PH. Cardiovascular risks from fine particulate air pollution. N Engl J Med. 2007; 356:511–3.
crossref
4. Ayres JG, Forsberg B, Annesi-Maesano I, Dey R, Ebi KL, Helms PJ, Medina-Ramón M, Windt M. Forastiere FEnvironment and Health Committee of the European Respiratory Society. Climate change and respiratory disease: European Respiratory Society position statement. Eur Respir J. 2009; 34:295–302.
crossref
5. Michelozzi P, Accetta G, De Sario M, D'Ippoliti D, Marino C, Baccini M, Biggeri A, Anderson HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J. Perucci CAPHEWE Collaborative Group. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med. 2009; 179:383–9.
crossref
6. Robine JM, Cheung SL, Le Roy S, Van Oyen H, Herrmann FR. Report on excess mortality in Europe during summer 2003 (EU Community Action Programme for Public Health, Grant Agreement 2005114). Montpellier: 2003 Heat Wave Project. Europe;2007.
7. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D'Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P. Heat effects on mortality in 15 European cities. Epidemiology. 2008; 19:711–9.
crossref
8. Delfino RJ, Brummel S, Wu J, Stern H, Ostro B, Lipsett M, Winer A, Street DH, Zhang L, Tjoa T, Gillen DL. The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003. Occup Environ Med. 2009; 66:189–97.
crossref
9. Dennekamp M, Abramson MJ. The effects of bushfire smoke on respiratory health. Respirology. 2011; 16:198–209.
crossref
10. Takaro TK, Knowlton K, Balmes JR. Climate change and respiratory health: current evidence and knowledge gaps. Expert Rev Respir Med. 2013; 7:349–61.
crossref
11. D'Amato G, Baena-Cagnani CE, Cecchi L, Annesi-Maesano I, Nunes C, Ansotegui I, D'Amato M, Liccardi G, Sofia M, Canonica WG. Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases. Multidiscip Respir Med. 2013; 8:12.
12. Filippidou EC, Koukouliata A. Ozone effects on the respiratory system. Prog Health Sci. 2011; 1:144–55.
13. WHO Regional Office for Europe (DK). Review of evidence on health aspects of air pollution: REVIHAAP Project. Copenhagen (Denmark): WHO Regional Office for Europe;2013.
14. Asero R. Birch and ragweed pollinosis north of Milan: a model to investigate the effects of exposure to “new” airborne allergens. Allergy. 2002; 57:1063–6.
crossref
15. Anenberg SC, Henze DK, Tinney V, Kinney PL, Raich W, Fann N, Malley CS, Roman H, Lamsal L, Duncan B, Martin RV, van Donkelaar A, Brauer M, Doherty R, Jonson JE, Davila Y, Sudo K, Kuylenstierna JC. Estimates of the global burden of ambient PM2:5, ozone, and NO2 on asthma incidence and emergency room visits. Environ Health Perspect. 2018; 126:107004–1. -14.
crossref
16. D'Amato G, Liccardi G, D'Amato M, Cazzola M. Outdoor air pollution, climatic changes and allergic bronchial asthma. Eur Respir J. 2002; 20:763–76.
17. D'Amato G, Cecchi L. Effects of climate change on environmental factors in respiratory allergic diseases. Clin Exp Allergy. 2008; 38:1264–74.
18. Wayne P, Foster S, Connolly J, Bazzaz F, Epstein P. Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. Ann Allergy Asthma Immunol. 2002; 88:279–82.
crossref
19. Liang KL, Su MC, Shiao JY, Wu SH, Li YH, Jiang RS. Role of pollen allergy in Taiwanese patients with allergic rhinitis. J Formos Med Assoc. 2010; 109:879–85.
crossref
20. D'Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JT, D'Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJ, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015; 8:25.
21. D'Amato G, Pawankar R, Vitale C, Lanza M, Molino A, Stanziola A, Sanduzzi A, Vatrella A, D'Amato M. Climate Change and Air Pollution: Effects on Respiratory Allergy. Allergy Asthma Immunol Res. 2016; 8:391–5.
