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352 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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Evidence for Herbal Medicine in Allergic Disorders
A recent systematic review and meta-analysis conclude herbal medicine is safe and effective in
improving symptoms and quality of life in adults as well as children with allergic rhinitis (Hoang
et al. 2021; Zheng et al. 2018). However, it also suggests that the beneficial effects last only up to
12 weeks of the treatment and longer treatment is associated with tachyphylaxis. In patients with
asthma, herbal medicine as an add-on therapy has been shown to improve lung function and asthma
control and to reduce rescue medication use and acute asthma exacerbations in several recent studies
(Shergis et al. 2016).
Similarly, a recent overview of multiple systematic reviews evaluating the effects of herbal
medicine in atopic dermatitis concluded that herbal medicine might be effective for the treatment
of atopic dermatitis, especially as an adjunctive therapy and that these therapeutic effects of herbal
medicine were due to a combination of their anti-inflammatory and immunomodulatory effects
(Kwon et al. 2020). Topical application of natural herbal oils such as olive oil, virgin coconut oil and
mineral oil has also shown remarkable symptomatic improvement in patients with atopic dermatitis
(Hussain et al. 2017). However, topical application of several other TCM herbal formulas has not
been shown to be conclusively effective to date (Thandar et al. 2017; Gu et al. 2014).
Unlike non-pharmacological measures, such as yoga and acupuncture, herbal medicine has
its own challenges. Based on available scientific literature to date, exact doses for all age groups
and special populations are not clearly defined for many herbs. There is also a potential for drug
interactions when herbal medicine is used in a patient taking conventional drugs. Some herbs can
cause serious toxic effects, especially when consumed in large doses. In TCM, the selection of
a specific formula is based on underlying TCM diagnosis and not on the conventional medical
diagnosis and therefore an appropriate selection of TCM formulas for therapeutic purposes requires
an understanding of the basic principles of TCM.
Conclusion
Herbal medicine is a wide subject, considering the fact that different herbs have been used
in the treatment of allergic disorders in different traditional systems of medicine across the
globe. Their safe integration into the conventional management of allergic disorders requires
high-quality scientific research to know their mechanisms, efficacy, dose and safety before making
evidence-based recommendations. At present, herbal medicine holds the potential to contribute to
the relief of patients suffering from allergic disorders.
Acknowledgment
Sujatha Reddy LPC. MSEd, BAMS, DCC Owner and CEO of Humanly Lakewood. Professional
Counselor and Ayurvedic Doctor.
Glossary of Abbreviations
ASHMI – Antiasthma Simplified Herbal Medicine Intervention
BL – Urinary Bladder Meridian
DU – Du Meridian (Governing Vessel)
Ex – Extra acupuncture point
FAHF-2 – Food Allergy Herbal Formula-2
FEV1 – Forced Expiratory Volume in the first second
FVC – Forced Vital Capacity
IgE – Immunoglobulin E
LI – Large Intestine Meridian
LU – Lung Meridian
Role of Acupuncture in Allergic Disorders 353
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RN – Ren Meridian (Conception Vessel)
RCT – Randomized Controlled Trial
SP – Spleen Meridian
ST – Stomach Meridian
TCM – Traditional Chinese Medicine
Th1 – T Helper Cell Type 1
Th2 – T Helper Cell Type 2
Treg – Regulatory T Cell
USFDA – The United States Food and Drug Administration
References
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Medications 4: 030.
Amaral-Machado, L., Oliveira, W. N., Moreira-Oliveira, S. S., Pereira, D. T., Alencar, E. N., Tsapis, N. et al. 2020.
Use of natural products in asthma treatment. Evidence-Based Complementary and Alternative Medicine
2020: 1021258.
Cheng, L., Chen, J., Fu, Q., He, S., Li, H., Liu, Z. et al. 2018. Chinese society of allergy guidelines for diagnosis and
treatment of allergic rhinitis. Allergy, Asthma & Immunology Research 10(4): 300–353.
Chu, X., Ci, X., He, J., Wei, M., Yang, X., Cao, Q. et al. 2011. A novel anti-inflammatory role for Ginkgolide B in
asthma via inhibition of the ERK/MAPK signaling pathway. Molecules 16(9): 7634–7648.
Fu, Q., Zhang, L., Liu, Y., Li, X., Yang, Y., Dai, M. et al. 2019. Effectiveness of acupuncturing at the sphenopalatine
ganglion acupoint alone for treatment of allergic rhinitis: a systematic review and meta-analysis.
Evidence-Based Complementary and Alternative Medicine 2019: 6478102.
Gu, S., Yang, A. W., Li, C. G., