Naclerio, Robert, Ansotegui, Ignacio J, Bousquet, Jean et al. · The World Allergy Organization journal · 2020 · DOI
Allergic rhinitis (hay fever and similar nasal allergies) affects millions of people and becomes worse when air pollution is present. This expert consensus report reviews how air pollution—both indoors and outdoors—makes allergic rhinitis symptoms worse, and discusses the best ways to manage it. The main treatment involves following standard allergy guidelines and reducing exposure to pollutants, though more research is needed on which medicines work best for people dealing with both allergies and air pollution.
Many ME/CFS patients report exacerbation of symptoms with air pollution exposure and have comorbid allergic or inflammatory upper airway disease. Understanding how environmental pollutants interact with allergic inflammation may clarify mechanisms of pollution-triggered symptom flares and inform environmental management strategies relevant to this population.
This consensus report does not provide new primary research data or establish causation between air pollution and allergic rhinitis—it synthesizes existing evidence. It does not specifically address ME/CFS populations or prove that findings about allergic rhinitis apply to post-viral or post-exertional conditions. The study does not definitively establish which pharmacological interventions are most effective, explicitly noting the lack of efficacy data.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Naclerio, Robert, Ansotegui, Ignacio J, Bousquet, Jean, Canonica, G Walter, D'Amato, Gennaro, Rosario, Nelson, et al. (2020). International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies.. The World Allergy Organization journal. https://doi.org/10.1016/j.waojou.2020.100106
BibTeX
@article{mecfsatlas-naclerio-2020-international-expert,
author = {Naclerio, Robert and Ansotegui, Ignacio J and Bousquet, Jean and Canonica, G Walter and D'Amato, Gennaro and Rosario, Nelson and Pawankar, Ruby and Peden, David and Bergmann, Karl-Christian and Bielory, Leonard and Caraballo, Luis and Cecchi, Lorenzo and Cepeda, S Alfonso M and Chong Neto, Herberto José and Galán, Carmen and Gonzalez Diaz, Sandra N and Idriss, Samar and Popov, Todor and Ramon, German D and Ridolo, Erminia and Rottem, Menachem and Songnuan, Wisuwat and Rouadi, Philip},
title = {International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies.},
journal = {The World Allergy Organization journal},
year = {2020},
doi = {10.1016/j.waojou.2020.100106},
note = {PubMed: 32256939},
url = {https://www.mecfsatlas.com/evidence/naclerio-2020-international-expert},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/naclerio-2020-international-expert
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