22. Davies JM. Pollen allergens. Nriagu JO, editor. Encyclopedia of environmental health. 2nd ed.Amsterdam (Netherlands): Elsevier;2019.
crossref
23. Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, Bardin PG, Bannister T, Barnes S, Bellomo R, Byrne T, Casamento A, Conron M, Cross A, Crosswell A, Douglass JA, Durie M, Dyett J, Ebert E, Erbas B, French C, Gelbart B, Gillman A, Harun NS, Huete A, Irving L, Karalapillai D, Ku D, Lachapelle P, Langton D, Lee J, Looker C, MacIsaac C, McCaffrey J, McDonald CF, McGain F, Newbigin E, O'Hehir R, Pilcher D, Prasad S, Rangamuwa K, Ruane L, Sarode V, Silver JD, Southcott AM, Subramaniam A, Suphioglu C, Susanto NH, Sutherland MF, Taori G, Taylor P, Torre P, Vetro J, Wigmore G, Young AC, Guest C. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health. 2018; 2:e255–63.
crossref
24. Thien F. Thunderstorm asthma: potential danger but a unique opportunity. Asia Pac Allergy. 2017; 7:55–6.
crossref
25. Junaid M, Syed JH, Abbasi NA, Hashmi MZ, Malik RN, Pei DS. Status of indoor air pollution (IAP) through particulate matter (PM) emissions and associated health concerns in South Asia. Chemosphere. 2018; 191:651–63.
crossref
26. Lai VW, Bowatte G, Knibbs LD, Rangamuwa K, Young A, Dharmage S, Thien F. Residential NO2 exposure is associated with urgent healthcare use in a thunderstorm asthma cohort. Asia Pac Allergy. 2018; 8:e33.
27. Sonomjamts M, Dashdemberel S, Logii N, Nakae K, Chigusa Y, Ohhira S, Ito C, Sagara H, Makino S. Prevalence of asthma and allergic rhinitis among adult population in Ulaanbaatar, Mongolia. Asia Pac Allergy. 2014; 4:25–31.
crossref
28. Wong CM, Vichit-Vadakan N, Vajanapoom N, Ostro B, Thach TQ, Chau PY, Chan EK, Chung RY, Ou CQ, Yang L, Peiris JS, Thomas GN, Lam TH, Wong TW, Hedley AJ, Kan H, Chen B, Zhao N, London SJ, Song G, Chen G, Zhang Y, Jiang L, Qian Z, He Q, Lin HM, Kong L, Zhou D, Liang S, Zhu Z, Liao D, Liu W, Bentley CM, Dan J, Wang B, Yang N, Xu S, Gong J, Wei H, Sun H. Qin ZHEI Health Review Committee. Part 5. Public health and air pollution in Asia (PAPA): a combined analysis of four studies of air pollution and mortality. Res Rep Health Eff Inst. 2010; 154:377–418.
29. Yoshihara S, Munkhbayarlakh S, Makino S, Ito C, Logii N, Dashdemberel S, Sagara H, Fukuda T, Arisaka O. Prevalence of childhood asthma in Ulaanbaatar, Mongolia in 2009. Allergol Int. 2016; 65:62–7.
crossref
30. Shima M. Health effects of air pollution: a historical review and present status. Nippon Eiseigaku Zasshi. 2017; 72:159–65.
crossref
31. Park M, Luo S, Kwon J, Stock TH, Delclos G, Kim H, Yun-Chul H. Effects of air pollution on asthma hospitalization rates in different age groups in metropolitan cities of Korea. Air Qual Atmos Health. 2013; 6:10.
crossref
32. Kim HH, Lee CS, Yu SD, Lee JS, Chang JY, Jeon JM, Son HR, Park CJ, Shin DC, Lim YW. Near-road exposure and impact of air pollution on allergic diseases in elementary school children: a cross-sectional study. Yonsei Med J. 2016; 57:698–713.
crossref
33. Abdul Halim ND, Latif MT, Ahamad F, Dominick D, Chung JX, Juneng L, Khan MF. The long-term assessment of air quality on an island in Malaysia. Heliyon (Lond). 2018; 4:e01054.
