Allergic Disease and Climate Change World Allergy Congress 2011

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1 Allergic Disease and Climate Change World Allergy Congress 2011 Jeffrey G Demain, MD, FAAAAI, FACAAI, FAAP Director, Allergy Asthma & Immunology Center of Alaska Associate Clinical Professor, University of Washington Adjunct Clinical Professor, University of Alaska

2 Disclosures Research Genentech (not relevant to this program) Industry Speaker none Financial No conflicts or disclosures I am not an expert on the topic of global warming.

3 Climate Change Scientific consensus that climate change is occurring and that our planet is warming is nearly unanimous. Increasing atmospheric greenhouse gases such as CO 2, NO 2, and CH 4 along with H 2 O vapor are thought to be contributing factors. Greenhouse gases trap solar energy near the Earth s surface, resulting in global warming - McMichael AJ, et al. Lancet 2006;367: Epstein PR. Epidemiology 2002;13:373-5

4 Expert credibility in climate change Anderegga WR, Prallb JW, Haroldc J, Schneidera SH Proc Natl Acad Sci 2010 Jul 6;107(27): (US) -1,372 highly regarded scientists surveyed * active researchers * actively publishing -97% believe that climate change is real and that there is an anthropogenic impact

- McMichael AJ, et al. Lancet 2006;367:859-6 - Intergovernmental Panel on Climate Change (IPCC).2011 - Epstein PR. Epidemiology 2002;13:373-5 Climate Change Global temperature has risen 0.

6 - McMichael AJ, et al. Lancet 2006;367: Intergovernmental Panel on Climate Change (IPCC) Epstein PR. Epidemiology 2002;13:373-5 Climate Change Global temperature has risen 0.74 C since 1950 Nighttime & winter variance: 1 C Temperatures rising faster in the polar regions: 2 C Projected temperature rise by C Range indicates uncertainty about future greenhouse gas emissions The increase will be greater at higher latitudes and over land

Circumpolar Regions Will continue to be the first to illuminate the impacts of climate change Over the next 100 years Alaska is projected to lose 90% of its historic tundra* Replaced with forestation

7 Circumpolar Regions Will continue to be the first to illuminate the impacts of climate change Over the next 100 years Alaska is projected to lose 90% of its historic tundra* Replaced with forestation and other vegetation growth Resulting in dramatic change to the ecosystem Extinction of some plant and animal species Increase in insects and pathogens may result in epidemics of plant disease and insect attacks Bachelet D, Earth Observatory, NASA, August 3, 2004 * Likely overestimated; Jeff Welkner, PhD; Director, ENRI Environment and Natural Resources Institute (NASA) UAF

8 Impact on Human Health World Health Report Over the past 30 years, climate change has resulted in 150,000 deaths annually 5 million disability adjusted life years annually Associated with Extreme heat, drought, storms and floods Changes in air and water quality Malnutrition from crop failures Transmission of infectious disease Changes in insect patterns Patz JA, et al. Nature 2005;438(17)

HEALTH EFFECTS OF CLIMATE CHANGE Urban Heat Effect Heat Stress Cardiorespiratory failure CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes 1 3 C by 2100 2 40 cm by 2100 IPCC

9 HEALTH EFFECTS OF CLIMATE CHANGE Urban Heat Effect Heat Stress Cardiorespiratory failure CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes 1 3 C by cm by 2100 IPCC estimates Adapted from Patz,1998 Air Pollution & Aeroallergens Insect related Diseases Water-borne Diseases Water resources & food supply Mental Health & Environmental Refugees Respiratory diseases, COPD, Asthma & Allergy Malaria Dengue Encephalitis Hantavirus Rift Valley Fever Stings / Anaphylaxis Cholera Vibrio parahaemolyticus Cryptosporidiosis Campylobacter Leptospirosis Malnutrition Diarrhea Toxic Red Tides Failed ice cellars Contaminated water Forced Relocation Overcrowding Infectious diseases Human Conflicts Cultural Impact

10 Impacts on Allergy, Asthma and Other Health Issues Changing Aerobiology and Air Quality Insect-borne Disease Water-borne and Food-borne Disease

11 Beggs PJ,et al. Environ Health Perspect 2005 The Allergy and Asthma Epidemic

12 PREVALENCE OF ALLERGIC RHINITIS SINCE THE INDUSTRIAL REVOLUTION 30 % GENETIC PREVALENCE LIMIT FOR ALLERGIC RHINITIS % % Airborne Allergen load Bostock 1 case 1819 Bostock 28 cases 1828 Lloyd Common

