Impact of air pollution, climate change, and nutrition on airway allergic diseases

H Paramesh

doi:10.4103/jpai.jpai_11_20

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Year : 2020 | Volume : 9 | Issue : 1 | Page : 4-6

Impact of air pollution, climate change, and nutrition on airway allergic diseases

H Paramesh
Lakeside Center for Health Promotion and Lakeside Education Trust; Divecha Center for Climate Change, Indian Institute of Science, Bengaluru, Karnataka, India; WHO-NGO Climate – Health Working Group, Geneva, Switzerland

Date of Submission	21-Nov-2019
Date of Decision	25-Dec-2019
Date of Acceptance	02-Jan-2020
Date of Web Publication	06-Nov-2020

Correspondence Address:
Dr. H Paramesh
Lakeside Center for Health Promotion and Lakeside Education Trust, Bengaluru, Karnataka, Divecha Center for Climate Change, Indian Institute of Science, Bengaluru, Karnataka, WHO-NGO Climate – Health Working Group, Geneva

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpai.jpai_11_20

How to cite this article:
Paramesh H. Impact of air pollution, climate change, and nutrition on airway allergic diseases. J Pediatr Assoc India 2020;9:4-6

How to cite this URL:
Paramesh H. Impact of air pollution, climate change, and nutrition on airway allergic diseases. J Pediatr Assoc India [serial online] 2020 [cited 2023 Oct 3];9:4-6. Available from: http://www.jpai.in//text.asp?2020/9/1/4/300096

Introduction

Air pollution – global warming – and climate change are the two faces of the same coin and are interrelated. There is wide scientific consensus that climate change is a reality and defining issue in the 21^st century.

Allergic airway diseases such as allergic rhinitis and asthma are the major early-onset noncommunicable chronic inflammatory respiratory diseases of environment origin both in developed and developing countries. In India, allergic airway diseases are the major cause of morbidity and an important psycho-socioeconomic health-care burden.^[1],[2],[3]

There is changing disease pattern in India as per our National Health Profile 2018. The incidence of communicable diseases such as diphtheria, whooping cough, and pneumonia is decreasing from 61% to 33% and that of noncommunicable diseases such as allergic diseases, asthma, chronic obstructive pulmonary disease, stroke, diabetes, cardiovascular diseases, and cancer is increasing from 30% to 55% between 1990 and 2016.^[4]

The economic burden to manage asthma is Rs. 140 billion per year, and for the medication for allergic rhinitis is Rs. 1 billion per year.

The risk factors for airway allergies are:^[5]

Genetic predisposition, which is brick and mortar and
Environment is an architect to bring out the disease, and can also initiate the disease as well.

The increase in allergic airway diseases is due to an imbalance in homeostasis in the immune system.

Losing the threshold of protection by:

Depriving of our protective germs in our environment
Change in traditional food habits
Adopting to Western lifestyle of living with poor cross-ventilation and sunlight in the house.

Higher exposure to triggers:

Both outdoor and indoor air pollution
Increase in the viral respiratory infections
Less access to health-care facilities.

Role of Nutrition in Airway Allergies

Diet plays a multifaceted role in shaping the observed worldwide trends of allergies. Sensitivity to food can occur by ingestion and inhalation of fumes while cooking and by skin contact. Nearly 10%–12% of asthmatic children experience food allergies, which can be both atopic and nonatopic.

The common foods causing allergic airway diseases are milk, eggs, fish, peanuts, soya, yeast, cheese, wheat, rice, and chocolates. Our questionnaire survey on 20,000 hospitalized patients shows that 19.75% of the studied children's asthma is triggered by food. The most blamed offenders are grapes –57%; guavas –51%; citrus fruits –28%; ice cream –21.5%; fried foods –19%; and tomato –12.5% and other food items are less common.^[6] The perception of the parents was not proved and children did well with any food when they are free from symptoms. A study of EuroPrevall on home screening of 2021 children in 2007–2008 revealed the prevalence of food allergy to be 1.88% (Mahesh et al., unpublished). Their observation was as follows: fried food –0.8%; nonveg –0.1%; bakery –0.5%; chocolate –0.3%; fish –0.1%, lentil –0.1%; spicy food –0.4%; ground nut –0.1%; dairy products –0.4%; and banana –0.2%.^[7]

There is nearly ten-fold difference in the perception of patient survey in the hospital in comparison to that of community home survey. The self-reported food allergy is nearly six times higher than proven food allergy.

Over the years, the focus of health care is on prevention of the allergic airway diseases.

The primary prevention deals with the sensitization of the patient to allergies, secondary prevention deals with sensitizing patients with the onset of symptoms, and tertiary prevention deals with controlling the symptoms.

Let us look into the dietary practices involved in the primary, secondary, and tertiary prevention at various levels with updated knowledge.

