EAACI guidelines on environmental science for allergy and asthma: The impact of short‐term exposure to outdoor air pollutants on asthma‐related outcomes and recommendations for mitigation measures

Author:

Agache Ioana1ORCID,Annesi‐Maesano Isabella2ORCID,Cecchi Lorenzo3ORCID,Biagioni Benedetta4,Chung Kian Fan5ORCID,Clot Bernard6,D'Amato Gennaro78ORCID,Damialis Athanasios9ORCID,del Giacco Stefano10ORCID,Dominguez‐Ortega Javier11,Galàn Carmen12ORCID,Gilles Stefanie13ORCID,Holgate Stephen14,Jeebhay Mohamed15ORCID,Kazadzis Stelios16ORCID,Nadeau Kari17ORCID,Papadopoulos Nikolaos1819ORCID,Quirce Santiago11,Sastre Joaquin20,Tummon Fiona78ORCID,Traidl‐Hoffmann Claudia212223ORCID,Walusiak‐Skorupa Jolanta24,Jutel Marek25ORCID,Akdis Cezmi A.26ORCID

Affiliation:

1. Faculty of Medicine Transylvania University Brasov Romania

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

3. Centre of Bioclimatology University of Florence Florence Italy

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

5. National Hearth & Lung Institute Imperial College London London UK

6. Federal office of meteorology and climatology MeteoSwiss Payerne Switzerland

7. Respiratory Disease Department Hospital Cardarelli Naples Italy

8. University of Naples Federico II Medical School of Respiratory Diseases 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 La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES) Madrid Spain

12. Inter‐University Institute for Earth System Research (IISTA), International Campus of Excellence on Agrifood (ceiA3) University of Córdoba Córdoba Spain

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

14. Faculty of Medicine University of Southampton Southampton UK

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

16. Physikalisch‐Meteorologisches Observatorium Davos World Radiation Center Davos Switzerland

17. John Rock Professor of Climate and Population Studies, Department of Environmental Health, Center for Climate, Health, and the Global Environment Harvard T.H. Chan School of Public Health Boston Massachusetts USA

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

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

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

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

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

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

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

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

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

Abstract

AbstractThe EAACI Guidelines on the impact of short‐term exposure to outdoor pollutants on asthma‐related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence‐informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short‐term exposure to all pollutants evaluated increases the risk of asthma‐related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic‐related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma‐related outcomes but global measures for clean air are needed to achieve significant impact.

Publisher

Wiley

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