34. Guo Y, Li S, Tawatsupa B, Punnasiri K, Jaakkola JJ, Williams G. The association between air pollution and mortality in Thailand. Sci Rep. 2014; 4:5509.
crossref
35. Phosri A, Ueda K, Phung VL, Tawatsupa B, Honda A, Takano H. Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand. Sci Total Environ. 2019; 651:1144–53.
crossref
36. HEI Collaborative Working Group on Air Pollution, Poverty, and Health in Ho Chi Minh City. Effects of short-term exposure to air pollution on hospital admissions of young children for acute lower respiratory infections in Ho Chi Minh City. Vietnam. Boston (MA): Health Effects Institute;2012. p. 5–72.
37. Wang IJ, Tung TH, Tang CS, Zhao ZH. Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health. 2016; 219:66–71.
crossref
38. Kuo CY, Chan CK, Wu CY, Phan DV, Chan CL. The short-term effects of ambient air pollutants on childhood asthma hospitalization in Taiwan: a national study. Int J Environ Res Public Health. 2019; 16:203.
crossref
39. Zhang Z, Tan L, Huss A, Guo C, Brook JR, Tse LA, Lao XQ. Household incense burning and children's respiratory health: A cohort study in Hong Kong. Pediatr Pulmonol. 2019; 54:399–404.
crossref
40. Gao Y, Chan EY, Li L, Lau PW, Wong TW. Chronic effects of ambient air pollution on respiratory morbidities among Chinese children: a cross-sectional study in Hong Kong. BMC Public Health. 2014; 14:105.
crossref
41. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016. Althea Med J. 2014; 1:5–72.
42. Rajak R, Chattopadhyay A. Short and long-term exposure to ambient air pollution and impact on health in India: a systematic review. Int J Environ Health Res. 2019 May 9. 1–25. [Epub].
44. Salvi S, Kumar GA, Dhaliwal RS, Paulson K, Agrawal A, Koul PA, Mahesh PA, Nair S, Singh V, Aggarwal AN, Christopher DJ, Guleria R, Mohan BV, Tripathi SK, Ghoshal AG, Kumar RV, Mehrotra R, Shukla DK, Dutta E, Furtado M, Bhardwaj D, Smith M, Abdulkader RS, Arora M, Balakrishnan K, Chakma JK, Chaturvedi P, Dey S, Ghorpade D, Glenn S, Gupta PC, Gupta T, Johnson SC, Joshi TK, Kutz M, Mathur MR, Mathur P, Muraleedharan P, Odell CM, Pati S, Sabde Y, Sinha DN, Thankappan KR, Varghese CM, Yadav G, Lim SS, Naghavi M, Dandona R, Reddy KS, Vos T, Murray CJ, Swaminathan S. Dandona LIndia State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018; 6:e1363–74.
crossref
45. Singh S, Sharma BB, Sharma SK, Sabir M. Singh VISAAC collaborating investigators. Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution. J Asthma. 2016; 53:238–44.
crossref
46. Palabrica FR, Tolentino C, Laroza M, et al. Effect of air pollution of the lung function of high school students at a public school in Quezon City, Metromanila, Philippines. Phil J of Allergy Asthma Immunol. 2015; 18:27–36.
48. Hahm MI, Chae Y, Kwon HJ, Kim J, Ahn K, Kim WK, Lee SY, Park YM, Han MY, Lee KJ, Lee HY, Min I. Do newly built homes affect rhinitis in children? The ISAAC phase III study in Korea. Allergy. 2014; 69:479–87.
crossref

Table 1.
