Current Allergy and Asthma Reports

, Volume 3, Issue 2, pp 146–152 | Cite as

Diesel fumes and the rising prevalence of atopy: An urban legend?

  • David Diaz-Sanchez
  • Lidia Proietti
  • Riccardo Polosa


Recently, the incidence of allergic diseases has increased in most industrialized countries of the world. Persistent exposure to particulate air pollution from motor vehicles has been implicated as one of the factors that is responsible for the observed increased prevalence of atopy. Epidemiologic studies conducted in different parts of the world have demonstrated an important association between ambient levels of motor vehicle traffic emissions and increased symptoms of asthma and rhinitis. Additionally, recent human and animal laboratory-based studies have shown that particulate toxic pollutants, and in particular diesel exhaust particles (DEP), can enhance allergic inflammation and induce the development of allergic immune responses. In this article, our current understanding of the mechanisms by which pollutants such as DEPs enhance the underlying allergic inflammatory response is reviewed, and the evidence that supports the causative link between particulate air pollution from motor vehicles and increasing allergic diseases is discussed.


Food Allergy Allergic Rhinitis Allergic Disease Allergy Clin Immunol Diesel Exhaust 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Blackley CM: Catarrhus aestivus: causes and nature. London: Dawsons of Pall Mall; 1873.Google Scholar
  2. 2.
    Diaz-Sanchez D: Pollution and the immune response: atopic diseases—Are we too dirty or too clean? Immunology 2000, 101:11–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Cacciola RR, Sarva M, Polosa R: Adverse respiratory effects and allergic susceptibility in relation to particulate air pollution: flirting with disaster. Allergy 2002, 57:281–286.PubMedCrossRefGoogle Scholar
  4. 4.
    WHO: Bronchial asthma. Fact sheet no. 206. January, 2000.Google Scholar
  5. 5.
    Strachan D, Sibbald B, Weiland S, et al.: Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol 1997, 8:161–176.PubMedGoogle Scholar
  6. 6.
    Okudaira H: Pathogenesis of allergic diseases: interactions between pollutants and pollens really important? Allerg Immunol (Paris) 2000, 32:94–96.Google Scholar
  7. 7.
    Sibbald B, Rink E: Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax 1991, 46:895–901.PubMedGoogle Scholar
  8. 8.
    Dofterud LK, Kvammen B, Bolle R, Falk ES: A survey of atopic diseases among school children in Sor-Varanger community: possible effects of subarctic climate and industrial pollution from Russia. Acta Derm Venereol 1994, 74:124–128.Google Scholar
  9. 9.
    Drosner M, Schreiber M, Borelli S: Epidemiological study of the prevalence of atopic diseases. Munich: MMV Medizin; 1991.Google Scholar
  10. 10.
    Davies RI, Rusznak C, Devalia IL: Why is allergy increasing? Environmental factors. Clin Exp Allergy 1998, 28 (Suppl_6):8–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Peterson B, Saxon A: Global increases in allergic respiratory disease: the possible role of diesel exhaust particles. Ann Allergy Asthma Immunol 1996, 77:263–268.PubMedCrossRefGoogle Scholar
  12. 12.
    Marone G: Asthma: recent advances. Immunol Today 1998, 19:5–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rook GA, Stanford IL: Give us this day our daily germs. Immunol Today 1998, 19:113–116.PubMedCrossRefGoogle Scholar
  14. 14.
    Pereira P, Saldiva PH, Sakae RS, et al.: Urban levels of air pollution increase lung responsiveness in rats. Environ Res 1995, 69:96–101.PubMedCrossRefGoogle Scholar
  15. 15.
    Kobayashi T, Ikeue T, Ikeda A: Four-week exposure to diesel exhaust induces nasal mueosal hyperresponsiveness to histamine in guinea pigs. Toxicol Sei 1998, 45:106–112.Google Scholar
  16. 16.
    Federal Highway Administration: Highway statistics summary to 1995. US Department of Transportation; 1997.Google Scholar
  17. 17.
    Dockery DW, Pope CA, Xu X, et al.: An association between air pollution and mortality in six US cities. N Engl J Med 1993, 329:1753–1759.PubMedCrossRefGoogle Scholar
  18. 18.
