The impact of outdoor pollution and extreme temperatures on asthma‐related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

Author:

Agache Ioana1ORCID,Canelo‐Aybar Carlos2,Annesi‐Maesano Isabella3ORCID,Cecchi Lorenzo4ORCID,Rigau David2,Rodríguez‐Tanta L. Yesenia2,Nieto‐Gutierrez Wendy2,Song Yang2,Cantero‐Fortiz Yahveth25,Roqué Marta25,Vasquez Juan Carlos2,Sola Ivan5,Biagioni Benedetta6,Chung Fan7ORCID,D'Amato Gennaro8ORCID,Damialis Athanasios9ORCID,del Giacco Stefano10ORCID,Vecillas Leticia de las11ORCID,Dominguez‐Ortega Javier11,Galàn Carmen12ORCID,Gilles Stefanie13ORCID,Giovannini Mattia1415,Holgate Stephen16,Jeebhay Mohamed17ORCID,Nadeau Kari18ORCID,Papadopoulos Nikolaos1920ORCID,Quirce Santiago11,Sastre Joaquin21,Traidl‐Hoffmann Claudia222324ORCID,Walusiak‐Skorupa Jolanta25,Sousa‐Pinto Bernardo26,Alonso‐Coello Pablo25,Salazar Josefina2,Jutel Marek27ORCID,Akdis Cezmi A.28ORCID

Affiliation:

1. Faculty of Medicine Transylvania University Brasov Romania

2. Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain

3. Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM Montpellier France

4. Centre of Bioclimatology University of Florence Florence Italy

5. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) Madrid Spain

6. Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital Florence Italy

7. Imperial College London UK

8. Medical School of Respiratory Diseases University of Naples Federico II Naples Italy

9. Department of Ecology, School of Biology, Faculty of Sciences Aristotle University of Thessaloniki Thessaloniki Greece

10. Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy

11. Department of Allergy Hospital La Paz Institute for Health Research (IdiPAZ) Madrid Spain

12. Department of Botany, Ecology and Plant Physiology International Campus of Excellence on Agrifood (ceiA3), University of Córdoba Córdoba Spain

13. Environmental Medicine, Faculty of Medicine University of Augsburg Augsburg Germany

14. Allergy Unit Meyer Children's Hospital IRCCS Florence Italy

15. Department of Health Sciences University of Florence Florence Italy

16. Faculty of Medicine University of Southampton Southampton UK

17. Occupational Medicine Division and Centre for Environmental & Occupational Health Research University of Cape Town Rondebosch South Africa

18. John Rock Professor of Climate and Population Studies; Chair, Department of Environmental Health, Interim Director Center for Climate, Health, and The Global Environment, Harvard T.H. Chan School of Public Health Boston Massachusetts USA

19. Allergy and Clinical Immunology Unit, Second Pediatric Clinic National and Kapodistrian University of Athens Athens Greece

20. Division of Evolution and Genomic Sciences University of Manchester Manchester UK

21. Instituto Carlos III, Ministry of Science and Innovation, Allergy Service, Fundación Jiménez Díaz Faculty of Medicine Universidad Autónoma de Madrid and CIBERES Madrid Spain

22. Department of Environmental Medicine, Faculty of Medicine University of Augsburg Augsburg Germany

23. Institute of Environmental Medicine, Helmholtz Center Munich‐German Research Center for Environmental Health Augsburg Germany

24. Christine Kühne Center for Allergy Research and Education Davos Switzerland

25. Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland

26. MEDCIDS‐Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal

27. Department of Clinical Immunology, ALL‐MED Medical Research Institute Wrocław Medical University Wroclaw Poland

28. Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich Davos Switzerland

Abstract

AbstractAir pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma‐related outcomes of short‐term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS‐E tools and the certainty of the evidence by using GRADE. Short‐term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma‐related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new‐onset asthma in agricultural workers, while exposure to 1,3‐dichloropropene may increase the risk of asthma‐related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma‐related ED visits and HA and asthma mortality (low certainty evidence).

Publisher

Wiley

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