6. Genetic Risk
ā¢ Oxidative stress
ļ master TF āNFE2L2ā translocates to Nuc.
ļ bind to antioxidant response element
ļ transcribe antioxidant genes
ā¢ GSTM1 (null genotype): antioxidative gene
ā āwheezing in children exposed to tobacco smoke during perinatal
period
ā āasthma attack in response to ozone
ā āinļ¬ammatory response to inhaled LPS (at 20,000 endotoxin
units): āIL-1Ī² and TNF-Ī± in the sputum
ā¢ TNF-Ī± SNP: proinflammatory gene
ā¢ Gene-gene-environmental interaction
Middleton 8th Edition
7. Classification of Air Pollutants
ā¢ Primary (directly emitted): SO2, some Nox, CO, PM10
ā¢ Secondary (form in the air): O3, some Nox, PM2.5, PM0.1
ā *Emission from source of 1o Ī± ambient conc. (but not for 2o)
ā āO3 paradoxically if āNO
ā¢ Indoor
ā Sources: cooking, AC, smoking, heating
ā Products: CO, CO2, SVOC, microbial, organic dusts, radon
ā¢ Outdoor (point/mobile sources)
ā Sources: industrial, agriculture, automobile
ā Products: CO, SVOC, PM, SO2 , O3, Nox
ā¢ Gaseous: CO, SVOC, PM, SO2 , O3, Nox
ā¢ Particulate: coarse (PM10), fine(PM2.5), ultrafine(PM0.1)
Jonathan A. Bernstein, et al., Health effects of air pollution, JACI 2004
8. Sources of Pollutants
ā¢ In the United States,
ā¢ Point sources
ā 93% of SO2
ā 51% of NOx
ā 9% of CO
ā 52% of VOC
ā¢ Both point and mobile sources contribute to PM
production.
Middleton 8th Edition
ā¢ Mobile sources
- 2% of SO2
- 45% of NOx
- 81% of CO
- 37% of VOC
9. ā¢ EPA determine ācriteria air pollutantsā
ā Human risks from short term exposure
ā¢ Nonattainment areas: don't meet the national standard
criteria
ā¢ Lead
ā¢ Carbon Monoxide (CO)
ā¢ Nitrogen Dioxide (NO2)
ā¢ Ozone, Ground Level
ā¢ Sulfur Dioxide (SO2)
ā¢ Particulate Matter (PM)
AQI
Standards for Air Pollutants
(the US Environmental Protective Agency)
Not currently regulated (Less data is known
about PM0.1 ;may have potentially more toxic
14. Mechanism (Direct)
ā¢ Free radical, oxidative stress generation
ā PAH on DEP, ozone, nitric dioxide
ā āEpithelial permeability
ā Inhibit the ciliary beat frequency (delayed
clearance of allergens and irritants)
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
15. Hierarchic Oxidative Stress Model
ā¢ āDose of PM sequentially induce responses
ā¢ Oxidative stress: āratio of glutathione/oxidized
glutathione
J.A.Bernstein, et al. Health effects of air pollution, JACI 2004
16. Mechanism (Direct *Imune)
ā¢ Modulate proinflammatory, chemotactic
markers from human bronchial epithelial cells
(in vitro)
ā ozone ļ āPAF, IL-8, GM-CSF, TNF-Ī±, sICAM-1
ā Nitric dioxide ļ LTC4, GM-CSF, TNF-Ī±, IL-8,
RANTES, sICAM-1
ā DEPs ļ IL-8, GM-CSF, sICAM-1
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
17. Mechanism (Direct)
ā¢ Covalent modification of key protein
ā Epigenetic modification
ā¢ Nocireceptor, ANS stimulation (HR, AW
reactivity): Ozone
ā¢ Procoagulant activity of ultrafine PM
18. Mechanism (Direct *Immune)
ā¢ Biologic compound: innate immune effects
ā Endotoxin, ozone
ā¢ Suppression of defense mechanism
ā Alveolar macrophage function
ā Dalay ciliary work
Middleton 8th Edition
19. Middleton 8th Edition
Heat shock proteins, oxidized lipids,
ļ¬brinogen, LMW hyaluronic acid
Hyaluronic: GAGs in AW matrix
Marker of ozone induced AW inflammation
20. Pollutant & Allergen Interactions
ā¢ Adjuvant effects in immune systems
