Q&A: Allergists can take action to address the health impact of climate change
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As climate change continues to impact the planet, events such as flooding and extreme heat will exacerbate symptoms for patients with allergies and asthma.
The CDC has released a report outlining guidance and other resources to help allergists and immunologists communicate with their patients to improve prevention and treatment strategies, mitigating the effects that climate change may have on their health.
Healio spoke with Joy Hsu, MD, MSc, FAAAAI, a medical officer with the Asthma and Community Health Branch of the CDC’s Division of Environmental Science and Practice at the National Center for Environmental Health (NCEH), and coauthor of the report, to find out more.
Healio: What prompted the release of this report?
Hsu: We are currently living in the warmest period in the history of modern civilization. Climate change has caused temperature extremes, sea level rise and severe weather events, resulting in major societal impacts. Climate change is already impacting human health through air pollution, allergens and pollen, diseases carried by vectors, food- and water-borne disease, precipitation extremes, temperature extremes and wildfires — and these health impacts are expected to increase.
The NCEH at the CDC has implemented climate and health activities for more than a decade. Recent efforts by NCEH’s Division of Environmental Health Science and Practice include seeking to expand climate work and foster collaboration. Climate change not only affects every aspect of public health, but it also involves cross-sectoral action.
NCEH’s comprehensive public health approach to climate change focuses on data, science and action, amplified by policy, partnerships, communication and evaluation, to create maximum impact — with integration of environmental justice and health equity in each area. To support this approach, we prepared this report to help build expertise among health care professionals regarding climate change and actions they can consider to help patients with asthma and other allergic-immunologic conditions.
More information about NCEH’s comprehensive public health approach to climate change is available online.
Healio: What are the greatest risks of climate change for patients with allergies or asthma?
Hsu: Climate change can affect anyone’s health. Some people and communities are disproportionately affected, including children, pregnant persons, older adults and those who are socially or economically disadvantaged. Health impacts can vary depending on individuals’ medical conditions.
For example, in some locations, climate change is projected to increase levels of ground-level ozone or possibly particulate matter, which can both worsen asthma symptoms. Also, exposure to these air pollutants has been significantly associated with asthma-related ED visits and hospitalizations, shown by results of a meta-analysis by Orellano and colleagues in PLoS One.
In another example, for people with allergic rhinoconjunctivitis sensitized to seasonal aeroallergens such as pollens and outdoor molds, the onset and duration of their “allergy season” can be influenced by climate change-associated increases in the number of frost-free days and seasonal air temperatures. More information about pollen and other allergens is available on the CDC website.
Also, potential health impacts of climate change can vary depending on an individual’s geographic location. For instance, people with asthma and mold allergy can experience more respiratory symptoms after a hurricane or other heavy precipitation event if they are exposed to mold in affected buildings, because excess moisture and standing water after these events can help mold grow in flooded homes and other buildings. More information about regional health impacts of climate for 10 regions in the U.S. is available at CDC.gov.
Healio: What are the most overlooked impacts of climate change on allergy and asthma care?
Hsu: Climate change-related disasters such as floods and wildfires can complicate management of any medical condition, including allergic-immunologic conditions not mentioned above. For example, disasters can affect usual access to medications (eg, for atopic dermatitis or hereditary angioedema), medical services (eg, allergen immunotherapy or supplemental gamma globulin) or electricity (eg, to refrigerate perishable, allergen-free foods).
Emergency action plans can help people stay healthy in an emergency. Collecting and protecting asthma action plans and/or food allergy and anaphylaxis care plans, when medically indicated, is part of an emergency action plan. The CDC website also has more information about how to make an emergency action plan.
Healio: Do you recommend any strategies for doctors to use in communicating these risks and impacts to patients?
Hsu: Health care professionals can consider using the example action steps we have provided in our report when caring for patients with asthma and other allergic-immunologic conditions. In addition, health care professionals can tailor anticipatory guidance to patients regarding climate-related health impacts. Considerations include an individual’s medical conditions, environmental exposures and geographic location. Further information on assessing environmental exposures can be found online.
For instance, health care professionals can teach patients with asthma, their families and their caregivers to use air quality measurements or air quality alerts to know when outdoor air pollution levels might be harmful in their area and adjust outdoor activities when air pollution levels are high. Health care professionals can also consider incorporating other strategies related to patient-centered communication and motivational interviewing.
Editorials are available and linked to below that discuss how health care professionals can tailor anticipatory guidance regarding climate-related health impacts by countering misinformation (Senay and colleagues) and communicating with patients (Wellbery and colleagues), as well as for educating residents in medical schools (Pass Philipsborn and colleagues).
References:
- Allergens and pollen. https://www.cdc.gov/climateandhealth/effects/allergen.htm. Updated Aug. 21, 2020. Accessed Feb. 16, 2022.
- ATSDR case studies in environmental triggers of asthma. US Department of Health and Human Services Agency for Toxic Substances and Disease Registry. https://www.atsdr.cdc.gov/csem/asthma/docs/asthma.pdf. Accessed Feb. 16, 2022.
- Climate effects on health. https://www.cdc.gov/climateandhealth/effects/default.htm. Updated March 2, 2021. Accessed Feb. 16, 2022.
- Orellano P, et al. PLoS One. 2017;doi:10.1371/journal.pone.0174050.
- Pass Philipsborn R, et al. Acad Med. 2021;doi:10.1097/ACM.0000000000003719.
- Plan ahead. https://www.cdc.gov/prepyourhealth/planahead/index.htm. Updated Nov. 17, 2020. Accessed Feb. 16, 2022.
- Pollen and your health. https://www.cdc.gov/climateandhealth/effects/pollen-health.htm. Updated Aug. 21, 2020. Accessed Feb. 16, 2022.
- Schramm PJ, et al. J Clim Chang Health. 2021;doi:10.1016/j.joclim.2021.100071.
- Sea level rise. https://www.sciencedirect.com/topics/earth-and-planetary-sciences/sea-level-rise. Accessed Feb. 16, 2022.
- Senay E, et al. Ann Intern Med. 2021;doi:10.7326/M20-6443.
- Wellbery CE, et al. Am Fam Physician. 2021;104(5):526-530.