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1 Unit for Experimental Asthma & Allergy Research, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, 2 Dept of Respiratory Medicine and Allergy, University Hospital, Umeå, Sweden, 3 Respiratory Cell and Molecular Biology Research Division, Southampton General Hospital, Tremona Road, Southampton, UK
CORRESPONDENCE: S-E. Dahlén, Unit for Experimental Asthma & Allergy Research, The National Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden. Fax: 46 8300619
Keywords: air pollution, allergy incidence, animal studies, asthma exacerbation, diesel, human exposure
Received: October 5, 2000
Accepted October 20, 2000
The authors were supported by the Swedish Heart and Lung Foundation, The Medical Research Council (project No 9071), the Swedish National Road Administration (Vägverket) and The Foundation for Health Care and Allergy Research (Vårdal).
Epidemiological studies have demonstrated an association between different levels of air pollution and various health outcomes including mortality, exacerbation of asthma, chronic bronchitis, respiratory tract infections, ischaemic heart disease and stroke. Of the motor vehicle generated air pollutants, diesel exhaust particles account for a highly significant percentage of the particles emitted in many towns and cities. This review is therefore focused on the health effects of diesel exhaust, and especially the particular matter components.
Acute effects of diesel exhaust exposure include irritation of the nose and eyes, lung function changes, respiratory changes, headache, fatigue and nausea. Chronic exposures are associated with cough, sputum production and lung function decrements. In addition to symptoms, exposure studies in healthy humans have documented a number of profound inflammatory changes in the airways, notably, before changes in pulmonary function can be detected. It is likely that such effects may be even more detrimental in asthmatics and other subjects with compromised pulmonary function.
There are also observations supporting the hypothesis that diesel exhaust is one important factor contributing to the allergy pandemic. For example, in many experimental systems, diesel exhaust particles can be shown to act as adjuvants to allergen and hence increase the sensitization response.
Much of the research on adverse effects of diesel exhaust, both in vivo and in vitro, has however been conducted in animals. Questions remain concerning the relevance of exposure levels and whether findings in such models can be extrapolated into humans. It is therefore imperative to further assess acute and chronic effects of diesel exhaust in mechanistic studies with careful consideration of exposure levels. Whenever possible and ethically justified, studies should be carried out in humans.
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