13 Suspected factors contributing to the rising prevalence of allergic disease Industrialization Changes in antigen exposure Changes in childhood infections Changes in home construction Changes in activity: location and intensity Changes in dietary habits Smoking by infants care givers Climate Change

14 Industrial Revolution Intergovernmental Panel on Climate Change

Concentrations of CO2 in the Atmosphere from 650,000 years ago to Present Day Older measurements come from air bubbles trapped in layers of ice

15 Concentrations of CO2 in the Atmosphere from 650,000 years ago to Present Day Older measurements come from air bubbles trapped in layers of ice from Antarctica and Greenland. By determining the age of the ice layers and the concentrations of gases trapped inside epa.gov/climatechangeindicators

Air Quality: Smoke and other Current impacts Respiratory Irritants Increase levels of airborne allergens over a longer season Birch season in Alaska is longer than a decade ago (anecdotal)

16 Air Quality: Smoke and other Current impacts Respiratory Irritants Increase levels of airborne allergens over a longer season Birch season in Alaska is longer than a decade ago (anecdotal) Respiratory disease exacerbations Increase in forest fire and tundra fire smoke Recent years have seen record breaking forest fire seasons 11 million acres burned in 2004/2005, the first and third largest seasons Record breaking tundra fires in 2007 Fairbanks exceeded EPA air quality small particulate standards repeatedly in 2004 and 2005; with a high 1,000 mcg/meter 3 Fires release mercury, up to 15 times greater in the air than the soil Future projections Greater amount of smoke with more respiratory disease exacerbations Greater release of mercury Increase in other pollutants, such as ozone and dust from newly retreated glaciers Continued increase in airborne allergens

Changes in Mold Sporulation Although not well studied, several papers suggest a correlation between rising CO2 & temperature and increasing mold spore counts and mycelia growth Retrospective study of

17 Changes in Mold Sporulation Although not well studied, several papers suggest a correlation between rising CO2 & temperature and increasing mold spore counts and mycelia growth Retrospective study of mold spore concentrations over 27 years in the UK (Hollins PD, et al. Int J Biometerol.2004;48(3):137-43) Increased number of days Cladosporium spores exceeded allergenic concentration correlated with rising regional temperature Correlation between rising CO2 and increasing mycelia colonies has been established (Lake JA, et al. J Experimental Botany.2009;60(11): ) Increase of CO2 from 400ppm to 800ppm increased established mycelia colonies 40%

Biomass and Toxicity of Poison Ivy to Elevated CO2 Mohan JE, Ziska

Increasing CO2 (570 versus 370 mcl/l) Increased photosynthesis by

to the 75% annual growth of the plants exposed to ambient CO2 The

the urushiol the more poisonous the plant Increasing vine abundance

18 Biomass and Toxicity of Poison Ivy to Elevated CO2 Mohan JE, Ziska LH, et al PNAS,2006;103(24): year study at Duke University Increasing CO2 (570 versus 370 mcl/l) Increased photosynthesis by 77% Annual biomass doubled Increases annual growth by 150% compared to the 75% annual growth of the plants exposed to ambient CO2 The more allergenic unsaturated urushiol increased The more unsaturated the urushiol the more poisonous the plant Increasing vine abundance may inhibit forest regeneration Biomass Unsaturated congeners for urushiol

Industrial Revolution may alter growth and pollen production of ragweed Controlled chambers Pre-industrial levels of CO 2

19 Changes in Weed Pollination Ziska L, Caulfield. Amer J of Plant Physiology,2000;27:893-8 Tested whether the increase in atmospheric CO 2 concentrations since the Industrial Revolution may alter growth and pollen production of ragweed Controlled chambers Pre-industrial levels of CO 2 (280 mcl/l) Current levels of CO 2 (370 mcl/l) Projected 2100 of CO 2 (600 mcl/l) Results +132% increase in pollen production from preindustrial to current +90% increase in pollen production from current to 2100.

Changes in Weed Pollination Ziska L, et al. J Allergy Clin Immunol, 2003.

20 Changes in Weed Pollination Ziska L, et al. J Allergy Clin Immunol, (2):290-5 URBAN versus SUBURBAN versus RURAL Maryland Existing temperature and CO 2 concentration CO 2 30% higher in urban Temperature 1.8 degrees C higher in urban CO 2 31% higher in urban Temperature 2 degrees C higher in urban Ragweed grew faster, flowered earlier and produced significantly greater biomass & pollen in the urban areas (189%) versus rural Associated with increased temperature & CO2

21 Rural vs. Urban Ragweed Urban ragweed emerged 3-4 days earlier vs. rural Suburban ragweed 61-66% greater biomass vs. rural Urban 189% greater vs. rural Ziska, JACI 2003