ā DEPs, transition metals
ā DEPs, polyaromatic HCs ļ synthesis of IgE, IL-4
(TH2 polarization)
ā DEPs: āHLA-DR and CD86 molecules
Middleton 8th Edition
21. Pollen Structure & Releasings
ā¢ TH2 polarization (IgE and non-IgE)
ā PALMs (Pollen associated lipid mediators): LTB4
like
ā Phytoprostanes: PGE like
ā¢ Simple count of pollen grains
ā not always correlate with the prevalence of
sensitization
ā Allergenic potency* (releasing, structure of
allergen): free allergen not coincide with peak
pollen counts
Middleton 8th Edition
23. Pollutant & Allergen Interactions
ā¢ Pollen allergens carried by airborne particles
(Combine aeroallergens with particles)
ā¢ Then released by hydration or pollution-
induced rupture of pollens
ā ā Lamellation of intine
ā Elicit degranulation of cytoplasmic prot. to intine
Depend on type of pollutant, pollen
*SO2 + grass ļ ādegranulation of allergen e.g. East
German
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
26. Pollutant & Allergen Interactions
ā¢ Adaptation of plants to abiotic stress
ā¢ To endure environmental stress
ā¢ Measure of pollen allergenicity as a parameter of air
emissions and climate changes
ā¢ Comparative proteomics: ROS-scavenging pathway
products
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
27. Climate Change & Allergy
ā¢ Global warming = Plant stressor
ā Production of greenhouse gases (mostly = CO2)
ā North America: earlier(ragweed grow faster), last
longer pollen season, āpathogenic allergen
production
ā āCO2 2X ļ ragweed production by 61%
ā Tree, grass, weed, and ragweed
ā āPotency of allergen (āAmb a I content)
ā āGene corresponding allergen response to
drought (Protect flower from dehydration)
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
Middleton 8th Edition
32. Smog
ā¢ Type I (classic)
ā SO2, PM10
ā Not associated with āallergy prevalence
ā East Germany: industrialized farm ābut traffic exhaust
ā¢ Type II: āTraffic exhaust
ā NOx, PM2.5, PM0.1
ā ā Allergy prevalence
ā West Germany: traditional farm but ātraffic exhaust
Middleton 8th Edition
ā Farmer Hypothesis
33. Farmer Hypothesis
ā¢ Asthma prevalence
ā Eastern, central Europe < western
ā Amish < Hutterite schoolchildren
ā¢ āAsthma in traditional farm (esp. animal,
āmicrobial load)
Middleton 8th Edition
34. Particulate Matter
Coarse PM
ā¢ 2.5-10 micron
ā¢ Abraded soil, road dust, construction debris
Fine, ultrafine PM
ā¢ Small but more absorbed and toxic
ā¢ Fine < 2.5 micron, Ultrafine < 0.1 micron
ā¢ Formed during combustion of fossil fuel
products
Middleton 8th Edition
Vehicles of airborne pollen
35. Particulate Matter
ā¢ āAsthma exacerbations and development
ā¢ Metals in PM (e.g., copper, nickel, zinc) induce
AW inļ¬ammation
ā¢ Ghio and Huang: HR variability and other
systemic effects
ā¢ Ischemic cardiovascular events (MI)
Middleton 8th Edition
37. Diesel Exhaust
ā¢ Diesel combustion ļ DEPs, NOx, O3 precursor
ā Elemental carbon core (70% of mass)
ā Organic compounds, transition metal coat
ā¢ Single diesel < 0.1 micron ļ agglomerate to
fine particles (<2.5 micron)
ā¢ Inflammation: PAHs rich > Low PAHs
ā¢ Cedar pollinosis in high traffic area
ā¢ Asthma prevalence, severity, hospitalization,
AR, sensitization, ālung function
Middleton 8th Edition
38. Diesel Exhaust
ā¢ Proinflammatory cytokines, chemokines from