The effect of air pollution on allergic diseases in the different countries of Asia-Pacific
Country Pollutants Key findings References
Australia O3, NOx, and VOC: principally temperature and wind conditions Those with higher mean annual residential NO2 exposure had greater odds of urgent healthcare use in the previous year (OR, 3.45 per one interquartile range increase; 95% CI, 1.31–9.10; p = 0.01). 22,23
China PM2.5, PM10, SO2, NO2, and O3 An increase of 10 mg/m3 or 10 ppb of PM2.5, PM10, SO2, NO2, and O3 corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% CI, 0.172–0.659) at lag 1 day, 0.127% (95% CI, 0.161–0.415) at lag 1 day, 0.603% (95% CI, 0.069–1.139) at lag 3 day, 0.649% (95% CI, 0.808–2.128) at lag 0 day and 0.944% (95% CI, 0.156–0.1598) at lag 1 day. O3 had a stronger effect on respiratory deaths among the elderly. 26
Mongolia Households smoking, severe air pollution The asthma prevalence 20.9% in Mongolian children was higher than that in Asia-Pacific countries. It was attributable to households' (especially mothers) smoking in draft-free houses designed for the cold area and severe air pollution due to rapid industrialization and urbanization. Prevalence of current wheezer and diagnosed asthma were 15.7% (95% CI, 14.7–16.8) and 4.7% (95% CI, 4.3–5.6) among adults in all age respectively. Prevalence of current allergic rhinitis was 23.6% (95% CI, 22.4–24.9) in all age group. Pollutants are SO2, CO, NO2, diesel exhaust particle, and PM2.5. 27,28
Japan SO2, NOx, and PM2.5 During the 1960s, air pollutants are particularly SO2. After 1970, the increasing automobile traffic has caused increases in concentrations of s NOx and PM. At present, PM2.5 and photo chemical oxidants have become a major concern. 29,30
Korea 1. PM10, CO, NO2, and VOC 1. Using adults as the referent, the RR of asthma admissions with 10-μg/m3 increase of PM10 is 1.5% (95% CI, 0.1%–2.8%) lower for children, and 1.3% (95% CI, 0.7%–1.9%) higher for the elderly; RR with 1-ppm increase of CO is 1.9% (95% CI, 0.3%–3.8%) lower for children; RR with 1-ppb increase of NO2 (1 ppb) is 0.5% (95% CI, 0.3%–0.7%) higher for the elderly. PM, and combustion pollutants such as SO2, CO, and NO2. Indoor air pollutants come from various sources: Environmental tobacco smoke, furniture, combustion products such as stoves and gas ranges, building materials, and biological agents from mold and animals. VOCs are important indoor air pollutants produced by evaporation at room temperature from diverse sources, such as building materials, paints, cleaning agents, furnishings, adhesives, combustion materials, floor, and wall coverings. Formaldehyde, xylene, toluene, benzene, ethyl-benzene, and phthalate are commonly found VOCs at home or in buildings. Children who had moved to a newly built home were 2.92 times (95% CI, 1.76–4.84) and 3.09 times (95% CI, 1.71–5.57) more likely to have overlapped rhinitis (rhinitis with asthma or eczema) or overlapped allergic rhinitis (overlapped rhinitis and exhibiting sensitization to more than one inhaled allergen in the skin prick test) from the phase III ISAAC study from Korea. 31,48
  2. CO, NO2, SO2, and O3 2. The frequency of asthma treatment during the past 12 months showed a significant increase with exposure to NO2 (1.67; 95% CI, 1.03–2.71) in the complex source zones. The frequency of allergic rhinitis treatment during the past 12 months increased significantly with exposure to black carbon (1.60; 95% CI, 1.36–1.90) (p < 0.001), SO2 (1.09; 95% CI, 1.01–1.17) (p < 0.05), NO2 (1.18; 95% CI, 1.07–1.30) (p < 0.01) for all subjects. 32
Malaysia O3, CO, NO, NO2, NOx, SO2, and PM10 Annual average concentrations of all air pollutants (PM10, O3, CO, NO, NO2, and NOx) on Langkawi Island were below the suggested limits by RMAQG and the WHO. The diurnal patterns showed an increase in all air pollutant concentrations except O3 during peak hours which are from 07:00 to 08:00 and from 17:00 to 18:00. 33
Thailand O3, NO2, SO2, PM10, and CO An increase of 10 μg/m3 in O3, NO2, SO2, PM10, and 1 mg/m3 in CO at lag 0–1 day was associated with a 0.69% (95% CI, 0.18–1.21), 1.42% (0.98–1.85), 4.49% (2.22–6.80), 1.18% (0.79–1.57), and 7.69% (5.20–10.23) increase in respiratory admission. 34,35
    PM10, SO2, and O3 on mortality. They found that all air pollutants had significant short-term impacts on nonaccidental mortality. An increase of 10 μg/m3 in PM10, 10 ppb in O3, 1 ppb in SO2 were associated with a 0.40% (95% posterior interval [PI], 0.22%–0.59%), 0.78% (95% PI, 0.20%–1.35%) and 0.34% (95% PI, 0.17%–0.50%) increase of nonaccidental mortality, respectively. O3 air pollution is significantly associated with cardiovascular mortality, while PM10 is significantly related to respiratory mortality.  
