An expert position paper on environment, occupation and climate change effects on allergic respiratory diseases in Italy (2026-09-23)

This expert position paper was developed by experts from nine Italian scientific societies with the aim of addressing in an integrated and multidisciplinary way the complex interactions between environmental and occupational exposures, climate change, and the onset of respiratory allergic diseases in the adult and paediatric population.Air pollution is the leading environmental risk factor for human health worldwide and in Italy. According to the State of Global Air 2025, it caused 7.9 million deaths in 2023, making it the second leading risk factor for mortality. In response to growing scientific evidence, the World Health Organization (WHO) updated its Air Quality guidelines in 2021, recommending substantially lower pollutant limits than those established by previous European legislation. The new European Ambient Air Quality Directive (2024/2881/EU), which entered into force in December 2024, introduces stricter air quality standards to be achieved by 2030, while strengthening monitoring systems and public access to air quality information. Italian epidemiological studies have consistently shown that exposure to particulate matter [PM: atmospheric PM with a diameter ≤ 10 μm (PM10) and atmospheric PM with a diameter ≤ 2.5 μm (PM2.5)], nitrogen dioxide (NO2), and ozone (O3) is associated with increased odds of rhinitis, asthma, chronic obstructive pulmonary disease (COPD), respiratory hospitalizations, and mortality both in the short and long term. These effects are mediated by inflammatory responses, oxidative stress, and molecular and epigenetic mechanisms. Children, particularly those living in densely populated urban areas with poor air quality, are among the most vulnerable populations. Climate change, which originates from the same anthropogenic emissions driving air pollution, i.e., from energy, transport, heating, cooling, and agriculture, is further aggravating the burden of respiratory disease through more frequent heatwaves, extreme weather events, and changes in the distribution and flowering seasons of allergenic plants. Rising pollen production, combined with air pollution, enhances allergen exposure and worsens allergic respiratory diseases. Therefore, integrated monitoring of pollen, air pollutants, and meteorological conditions is essential for improving disease prediction and prevention. Particular concern is raised by thunderstorm asthma, characterized by sudden outbreaks of severe asthma following thunderstorms. Indoor air pollution is also emerging as a major public health concern because of the growing use of chemicals and the high fraction of time spent indoors. Passive smoking, combustion products from cooking and heating, volatile organic compounds, and inadequate ventilation are associated with respiratory symptoms and impaired lung function. Schools are of particular concern, as elevated levels of carbon dioxide and PM are frequently reported in classrooms. Occupational exposure to dust, fumes and gases remains an important cause of occupational asthma and respiratory impairment. This document promotes operational proposals for risk prevention and mitigation, encourages scientific research and fosters the dialogue with public health and environmental authorities, in order to strengthen respiratory health protection policies.