Agache, Ioana, Annesi-Maesano, Isabella, Cecchi, Lorenzo, Biagioni, Benedetta, Chung, Fan, D'Amato, Gennaro, Damialis, Athanasios, del Giacco, Stefano, Dominguez Ortega, Javier, Galán, Carmen, Gilles, Stefanie, Holgate, Stephen, Jeebhay, Mohamed, Kazadzis, Stelios, Nadeau, Kari, Papadopoulos, Nikos G., Quirce, Santiago, Sastre, Joaquin, Traidl-Hoffmann, Claudia, Walusiak-Skorupa, Jolanta, Zemelka-Wiacek, Magdalena, Jutel, Marek and Akdis, Cezmi A. (2025) EAACI guidelines on environmental science for allergy and asthma—recommendations on the impact of indoor air pollutants on the risk of new-onset asthma and on asthma-related outcomes. Allergy: European Journal of Allergy and Clinical Immunology, 80 (3), 651-676. (doi:10.1111/all.16502).
Abstract
The EAACI Guidelines used the GRADE approach to evaluate the impact of major indoor air pollutants (dampness and mould, cleaning agents, volatile organic compounds and pesticides) on the risk of new-onset asthma and on asthma-related outcomes. The guideline also acknowledges the synergies among indoor air pollutants and other components of the indoor exposome (allergens, viruses, endotoxins). Very low to low certainty of evidence was found for the association between exposure to indoor pollutants and increased risk of new-onset asthma and asthma worsening. Only for mould exposure there was moderate certainty of evidence for new-onset asthma. Due to the quality of evidence, conditional recommendations were formulated on the risk of exposure to all indoor pollutants. Recommendations are provided for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management. For policymakers and regulators this evidence-informed guideline supports setting legally binding standards and goals for indoor air quality at international, national and local levels. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but community and governmental measures for improved indoor air quality are needed to achieve significant impact.
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