EAACI
Guidelines on Environmental Science for Allergy and Asthma—Evidence‐Based Recommendations for Prevention and Public Health Action to Mitigate the Impact of Pollen Exposure on Respiratory Allergy
Lorenzo Cecchi, Isabella Annesi‐Maesano, Benedetta Biagioni, Kian Fan Chung, Bernard Clot, Gennaro D'Amato, Athanasios Damialis, Stefano Del Giacco, Javier Dominguez‐Ortega, Carmen Galán, Stefanie Gilles, Stephen Holgate, Mohamed Jeebhay, Stelios Kazadzis, Kari Nadeau, Nikolaos G. Papadopoulos, Santiago Quirce, Joaquin Sastre, Claudia Traidl‐Hoffmann, Fiona Tummon, Jolanta Walusiak‐Skorupa, Magdalena Zemelka‐Wiacek, Marek Jutel, Cezmi A. Akdis, Ioana Agache ABSTRACT
Developed using the GRADE methodology, these EAACI guidelines provide evidence‐based recommendations on the effectiveness of pollen reduction/avoidance strategies for allergic rhinitis (AR) and asthma, the utility of biomarkers for monitoring pollen‐induced asthma and the efficiency of mitigation measures and of public health strategies. Systematic and narrative reviews and health economic analysis support the recommendations. According to GRADE, the certainty of evidence was moderate to very low, therefore conditional recommendations are provided to guide healthcare professionals, patients, and policymakers in developing personalized, preventive, and scalable interventions. Reducing/avoiding exposure to pollen should be recommended to reduce the risk of severe asthma exacerbations. Lung function decrease and exhaled nitric oxide increase may be predictive for pollen‐induced asthma exacerbations. Real‐time pollen monitoring and pollen concentration‐based forecast may be recommended for managing pollen‐induced AR and/or asthma. Pollutant information should be included in pollen information systems. Combined forecast (weather, pollen, pollutants) and warning systems might reduce the impact of thunderstorm asthma (TA). Emergency department/asthma‐related services should be strengthened during pollen season and in TA. Personalized frameworks covering the types and allergenic potential of pollen, the coaggressors and the vulnerability of each patient are needed in daily practice. The fundamental role of prevention should be further prioritized.