key: cord-0942002-l8re6ahs
authors: Gallo, Oreste; Bruno, Chiara; Orlando, Pietro; Locatello, Luca Giovanni
title: The impact of lockdown on allergic rhinitis: What is good and what is bad?
date: 2020-09-11
journal: Laryngoscope Investig Otolaryngol
DOI: 10.1002/lio2.459
sha: 05993a2b7996306668e21a04aaea86ade8def529
doc_id: 942002
cord_uid: l8re6ahs

nan

The impact of lockdown on allergic rhinitis: What is good and what is bad?

To the Editor,

We read with great interest the Editorial by Gelardi et al about the adverse effect of lockdown on patients with perennial rhinitis to dust mite. 1 The authors brilliantly highlighted one of the issues derived from the government's measures to minimize SARS-CoV2 transmission with the aid of social distancing and mass face masking and, as the pandemic is still ongoing worldwide, the reduction of exposure to nasal irritants is becoming of the uttermost importance.

However, this is just one of the potential effects of lockdown on the allergic rhinitis population: forcefully obliged at home, many people were exposed not only to indoor allergens such as dust mites but also to several other pollutants linked to different human activities (eg, tobacco and cooking smoke, chemical vapors of cleaning products). [2] [3] [4] The air pollution has long been regarded as a public health concern because of its association with increased susceptibility to respiratory infections and with the exacerbation of allergic respiratory diseases. 2 COVID-19 pandemic impacted billions across the world and economies have come to a grinding halt that has caused a transient improvement in air pollution that was documented in the most industrialized areas ( Figure 1, NO 2 ) . 5, 6 Although other climate variables may also have a role, such a situation is probably a major cause for air quality improvement. 5 In the northern hemisphere, such unparalleled lockdown has coincided with the advent of spring and with the usual peak in seasonal allergic rhinitis (AR). It is still unclear what is the impact of air pollution on AR and asthma because of their complex interrelationships. 2 Experimental works and clinical evidence have shown that airborne pollutants can interact with pollen so as to exacerbate these conditions. 2, 7 Such interactions, mainly with outdoor allergens, can occur through several mechanisms that have been only partially elucidated:

for instance, chemicals might facilitate pollen release, increase the expression of some allergens in pollen grains, and promote a nonspecific airway inflammation. [2] [3] [4] Overall, the environmental pollution may worsen allergic response by increasing the allergenicity of outdoor pollen and by promoting nonspecific airway inflammation. 2, 7 Based on these highlights, we believe that we are having an invaluable opportunity to understand how human activities can affect both air and life quality in the allergic population. As previously stated, AR and asthmatic patients are supposed to benefit from the reduction of F I G U R E 1 These images, using data from the Copernicus Sentinel-5P satellite, show the average nitrogen dioxide concentrations, above Italy, from March 14 to 25, 2020, compared to the monthly average concentrations from 2019. (© contains modified Copernicus Sentinel data [2019-2020], processed by KNMI/ESA) 6 

COVID-19: when dust mites and lockdown create the perfect storm

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

Will environmental impacts of social distancing due to the pandemic caused by SARS-CoV-2 decrease allergic disease?

Global lockdown, pollution, and respiratory allergic diseases: are we in or are we out?

Preliminary Analysis on Air Quality in Lombardy during the COVID-19 Emergency. Milan: Lombardy Regional Agency for Environmental Protection

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The need for clean air: the way air pollution and climate change affect allergic rhinitis and asthma

Particle sizeselective assessment of protection of European standard FFP respirators and surgical masks against particles-tested with human subjects