    Polosa R: Prevalence of atopy and urban air pollution: dirty business. Clin Exp Allergy 1999, 29:1439–1441.PubMedCrossRefGoogle Scholar
  19. 19.
    Ishizaki T, Koizumi K, Ikemori R, et al.: Studies of prevalence of Japanese cedar pollinosis among the residents in a densely cultivated area. Ann Allergy 1987, 58:265–270.PubMedGoogle Scholar
  20. 20.
    Wade JF 3rd, Newman LS: Diesel asthma: reactive airways disease following overexposure to locomotive exhaust. J Occup Med 1993, 35:149–154.PubMedCrossRefGoogle Scholar
  21. 21.
    Abbey DE, Burchette RJ, Knutsen SF, et al.: Long-term particulate and other air pollutants and lung function in nonsmokers. Am J Respir Crit Care Med 1998, 158:289–298.PubMedGoogle Scholar
  22. 22.
    Gergen PJ, Turkeltaub PC, Kovar MG: The prevalence of allergic skin test reactivity for eight common aeroallergens in the US population: results from the second National Health and Nutrition Examination Survey. J Allergy Clin Immunol 1987, 80:669–79.PubMedCrossRefGoogle Scholar
  23. 23.
    Popp W, Zwick H, Steyrer K, et al.: Sensitization to aeroallergens depends on environmental factors. Allergy 1989, 44:572–575.PubMedCrossRefGoogle Scholar
  24. 24.
    Braback E, Kalvesten L: Urban living as a risk factor for atopic sensitisation in Swedish school children. Pediatr Allergy Immunol 1992, 2:14–19.Google Scholar
  25. 25.
    Wyler C, Braun-Fahrlander C, Kunzli N, et al.: Exposure to motor vehicle traffic and allergic sensitization: The Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA). Team Epidemiology 2000, 11:450–456.CrossRefGoogle Scholar
  26. 26.
    von Mutius E, Fritzsch C, Weiland SK, et al.: Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison. BMJ 1992, 305:1395–1399.Google Scholar
  27. 27.
    von Mutius E, Martinez FD, Fritzsch C, et al.: Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med 1994, 149(2 Pt 1):358–364.Google Scholar
  28. 28.
    Leung R, Ho P, Lam CW, Lai CKW: Sensitization to inhaled allergens as a risk factor for asthma and allergic diseases in Chinese population. J Allergy Clin Immunol 1997, 99:594–599.PubMedCrossRefGoogle Scholar
  29. 29.
    European Environment Agency Task Force (European Commission): The urban environment. In Europe’s Environment: The Dobris Assessment 2001. Edited by Stanners D, Bordeau P. Brussels: EEA; 2002:504–555.Google Scholar
  30. 30.
    von Mutius E, Weiland SK, Fritzsch C, et al.: Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet 1998, 351:862–866. The prevalence of hay fever and atopic sensitization increased significantly in former East Germany soon after reunification, highlighting the importance of western living conditions in the development of allergies.CrossRefGoogle Scholar
  31. 31.
    Wjst M, Reitmeir P, Dold S, et al.: Road traffic and adverse effects of respiratory health in children. BMJ 1993, 307:596–600.PubMedGoogle Scholar
  32. 32.
    Weiland SK, Mundt KA, Ruckmann A, Keil U: Self-reported wheezing and allergic rhinitis in children and traffic density on street of residence. Ann Epidemiol 1994, 4:243–247.PubMedCrossRefGoogle Scholar
  33. 33.
    Ring J, Kramer U, Schafer T, et al.: Environmental risk factors for respiratory and skin atopy: results from epidemiological studies in former East and West Germany. Int Arch Allergy Immunol 1999, 118:403–407.PubMedCrossRefGoogle Scholar
  34. 34.
    Kramer U, Koch T, Ranft U, et al.: Traffic-related air pollution is associated with atopy in children living in urban areas. Epidemiology 2000, 11:64–70.PubMedCrossRefGoogle Scholar
  35. 35.
    Polosa R, Russo S, Sciuto R, et al.: Increased prevalence of allergic sensitisation in a high risk group exposed to road traffic fumes: a pilot study. Eur Respir J 1999, 14(Suppl 30):170S.Google Scholar
  36. 36.
