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Will environmental impacts of social distancing due to the pandemic caused by SARS-CoV-2 decrease allergic disease?

  • Valentin Navel
    Correspondence
    Corresponding author: Valentin Navel, MD, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France 63000.
    Affiliations
    Université Clermont Auvergne, CNRS, INSERM, GReD, Translational Approach to Epithelial Injury and Repair, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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  • Frédéric Chiambaretta
    Affiliations
    Université Clermont Auvergne, CNRS, INSERM, GReD, Translational Approach to Epithelial Injury and Repair, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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  • Frédéric Dutheil
    Affiliations
    Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Witty Fit, Clermont-Ferrand, France
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Published:April 26, 2020DOI:https://doi.org/10.1016/j.jaci.2020.04.026

      Key words

      The burden of climatic change and air pollution represents a massive challenge for humanity, affecting the development of allergic diseases and upsetting the exposome.
      • Agache I.
      • Miller R.
      • Gern J.E.
      • Hellings P.W.
      • Jutel M.
      • Muraro A.
      • et al.
      Emerging concepts and challenges in implementing the exposome paradigm in allergic diseases and asthma: a Practall document.
      Air pollution, a causative factor of climate change, contributes to 9 million deaths per year,
      • Forouzanfar M.H.
      • Afshin A.
      • Alexander L.T.
      • Anderson H.R.
      • Bhutta Z.A.
      • Biryukov S.
      • et al.
      Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.
      and more than 500 million people have an allergic disease around the world.
      • Permaul P.
      • Gaffin J.M.
      • Petty C.R.
      • Baxi S.N.
      • Lai P.S.
      • Sheehan W.J.
      • et al.
      Obesity may enhance the adverse effects of NO2 exposure in urban schools on asthma symptoms in children.
      In urban areas of industrial countries, the ocular surface, the respiratory tracts, and the skin are exposed daily to the intense burden of particulate matter, ozone (O3), carbon dioxide (CO2), nitrogen dioxide (NO2), and sulfur dioxide (SO2) produced by diesel combustion and industrial fumes. Air pollution is a causative factor for both various symptoms such as bronchospasm, rhinorrhea, eye redness, and irritation and various allergic diseases such as asthma, chronic rhinitis, nasal polyposis, atopic dermatitis, seasonal or perennial allergic conjunctivitis, and vernal or atopic keratoconjunctivitis.
      • Demain J.G.
      Climate change and the impact on respiratory and allergic disease: 2018.
      Since December 8, 2019, humanity has been confronted with a viral pneumonia pandemic caused by a coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially described in Wuhan, Hubei, China, the increase in worldwide tourism and commercial airline flights upgraded the numbers of countries infected, causing several million cases and hundred-thousands of deaths. The worldwide authorities responded by promulgating global quarantine in accordance with the World Health Organization. Consequently, human activities have been drastically decreased, with massive reduction in greenhouse gas emissions. Since the last 1 century, the worldwide emission of greenhouse gases, that is, NO2 and CO2, has involved a global warming up to 1°C compared with the preindustrial era, increasing air humidity and mold exposure, and modifying pollen patterns.
      • Wuebbles D.J.
      • Fahey D.W.
      • Hibbard K.A.
      • Dokken D.J.
      • Stewart B.C.
      • et al.
      U.S. Global Change Research Program
      Climate Science Special Report: Fourth National Climate Assessment, Volume I. U.S. Global Change Research Program.
      Concordantly with the climatic changes, sensitization rates and allergic diseases increased with the level of allergenicity of several species of plants such as ragweed, birch, or plane tree. The heat stress and the air pollution peaks promote mucosal and systemic inflammation, decreasing the airway hyperreactivity threshold and increasing asthma exacerbations and the global mortality.
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      • et al.
      Effects on asthma and respiratory allergy of climate change and air pollution.
      Putative etiologic relation between atmospheric changes and allergic diseases is mediated by inflammation and oxidative stress in tissues exposed, enhancing immunologic responses to allergens, carrying aeroallergens into the airways, and inducing epithelial permeability.
      • D’Amato G.
      • Vitale C.
      • De Martino A.
      • Viegi G.
      • Lanza M.
      • Molino A.
      • et al.
      Effects on asthma and respiratory allergy of climate change and air pollution.
      Interestingly, NASA’s Aura satellite described an NO2 decrease by 25% across China from January 1-20, 2020 (before the quarantine), to February 10-25 (during the quarantine). A similar decrease was measured in most megalopolis of developing countries around the world where containment was set for limiting the spreading of the SARS-CoV-2 (Fig 1).
      European Space Agency
      Nitrogen dioxide concentrations over France.
      At the time of writing, a third of humanity (more than 3 billion people) have to stay confined at home. Initially spreading around Asia, the epicenter of epidemic moved to Europe and, tomorrow, probably in American and African continent. Even if this global containment lasts 1 or 2 months, the impact of the air quality should be significant on the allergic diseases exposome during forthcoming months. We have seen smaller examples in which regional decrease in the use of fossil fuels is related to decreased exacerbation of allergic disease. However, the pandemic caused by SARS-CoV-2 has resulted in a global decrease in the use of fossil fuels. This may offer an unintended insight on a global scale into the impact of decreased fossil fuel use on allergic and respiratory disease.
      Figure thumbnail gr1
      Fig 1A major decrease in NO2 pollution in most megalopolis of developing countries following containment for limiting the spreading of the pandemic caused by SARS-CoV-2 (satellite images from European Spatial Agency).
      European Space Agency
      Nitrogen dioxide concentrations over France.

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      Linked Article

      • The bimodal SARS-CoV-2 outbreak in Italy as an effect of environmental and allergic causes
        Journal of Allergy and Clinical ImmunologyVol. 146Issue 2
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          We read with attention the very recent Editorial by Navel et al1 in the latest issue of the Journal. The topic intrigued us because we are currently investigating how come Italy is cropped into 2 great coronavirus disease 2019 (COVID-19)-infected macro areas, an upstream (Northern) zone and a downstream (Central-Southern) zone, with respect to the river Po. More recent data from the Italian Ministry of Health assessed that the 7 regions in the Northern macro area account for about 79.81% of the whole severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive population.
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      • Global lockdown, pollution, and respiratory allergic diseases: Are we in or are we out?
        Journal of Allergy and Clinical ImmunologyVol. 146Issue 3
        • Preview
          We have read with great interest the work by Navel et al1 about the impact of the current coronavirus disease 2019 pandemic on the burden of allergic diseases. The authors suggest that, thanks to the global lockdown of the majority of human industrial activities, the substantial reduction in air pollution in the urban areas, a well-known inducer of nonspecific airway inflammation, may have a positive effect on seasonal allergic diseases.1 Indeed, we are now facing a unique chance to decipher some of the complex interplays between the outdoor allergens, the air quality, and respiratory allergic diseases but, in order to have a full picture, we believe more (f)actors are needed on the stage.
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