bronchial epithelium
ā¢ Alter T cell response
ā¢ Murine model, in vitro human Ba,L: āTh2
response (āsIgE)
ā Interfere IFN-ŅÆ producing pathway
ā Oxidant dependent pathway
ā¢ āSusceptible to viral infection (viral entry)
Middleton 8th Edition
39. Sulfer Dioxide
ā¢ Water soluble gas, might form H2SO4 particle
ā¢ Bronchoconstriction (rapid onset) in healthy,
asthma (āeffect in asthma)
ā¢ Prior O3 or cold air exposure ļ ābronchial
sensitivity to SO2 in asthma
ā¢ Nasal breath: āeffect (water solubilize)
ā AR/sinusitis +/- asthma
ā Exercise: should not exercise outdoor on polluted
day
Middleton 8th Edition
40. Nitrogen Dioxides
ā¢ Precursor to photochemical smog (O3)
ā¢ Combustion of fossil fuels or natural gas
ā¢ Urban and industrial regions
ā¢ āSevere asthmatic attack, AW inflammation
ā¢ āImmediate, late-phase response to inhaled
allergen in atopic pt
Middleton 8th Edition
41. Deficits in the Growth of FEV1
Gauderman WJ, et al.The Effect of Air Pollution on Lung
Development from 10 to 18 Years of Age, NEJM 2004
42. Ozone
ā¢ Stratospheric ozone is āgoodā, but ground
(troposphere) ozone is ābadā
ā¢ Main ingredient in āsmogā
ā¢ UV sunlight + Nox, VOCs = Ozone
ā Photochemical smog
ā Peak level in the afternoon of sunny days
ā¢ Chest pain, coughing, throat irritation, AW
inflammation
ā Pain due to nociceptor stimuli
Middleton 8th Edition
Jonathan A. Bernstein, et al., Health effects of air pollution, JACI 2004
44. Ozone
ā¢ āFEV1, āNonspecific AW hyperresponsiveness
ā Sensory-neural reflexes
ā Asthma exacerbation, development (chronic
expose)
ā Adult onset asthma in male
ā¢ *O3 + exercise ļ āFEV1, FVC, āAW resistance
(avoid outdoor exercise on āAQI day)
https://www.epa.gov/
45. Ozone
ā¢ AW inflammation (ROS; NFKB, TLRs)
ā¢ Innate immune response in asthma: āTLR4
ā¢ āImmediate, late-phase response to inhaled
allergen (āSputum Eo after 6 hr)
ā¢ Dose dependent
Middleton 8th Edition
46. Specific Volatile Organic Compounds
(SVOC)
ā¢ Subgroup of VOCs
ā Polyaromatic hydrocarbon(PAH), dioxins, benzene,
aldehydes, 1,3-butadiene
ā¢ Higher Mw
ā¢ Higher boiling point temp.
https://www.epa.gov/
47. Indoor Pollutants
ā¢ Biomass, NO2, PM, ETS, Endotoxin
ā¢ Sources:
ā Outdoor(PM2.5)
ā Smoking(Cigar, E-cigarete, marijuana)
ā Biomass burning (stoving, incense)
ā¢ Top 10 preventable RFs to the global burden
of disease (WHO declaration)
E.Matsui, et al.,Indoor Environmental Control Practices and
Asthma Management. Pediatrics. 2016;138(5):e20162589
48. Biomass
ā¢ Polyaromatic HCs, NO2, quinones, ROS,
airborne endotoxin
ā¢ Tobacco smoke, heating sources
ā¢ Predominantly in women, their children
ā¢ COPD development
ā¢ Children in Guatemala: āasthma symptoms
(biomass burning for cooking compared with
plancha stoves)
Middleton 8th Edition
49. Biomass
ā¢ Acute lower RS infection (RS epithelium
damage, MĆ, mucociliary dysfunction)
ā¢ In utero: ābirth weight, future lung fn. effects
ā¢ Oncogenic: AdenoCA lung due to DNA damage
(ROS)
Middleton 8th Edition
50. Indoor NO2
ā¢ Outdoor ā traffic
ā¢ Indoor ā gas heat, older wood-burning stoves,
unvented space heaters
ā¢ Higher indoor NO2: worsen asthma
ā¢ Ensuring that the stove is properly vented
ā¢ 1 RCT: ā40-50% in indoor NO2 when a gas
stove was replaced with an electric one
ā This degree reduction improve asthma?