Vietnam PM10, O3, NO2, and SO2 were 73, 75, 22, and 22 μg/m3 PM10, O3, NO2, and SO2 were 73, 75, 22, and 22 μg/m3, with higher pollutant concentrations observed in the dry season compared with the rainy season. The major cause might be the reliance of approximately 80% population conventional biomass burning in the region. 35-37
Taiwan PM10, PM2.5, CO, and O3 1. Exposure to PM10, PM2.5, CO, and O3 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]). PM2.5 may have increased the risk of AR (1.54 [1.03–2.32]). 37,38
    2. Exposure to PM2.5 and mite allergens had a synergistic effect on the development of asthma. PM2.5, PM10, O3, SO2, and NO2 were positively associated with childhood asthma  
Hong Kong High- or low-pollution district 2.5 10 3 2 2 hospitalization, while O3 was negatively associated with childhood asthma hospitalization. SO2 was identified as the most significant risk factor. Compared to those in the low-pollution district, girls in the high-pollution district (HPD) were at significantly higher risk for cough at night (OR adjusted, 1.81; 95% CI, 1.71–2.78) and phlegm without colds (OR adjusted, 3.84; 95% CI, 1.74–8.47). Marginal significance was reached for elevated risks for asthma, wheezing symptoms, and phlegm without colds among boys in HPD (adjusted OR, 1.71–2.82), and chronic cough among girls in HPD (OR adjusted, 2.03; 95% CI, 0.88–4.70). 39,40
India PM2.5 and PM10 Short-term exposures to ambient pollutants have strong associations between COPD, respiratory illnesses and higher rates of hospital admission or visit. The long-term effects of ambient air pollution, was associated with deficit lung function, asthma. PM2.5 and PM10 are primarily responsible for respiratory health problems. 41-44
  PM2.5 and PM10 The ORs for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI, 1.43–1.85), 1.71 (95% CI, 1.49–1.96). and 1.53 (95% CI, 1.31–1.78) in the younger group. In the older group, they were 1.19 (95% CI, 1.04–1.36), 1.51 (95% CI, 1.31–1.75), and 1.51 (95% CI, 1.29–1.76). 45
Indonesia SPM, PM10, and PM2.5 An assessment during the feast of Ied Al Fitr in 2016 and 2017 indicated a further decrease in PM2.5 due to highly reduced inner-city traffic. These events exhibited an extreme reduction of the PM2.5 concentration in Jakarta. Impact only on asthma. Indonesian Government data
Philippines   An assessment of 153 highs school students noted that exposure to air pollution affected lung function which only 54.7% having normal lung functions. Exposure to indirect smoking had a large effect on lower lung function values compared to total suspended particulate matter levels. 46

O3, ozone; NO2, nitrogen dioxide; PM, particulate matter; PM2.5, PM with a diameter of 2.5 μm or less; PM10, PM with a diameter of 10 μm or less; SO2, sulfur dioxide; NOx, nitrogen oxides; VOC, volatile organic compound; OR, odds ratio; CI, confidence interval; RR, relative rate; ISSAC, International Study of Asthma and Allergies in Childhood; RMAQG, Recommended Malaysian Air Quality Guidelines; WHO, World Health Organization; AR, allergic rhinitis; COPD, chronic obstructive pulmonary disease; SPM, suspended particulate matter.

TOOLS
Similar articles