University of Oulu

Paciência, I, Cavaleiro Rufo, J, Moreira, A. Environmental inequality: Air pollution and asthma in children. Pediatr Allergy Immunol. 2022; 33:e13818. doi: 10.1111/pai.13818

Environmental inequality : air pollution and asthma in children

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Author: Paciência, Inês1,2,3; Rufo, João Cavaleiro1,2; Moreira, André1,2,4,5
Organizations: 1EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
2Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
3Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
4Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
5Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-02-01


Introduction: Whether you benefit from high-quality urban environments, such as those rich in green and blue spaces, that may offer benefits to allergic and respiratory health depends on where you live and work. Environmental inequality, therefore, results from the unequal distribution of the risks and benefits that stem from interactions with our environment.

Methods: Within this perspective, this article reviews the evidence for an association between air pollution caused by industrial activities, traffic, disinfection-by-products, and tobacco/e-cigarettes, and asthma in children. We also discuss the proposed mechanisms by which air pollution increases asthma risk, including environmental epigenetic regulations, oxidative stress, and damage, disrupted barrier integrity, inflammatory pathways, and enhancement of respiratory sensitization to aeroallergens.

Results and conclusions: Environmental air pollution is a major determinant of childhood asthma, but the magnitude of effect is not shared equally across the population, regions, and settings where people live, work, and spend their time. Improvement of the exposure assessment, a better understanding of critical exposure time windows, underlying mechanisms, and drivers of heterogeneity may improve the risk estimates. Urban conditions and air quality are not only important features for national and local authorities to shape healthy cities and protect their citizens from environmental and health risks, but they also provide opportunities to mitigate inequalities in the most deprived areas where the environmental burden is highest. Actions to avoid exposure to indoor and outdoor air pollutants should be complementary at different levels—individual, local, and national levels—to take effective measures to protect children who have little or no control over the air they breathe.

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Series: Pediatric allergy and immunology
ISSN: 0905-6157
ISSN-E: 1399-3038
ISSN-L: 0905-6157
Volume: 33
Issue: 6
Article number: e13818
DOI: 10.1111/pai.13818
Type of Publication: A2 Review article in a scientific journal
Field of Science: 1172 Environmental sciences
3142 Public health care science, environmental and occupational health
Copyright information: © 2022 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. This is the peer reviewed version of the following article: Paciência, I, Cavaleiro Rufo, J, Moreira, A. Environmental inequality: Air pollution and asthma in children. Pediatr Allergy Immunol. 2022; 33:e13818, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.