E.Matsui, et al.,Indoor Environmental Control Practices and
Asthma Management. Pediatrics. 2016;138(5):e20162589
51. Environmental Tobacco Smoking
ā¢ Ā½ pack of cigarette = PM 4 mcg/m3
ā¢ Restaurants in Paducah, Kentucky1
ā 87 Ī¼g/m3 in the nonsmoking areas
ā The mean PM2.5 was 177 Ī¼g/m3 in smoking areas
ā¢ 29 times higher than that in smoke-free air
ā¢ 6 times higher than local outdoor air in Paducah
ā¢ PM, non-PM (air nicotine, other gaseous pollutants)
ā HEPA purifiers: filter only PM
ā¢ Control: stop smoking > home smoking free > HEPA
purifiers (home free: not eliminate exposure)
1.Jones SC, Travers MJ, Hahn EJ, et al. Secondhand smoke and indoor
public spaces in Paducah, Kentucky. J Ky Med Assoc 2006;104:281-8.
2.E.Matsui, et al.,Indoor Environmental Control Practices and
Asthma Management. Pediatrics. 2016;138(5):e20162589
52. Environmental Tobacco Smoking
ā¢ Mainstream smoke: taken by smoker
ā¢ Sidestream smoke: burning end, exhaled from
smoker
ā¢ Cotinine = direct metabolite of nicotine, but
longer T1/2 in body
ā Slower mechanism in African Americans
ā¢ Present in saliva, urine, serum, hair
Middleton 8th Edition
53. Environmental Tobacco Smoking
ā¢ E-cigarette aerosol and tobacco: similar
amounts of ROS
ā Size of the particles: respirable range (median
aerodynamic diameter of 1.03 Ī¼m)
C. Dinakar et al., The Health Effects of Electronic Cigarettes, NEJM 2016
54. Environmental Tobacco Smoking
ā¢ Epigenetic modiļ¬cations (oxidative stress)
ā DNA methylation and others
ā Effect on children exposed in utero or during early
life (hypothesis)
ā¢ Asthma exacerbations in children
ā¢ āUrinary LTE4 in children
ā¢ Epidemiologic study: development of allergy
esp. in early life2
1.Middleton 8th Edition
2.Seymour BW, et al. Second-hand smoke increases bronchial hyperreactivity and
eosinophilia in a murine model of allergic aspergillosis. Clin Dev Immunol 2003;10:35-42
55. Endotoxin
ā¢ Tobacco smoke, PM in occupational and domestic
environments
ā¢ Effect of early LPS exposure on atopy or asthma
development is unclear
ā Hygiene/Farmer hypothesis
ā¢ Inhaled LPS interacts with CD14 and TLR4
ā¢ āCD11b and CD14 in AW monocytes and
macrophages in asthma
ā¢ āAllergen response: IgE-dependent and present
to mucosal T cells
Middleton 8th Edition
56. Amish environment protects against asthma
by shaping the innate immune response
(Picture from Quick Take; Asthma Risk and Farming)
M.M. Stein, et al. Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children, NEJM 2016
57. RS Effects of Air Pollution
ā¢ Upper & lower RS symptom
ā¢ Acute changes in lung function
ā O3: AW inflam & hyperresponsive, asthma, allergen
sensitize (early & late)
ā PM: AW inflam, asthma, IHD
ā Nox: wheezing, allergen response (early & late), AW
inflam, worsen asthma, āRS infection
ā SO2, sulfates, acid aerosols : RS irritant,