    Hirsch T, Weiland SK, von Mutius E, et al.: Inner city air pollution and respiratory health and atopy in children. Eur Respir J 1999, 14:669–677.PubMedCrossRefGoogle Scholar
  37. 37.
    Charpin D, Pascal E, Birnbaum J, et al.: Gaseous air pollution and atopy. Clin Exp Allergy 1999, 29:1474–1480.PubMedCrossRefGoogle Scholar
  38. 38.
    Jedrychowsky W, Maugeri U, Jedrychowska-Bianchi I: Prevalence of allergy across the areas with different outdoor air pollution. In Search for Epidemiologic Evidence on Air Quality and Health in Children and Adults. Edited by Jedrychowsky W, Maugeri U, Jedrychowska-Bianchi I. Luxembourg: ICSRB; 2000:173–181. Detailed cross-sectional health survey of 1129 schoolchildren in which a number of potential confounding factors were computed in a multivariate logistic regression analysis. This shows the higher prevalence in allergy was independently associated with exposure to increasing urban air pollution levels.Google Scholar
  39. 39.
    Nordenhall C, Pourazar J, Ledin MC, et al.: Diesel exhaust enhances airway responsiveness in asthmatic subjects. Eur Respir J 2001, 17:909–915.PubMedCrossRefGoogle Scholar
  40. 40.
    Diaz-Sanchez D, Tsien A, Fleming J, Saxon A: Combined diesel exhaust particulate and ragweed allergen challenge markedly enhances human in vivo nasal ragweed-specific IgE and skews cytokine production to a T helper cell 2-type pattern. J Immunol 1997, 158:2406–2413.PubMedGoogle Scholar
  41. 41.
    Diaz-Sanchez D, Dotson AR, Takenaka H, Saxon A: Diesel exhaust particles induce local IgE production in vivo and alter the pattern of IgE messenger RNA isoforms. J Clin Invest 1994, 94:1417–1425.PubMedCrossRefGoogle Scholar
  42. 42.
    Suzuki T, Kanoh T, Ishimori M, et al.: Adjuvant activity of diesel exhaust particulates (DEP) in production of anti-IgE and anti-IgG1 antibodies to mite allergen in mice. J Clin Lab Immunol 1996, 48:187–199.PubMedGoogle Scholar
  43. 43.
    Muranaka M, Suzuki S, Koizumi K, et al.: Adjuvant activity of diesel-exhaust particulates for the production of IgE antibody in mice. J Allergy Clin Immunol 1986, 77:616–623.PubMedCrossRefGoogle Scholar
  44. 44.
    Miyabara Y, Takano H, Ichinose T, et al.: Diesel exhaust enhances allergic airway inflammation and hyperresponsiveness in mice. Am J Respir Crit Care Med 1998, 157(4 Pt 1):1138–1144.PubMedGoogle Scholar
  45. 45.
    Rudell B, Ledin MC, Hammarstrom U, et al.: Effects on symptoms and lung function in humans experimentally exposed to diesel exhaust. Occup Environ Med 1996, 53:658–662. The first study to look experimentally at the effect of diesel exhaust exposure on healthy human subjects. Exposure to diesel exhaust caused significant increases in airway resistance and specific airway resistance that were not significantly reduced by a particle trap.PubMedCrossRefGoogle Scholar
  46. 46.
    Rudell B, Blomberg A, Helleday R, et al.: Bronchoalveolar inflammation after exposure to diesel exhaust: comparison between unfiltered and particle trap filtered exhaust. Occup Environ Med 1999, 56:527–534.PubMedGoogle Scholar
  47. 47.
    Salvi S, Blomberg A, Rudell B, et al.: Acute inflammatory responses in the airways and peripheral blood after shortterm exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med 1999, 159:702–709.PubMedGoogle Scholar
  48. 48.
    Rudell B, Wass U, Horstedt P, et al.: Efficiency of automotive cabin air filters to reduce acute health effects of diesel exhaust in human subjects. Occup Environ Med 1999, 56:222–231.PubMedGoogle Scholar
  49. 49.
