Abstract
Allergic rhinitis affects the quality of life of millions of people worldwide. Air pollution not only causes morbidity, but nearly 3 million people per year die from unhealthy indoor air exposure. Furthermore, allergic rhinitis and air pollution interact. This report summarizes the discussion of an International Expert Consensus on the management of allergic rhinitis aggravated by air pollution. The report begins with a review of indoor and outdoor air pollutants followed by epidemiologic evidence showing the impact of air pollution and climate change on the upper airway and allergic rhinitis. Mechanisms, particularly oxidative stress, potentially explaining the interactions between air pollution and allergic rhinitis are discussed. Treatment for the management of allergic rhinitis aggravated by air pollution primarily involves treating allergic rhinitis by guidelines and reducing exposure to pollutants. Fexofenadine a non-sedating oral antihistamine improves AR symptoms aggravated by air pollution. However, more efficacy studies on other pharmacological therapy of coexisting AR and air pollution are currently lacking.
Highlights
Pollution is the introduction of excessive elements into the environment resulting in detrimental health effects
Epidemiological and clinical studies demonstrate the immunological effect resulting from both aeroallergen and pollutant co-exposure, which is inducing inflammatory responses with recruitment of inflammatory cells, cytokines, and interleukins
Rhinitis symptoms can be mediated by a neurogenic component upon exposure to environmental irritants
Summary
Pollution is the introduction of excessive elements into the environment resulting in detrimental health effects. Ventilation and air conditioning (HVAC) systems have the inherent capacity to circulate an extensive air volume within residences and, can reduce indoor air pollutants by improving outdoor and indoor air exchange These can be combined with high efficiency particulate air (HEPA) filters capable of extracting 0.3 mm in size air particles and can effectively reduce infectious and allergic triggers of respiratory illnesses.[125,126] An alternative or better, a supplement to this, is opening windows periodically to allow external air ventilation, if outside temperature, humidity, and level of outdoor pollutants permit.[125,126] current evidence strongly suggests air filtration is a powerful tool to reduce the health risks of PM exposure and prevent disease progression.[127] Other filters called powered electronic filters use high voltage electrical field to ionize particulates which can get deposited downstream on collecting panels within the device. Attempts to improve our understanding should encompass the following general approaches: 1) Insight into gene-environment interactions (i.e. internal and external exposomes); 2) Better characterization of clinically important symptoms in order to treat or prevent them, should we be unable to prevent the disease itself; and 3) Assess clinical effectiveness of these measures, their overall cost to the individual, the health care system, and society.[140]
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