Bronchospasm(āexacerbation)
ā ETS: asthma
J.A.Bernstein, et al. Health effects of air pollution, JACI 2004
58. Long-term exposure
ā¢ āSensitization to allergens during childhood
ā Observational study in Japan: Cedar pollinosis
ā Cross-sectional: atopic children, road density
ā Meta-analysis: concentrations of PM
ā¢ ā Asthma, allergy incidence
G. Schiavoni et al., The dangerous liaison between pollens and
pollution in respiratory allergy, Ann Allergy Asthma Immunol 2017
59. Decreased Lung Growth of FEV1
Related to Increased Pollutants
Gauderman WJ, et al.The Effect of Air Pollution on Lung
Development from 10 to 18 Years of Age, NEJM 2004
60. Proportion of Children who had low FEV1
Related to Increased Pollutants (exc. O3)
Gauderman WJ, et al.The Effect of Air Pollution on Lung
Development from 10 to 18 Years of Age, NEJM 2004
61. Increased Lung Growth of FEV1
Related to Decreased Pollutants (exc. O3)
Gauderman WJ, et al. Association of Improved Air
Quality with Lung Development in Children, NEJM 2015
Mean 4-Year Lung-Function Growth vs the Mean Levels of Four Pollutants
63. CXCR2 Antagonist
Remo C Russo, et al. The CXCL8/IL-8 chemokine family and its
receptors in inflammatory diseases, Expert Rev. Clin. Immunol. 2014
64. Management
ā¢ Antioxidant
ā Ī±-tocopherol + vit C: O3-induced lung function
decrements
ā Oral sulforaphane; in broccoli
ā¢ Induced phase II enz. in B cells
ā¢ Blocked DEP enhancement of IgE production
65. Environmental Control
ā¢ Target
ā Primary: avoid sensitize, asthma development
ā Secondary: Prevent asthma morbidity
ā¢ Multiple intervention over long period of time
(at least 1-2 yr)
M.Hauptman, et al., Environmental Control: The First Tanet of Allergy, JACI Pract 2018
67. Air Cleaning Options
in Residential Buildings
ā¢ Whole-house ļ¬ltration (WHF)
ā Filters or cleaners installed on the central HVAC
system)
ā¢ Free-standing portable room air cleaners
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
68. Whole-house ļ¬ltration (WHF)
ā¢ Heating, Ventilation, Air Conditioning (HVAC) system
ā¢ MERV: minimum efļ¬ciency reporting value
ā Tested by 12 particle sizes 0.3-10 micron as ASHRAE standard
testing method ver 52.2-2007
ā¢ Adequate airļ¬ow for ventilation
ā Residential ļ¬lters: airļ¬ow velocity 300 ft/min (MERV 1-12)
ā Systemās fan remain on for maximum beneļ¬t
ā¢ Media ļ¬lters: maintain efficacy after use
ā Loss electrostatic activity
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
69. Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
Residential and ofļ¬ce: MERV 1-12
Ductwork length > 10 ft (3m): MERV ā„ 6
70. Whole-house ļ¬ltration (WHF)
1. Panel ļ¬lters (Inexpensive to higher efficenct)
2. Washable/reuseable ļ¬lters
3. High-efļ¬ciency particulate air (HEPA) ļ¬lters
4. EACs
5. Hybrid combinations of the prior types
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
71.
