The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis

IntroductionIn the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem.ObjectiveIn this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis.MethodTo reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results.ResultsExposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues.ConclusionDramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations

Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease

Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet’s health in the context of the ‘epithelial barrier hypothesis,’ including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease

A Baker with Asthma and Wheat Flour Food Allergy

Patients with wheat flour food allergy and with baker's asthma are not sensitised to wheat pollen, despite the fact that they share some common allergens. In the same way, asthmatic bakers tolerate the ingestion of bread. The difference in sensitisation routes (inhalation versus ingestion) and allergenic source (wheat flour versus processed wheat foodstuffs) could explain this fact, although some wheat allergens, like a-amylase inhibitors, lipid transfer proteins and gliadin are implicated in both types of allergy. We report the case of a 45-year-old male who worked in a bakery for 30 years as a baker. He was confirmed to have occupational asthma, rhinitis and food allergy due to wheat flour

A retrospective analysis of practice patterns in the management of acute asthma attack across Turkey

Objective To evaluate patient characteristics and practice patterns in the management of acute asthma attack at tertiary care centers across Turke

A cost-of-illness study estimating the direct cost per asthma exacerbation in Turkey

Objective: To calculate direct cost per asthma exacerbation at tertiary healthcare centers across Turkey

A retrospective analysis of practice patterns in the management of acute asthma attack across Turkey

Objective To evaluate patient characteristics and practice patterns in the management of acute asthma attack at tertiary care centers across Turke

Asthma control test via text messaging: could it be a tool for evaluating asthma control?

Introduction: Originally, the Asthma Control Test (ACT) was designed for English-speaking patients using a paper-and-pencil format. The Turkish version of the ACT was recently validated. This article compares the paper-and-pencil and web-based texting formats of the Turkish version of the ACT and evaluates the compatibility of these ACT scores with GINA-based physician assessments of asthma control. Methods: This multicentre prospective study included 431 asthma patients from outpatient clinics in Turkey. The patients were randomized into a paper-and-pencil group (n = 220) and a text messaging group (n = 211). Patients completed the ACT at Visit 1, after 10 +/- 2 days, and at 5 +/- 1 week to demonstrate the reliability and responsiveness of the test. At each visit, physicians assessed patients' asthma control levels. Results: The ACT administered via texting showed an internal consistency of 0.82. For the texting group, we found a significant correlation between the ACT and physician assessments at Visit 1 (r = 0.60, p < 0.001). The AUC was 0.87, with a sensitivity of 78.0% and a specificity of 77.5% for a score of <= 19 for screening "uncontrolled" asthma in the texting group. Conclusion: When the Turkish version of the ACT was administered via either the paper-and-pencil or text messaging test, scores were closely associated with physician assessments of asthma control

The validation of the Turkish version of Asthma Control Test

Current guidelines focus more on levels of asthma control than on severity of asthma. The original version of the Asthma Control Test (ACT), a self-administered instrument to determine asthma control levels, was designed for English-speaking patients. More recently, the ACT has been translated into many languages and has been validated for many cultures, but this is the first study to evaluate the Turkish version