Maternal Diet to Primary Prevention in Developing Sensitivity of Food

High intake of dietary antioxidants during pregnancy influences the postnatal susceptibility of atopic diseases in children by the Th1 cell response and the high intake of meat during pregnancy increases the risk of asthma, allergic rhinitis, and atopic dermatitis in children.^[2]

Maternal obesity and weight gain in pregnancy increases childhood asthma. C-section babies have higher increase of asthma due to deprivation of protective germs from the mother's birth canal.^[8]

Separation of newborns from mothers soon after birth will increase the allergic rhinitis and their gut flora will be coliform and Staphylococcus aureus instead of nonallergic children of rooming in children with mother who have Lactobacillus and Bifidobacteria.^[9]

Breastfeeding Practices and Introduction of Solids to Children

The World Health Organization, the American Academy of Pediatrics (AAP), the European Academy of Allergy Asthma Clinical Immunology, the Indian Academy of Pediatrics currently recommended breastfeeding over 4–6 months and introduction of solids after 6 months of age.

Recent dietary intervention of AAP to prevent atopic diseases as on 2019 are;^[10]

Exclusive breastfeeding for the first 3–4 months decreases the eczema and wheezing in the first 2 years of life
Longer duration of breastfeeding protects against asthma post the age of 5 years
There is a lack of evidence to prove whether partially or extensively hydrolyzed formula prevents atopic diseases
There is no evidence that delaying the introduction of solid allergic foods will prevent atopic diseases
There is evidence that early introduction of infants with infant-safe forms of peanuts reduces the risk of peanut allergy. The American Association of Clinical Immunology 2019 reports that peanut exposure orally induces tolerance than by contact on eczematous skin as a portal which triggers allergy
Delayed peanut ingestion increases the risk of sensitization with time
Skin as a portal triggers allergy.

Diet rich in fresh fruits, vegetables, butter, curds, fish, and other foods with antioxidants and omega-3 fatty acids decreases asthma. However, food additives which trigger asthma need to be avoided, such as metabisulfite, sulfuroxide, sodium sulfate, potassium bisulfate, and potassium metabisulfate, especially packaged foods.^[11]

Dietary Restrictions in Allergic Children

Avoid frequent consumption of fast food with high fat-, salt-, and sugar-containing snacks, take-away food, sandwiches, pasta, pizza, noodles, red meat, and soft drinks containing preservatives and colorants, which significantly increase allergic rhinitis symptoms.^[12]

Asthmatic Children Should Be Advised

To have smaller frequent meals than heavy meals to decrease the chances of gastro-esophageal reflux and for better diaphragmatic efforts
To have good timing of eating and relax while eating and share the table with family members
To prefer homemade food, and occasionally have fast-foods with less fat, salt and sugar
To take fresh fruits, vegetables, butter, fish, and omega-3 fatty acids and minimize gas-producing foods.

We do recommend traditional food habits to each country. Our traditional food habits over 5000 years have their beneficial effects in the way we prepare food:

(a) Mixing of foods, (b) sprouting, (c) marinating in curds, (d) tempering with spices in oil, (e) garnishing with coconut shreds and coriander leaves, (f) using traditional cookwares such as iron vessels and earthen pots for fish curry.^[13]

Obesity and Asthma

A study in Japan conducted on children aged 4–5 years showed asthma is more prevalent in children with overweight. The decrease in lung function is proportionally related to obesity. Female gender is a factor for obesity and asthma.

The prevalence of obesity in India had increased by 5.1% from 15% to 20.1% in boys and 4.04% from 13.7% to 18.1% between 2002 and 2011.

The study showed that obesity in India is more of a local problem than a national problem. In addition, one has to keep in mind that air pollution from pesticides and fertilizers produces endocrine disruptors, causing obesity.^[14]

The Food Safety Standards Authority of India on November 7, 2019, had brought new standards, which are beneficial to allergic children in general and asthmatics in particular, as follows:

Foods with high fat, salt, sugar (HFSS) should not be sold to school canteen/mess and hostel kitchens in the surrounding of 50 m of the school campus
School campus should be converted into Eat Right schools
Ban advertisement on HFSS food in schools and in the surrounding of 50 m from the school campus
Regular inspection of premises should be conducted to ensure that safe, healthy, and hygienic food is served to students.

Recommendations

EAT Adequately: Wholesome 70%–80% food of the menu
EAT Moderately: Packed foods in small proportions
EAT Sparingly: HFSS foods but to be decreased.

“One who knows what to eat does not get disease

Whoever is the father, under- and mal-nutrition is the mother of the diseases.”

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

References

1.	Paramesh H. IAP Textbook of Paediatrics. 7^th ed.. J.P. Brothers, India; 2019.
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3.	National Commission of Macroeconomics and Health. GOI; 2005.
4.	National Health Profile 2018, Government of India.
5.	Paramesh H. Social determinants of health: Past present and future. Curr Sci 2019;116:12-3.
6.	Paramesh H. Epidemiology of asthma in India. Indian J Ped 2002;69:309-12.
7.	GINA; 2018.
8.	Smidt H, Willem M. Anaerobic Microbial Dehalogenation. Annual Review of Microbiology 2004;58:1, 43-73.
9.	A. A.P Clinical Report; 2019. p. 12-3.
10.	Gupta KB, Verma M. Nutrition and Asthma. Lung India 2007;24:105-14. [Full text]
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12.	Davidar RN. Why we eat the way we do. THE HINDU– Folio Spl issue. Food: 30.4.2000
13.	Gulati A, Hochdorn A, Paramesh H, Paramesh EC, Chiffi D, Kumar M, et al. Physical activity pattern among school children in India. Indian J Pediatr 2014;81 Suppl 1:47-54.
14.	Food safety standards authority of India (FSSA); Nov 2019.