Environmental Changes Exacerbating Allergy, Asthma

Fran Lowry

February 26, 2018

ORLANDO — Environmental changes occurring around the world and their effects on allergic and respiratory diseases will be in the spotlight at the upcoming joint congress of the American Academy of Allergy, Asthma and Immunology (AAAAI) and World Allergy Organization (WAO).

David Peden

"We'll have talks about how pollution causes both airway and systemic inflammation, and how that directly relates to worsening of the diseases that we take care of," said AAAAI President David Peden, MD, from the University of North Carolina School of Medicine and the UNC Center for Environmental Medicine, Asthma, and Lung Biology in Chapel Hill.

"And we'll be hearing about how elements in the environment can actually cause epigenetic changes," he told Medscape Medical News.

During her keynote, Linda Birnbaum, PhD, from the National Institute of Environmental Health Sciences and the National Toxicology Program in Bethesda, Maryland, will talk about the unique interactions between genes and environment that contribute to human health and disease. She will also discuss global increases in noncommunicable diseases attributable to environmental conditions and identify opportunities to improve human health by modifying environmental exposures.

Birnbaum's work focuses on the pharmacokinetic behavior of environmental chemicals, mechanisms of actions of toxicants, including endocrine disruption, and the link between real-world exposures and health effects, Peden explained.

"Our theme will also include discussions about how changes in worldwide climate affect the amount of allergens and the other things that traditionally induce allergy and, in fact, could make allergic diseases worse," he said.

"For example, there are actually good data that show that with prolonged warming seasons and somewhat milder winters, there is often a longer period of pollination," said Peden, whose research interest is air pollution and asthma.

"We also know that if you grow plants in more carbon dioxide or in an environment exposed to ozone or other pollutants, they respond by making more pollens and more stuff that people have become allergic to. This may be evolutionary; it may be that the plants are responding to environmental stress to ensure that they continue to be around," he added.

Air Pollution

During his plenary, Peden will discuss things that can be done to address indoor and outdoor pollutants, present data that support what works, and explain how genetic changes can be used to trace pollutant exposures.

Up to 44% of asthma around the world is due to environmental factors, according to the World Health Organization. About 9 million people die each year from the impact of polluted air, water, and soil, a recent report from the Lancet commission on pollution and health notes. Of those, about 6 million are due to air pollution, Peden explained.

"A lot of this is due to the use of indoor biomass. In many parts of the world, people burn wood, animal dung, or twigs — basically anything that can burn — because that is their primary heat or cooking source. This has actually been identified as a worldwide problem, especially in low- and middle-income countries where a lot of the population uses indoor biomass," he said. "There are substantial economic costs associated with this increased disease burden," he said, which includes COPD, lung cancer, and cardiovascular disease.

However, policies and regulations that make the air cleaner are working, Peden said.

"One great example comes from the Southern California Children's Study, run out of USC, where they've got 2.5 decades of data on children and adults," Peden pointed out. "It turns out that as the air has gotten cleaner, lung growth is better and there is less asthma-related disease. That air is cleaner, to a great extent, because of the regulatory things that have happened on a national level."

Mary Beth Fasano

"We have programming covering all of the usual topics — such as eczema, food allergy, asthma, and immune disorders," said Mary Beth Fasano, MD, from the University of Iowa in Iowa City, who is chair of the AAAAI annual meeting program. "But I would encourage folks to take advantage of the sessions that really focus on this year's theme."

"Learning how somebody in Japan or South Africa or South America is managing asthma or managing food allergy is going to be such a huge eye opener for those of us in the United States. We tend to put our blinders on and think that this is how things are done everywhere, but that's not so," Fasano pointed out. "Enhancing our international perspective on how diseases are evaluated and managed and being able to network with people from around the world will be a unique and wonderful opportunity for attendees of this meeting."

Mario Sanchez-Borges

The WAO will host a plenary — Asthma and Allergic Disorders in an Environment of Continuous Climate Change — comoderated by Peden and Mario Sanchez-Borges, MD, from the Centro Medico Docente La Trinidad in Caracas, Venezuela, who is immediate past president of the WAO

"There is evidence showing that allergic diseases, especially asthma and allergic rhinitis, are increasing as a result of environmental change, not only in developed countries, but also in less-developed areas of the world," Sanchez-Borges told Medscape Medical News.

"For example, dry climates are becoming more humid and warmer and places that used to be warm and humid are now dryer, so human health is changing because of the change in the environment. Climate plays a huge role in this," he said.

"By attending this meeting, clinicians and other healthcare providers can be updated on the most important issues regarding new therapies for allergic diseases, including immunotherapy, which offers the chance to alter the natural history of allergic disease," Sanchez-Borges said.

Fasano and Sanchez-Borges have disclosed no relevant financial relationships. Peden reports that his research is supported by the Environmental Protection Agency and the National Institute of Environmental Health Sciences.

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