Abstract
Environmental factors play an important role in the development and exacerbation of allergic rhinitis (AR) in childhood. Indoor air pollution, such as house dust mites and secondhand smoke, can significantly increase the onset of AR, while pet dander may affect the exacerbation of AR symptoms in children. Furthermore, traffic related air pollution and pollen are outdoor air pollutants that can affect immune competency and airway responsiveness, increasing the risk of AR in children. Climate change has increased AR in children, as growth patterns of allergenic species have changed, resulting in longer pollen seasons. More extreme and frequent weather events also contribute to the deterioration of indoor air quality due to climate change. Additionally, viruses provoke respiratory tract infections, worsening the symptoms of AR, while viral infections alter the immune system. Although viruses and pollution influence development and exacerbation of AR, a variety of treatment and prevention options are available for AR patients. The protective influence of vegetation (greenness) is heavily associated with air pollution mitigation, relieving AR exacerbations, while the use of air filters can reduce allergic triggers. Oral antihistamines and intranasal corticosteroids are common pharmacotherapy for AR symptoms. In this review, we discuss the environmental risk factors for AR and summarize treatment strategies for preventing and managing AR in children.
Highlights
A global health problem with significant economic burden, allergic rhinitis (AR) has established itself as the most common chronic allergic disease and affects approximately 40% of the population worldwide [1,2,3]
During the Health Effects of School Environment (HESE) project, it was found that 78% of children attending schools in Norway, Sweden, Denmark, France, and Italy are exposed to high levels of inhalable particulate matter with a diameter of 10 micrograms (PM10), and 66% are exposed to carbon dioxide (CO2) over 1000 ppm [20]
A birth cohort study of over 4000 children followed for 16 years found that exposure to secondhand smoke during infancy was associated with a 1.18 increased risk of rhinitis up to 16 years of age, but exposure to secondhand smoke throughout childhood was not associated with the development of rhinitis, suggesting an early window of susceptibility to SHS [29]
Summary
A global health problem with significant economic burden, allergic rhinitis (AR) has established itself as the most common chronic allergic disease and affects approximately 40% of the population worldwide [1,2,3]. AR is a chronic inflammatory disease in the upper airways that is induced by an abnormal immunological response to airborne antigens [8] It is an immunoglobulin-E (IgE) mediated type 1 hypersensitivity illness triggered by a wide array of environmental allergens such as pollen, mold, and dust [9]. With additional exposure to allergens and pollutants, histamines, arachidonic acid metabolites, and other inflammatory mediators are released from mast cells, resulting in sneezing, nasal congestion, and other common AR symptoms [17]. Pollutants can provoke the nasal mucosa, allowing the release of mediators of allergic inflammation and increasing nasal hyperreactivity [9] Both outdoor air pollution, such as traffic related air pollution (TRAP), and indoor air pollution, including pet dander, molds, and tobacco smoke, contribute to the development of AR in children [18]
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