Immunological Alchemy: Unmasking Climate Change’s Global Impact on Health and Allergies
By: Eliana Liporace
As the world grapples with the relentless march of climate change, it’s becoming increasingly evident that this crisis is far more than a threat to our environment; it’s a profound assault on human health. Recent scientific investigations have unveiled a troubling reality: climate change, driven by the unchecked emissions from heavy traffic and industry, is orchestrating a disruptive symphony of altered allergen distribution. The consequences are dire, with a surge in allergic respiratory disorders, including asthma and allergic rhinitis. But it is not only the scientific data that gives us pause; it is the ethical concerns borne out of a stark truth: vulnerable populations bear a disproportionate burden of climate-induced allergic diseases. Cross-sector collaboration must become the scientific community’s mantra, as the path to a holistic healthcare response is paved with interdisciplinary teams that unite healthcare, environmental science, policy-making, and public health. Together, they can face the multifaceted challenges posed by climate change with greater efficacy.
But the work is not limited to institutions and professionals alone. Public awareness and engagement are essential for the success of this response. The foundation of this rests on a commitment to bioethical principles, weaving together beneficence, non-maleficence, justice, and respect for autonomy into the fabric of healthcare delivery.
The future of allergy and immunology in the era of climate change hinges on our willingness to embrace these ethical imperatives and take decisive actions to safeguard the health of our planet and its people.
The United Nations Framework Convention on Climate Change calls for the protection of the climate system for the benefit of present and future generations, emphasizing equity and shared but differentiated responsibilities. However, the causative responsibility for climate change is vastly imbalanced between nations, highlighting the ethical dilemma we face. Van Rensselaer Potter's concept of global bioethics, which champions personal and collective responsibility has faded over the years, leading to an erosion of our moral duty towards the future (Williams et al., 2021). The tragic irony is that the most vulnerable populations, who bear the least responsibility for climate change, will suffer its gravest consequences (Sauerborn & Ebi, 2012). Wealthier nations, responsible for a significant share of global warming, have the means to protect themselves, deepening the ethical dilemma. John Rawls' difference principle, which permits inequalities only if they benefit the least well-resourced in society, underscores the ethical responsibility of affluent nations to support the economic development of poorer countries and assist in adaptation strategies (Williams et al., 2021).
Resilience, as defined by the IPCC, is the capacity of systems to cope with disturbances while maintaining their essential functions, structures, and adaptability. Adaptation and transformation are critical facets of resilience, but their effectiveness hinges on the availability, accessibility, and acquisition potential of various capitals—human, social, natural, physical, and financial (Amoak, 2022). The complexity further arises from various social, political, and economic factors that can serve as protective buffers for populations. Infrastructure, adaptive behaviors, cultural practices, and governance can mitigate vulnerabilities caused by ecosystem service degradation. However, the relationship between resource scarcity and health outcomes is unlikely to be linear, with health impacts only emerging when resources are severely constrained. Until a certain threshold is reached, the depletion of ecosystem services may have minimal health impacts (Myers & Patz, 2009).
In the last century, the rapid industrialization and economic growth of many nations unleashed a surge in air pollutant emissions that transformed air quality into a major environmental concern. Simultaneously, the dramatic escalation of greenhouse gases, particularly CO2, has ignited significant planetary warming, temperature volatility, forest fires, droughts, and floods (D’Amato, et al., 2016). The escalation of urbanization and vehicular emissions in urban centers has led to a parallel increase in allergic respiratory diseases, primarily attributed to air pollution. This phenomenon manifests not only in morbidity but also in respiratory disease-related mortality. The continuous deterioration of air quality, primarily due to elevated levels of outdoor air pollutants such as vehicle emissions, underpins the prevailing morbidity trend associated with allergic respiratory diseases (D’Amato et al., 2010).
Figure 1. Exposure to and effects of environmental toxicants can occur through the skin, bloodstream, respiratory system, and digestive tract, leading to either immune activation or immune suppression (Kreitinger et al., 2016).
The role of indoor and outdoor air pollution in undermining respiratory health cannot be understated. Pollutants such as inhalable particles, particularly PM2.5, PM10, and ozone, pose significant health risks (Takizawa, 2011). Fine particles infiltrate deep into the respiratory system, affecting delicate alveoli and inciting oxidative stress and cellular injury. One study’s findings challenge the conventional separation of air pollutants and greenhouse gases (GHGs), pointing out that these emissions are often inseparable (Melamed et al., 2016). Moreover, common GHGs have lifetimes in the order of centuries and have global-scale impacts, while air pollutants typically have much shorter lifetimes. This divergence in lifetimes is crucial for understanding the geographical scale of the impacts, which is directly linked to the location of emissions. Air pollution models for climate change scenarios predict an increase in ozone concentrations across large areas, with uncertain implications for particle concentrations. The enduring effects of ozone are particularly grim, contributing to structural airway damage, severe asthma symptoms, and a surge in respiratory hospital admissions and deaths (Rothenberg, 2022). The economic cost of premature deaths and health impacts from air pollution is staggering, standing at trillions of dollars, reflecting a crisis of global proportions (D’Amato, et al., 2016).
Figure 2. Various pathways by which climate parameters and air pollutants can impact the release, potency, and consequences of both allergens and adjuvants (Reinmuth-Selzle et al., 2017).
The European Union of Medical Specialists plays a crucial role in ensuring harmonization in the management of allergic diseases through training, continuous medical education, and quality assurance. It advocates for a full specialty of allergology in each European country, emphasizing the importance of uniform, high-standard care (Agache, 2019). With this comes a pressing need for integrating climate change education into medical curricula. Medical students must be equipped with the knowledge and skills to manage patients’ climate-related health issues, engage in public health promotion, and provide sustainable healthcare. Reports documented in the Journal of Public Health Research have found that medical students and doctors are aware of the health impacts of climate change but often feel unprepared to address mitigation and adaptation measures (Mazwell & Blashki, 2016). Uncertainty should not deter public health action. Doctors need to develop competencies related to the identification of climate-sensitive patients, addressing risk factors, and diagnosing and managing climate-related illnesses (Frumkin et al., 2008). Climate change is expected to reshape the distribution and intensity of health needs, necessitating broader involvement from healthcare practitioners, including epidemiology, emergency response, and community education.
As we confront these challenges, healthcare equity emerges as an ethical cornerstone, requiring our unwavering commitment. Access to quality healthcare must be universal, transcend disparities, and embrace vulnerable communities that often find themselves on the fringes of healthcare access. Sustainability and climate action must be embedded in the very fabric of healthcare policies and practices, spanning from sustainable procurement practices to the creation of climate-resilient healthcare facilities. Interdisciplinary collaboration is our beacon of hope, for it is only by uniting healthcare, environmental science, policy-making, and public health that we can confront the multifaceted challenges posed by climate change.
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Images:
Kreitinger, J. M., Beamer, C. A., & Shepherd, D. M. (2016). Environmental Immunology: Lessons Learned from Exposure to a Select Panel of Immunotoxicants. Journal of immunology (Baltimore, Md. : 1950), 196(8), 3217–3225. https://doi.org/10.4049/jimmunol.1502149
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