Acknowledging the environmental allergy epidemic in children in the UK

The World Allergy Organization (WAO) estimates that allergy prevalence among all age groups is 10–40% globally.1WAOThe WAO White Book on Allergy. World Allergy Organization, Milwaukee, WI2013Google Scholar Allergic diseases have become more prevalent in high-income countries, an issue that is of increasing concern.2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 3Asher MI Montefort S Björkstén B et al.Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys.Lancet. 2006; 368: 733-743Summary Full Text Full Text PDF PubMed Scopus (3152) Google Scholar The UK has the highest incidence of allergic disease in the world.1WAOThe WAO White Book on Allergy. World Allergy Organization, Milwaukee, WI2013Google Scholar, 2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar However, this allergy epidemic has not been given the same level of public and governmental attention as other chronic illnesses, such as cancer or cardiovascular disease.1WAOThe WAO White Book on Allergy. World Allergy Organization, Milwaukee, WI2013Google Scholar Alongside the emerging allergy epidemic, concern around climate change has been increasing worldwide with the rise in air pollution and toxic emissions from fossil fuel combustion.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar Deteriorating air quality in major urban areas has been documented across Europe.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 5De Sario M Katsouyanni K Michelozzi P Climate change, extreme weather events, air pollution and respiratory health in Europe.Eur Respir J. 2013; 42: 826-843Crossref PubMed Scopus (149) Google Scholar The increase in air pollution and incidence of allergies in children in the UK makes understanding the association between these occurrences imperative. This association has been reasonably unexplored in the literature. In 2000, the burden of diseases from global climate change for all ages amounted to more than 150 000 deaths worldwide, of which roughly 88% were children younger than 5 years.6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar Air pollution, an element of climate change, is one of the biggest killers of children worldwide.7Landrigan PJ Air pollution and health.Lancet Public Health. 2017; 2: e4-e5Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar, 8Landrigan PJ Fuller R Acosta NJ et al.The Lancet Commission on pollution and health.Lancet. 2017; (published online Oct 19.)DOI:10.1016/S0140-6736(17)32345-0Summary Full Text Full Text PDF PubMed Scopus (1962) Google Scholar In the UK, allergic diseases are common causes of chronic illnesses leading to deaths of children.1WAOThe WAO White Book on Allergy. World Allergy Organization, Milwaukee, WI2013Google Scholar Allergic reaction tends to occur when the body's immune system produces IgE antibodies to attack an allergen and protect the body.2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar Although allergic diseases are common among children, they can also occur in adulthood.2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar Different types of allergies can result in varying symptoms in different individuals; these symptoms can range from sneezing to more severe reactions such as anaphylaxis.2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar In the past two decades, hospital admissions from all causes of anaphylaxis increased by 615% in the UK.9Turner PJ Gowland MH Sharma V et al.Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992–2012.J Allergy Clin Immunol. 2015; 135: 956-963Summary Full Text Full Text PDF PubMed Scopus (442) Google Scholar Plausible explanations for this increase include genetic factors,2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar reactions to food,2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 9Turner PJ Gowland MH Sharma V et al.Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992–2012.J Allergy Clin Immunol. 2015; 135: 956-963Summary Full Text Full Text PDF PubMed Scopus (442) Google Scholar reduced intake of vitamin D and omega-3 fatty acids,10Arshi S Ghalehbaghi B Kamrava SK Aminlou M Vitamin D serum levels in allergic rhinitis: any difference from normal population?.Asia Pac Allergy. 2012; 2: 45-48Crossref PubMed Google Scholar and environmental air pollutants.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 5De Sario M Katsouyanni K Michelozzi P Climate change, extreme weather events, air pollution and respiratory health in Europe.Eur Respir J. 2013; 42: 826-843Crossref PubMed Scopus (149) Google Scholar, 6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar A major challenge for climate scientists is to predict potential environmental changes over the next few decades and to communicate to clinicians those changes that will presumably affect human health, such as environmental allergies in children.11Pidgeon N Fischhoff B The role of social and decision sciences in communicating uncertain climate risks.Nat Clim Change. 2011; 1: 35-41Crossref Scopus (414) Google Scholar In the Lancet Commission on pollution and health, Philip Landrigan and colleagues8Landrigan PJ Fuller R Acosta NJ et al.The Lancet Commission on pollution and health.Lancet. 2017; (published online Oct 19.)DOI:10.1016/S0140-6736(17)32345-0Summary Full Text Full Text PDF PubMed Scopus (1962) Google Scholar highlighted that, in 2015, the effects of pollution on planetary health resulted in three times more deaths than from AIDS, tuberculosis, and malaria combined. We hope that the recommendations in this Commission increase the awareness of the general public, government, and policy makers about the effects of air pollution on human health, such as environmental allergic diseases in children. Research has shown that microscopic concentrations of air pollutants, such as fine particulate matter (≤2·5 μm in aerodynamic diameter), are associated with increased respiratory illnesses in children.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar Children have high skin permeability, resulting in allergic sensitisation via impaired skin barriers.2Longo G Berti I Burks AW Krauss B Barbi E IgE-mediated food allergy in children.Lancet. 2013; 382: 1656-1664Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar Hence, young children tend to be susceptible to the effects of toxic air pollutants and climate change.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 5De Sario M Katsouyanni K Michelozzi P Climate change, extreme weather events, air pollution and respiratory health in Europe.Eur Respir J. 2013; 42: 826-843Crossref PubMed Scopus (149) Google Scholar, 6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar, 12Majeed H Lee J The impact of climate change on youth depression and mental health.Lancet Planet Health. 2017; 1: e94-e95Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar Climate change has resulted in increased global temperatures and greater concentrations of greenhouse gases such as carbon dioxide and ozone in the atmosphere, which have been shown to promote the growth of aeroallergens (eg, pollens such as ragweed and mold) that cause allergic diseases in children.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar High concentrations of greenhouse gases in the UK's urban areas affect chemical reaction rates and pollutant transport mechanisms.4Perera FP Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change.Environ Health Perspect. 2017; 125: 141-148Crossref PubMed Scopus (182) Google Scholar, 6Sheffield PE Landrigan PJ Global climate change and children's health: threats and strategies for prevention.Environ Health Perspect. 2011; 119: 291-298Crossref PubMed Scopus (213) Google Scholar Even in regions with good air quality in rural areas of the UK, changes in air circulation have the potential to modify the long-range transport of pollutants emitted by biomass burning.5De Sario M Katsouyanni K Michelozzi P Climate change, extreme weather events, air pollution and respiratory health in Europe.Eur Respir J. 2013; 42: 826-843Crossref PubMed Scopus (149) Google Scholar The literature on the effects of climate change on allergic diseases in children is still in its infancy, but we believe that the susceptibility of children in the UK to environmental allergies will continue to increase because of rising air pollution. Although only a few health-care advocates and political leaders understand the underlying science well enough to evaluate climate-related proposals with respect to their impact on allergic diseases in children,11Pidgeon N Fischhoff B The role of social and decision sciences in communicating uncertain climate risks.Nat Clim Change. 2011; 1: 35-41Crossref Scopus (414) Google Scholar we believe that the Lancet Commission should unite researchers, paediatricians, allergy specialists, climatologists, policy makers, and public health professionals not only in the UK, but worldwide. This unity will likely result in establishment of policies to decrease the incidence of allergies in children in the UK, and possibly set a precedent for other countries to do likewise. We declare no competing interests.

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