22 The National Resources Defense Council Pollution & Allergenic Ragweed August 3, 2011

Change in Growth Rate for Weedy Species in Increased CO2 Environment despite Herbicides 370-400 mcmol/mol 600-800 mcmol/mol Ziska LH, Epstein

23 Change in Growth Rate for Weedy Species in Increased CO2 Environment despite Herbicides mcmol/mol mcmol/mol Ziska LH, Epstein PR, Schlesinger WH Rising CO 2, Climate Change, and Public Health: Exploring the Links to Plant Biology. Environ Health Perspect 117:

24 Changes in Tree Pollination International research to identify pollen trends Poland (Puc, Wolski. Ann Agric Environ Med, 2002) increase in birch pollen concentration correlated with air temperature Denmark (Rasmussen A. Aerobiologia, 2002) earlier start, earlier peak and increased level of birch pollen correlated with increased winter and spring temperature Spain (Vazquez L. et al. Int J Biometeorol, 2003) projectors of pollen concentration included temperature and sunlight hours Summary Pre-season temperature and precipitation are important projectors of tree pollen production and start date

25 Changes in Allergenicity (Finland) Ahlholm JU, et al.clin Exp Allergy, 1998, 28: P<0.05

The Possible Role Of Climate Changes In Variations Of Pollen Seasons And Allergic Sensitizations Over 27 years Ariano R, Canonica GW, Passalaqua G; Genoa Italy Study Period 1981-2007 Methods Pollen

26 The Possible Role Of Climate Changes In Variations Of Pollen Seasons And Allergic Sensitizations Over 27 years Ariano R, Canonica GW, Passalaqua G; Genoa Italy Study Period Methods Pollen collected with a Hirst type trap Pollens monitored birch, cypress, olive, grass, weed (parietaria) Patients evaluated Prick Skin Test for both indoor and outdoor allergens Climate Variables monitored Irradiation, Temperature, # days >30 C, Humidity & Rainfall Ariano R, et al. Annals Allergy Asthma Immunol 2010;104:

27 The Possible Role Of Climate Changes In Variations Of Pollen Seasons And Allergic Sensitizations Over 27 years Ariano R, Canonica GW, Passalaqua G; Genoa Italy Results: Pollen trends Increased tree & weed pollen cycle duration (earlier) Trees (80 days) & Weeds (30 days) Increased tree, grass & weed pollen load Patient trends (# of patients with positive skin test) Increased pollen sensitivity throughout study period No change in DM sensitivity during same period Correlation between Climate & Pollen/Patient trends Increased irradiation > increased temp & # days >30 C No correlation with humidity & rainfall Ariano R, et al. Annals Allergy Asthma Immunol 2010;104:

28 Findings Variables Irradiation Dust Mite (control) Olive Pollen Sensitized Patients Days > 30ºC Tree Pollen Count Temperature ºC Season Duration

29 The Possible Role Of Climate Changes In Variations Of Pollen Seasons And Allergic Sensitizations Over 27 years Ariano R, Canonica GW, Passalaqua G; Genoa Italy Conclusion: The progressive climate changes, with increased temperatures, may modify the global pollen load and may influence the rate of allergic sensitization over long periods. Ariano R, et al. Annals Allergy Asthma Immunol 2010;104:

30 SNAP Scenario Network Alaska Program 50 km grid 12 km grid 3 km grid Scott Rupp,PhD UAF 1 km grid

31 Interior Vegetation (km^2) Simulated Vegetation Distribution Crossover -- ECHAM5 ALFRESCO Conifer Rep (200) ALFRESCO Conifer Mean ALFRESCO Deciduous Rep (200) ALFRESCO Deciduous Mean Verticals at 2004 and Year

32 Trees invading warming Arctic will cause warming over the entire region Swann AL, et al. Proc Nat Acad Sci 2010; 107(4): (US) Denali National Park is one area that will become more heavily forested as the result of global warming. A new study indicates that as (broadleaf) trees move northward with increasing temperatures, they will enhance warming over the entire Arctic north above 60 degrees north latitude, accelerating the melting of sea ice University of California, Berkeley

Park is dominated by glaciers and sparse high-arctic tundra vegetation.

