key: cord-0922069-qyl7t7wq authors: Pali‐Schöll, Isabella; Roth‐Walter, Franziska; Jensen‐Jarolim, Erika title: One Health in allergology: A concept that connects humans, animals, plants, and the environment date: 2021-03-27 journal: Allergy DOI: 10.1111/all.14804 sha: e6f73853e8da637d3d7dfe37cdd1565ccc65bf17 doc_id: 922069 cord_uid: qyl7t7wq One Health is "a collaborative effort of multiple disciplines - working locally, nationally, and globally - to attain optimal health for people, animals, and the environment", the so-called One Health triad1 (Fig. 1).Historically, aspects of One Healthwere already discussed in the fourth century by Hippocrates, who realized that a clean environment is very important for human health1 . More recently, Rudolf Virchow (1821-1902) coined the term "zoonosis" in 1880and fathered modern One Healthin the sense of OneMedicine by strongly supporting the view of human and animal health being linked to each other.1. One Health is "a collaborative effort of multiple disciplines -working locally, nationally, and globally -to attain optimal health for people, animals, and the environment ", the so-called One Health triad 1 (Figure 1 ). Historically, aspects of One Health were already discussed in the fourth century by Hippocrates, who realized that a clean environment is very important for human health. 1 More recently, Rudolf Virchow (1821-1902) coined the term "zoonosis" in 1880 and fathered modern One Health in the sense of One Medicine by strongly supporting the view of human and animal health being linked to each other. 1 Amuasi et al 2 even propose that the One Health policy is vital to ensure health of and on the planet, and avoid future catastrophes: "One Health, which recognizes the fundamental interconnectedness of humans, animals, and their shared environment, is key to ensuring the healthy and sustainable future of the planet." Prestigiously, WHO has also taken up the One Health idea, concentrating on food safety, combatting antibiotic resistance, and controlling zoonoses, all for achieving better public health outcomes. 3 One Health thus is a timely concept in terms of the current COVID-19 pandemic, considering the interspecies viral transmission A One Health approach is needed in allergolgy, as allergic diseases are found in human and non-human mammals alike, [5] [6] [7] , the prevalence of some of them still on the rise, and the diagnosis and treatment comparable in many cases. 8, 9 For all mammalian species affected by allergies, a plethora of common factors seems to be responsible for disease development, duration, and severity ( Figure 1 ). Effects of the global warming, climate change, and air pollution have already become clear, 10 among them, we find novel species of plants (eg, ragweed) and animals (eg, insects like Polistes spp.) in geographical regions where they have not been resident before. The early and prolonged blooming season due to increased temperature leads to higher and prolonged allergen exposure for patients, and allergenicity of molecules becomes more potent in combination with CO 2, 11 ozone, 12 or pollution contributing fine-and ultra-fine particles. 13 Other factors studied individually, but less investigated in their interconnectedness within the One Health triad, are the environmental hygiene status (ie, meeting microbes, parasites, and dirty soil); body hygiene (shampoos, shaving, deodorants, perfumes, disinfectants, etc.); diet and food composition (dietary fiber, micronutrients); nutritional status (nutrient deficiencies); food processing (cooking, pasteurization, frying, etc.); microbiota (endogenous on skin and in gut; and exogenous on plants andin soil); pollution of water, air, and environment (eg, diesel-exhaust particles); medications like antibiotics or acid-suppressing drugs contributing to increased allergenicity of encountered proteins 14, 15 ; and many more. All of these factors may have a varying influence on development and outcome of allergic diseases. Therefore, to successfully combine them, a well-coordinated approach in humans and in animals is necessary. How the One Health approach can be applied to allergy, is discussed here by lipocalins in cow's milk as example. Cow's milk can be allergenic, while raw milk protects against allergies. 16 The major whey protein beta-lactoglobulin (BLG), a lipocalin, is a typical milk allergen (Bos d 5), but can also mediate immune resilience. Proteins of the lipocalin family are carrier molecules, for example, for ironsiderophore complexes, vitamins A and D, and zinc. It was shown that the loading of BLG with vitamins and iron complexes is decisive: When BLG shuttles ligands into immune cells, it causes immuneresilience, while uptake without ligands evokes a Th2-response in vitro, resulting in allergy in murine models. [17] [18] [19] [20] [21] [22] Moreover, symptom reduction could be achieved by consumption of loaded BLG in house dust-mite allergic 23 and birch pollen allergic patients. 