Aeroallergens and the skin

Author: Dr Tim Aung, Primary Care Practitioner, Brisbane, Queensland, Australia. DermNet NZ Editor-in-Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. February 2019.


What are aeroallergens?

Aeroallergens are various airborne substances or inhalants, such as pollens, spores, and other biological or non-biological airborne particles that can cause allergic disorders. Inhalation or cutaneous contact with aeroallergens can trigger a release of proteins in the form of an allergic reaction on the skin and mucous membranes [1,2].

Airborne particles can also cause irritant reactions without causing an immunological response.

Which are the most common aeroallergens?

The most common aeroallergens causing disease are pollens and house dust mites. Pollens are derived from:

  • Grasses
  • Trees
  • Rye
  • Weeds.

Other aeroallergens may include:

  • Lilies, daisies and other perfumed flowers
  • Latex allergen in glove powder
  • Animal dander/fur (dogs, cats, rabbit)
  • Rodents (mouse, rat, guinea pig)
  • Cockroach debris
  • Mould and fungal spores
  • Cosmetics, including perfume, antiperspirant and deodorant
  • Pesticide spray
  • Tobacco smoke (a common irritant and a rare allergen).

Combustion product irritants include:

  • Carbon dioxide (CO2
  • Carbon monoxide (CO)
  • Nitrogen dioxide (NO2
  • Sulphur dioxide (SO2
  • Volatile organic compounds (VOCs)
  • Lead
  • Other particulate matter
  • Ozone.

Who gets diseases from aeroallergens?

Allergies only affect susceptible individuals (see allergies explained) whereas irritant reactions can affect anyone.

The prevalence of aeroallergens is quite variable from one region or country to another, depending on the climate, the local plants and animals, and the degree of pollution [3,4].

Climate change has been reported to contribute to the rise of some types of aeroallergens and a surge in allergic disorders [5–7].

  • House dust mites are prevalent in developing countries.
  • Pollen aeroallergens are prevalent in temperate zone countries.
  • Pollen counts vary with exact location and flora, time of year, altitude, temperature, humidity, wind, electrical activity and rain [8]

In New Zealand, the aeroallergens are mainly grasses [8]. The pollen season lasts for about 34 weeks beginning in July or August.

  • In Scandinavia, the main allergen is birch.
  • In North America, the main aeroallergens are ragweed and deciduous tree pollen.
  • Olive pollen is prevalent in the Mediterranean.
  • Feverfew and mugwort are important aeroallergens in Eastern Europe and India.
  • In Japan, the Japanese cedar is responsible for many cases of pollen allergy.
Pollen forecast February 2019, Hamilton, NZ

How do aeroallergens cause disease?

Although usually due to other factors, some common skin conditions are occasionally triggered or aggravated by aeroallergens [9–11]. How this occurs remains unclear (see figures below for proposed mechanisms).

Induction and effector mechanisms

Induction and effector mechanisms in type 1 hypersensitivity. Image from Microbiology and Immunology Online (courtesy of R Hunt, University of South Carolina) [12].

Aeroallergen pathways

Aeroallergen pathways resulting in local IgE production in chronic rhinosinusitis with nasal polyps. Image from Allergy Asthma Immunol Res. 2015 (courtesy of G Gavaert, Ghent University) [13].

Which health problems are due to aeroallergens?

Aeroallergens commonly cause allergic rhinitis, allergic conjunctivitis, and allergic asthma, and may contribute to eosinophilic oesophagitis [14­–16].

Skin conditions due to aeroallergens are less common. They include:

Skin conditions sometimes associated with aeroallergens

How is the role of aeroallergens investigated?

When a careful history and examination findings lead to suspicion of a cutaneous reaction to aeroallergens, investigations may include:

How are reactions to aeroallergens minimised?

The avoidance and elimination of aeroallergen triggers can be challenging.

Pollens

Be aware of the allergenic plants in your region and monitor the local pollen forecast. Stay indoors and consider taking antihistamines and other medications when the pollen count is high.