33 Mummified Trees Could Take Climate Scientists Back to the Future Joel Barker, Byrd Polar Research Center Ohio State University National Science Foundation The landscape of Quttinirpaaq National Park is dominated by glaciers and sparse high-arctic tundra vegetation. The mummified trees have very narrow growth rings, indicating a very harsh environment during their lifetime. Canadian Arctic

34 Air Pollution

- 2004 Boundary Fire, near Fairbanks: 537,627 acres - 11 million acres burned in

35 Boundary Fire, near Fairbanks: 537,627 acres - 11 million acres burned in 2004/2005, the first and third largest seasons - Estimated wildfires in Alaska annually

36 Hotspots: Cities Air pollution Heat waves Exacerbations of chronic disease Extreme precipitation events and waterborne disease Increased pollen Atlanta Anchorage

37 Urban Heat Thermal Satellite Image of Phoenix, AZ Night Surface Temperature

38 Changing Patterns of Insects

* Mowry T, Fairbanks Daily Miner, Aug 13, 2006 **Conversation with Derek Sikes, PhD, UAF Entomology ***Frazier M, et al, Am Nat 2006.

biologist with the Department of Fish & Game * Used 3 homemade traps (soda bottles & whitefish) Trapped 3,461 YJ on his property in a week

39 * Mowry T, Fairbanks Daily Miner, Aug 13, 2006 **Conversation with Derek Sikes, PhD, UAF Entomology ***Frazier M, et al, Am Nat Increasing Hymenoptera in Alaska The number of hymenoptera in Fairbanks estimated to have increased 10 fold ** Jack Whitman, a biologist with the Department of Fish & Game * Used 3 homemade traps (soda bottles & whitefish) Trapped 3,461 YJ on his property in a week Destroyed 9 aerial nests in three weeks Estimated over 12,000 YJ This pattern was similar throughout the state Insects adapt well to warmer temperature ***

40 Hymenoptera Related Deaths in Alaska 2 deaths from hymenoptera stings in Fairbanks during the summer of 2006 Demain, J. G. & Gessner, B. D. Increasing incidence of medical visits due to insect stings in Alaska. Alaska Epidemiology Bulletin 13 (2008)

41 Number of Cases Rate per 1000 person-years Does temperature change correlate with changing patterns of insects? Any diagnosis Primary diagnosis Any diagnosis, unique events Linear (Any diagnosis) Chi-Square for trend p< y = 2.35x R 2 = ; p< Demain, J, Gessner, B, McLaughlin J, Sikes,D, Foote,T Allergy & Asthma Proc,2009,30: Year

Epidemiologic Regions of Alaska Northern http://climate.gi.alaska.

42 Epidemiologic Regions of Alaska Northern Interior Anchorage/Mat-Su Southwest Gulf Coast Southeast

43 Annual Winter Percent change in insect Largest temperature temperature insect sting insect sting sting incidence (Х 2 for Region Community Increase* Increase* incidence incidence trend, p-value) Northern Barrow % (13, p<0.001) Southwest Bethel % (8, p=0.005) Interior Fairbanks % (28, p<0.001) Southcentral Anchorage % (22, p<0.001) Southeast Juneau % (22, p<0.001) Gulf Kodiak % (0.1, p=0.75) Statewide % (54, p<0.001)

44 Annual Winter Percent change in insect Largest temperature temperature insect sting insect sting sting incidence (Х 2 for Region Community Increase* Increase* incidence incidence trend, p-value) Northern Barrow % (13, p<0.001) Southwest Bethel % (8, p=0.005) Interior Fairbanks % (28, p<0.001) Southcentral Anchorage % (22, p<0.001) Southeast Juneau % (22, p<0.001) Gulf Kodiak % (0.1, p=0.75) Statewide % (54, p<0.001)

45 Annual Winter Percent change in insect Largest temperature temperature insect sting insect sting sting incidence (Х 2 for Region Community Increase* Increase* incidence incidence trend, p-value) Northern Barrow % (13, p<0.001) Southwest Bethel % (8, p=0.005) Interior Fairbanks % (28, p<0.001) Southcentral Anchorage % (22, p<0.001) Southeast Juneau % (22, p<0.001) Gulf Kodiak % (0.1, p=0.75) Statewide % (54, p<0.001)

46 Annual Winter Percent change in insect Largest temperature temperature insect sting insect sting sting incidence (Х 2 for Region Community Increase* Increase* incidence incidence trend, p-value) Northern Barrow % (13, p<0.001) Southwest Bethel % (8, p=0.005) Interior Fairbanks % (28, p<0.001) Southcentral Anchorage % (22, p<0.001) Southeast Juneau % (22, p<0.001) Gulf Kodiak % (0.1, p=0.75) Statewide % (54, p<0.001)

47 Annual Winter Percent change in insect Largest temperature temperature insect sting insect sting sting incidence (Х 2 for Region Community Increase* Increase* incidence incidence trend, p-value) Northern Barrow % (13, p<0.001) Southwest Bethel % (8, p=0.005) Interior Fairbanks % (28, p<0.001) Southcentral Anchorage % (22, p<0.001) Southeast Juneau % (22, p<0.001) Gulf Kodiak % (0.1, p=0.75) Statewide % (54, p<0.001)

