The Role of Socioeconomic Status in the Association of Lung Function and Air PollutionA Pooled Analysis of Three Adult ESCAPE Cohorts

Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Rhinitis: characterisation and association with air pollution

La rinitis tiene un impacto importante en la salud pública, sin embargo en los adultos no existe una estandarización de la definición en los estudios epidemiológicos. Además, apenas se conocen los factores ambientales de la rinitis y, en particular, existen muy pocos estudios sobre los efectos de la contaminación atmosférica a largo plazo sobre la rinitis en adultos. Para llenar estos vacíos, utilizamos datos de dos estudios epidemiológicos europeos multicéntricos con datos extensos sobre la salud respiratoria y con datos de exposición individual a la contaminación atmosférica a largo plazo. Nuestros resultados mostraron que para caracterizar mejor la rinitis, es necesario considerar conjuntamente todas las características de los síntomas nasales, las comorbilidades y la sensibilización alérgica, y no restringir la enfermedad a una pregunta o a una prueba de sensibilización alérgica. No encontramos asociación entre la contaminación atmosférica a largo plazo y la incidencia de rinitis, pero demostramos que la exposición a la contaminación del aire a largo plazo aumenta la severidad de la rinitis, enfatizando que es necesario controlar la contaminación atmosférica.Whereas rhinitis has an important public health impact, in adults there is no standardized definition of rhinitis in epidemiological studies. Furthermore, environmental factors of rhinitis are barely known, and in particular, there are very few studies on the effects of long-term exposure to air pollution on rhinitis in adults. To fill these gaps, we used data from two European multicentre epidemiological studies with extensive data on respiratory health and individual estimated exposures to long-term air pollution. Our findings showed that to better characterize rhinitis, one need to consider together all the characteristics of the nasal symptoms, the comorbidities and the allergic sensitization, and not to restrict the disease to one question or one allergic sensitization test. We found no association between long-term air pollution and incidence of rhinitis, but we showed that long-term exposure to air pollution is associated to an increased severity of rhinitis, emphasising that air pollution needs to be controlled

Rhinite : caractérisation et association avec la pollution atmosphérique

Whereas rhinitis has an important public health impact, in adults there is no standardized definition of rhinitis in epidemiological studies. Furthermore, environmental factors of rhinitis are barely known, and in particular, there are very few studies on the effects of long-term exposure to air pollution on rhinitis in adults. To fill these gaps, we used data from two European multicentre epidemiological studies with extensive data on respiratory health and individual estimated exposures to long-term air pollution. Our findings showed that to better characterize rhinitis, one need to consider together all the characteristics of the nasal symptoms, the comorbidities and the allergic sensitization, and not to restrict the disease to one question or one allergic sensitization test. We found no association between long-term air pollution and incidence of rhinitis, but we showed that long-term exposure to air pollution is associated to an increased severity of rhinitis, emphasising that air pollution needs to be controlled.Alors que la rhinite a un fort impact sur la santé publique, chez l’adulte, il n’existe pas de définition standardisée de la rhinite dans les études épidémiologiques. De plus, les facteurs environnementaux de la rhinite sont mal connus et, en particulier, il existe très peu d'études sur les effets à long terme de la pollution atmosphérique sur la rhinite chez l'adulte. Pour combler ces lacunes, nous avons utilisé les données de deux études épidémiologiques multicentriques européennes ayant des données détaillées sur la santé respiratoire et d'exposition annuelle individuelle à la pollution atmosphérique. Nos résultats ont montré que pour mieux caractériser la rhinite, il faut considérer l’ensemble des caractéristiques des symptômes nasaux, les comorbidités et la sensibilisation allergique, et ne pas limiter la maladie à une question ou à un test de sensibilisation allergique. Nous n'avons trouvé aucune association entre la pollution atmosphérique à long terme et l'incidence de la rhinite, mais nous avons montré que l'exposition à long terme à la pollution était associée à une augmentation de la sévérité de la rhinite, soulignant le besoin de contrôler les niveaux de pollution atmosphérique

Rhinitis : characterization and association with air pollution

Alors que la rhinite a un fort impact sur la santé publique, chez l’adulte, il n’existe pas de définition standardisée de la rhinite dans les études épidémiologiques. De plus, les facteurs environnementaux de la rhinite sont mal connus et, en particulier, il existe très peu d'études sur les effets à long terme de la pollution atmosphérique sur la rhinite chez l'adulte. Pour combler ces lacunes, nous avons utilisé les données de deux études épidémiologiques multicentriques européennes ayant des données détaillées sur la santé respiratoire et d'exposition annuelle individuelle à la pollution atmosphérique. Nos résultats ont montré que pour mieux caractériser la rhinite, il faut considérer l’ensemble des caractéristiques des symptômes nasaux, les comorbidités et la sensibilisation allergique, et ne pas limiter la maladie à une question ou à un test de sensibilisation allergique. Nous n'avons trouvé aucune association entre la pollution atmosphérique à long terme et l'incidence de la rhinite, mais nous avons montré que l'exposition à long terme à la pollution était associée à une augmentation de la sévérité de la rhinite, soulignant le besoin de contrôler les niveaux de pollution atmosphérique.Whereas rhinitis has an important public health impact, in adults there is no standardized definition of rhinitis in epidemiological studies. Furthermore, environmental factors of rhinitis are barely known, and in particular, there are very few studies on the effects of long-term exposure to air pollution on rhinitis in adults. To fill these gaps, we used data from two European multicentre epidemiological studies with extensive data on respiratory health and individual estimated exposures to long-term air pollution. Our findings showed that to better characterize rhinitis, one need to consider together all the characteristics of the nasal symptoms, the comorbidities and the allergic sensitization, and not to restrict the disease to one question or one allergic sensitization test. We found no association between long-term air pollution and incidence of rhinitis, but we showed that long-term exposure to air pollution is associated to an increased severity of rhinitis, emphasising that air pollution needs to be controlled

