Project Modifications

1. We will communicate with Dr. Leru’s PhD students to receive feedback on our lifestyle survey for further iteration.

2. We will be creating even more documentation to support our data analysis tool with potential for a how-to guide for specific tasks.

3. We will reach out to Dr. Leru’s team for feedback on our allergy pamphlet.

4. We will be creating a website to summarize our project for the reference of Dr. Leru, her colleagues, our advisors, and future Bucharest IQP students and collaborators.

Respiratory allergies have been a major chronic disease in North America since the 1990s (Ziska et al., 2010). Since ragweed originated from this area, it would be helpful to further examine its allergies situation in order to compare this information to what can be seen in Romania today.

In the United States, pollen allergies affect the health of a third of the population and cost an average of $21 billion dollars on the country’s economy each year (Ziska et al., 2010). Allergy symptoms are usually allergic rhinitis, conjunctivitis and asthma, with allergic rhinitis being the most common. The National Allergy Bureau (NAB) is a section of the American Academy of Allergy Asthma and Immunology Aeroallergen Network (AAAAI) and has been collecting pollen information from 51 pollen stations in the United States and Canada (50 in the US and 1 in Canada) since 2003. Some of the station locations are shown in figure below:

https://drive.google.com/file/d/1dF8bLc3Eb461iISxXNJIm1-RSVhmknvV/view?usp=sharing

Figure 7: Locations of the stations (Lo et al., 2019)

These stations use Burkard volumetric air samples for pollen data collection, similar to what our sponsor has been using in Bucharest. Even though tree pollen such as Quercus (oak) and cupressac (cedar) are the most abundant, Ambrosia (ragweed) remains in the top five most abundant pollen species present. Ambrosia season in North America begins as early as July and extends to November (Lo et al., 2019).

https://drive.google.com/file/d/1FSjLGsfxVvWIsVAyKIKnEtsVpSl-YfLv/view?usp=sharing

Figure 8: Ambrosia pollen concentration calendar (Lo et al., 2019)

a. Similarities in Factors affecting Pollen Allergies

Similar to the rest of the world, the rise in respiratory allergies in North America is affected by climate change, air pollution, and the lifestyle of the people. Not only that, but allergies specifically are linked to other cardiovascular diseases in the United States.

Climate

Ambrosia season begins in late summer and early fall, and ends by the date of the first frost. Milder winters and warmer seasonal temperatures lengthen the frost-free period, leading to an earlier and longer ragweed season duration. Using simple regressions for data collected in 1995-2009, researchers have determined that the increase in duration of the ragweed pollen season correlates with latitude in North America. For latitudes above ~44^oN, the season increases as much as 13-27 days in 2009 compared to 1995. This is consistent with findings from the Intergovernmental Panel on Climate Change (IPCC), stating that global warming is affecting seasonal temperature and duration, thus, having an impact on aeroallergen seasons (Ziska et al., 2010).

Pollutants

In the United States, 9.7% children age 4 to 17 are affected by allergic rhinitis. Traffic-related air pollutants (TRAP), including CO, NOx and ozone increase the risk of sensitization and allergic diseases. Children living near major roads have increased risk of respiratory disease, as well as deficits in lung function growth. A study done on 5277 children in Southern California showed that children living at close proximity to a freeway are more likely to develop rhinitis. Specifically, those living within 500m of a major freeway are 10 times more likely to develop pollen related rhinitis if they are already sensitized to at least one pollen group. This study, among others in the US, linked air pollutants to the development and exacerbation of respiratory diseases (Zhou et al., 2018).

Lifestyle

Since 1990, the number of allergic patients have drastically increased. Many attributes this to the growing lifestyle of staying indoor led to the development of different forms of allergies. Being indoor for the majority of their activities leads to children having increased sensitization to the indoor allergens such as dust mite and fungi spores. Additionally, children in the United States spend a lot of time indoors in front of a screen and consume a diet of more processed food. This decreases physical activity and encourages obesity, which is linked to asthma (Platts-Mills, 2016).

Other Health Risks

Atopic Dermatitis, also known as eczema, is a common allergic disease among the US population. Heat, sweat, body pain, sleep deprivation, fatigue, and depression make exercising challenging and cause a decrease in physical activities in AD patients, making them susceptible to other health risks (Silverberg et al., 2016). Adults with eczema, with decreased physical activity along with smoking, consuming alcohol, are at higher risk of cardiovascular and cerebrovascular diseases, such as coronary artery disease, angina, heart attack, stroke, and peripheral vascular disease (Silverberg, 2015). They are also more likely to have a higher body mass index, and higher risk of obesity, hypertension, diabetes, and high cholesterol, especially with those that also experience fatigue or insomnia (Silverberg et al., 2015).

This is not limited to adults, as children with eczema are also highly affected. Even though the risk of developing a cardiovascular disease is low, children with asthma and hay fever have a higher chance of obesity and vice versa (Silverberg, 2016).

b. Efforts in North America

The United States has made attempts to protect the people from allergic diseases. There have been efforts to control the environment to reduce the symptoms. Doctors need to obtain the environmental and medical history, and determine which allergens or pollutants that most affect the patients. The guidelines for these tests can be found in the reports from the American Academy of Pediatrics. Additionally, for the school environment, the Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC) provide online resources on their websites to help families and educators to better control children’s exposure to allergens (Matsui, 2016).

For adults, occupational asthma is a great concern, especially for those who work on job sites, accounting for up to 15% of the disabling asthma cases in the US (Cartier, 1994). There are over 200 organic and inorganic allergens for field workers, such as dust, plants, animals, gases and other chemicals (Chan-Yeung et al., 1994). In order to reduce occupational asthma, the Occupational Safety and Health Administration (OSHA) established some permissible exposure limits for some allergenic materials, such as cobalt, nickel, platinum salts, and isocyanates. However, the majority of the materials that cause asthma are still unregulated (Abramson, 2016).

Using the information gathered from the rest of the world and North America up to this point, knowledge can be extended and compared to Romania. The biological mechanisms and invasion of ragweed is known. The impacts of the factors of climate, pollutants, city keep, and other diseases are studied. The efforts of other countries can be used as examples to learn from and have the potential to be applied in Romania.