48 Results Each of the databases revealed an increasing trend for patients seeking medical care for bites & stings (p <0.001) From 1999 to 2006 Fairbanks Memorial a 4 fold rise in 2006 from the previous years AAIC had a 3 fold rise in compared with Medicaid recipients had a significant rise from 1999 through 2006 A 6.4% population increase from 2000 to 2006 based on US Census Bureau data does not account for these observations 2000 (626,932) versus 2006 (670,053) The determinants of insect bites & stings are complex but likely influenced by temperature increases, particularly winter temperatures. Demain, J, Gessner, B, McLaughlin J, Sikes,D, Foote,T. Allergy & Asthma Proc,2009,30:

49 Continuation of the rising trend

50 Distribution or Survival of Insects Arthropods are extremely temperature sensitive Climate changes have impacted life cycles and expanded inhabitable territory Mosquitoes and plant communities are migrating to higher ground as permafrost thaws and glaciers retreat (Worldwide) Beetle plagued forests in Alaska have impacted over 4,000,000 acres, (US) Lepidoptera are expanding their northern boundaries in the northern hemisphere, (UK) Ticks (Ixodes ricinus) that transmit Lyme borreliosis and viral encephalitis have extended northwards in Sweden associated with fewer winter days below 10 degrees and more summer days above 50 degrees, (Sweden)

51 Do the observable changes the Circumpolar Regions predict what is to come? Are hymenoptera another indicator species or bellwether of climate change? Will changing patterns of pollination impact our respiratory health?

52 Certainties Our planet is warming The amount of greenhouse gases (CO 2, NO 2, CH 4 & H 2 O) are increasing in the atmosphere. Changes in our ecosystem appears to be occurring in response to changing temperatures and other variables

Uncertainties The estimation of health trends and its effects are subject to many variables Prior to anthropogenic climate change there was little focus on climate-health relationship The health risk

53 Uncertainties The estimation of health trends and its effects are subject to many variables Prior to anthropogenic climate change there was little focus on climate-health relationship The health risk of climate related thermal stress, floods and infectious disease lends itself to study while other impacts receive less attention Disruption of fisheries and Subsistence Life Loss of livelihoods and Way of Living Population displacement and Cultural disruption

54 Technical Work Groups for Adaptation Advisory Group Governor (Mitigation TWG framework is similar) Governor s Sub-Cabinet on Climate Change Immediate Action Work Group Mitigation Advisory Group Research Needs Work Group Climate Change Adaptation Advisory Group Appointed Members Appointed Members Appointed Members Appointed Members Public Infrastructure Technical Work Group Interested Parties Technical Experts Public Health & Culture Technical Work Group Interested Parties Technical Experts Public Natural Systems & Associated Economies Technical Work Group Interested Parties Technical Experts Public Other Economic Activities Technical Work Group Interested Parties Technical Experts Public

55 Climate Change in Alaska

56 IPCC, 34 th session, Nov 11-19, 2011 Kampala, Uganda AR5 underway

57 Why Us?

58 CO2, Climate Change and Health Melting Permafrost in our Backyards Fire & Smoke Pollution Disrupted Lives and Way of Living Mold 70 Pollen 60 Heatwaves & smog Height SeedMass 20 Pollen Biomass 10 Particulates & pollen *WNV Poison Ivy Tree pollen 0 Lyme Interior Vegetation (km^2) ALFRESCO Conifer Rep (200) ALFRESCO Conifer Mean ALFRESCO Deciduous Rep (200) ALFRESCO Deciduous Mean X CO2 Stalks Ragweed ELISA-quantified Amb a 1 Melting Sea Ice, Erosion & Injuries Hymenoptera Veg Crossover -- ECHAM5 Verticals at 2004 and CO2350 CO2700 ppm ppm Year

59 You can observe a lot just by watching Yogi Berra

60 ..the present problem of global warming is neither proof of the late capitalism s intent to commit industrial sins against Mother Earth nor a hallucination imposed on the world by anti-business activists. It is simply a reflection of the scale of our vulnerability, the scale on which we must now think and act. The Long Summer: How Climate Changed Civilization. Brian Fagen, PhD

62 Gracias

Global Climate Change, and Airborne Allergens One Health 5/18/2015

Global Climate Change, and Airborne Allergens One Health 5/18/2015 Jeffrey G Demain, MD, FAAP, FACAAI, FAAAAI Director, Allergy Asthma & Immunology Center of Alaska Clinical Professor, Dept of Pediatrics,