The environmental predictors of allergic disease☆,☆☆
Section snippets
AMBIENT AIR POLLUTION
Air pollution is felt by many to be one of the more pressing problems toward the end of this century, posing a potential threat to the health and well-being of entire populations. When an attempt is made to understand the potential adverse effects of air pollution, the distinction between exacerbation of pre-existing disease in already-affected subjects from the potential adverse effects on the inception of newly developing cases of allergic disease seems essential. Although increasing evidence
TRAFFIC EXPOSURE
It has been argued that other types of pollutants that are associated with increasing traffic exposure characteristic of Western cities may be of greater relevance to the inception of allergic diseases than are the traditional type of pollution occurring with burning of coal and other fossil fuels. Diesel exhaust is the single major contributor to particulate matter in most urban areas worldwide, accounting for up to 90% of the total particle mass in some major cities.18 The mass median
OZONE
Single ozone exposure has been shown to evoke cough, breathlessness, and chest pain on inspiration; to result in a restrictive ventilatory defect with decrements in forced vital capacity and FEV1; to induce neutrophilic inflammation of the airway submucosa; and to increase airway reactivity.12 The response to ozone shows large intersubject variability,32, 33 with approximately 10% to 20% of the population sensitive to the development of reductions in lung function after ozone exposure34, 35
ENVIRONMENTAL TOBACCO SMOKE EXPOSURE
There is strong, consistent evidence to suggest that environmental tobacco smoke (ETS) exposure increases the risk of lower respiratory tract illnesses in infancy and childhood.51, 52 A review on adverse health effects of ETS exposure by the US Environmental Protection Agency51 concluded that passive smoke exposure is causally associated with an increased risk of lower respiratory tract infections such as bronchitis and pneumonia, mainly in infants and young children, a small but significant
SOCIOECONOMIC STATUS
High prevalences of childhood asthma and atopic diseases have been found in affluent Western societies. In the developing world a gradient between affluent and poor regions has been seen. In Harare, the capital of Zimbabwe, the prevalence of airway hyperresponsiveness, as assessed by a free-running test, was significantly higher in a wealthier part of the city than in its poorer districts.57 In the United Kingdom high social class was associated with a higher prevalence of atopic eczema.58
NUTRITION
Changes in dietary habits have been implicated as a factor characteristic of societies with increasing affluence, therefore possibly relating to the increase in the prevalence of asthma and atopy seen over the last decades. In some prospective studies breast-feeding has been found to have a transient beneficial effect on the incidence of eczema, food allergy, and early wheezing illnesses in the first 1 to 3 years of life,61, 62 but these findings could not be reproduced by others.63
ALLERGEN EXPOSURE
There is increasing evidence to suggest that the level of allergen exposure is a risk factor for the development of atopic sensitization in children.74, 75, 76 In the German Multicenter Atopy Study76 a large birth cohort following newborn children up to the age of 7 years, house dust mite and cat allergen concentrations in domestic carpet dust were strongly related to the development of atopic sensitization toward that specific allergen in the first 3 years of life. A clear dose-response
FAMILY SIZE
There is increasing consistent evidence that sibship size contributes to the expression of atopy in families. Many authors have shown that the number of siblings is inversely related to the prevalence of self-reported inhalant allergy,82 hay fever,83, 84, 85, 86 atopic eczema,87, 88, 89 skin test reactivity,84, 90, 91, 92, 93 and the presence of specific IgE anitibodies in the serum86, 94, 95 in children, adolescents, and adults. Most reports that were large enough to allow a separate analysis
INFECTIONS
There is still a continuing debate about a potential causal role of virus infections, mainly respiratory syncytial virus (RSV), for the subsequent development of childhood wheezing illness, asthma, and atopy. Two major hypotheses have been proposed to explain the association between respiratory tract infections and subsequent respiratory abnormalities.100 One hypothesis states that viral infections early in life damage the growing lung or alter host immune regulation. The second hypothesis
OUTLOOK
When we speculate about future avenues to reduce our ignorance about the relevant causal factors for the inception of allergic diseases, several issues come to mind. In epidemiology informative study populations must be identified. These may include populations over a broad range of exposure to a suspected risk factor or populations with a significant contrast in the prevalence of allergic diseases. Within the latter group a comparison of environmental influences in ethnically similar groups
CONCLUSIONS
Environmental factors play an important role for the development and manifestation of allergic conditions in genetically predisposed subjects. There is little evidence to suggest that exposure to air pollutants such as sulfur dioxide, particulate matter, traffic exhaust, or ozone is associated with the inception of new cases of atopy or asthma. Rather, lifestyle factors relating to the socioeconomic status of a population or a family, its size, and the number of siblings of a given individual,
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2022, Allergology InternationalCitation Excerpt :Therefore, the development of individualized, predictive, and preventive measures against the onset and aggravation of hay fever is imperative.2,3 Hay fever is a multifactorial disease caused by environmental factors such as exposure to pollen and air pollutants (particulate matter 2.5); lifestyle habits, such as diet, use of contact lens, smoking habit, and exercise; and epidemiological factors, such as younger age, female sex, and genetics.4–8 However, the multifactorial nature of hay fever, which encompasses a myriad of variables closely related to an individual's ever-changing living conditions, presents difficulty in collecting meaningful data through traditional epidemiological research.2,9
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