24 Apart from this being an important immunological observation, following the One Health concept, we must scrutinize its systematic impact for humans and animals. The following ques- • The "mini-farm effect" implies that keeping pets, especially dogs, who bring dirt and microbes into the home, can add to preventing F I G U R E 1 The One Health concept includes all organic life on our planet, humans, animals, and plants, which are all exposed to global threats (bright blue circle). Climate change, pollution, industrial agriculture, and food processing impacts not only quality of life, but also public health. Allergists are aware that these factors alsopose an enhanced risk for atopic diseases. Climate change and global warming lead to migration of plants, prolonged flowering seasons, and increased allergenicity, and enhances risk for allergy development and symptoms in animals and people. Welfare and health conditions of animals influence rate and state of their products like proteins in milk or dander, modulating their allergenicity. The living conditions (hygiene, urbanization) and feed of pets and farm animals shape the microbiome of animals and the environment, and subsequently the health of animal and owner. Processing changes allergenicity of food and feed allergens by influencing protein structure and ligand loading, for human and veterinary individuals alike. Pollution of water, soil or air affects allergenicity of proteins from environment, plants, and animals, as does depletion of nutrients/nutrient diversity in soil, which could render proteins in plants devoid of loading molecules, increasing their allergenicity. Many more of these factors may be intertwined. One Health has thus become a strategic program in WHO, and also recently a novel thematic program in EAACI the development of allergy in children. In the One Health context we need to know: Does the hygiene status of the pet dog (deworming, shampooing and thereby changing the skin microbiome) change the health status of the dog and subsequently also the allergy status of people in the household? • Allergenic molecules are often carried along with (beneficial or disadvantageous) microbes, ligands, or particles. In the shared environment, does the soil-or the plant microbiome, where the allergens stem from, affect the prevalence of allergies? • Allergens in pollen and plant food are often pathogenesis-related proteins, getting overexpressed during environmental stress or microbial threats. Does the pollution of air/soil/water or the climate change (temperature, humidity, flowering season) also impair ligand load to carrier molecules in plants? • Do global warming, climate change, and urbanization affect stress and hormone levels of different species, possibly laying the basis for a decompensated, hyperreactive immune system? In line with the WHO definition of One Health, 3 to address these and upcoming questions in allergology, interdisciplinarity from a broad range of fields of expertise is required, including allergology and immunology, internal medicine, ENT, pediatrics, dermatology, nutrition/dietetics, ecology, biology, agriculture, veterinary medicine, aerobiology, microplastics, water ecology, and many more. An interdisciplinary and holistic approach is required to prevent diseases like the allergy epidemic, natural catastrophes, and devastation of the planet Earth. This will only be possible by communicating, discussing, and acting according to the One Health concept in an interdisciplinary strategic attempt, including public and lay people, politicians and legislative, practitioners and scientists. One Health has thus not only become a strategic program in the WHO, but also recently a thematic program in EAACI. Franziska Roth-Walter https://orcid.org/0000-0001-5005-9228 Erika Jensen-Jarolim https://orcid.org/0000-0003-4019-5765 Introduction to One Health: An Interdisciplinary Approach to Planetary Health Calling for a COVID-19 one health research coalition Allergens in veterinary medicine EAACI position paper: comparing insect hypersensitivity induced by bite, sting, inhalation or ingestion in human beings and animals Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs Formulations for allergen immunotherapy in human and veterinary patients: new candidates on the horizon Allergen immunotherapy in people, dogs, cats and horses -differences, similarities and research needs Global warming, climate change, air pollution and allergies Ragweed plants grown under elevated CO2 levels produce pollen which elicit stronger allergic lung inflammation Impact of air pollution on symptom severity during the birch, grass and ragweed pollen period in Vienna, Austria: importance of O3 in 2010 Association of airborne particulate matter with pollen, fungal spores, and allergic symptoms in an arid urbanized area Country-wide medical records infer increased allergy risk of gastric acid inhibition Anti-acid medication as a risk factor for food allergy The beneficial effect of farm milk consumption on asthma, allergies, and infections: from meta-analysis of evidence to clinical trial Retinoic acid-loading of the major birch pollen allergen Bet v 1 may improve specific allergen immunotherapy: In silico, in vitro and in vivo data in BALB/c mice Retinoic acid prevents immunogenicity of milk lipocalin Bos d 5 through binding to its immunodominant T-cell epitope Cow's milk protein beta-lactoglobulin confers resilience against allergy by targeting complexed iron into immune cells Bet v 1 from birch pollen is a lipocalin-like protein acting as allergen only when devoid of iron by promoting Th2 lymphocytes The major cow milk allergen Bos d 5 manipulates T-helper cells depending on its load with siderophore-bound iron Bovine beta-lactoglobulin cross-protects against pollen allergies in an innate manner in BALB/c mice: potential model for the farm effect Targeted micronutrition via holo-BLG based on the farm effect in house dust mite allergic rhinoconjunctivitis patients -first evaluation in a standardized allergen exposure chamber Dietary supplementation with a new immune tablet ameliorates human symptom load during birch pollen season: lower B-cell numbers yet with higher intracellular iron One Health in allergology: A concept that connects humans, animals, plants, and the environment