International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies

Abstract

Allergic rhinitis affects the quality of life of millions of people worldwide. Air pollution not only causes morbidity, but nearly 3 million people per year die from unhealthy indoor air exposure. Furthermore, allergic rhinitis and air pollution interact. This report summarizes the discussion of an International Expert Consensus on the management of allergic rhinitis aggravated by air pollution. The report begins with a review of indoor and outdoor air pollutants followed by epidemiologic evidence showing the impact of air pollution and climate change on the upper airway and allergic rhinitis. Mechanisms, particularly oxidative stress, potentially explaining the interactions between air pollution and allergic rhinitis are discussed. Treatment for the management of allergic rhinitis aggravated by air pollution primarily involves treating allergic rhinitis by guidelines and reducing exposure to pollutants. Fexofenadine a non-sedating oral antihistamine improves AR symptoms aggravated by air pollution. However, more efficacy studies on other pharmacological therapy of coexisting AR and air pollution are currently lacking.

Keywords: AER, Allergic eosinophilic rhinitis; AP, Activator protein; AR, Allergic rhinitis; ARE, Antioxidant response element; Air pollutants; Air pollution; Allergic rhinitis; Antioxidant enzymes; CFS, Chronic fatigue syndrome; CO, Carbon monoxide; COPD, Chronic obstructive pulmonary disease; Climate change; DAMP, Damage-associated molecular patterns; DEP, Diesel exhaust particles; ECAT, Elemental carbon attributable to traffic; ECP, Eosinophil cationic protein; GSH-Px, Glutathione peroxidase; HDM, House dust mites; HEPA, High efficiency particulate air; HO, Hemeoxygenase; HVAC, Heating, ventilation and air conditioning; IAP, Indoor air pollution; IAQ, Indoor air quality; INS, Intranasal steroids; Indoor air quality; LDH, Lactate dehydrogenase; MCP, Monocyte chemotactic protein; MSQPCR, Mold specific quantitative PCR; NAR, Non allergic rhinitis; NF-κβ, Nuclear factor kappa β; NO2, Nitrogen dioxide; NOx, Nitric oxides; Nrf2, Nuclear factor erythroid-2 related factor; O3, Ozone; OAP, Outdoor air pollution; Occupational rhinitis; Oxidative stress; PAMP, Pathogen-associated molecular patterns; PM, Particulate matter; PON, Paraoxonase; RNS, Reactive nitrosative species; ROS, Reactive oxygen species; SO2, Sulphur dioxide; SOD, Superoxide dismutase; TLR, Toll like receptor; TNF, Tumor necrosis factor; TOS, Total oxidative status; TRAP, Traffic related air pollutants; UFP, Ultra-fine particles; VOCs, Volatile organic compound.