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Climate Change-Associated Environmental Factors and Pollutants: Impact on Allergic Diseases, Epidemiology, Severity, and Health Care Burden

Montoro J1,2, Antolín-Amérigo D3,4, Izquierdo-Domínguez A5,6, Zapata JJ7, García-Gallardo MV8, González R9, Armentia A10,11, Rondón C12,13, Fernández MM14, Pedrero SG15, Valero A16

1Sección de Alergia, Unidad Especializada de Asma Grave, Hospital de Arnau de Vilanova - Líria, Valencia, Spain
2Facultad de Medicina, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
3Servicio de Alergia, Hospital Universitario Ramón y Cajal, Madrid, Spain
4Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
5Servicio de Alergología, Hospital Universitario de Terrassa, Barcelona, Spain
6Unidad Alergo-Rino, Hospital Teknon, Barcelona, Spain
7Clínica de Alergia Dr. Zapata, Almería, Spain
8Servicio de Neumología, Hospital Universitario de Burgos, Burgos, Spain
9Servicio de Alergología, Hospital Universitario de Canarias, La Laguna, Spain
10Servicio de Alergia, Hospital Universitario Rio Hortega, Valladolid, Spain
11Catedrática de Alergia, Universidad de Valladolid, Valladolid, Spain
12Servicio de Alergia, Hospital Regional Universitario de Malága, Malaga, Spain
13Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Málaga, Spain
14Servicio de Alergia UMA CIBERES IIS, Fundación Jiménez Díaz, Madrid, Spain
15Adelphi Targis, Barcelona, Spain
16Director Médico Centro ALERGO AVANTA, Barcelona, Spain

J Investig Allergol Clin Immunol 2025; Vol. 35(4)
doi: 10.18176/jiaci.1067

Background: Allergic diseases affect up to 40% of adults worldwide, a percentage that is increasing with environmental changes related to global warming.
Methods: A systematic review of the literature was performed to identify and evaluate current evidence of the effect of climate change–related environmental factors on the prevalence, incidence, and severity of allergic diseases in terms of the impact on patients with allergy. PECO criteria for 2 research questions were established and guided the literature searches of the PubMed and Cochrane databases (January 1, 2016 to December 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (P<.05), nonsignificant (P>.05), or undetermined (P value not reported).
Results: Assessment of the 2 questions enabled us to identify 609 publications. Of these, 96 were assessed for eligibility and 42 provided data. Environmental factors, including the presence of pollutants, influenced patients’ conditions in terms of effects on allergy, exposure to allergen(s), and the immune system. The pollutants most frequently reported to have an impact were nitrogen dioxide (NO2) and particles <2.5 μm in diameter. The allergic diseases most frequently reported to be affected by environmental factors were respiratory disease (asthma and rhinitis) and atopic dermatitis, with an impact on epidemiology and health care burden.
Conclusion: Environmental pollution increased the frequency and health care burden of allergic diseases. The effect of environmental pollution was predominantly caused by pollutants such as NO2 and particles <2.5 μm in diameter and was observed across allergic diseases, including respiratory disease (asthma and rhinitis) and atopic dermatitis.

Key words: Environment, Allergy, Patient, Severity, Epidemiology, Climate change