72. Panel Filters
Inexpensive panel ļ¬lters
ā¢ No beneļ¬t to small particulate
ā¢ Capturing and dumping particulates
downstream
ā¢ No/very low MERV 1 ā 2
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
73. Panel Filters
Panel furnace higher-efļ¬ciency ļ¬lters
ā¢ The most effective are usually of non-woven
materials, e.g. polyoleļ¬n
ā Can reach MERV of 11 - 12 in 1-in pleated panel
ā American Lung Association Health House
recommends MERV ā„ 11
ā Filter change intervals: q 3 mo for residential use with
annual replacement
ā Custom installed 2- to 5-in ļ¬lters: ācapacity but
expensive
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
74. Panel Filters
Washable panel ļ¬lters
ā Metal or woven nylon ļ¬lament
ā If charged materials coated ļ āefļ¬ciency
dramatically
ā Inadequate washing might leave residual damp
dirt ļ substrate for mold or bacterial growth
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
75. HEPA HVAC Filters
ā¢ Minimum particle collection efļ¬ciency =
99.97% on 0.3 micron of speciļ¬ed aerosol
ā Better greater than and less than that size
ā¢ Term HEPA: particulate > 0.3 micron
ā Misuse: āāHEPA-typeāā or āāHEPA-likeāā may not
meet performance
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
76. HEPA HVAC Filters
ā¢ HEPA ļ¬lters for HVAC systems require bypass
systems
ā Up to 80% of the air intake not pass ļ¬lter because
of high airļ¬ow resistance
ā¢ Furnace HEPAs: highly efļ¬cient in closed
systems
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
77. Powered Electronic Filters
ā¢ EACs or Electronic Precipitators
ā¢ Entering dust, air are ionized in a high-voltage
electric ļ¬eld
ā¢ Precipitated onto collecting surfaces
ā¢ āEfļ¬ciency: the plates load, covered with
dust ļ recommend clean q 1 month
ā¢ Produce low levels of ozone
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
79. Composite Component Systems
ā¢ EACs
ā¢ Standard disposable elements to UV lights
(germicidal effects)
ā¢ Coatings for catalytic conversion of ozone
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
80. Portable Air Cleaners
ā¢ Clean air delivery rate: decay of the presence
of these aerosols (as AHAM standard)
ā Cigarette smoke: 0.09 ā 1 micron particle size
ā Fine calibrated test dust: 0.5 ā 3 micron
ā Mulberry pollen: 5 ā 11 micron
ā¢ Label with the clean-air delivery rate numbers
ā The higher, the faster cleans
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
81.
82. Portable Air Cleaners
ā¢ Ionizer air cleaners or puriļ¬ers
ā¢ HEPA room air cleaners
ā¢ Non-HEPA room air cleaners that contain disposable
or washable ļ¬lters
ā¢ Composite of above
Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
āāPuriļ¬ersāā (like the EACs): means of an electronic ļ¬eld
Limitation: 1. Unionized particle released
2. Ionization can also produce ozone
(although ozone-to-oxygen converters are now added on many of
these devices)
83. HEPA Room Air Cleaners
ā¢ High-Efficiency Particulate Air
ā¢ Filter only particulate (not for gaseous)
ā¢ Many RCTs ļ symptom reduction
ā¢ āIndoor PM concentration: 25-50%
ā āAsthma symptoms, exacerbation
ā¢ Little evidence to support efficacy in āairborne
animal allergens, pollen
ā¢ *Nonionizing HEPA purifiers with āclean air
delivery rates (room size appropriate)
E.Matsui, et al.,Indoor Environmental Control Practices and
Asthma Management. Pediatrics. 2016;138(5):e20162589
84. Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
WHF trail: mostly positive
85. Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
86. Louisville, et al. Air ļ¬lters and air cleaners: Rostrum by the American
Academy of Allergy, Asthma & Immunology Indoor Allergen Committee, JACI 2010
Need sufficient duration & combined multi-intervention
87. Summary
Pollutants + climatic changes
= plant, human stressors
ā¢ Direct: Inflammation + āsusceptibility to allergen
ā¢ Indirect
ā Combining aeroallergens with particles (diesel
exhaust): spreading
ā Adaptation of plants to abiotic stress: ā qualitative &
quantitative allergenicity
88. Summary
ā¢ History taking: home, + of relatives, school,
daycare, transportation
ā¢ Measures
ā Source removal
ā Source control
ā Mitigating strategies