    Blomberg A, Sainsbury C, Rudell B, et al.: Nasal cavity lining fluid ascorbic acid concentration increases in healthy human volunteers following short term exposure to diesel exhaust. Free Radic Res 1998, 28:59–67.PubMedGoogle Scholar
  50. 50.
    Salvi SS, Nordenhall C, Blomberg A, et al.: Acute exposure to diesel exhaust increases IL-8 and GRO-alpha production in healthy human airways. Am J Respir Crit Care Med 2000, 161(2_Pt_1):550–557.PubMedGoogle Scholar
  51. 51.
    Erger RA, Casale TB: Interleukin-8 plays a significant role in IgE-mediated lung inflammation. Eur Respir J 1998, 11:299–305.PubMedCrossRefGoogle Scholar
  52. 52.
    Fujieda S, Diaz-Sanchez D, Saxon A: 12 Combined nasal challenge with diesel exhaust particles and allergen induces in vivo IgE isotype switching. Am J Respir Cell Mol Biol 1998, 19:507–512.PubMedGoogle Scholar
  53. 53.
    Diaz-Sanchez D, Garcia MP, Wang M, et al.: Nasal challenge with diesel exhaust particles can induce sensitization to a neoallergen in the human mucosa. J Allergy Clin Immunol 1999, 104:1183–1188. In this elegant work, the authors demonstrate that DEP can act as immunological adjuvants with an exuberant IgE response to a neoantigen and might increase allergic sensitization in humans.PubMedCrossRefGoogle Scholar
  54. 54.
    Diaz-Sanchez D, Penichet-Garcia M, Saxon A: Diesel exhaust particles directly induce activated mast cells to degranulate and increase histamine levels and symptom severity. J Allergy Clin Immunol 2000, 106:1140–1146.PubMedCrossRefGoogle Scholar
  55. 55.
    Devouassoux G, Saxon A, Metcalfe DD, et al.: Chemical constituents of diesel exhaust particles induce IL-4 production and histamine release by human basophils. J Allergy Clin Immunol 2002, 109:847–853.PubMedCrossRefGoogle Scholar
  56. 56.
    Terada N, Hamano N, Maesako KI, et al.: Diesel exhaust particulates upregulate histamine receptor mRNA and increase histamine-induced IL-8 and GM-CSF production in nasal epithelial cells and endothelial cells. Clin Exp Allergy 1999, 29:52–59.PubMedCrossRefGoogle Scholar
  57. 57.
    Hiruma K, Terada N, Hanazawa T, et al.: Effect of diesel exhaust on guinea pig nasal mucosa. Ann Otol Rhinol Laryngol 1999, 108:582–588.PubMedGoogle Scholar
  58. 58.
    Kobayashi T, Ikeue T, Ikeda A: Four-week exposure to diesel exhaust induces nasal mucosal hyperresponsiveness to histamine in guinea pigs. Toxicol Sci 1998, 45:106–112.PubMedGoogle Scholar
  59. 59.
    Yoshimura S, Bondeson J, Brennan FM, et al.: Role of NFkappaB in antigen presentation and development of regulatory T cells elucidated by treatment of dendritic cells with the proteasome inhibitor PSI. Eur J Immunol 2001, 31:1883–1893.PubMedCrossRefGoogle Scholar
  60. 60.
    Don Porto Carero A, Hoet PH, Nemery B, Schoeters G: Increased HLA-DR expression after exposure of human monocytic cells to air particulates. Clin Exp Allergy 2002, 32:296–300.CrossRefGoogle Scholar
  61. 61.
    Moffatt MF, Schou C, Faux JA, et al.: Association between quantitative traits underlying asthma and the HLA-DRB1 locus in a family-based population sample. Eur J Hum Genet 2001, 9:341–346.PubMedCrossRefGoogle Scholar
  62. 62.
    Kerkvliet NI, Oughton JA: Acute inflammatory response to sheep red blood cell challenge in mice treated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD): phenotypic and functional analysis of peritoneal exudate cells. Toxicol Appl Pharmacol 1993, 119:248–257.PubMedCrossRefGoogle Scholar
  63. 63.