Susceptibility factors relevant for the association between long-term air pollution exposure and incident asthma

In this review, we identified 15 studies in children and 10 studies in adults that assessed the association between long-term exposure to air pollution and incident asthma and that conducted stratified analyses to explore potential susceptibility factors. Overall, adult never-/former smokers seem to be at higher risk of incident asthma due to air pollution. Children without atopy and children from low socioeconomic status families also seem to be at higher risk of incident asthma due to air pollution. While interaction between air pollution and genes involved in the response to oxidative stress pathways have been explored, results are somewhat inconsistent and in need of replication. To evaluate interactions, large sample sizes are necessary, and much more research, including data pooling from existing studies, is needed to further explore susceptibility factors for asthma incidence due to long-term air pollution exposure.SESAP: ANSES EST-2012-16

Outdoor air pollution and asthma in a changing climate

International audienceThe purpose of the chapter is to summarize the recent research on the associations between long-term exposure to air pollution and asthma and allergies, both in adults and children, and to identify knowledge gaps for future research. The chapter also discusses the evidence of the impacts of climate change on air pollution as well as the possible interactions between air pollution, climate change, and allergens

Susceptibility factors relevant for the association between long-term air pollution exposure and incident asthma

In this review, we identified 15 studies in children and 10 studies in adults that assessed the association between long-term exposure to air pollution and incident asthma and that conducted stratified analyses to explore potential susceptibility factors. Overall, adult never-/former smokers seem to be at higher risk of incident asthma due to air pollution. Children without atopy and children from low socioeconomic status families also seem to be at higher risk of incident asthma due to air pollution. While interaction between air pollution and genes involved in the response to oxidative stress pathways have been explored, results are somewhat inconsistent and in need of replication. To evaluate interactions, large sample sizes are necessary, and much more research, including data pooling from existing studies, is needed to further explore susceptibility factors for asthma incidence due to long-term air pollution exposure.SESAP: ANSES EST-2012-16

The sensitization pattern differs according to rhinitis and asthma multimorbidity in adults: the EGEA study.

International audienceMono- and polysensitization are different IgE-mediated allergic phenotypes in children. Allergic sensitization is associated with both allergic asthma and allergic rhinitis, however, associations between the sensitization pattern and particularly polysensitization with asthma and rhinitis remains poorly studied in adults.The aim of this study was to assess how the allergic sensitization pattern associates with asthma, rhinitis and their multimorbidity.1199 adults from the EGEA study, with extensive phenotypic characterization and all data available on skin prick tests to 10 allergens, total IgE and blood eosinophils were included. Using questionnaires only, participants were classified into 6 groups: asymptomatic (no asthma, no rhinitis), non-allergic rhinitis alone, allergic rhinitis alone, asthma alone, asthma+non-allergic rhinitis and asthma+allergic rhinitis. Mono- and polysensitization were defined by a positive skin prick test to one or more than one allergen respectively.Asymptomatic participants and those with non-allergic rhinitis alone were mostly non-sensitized (around 72%) while around 12% were polysensitized. Between 32% and 43% of participants with allergic rhinitis alone, asthma alone and asthma+non-allergic rhinitis were non-sensitized and between 37% and 46% of them were polysensitized. 65% of the participants with asthma+allergic rhinitis were polysensitized. The level of total IgE followed a similar trend to that of allergic sensitization. Eosinophils were increased in asthma, especially when associated with rhinitis. Nasal symptoms were more severe and eczema more common in participants with both asthma and allergic rhinitis than in the other groups.Allergic sensitization and particularly polysensitization rates widely differ according to asthma and rhinitis status. This study emphasized the importance of taking into account multimorbidity between asthma and rhinitis and showed that allergic sensitization is not a dichotomic variable

The sensitization pattern differs according to rhinitis and asthma multimorbidity in adults: the EGEA study.

International audienceMono- and polysensitization are different IgE-mediated allergic phenotypes in children. Allergic sensitization is associated with both allergic asthma and allergic rhinitis, however, associations between the sensitization pattern and particularly polysensitization with asthma and rhinitis remains poorly studied in adults.The aim of this study was to assess how the allergic sensitization pattern associates with asthma, rhinitis and their multimorbidity.1199 adults from the EGEA study, with extensive phenotypic characterization and all data available on skin prick tests to 10 allergens, total IgE and blood eosinophils were included. Using questionnaires only, participants were classified into 6 groups: asymptomatic (no asthma, no rhinitis), non-allergic rhinitis alone, allergic rhinitis alone, asthma alone, asthma+non-allergic rhinitis and asthma+allergic rhinitis. Mono- and polysensitization were defined by a positive skin prick test to one or more than one allergen respectively.Asymptomatic participants and those with non-allergic rhinitis alone were mostly non-sensitized (around 72%) while around 12% were polysensitized. Between 32% and 43% of participants with allergic rhinitis alone, asthma alone and asthma+non-allergic rhinitis were non-sensitized and between 37% and 46% of them were polysensitized. 65% of the participants with asthma+allergic rhinitis were polysensitized. The level of total IgE followed a similar trend to that of allergic sensitization. Eosinophils were increased in asthma, especially when associated with rhinitis. Nasal symptoms were more severe and eczema more common in participants with both asthma and allergic rhinitis than in the other groups.Allergic sensitization and particularly polysensitization rates widely differ according to asthma and rhinitis status. This study emphasized the importance of taking into account multimorbidity between asthma and rhinitis and showed that allergic sensitization is not a dichotomic variable