Moulds

Thoroughly clean contaminated areas such as bathroom, laundry, and basement. Ventilate damp areas.

House-dust mite

Clean and vacuum all pillows, mattresses, bed-sheets, towels, carpets, and upholstered furniture. Consider using pillow and mattress protectors.

Animal dander and fur

Avoid contact with animals if possible. Bathe pets regularly.

What is the treatment for aeroallergen allergy?

The treatment of an aeroallergen allergic disease depends on the symptoms experienced.

Immunotherapy for allergic diseases (serial subcutaneous injections or sublingual) can reduce the reaction to aeroallergens in some patients.

See smartphone apps to check your skin.
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Related information

 

References

  1. Chapman MD. Allergen nomenclature. Clin Allergy Immunol 2008; 21: 47–58. PubMed
  2. National Institute of Allergy and Infectious Diseases (U.S. Dept of Health and Human Services). Airborne Allergens: something in the air. NIH Publication No. 03-7045. April 2003. Available at: www.niaid.nih.gov (accessed 22 June 2018)
  3. Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol 2016; 34: 181–189. DOI: 10.12932/AP0770. PubMed
  4. Choi IS, Lee SS, Myeong E, Lee JW, Kim WJ, Jin J. Seasonal variation in skin sensitivity to aeroallergens. Allergy Asthma Immunol Res 2013; 5: 301–8. DOI: 10.4168/aair.2013.5.5.301. PubMed Central
  5. Cecchi L, D'Amato G, Annesi-Maesano I. External exposome and allergic respiratory and skin diseases. J Allergy Clin Immunol 2018; 141: 846–57. DOI: 10.1016/j.jaci.2018.01.016. PubMed
  6. Sheffield PE, Weinberger KR, Kinney PL. Climate change, aeroallergens, and pediatric allergic disease. Mt Sinai J Med 2011; 78: 78–84. DOI: 10.1002/msj.20232. PubMed
  7. Beggs PJ. Adaptation to impacts of climate change on aeroallergens and allergic respiratory diseases. Int J Environ Res Public Health 2010; 7: 3006–21. DOI: 10.3390/ijerph7083006. PubMed
  8. The New Zealand pollen forecast. Fountain D. MetService Blog. Accessed 6 February 2019. Available at: https://blog.metservice.com/pollen
  9. Bains P, Dogra A. Skin prick test in patients with chronic allergic skin disorders. Indian J Dermatol 2015; 60: 159–64. DOI: 10.4103/0019-5154.152513. PubMed
  10. Werfel T. The role of leukocytes, keratinocytes, and allergen-specific IgE in the development of atopic dermatitis. J Invest Dermatol 2009; 129: 1878–91. DOI: 10.1038/jid.2009.71. PubMed
  11. Cosićkić A, Skokić F, Colić-Hadzić B, Suljendić S, Hasanović E. Hypersensitivity to aeroallergens in children with atopic dermatitis. Acta Clin Croat 2012; 51: 591–600. PubMed
  12. Park H. An overview of eosinophilic esophagitis. Gut Liver 2014; 8: 590–7. DOI: 10.5009/gnl14081. PubMed
  13. Raheem M, Leach ST, Day AS, Lemberg DA. The pathophysiology of eosinophilic esophagitis. Front Pediatr 2014; 2: 41. DOI: 10.3389/fped.2014.00041. PubMed
  14. Ghaffar A, Hunt R. Immunology-chapter seventeen hypersensitivity reactions. In: http://www.microbiologybook.org/ghaffar/hyper00.htm (accessed 08 Jun 2018)
  15. De Schryver E, et al. Local immunoglobulin E in the nasal mucosa: clinical implications. Allergy Asthma Immunol Res 2015; 7: 321–31. DOI: 10.4168/aair.2015.7.4.321. PubMed
  16. Green DJ, Cotton CC, Dellon ES. The role of environmental exposures in the etiology of eosinophilic esophagitis: a systematic review. Mayo Clin Proc 2015; 90: 1400–10. DOI: 10.1016/j.mayocp.2015.07.015. PubMed

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