    Jaffar Z, Roberts K, Pandit A, et al.: B7 costimulation is required for IL-5 and IL-13 secretion by bronchial biopsy tissue of atopic asthmatic subjects in response to allergen stimulation. Am J Respir Cell Mol Biol 1999, 20:153–162.PubMedGoogle Scholar
  64. 64.
    Burastero SE, Magnani Z, Confetti C, et al.: Increased expression of the CD80 accessory molecule by alveolar macrophages in asthmatic subjects and its functional involvement in allergen presentation to autologous Th2 lymphocytes. J Allergy Clin Immunol 1999, 103:1136–1142.PubMedCrossRefGoogle Scholar
  65. 65.
    Moser M: Regulation of Th1/Th2 development by antigenpresenting cells in vivo. Immunobiology 2001, 204:551–557.PubMedCrossRefGoogle Scholar
  66. 66.
    Nel AE, Diaz-Sanchez D, Ng D, et al.: Enhancement of allergic inflammation by the interaction between diesel exhaust particles and the immune system. J Allergy Clin Immunol 1998, 102(4 Pt 1):539–554.PubMedCrossRefGoogle Scholar
  67. 67.
    Fahy O, Senechal S, Pene J, et al.: Diesel exposure favors Th2 cell recruitment by mononuclear cells and alveolar macrophages from allergic patients by differentially regulating macrophage-derived chemokine and IFN-gamma-induced protein-10 production. J Immunol 2002, 168:5912–19. This is an important illustration of the role of diesel constituents in augmenting antigen presentation. Diesel-dependent increase of allergen-induced production of macrophage-derived chemokine could be completely inhibited by blocking the B7:CD28 pathway.PubMedGoogle Scholar
  68. 68.
    Takizawa H, Ohtoshi T, Kawasaki S, et al.: Diesel exhaust particles induce NF-kB activation in human bronchial epithelial cells in vitro: importance in cytokine transcription. J Immunol 1999, 162:4705–4711.PubMedGoogle Scholar
  69. 69.
    Ng D, Kokot N, Hiura T, et al.: Macrophage activation by polycyclic aromatic hydrocarbons: evidence for the involvement of stress-activated protein kinases, activator protein-1, and antioxidant response elements. J Immunol 1998, 161:942–951. A study that establishes the importance of oxidant response pathways for chemicals present in diesel and other pollutants in modulating the immune system.PubMedGoogle Scholar
  70. 70.
    Nel AE, Diaz-Sanchez D, Li N: The role of particulate pollutants in pulmonary inflammation and asthma: evidence for the involvement of organic chemicals and oxidative stress. Curr Opin Pulm Med 2001, 7:20–26.PubMedCrossRefGoogle Scholar
  71. 71.
    Whitekus MJ, Li N, Zhang M, et al.: Thiol antioxidants inhibit the adjuvant effects of aerosolized diesel exhaust particles in a murine model for ovalbumin sensitization. J Immunol 2002, 168:2560–2567.PubMedGoogle Scholar
  72. 72.
    Pacheco KA, Tarkowski M, Sterritt C, et al.: The influence of diesel exhaust particles on mononuclear phagocytic cellderived cytokines: IL-10, TGF-beta and IL-1 beta. Clin Exp Immunol 2001, 126:374–383.PubMedCrossRefGoogle Scholar
  73. 73.
    Yoshino S, Hayashi H, Taneda S, et al.: Effect of diesel exhaust particle extracts on induction of oral tolerance in mice. Toxicol Sci 2002, 66:293–297. A demonstration of the potential of diesel exhaust particles to break oral tolerance is provided. It suggests the possibility that exposure to pollutants may also contribute to increased occurrence of food allergies.PubMedCrossRefGoogle Scholar
  74. 74.
    Yoshino S, Sagai M: Induction of systemic Th1 and Th2 immune responses by oral administration of soluble antigen and diesel exhaust particles. Cell Immunol 1999, 192:72–78.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2003

Authors and Affiliations

  • David Diaz-Sanchez
    • 1
  • Lidia Proietti
    • 1
  • Riccardo Polosa
    • 1
  1. 1.Dipartimento di Medicina Interna e SpecialisticaUniversità di Catania, Ospedale TomaselliCataniaItaly

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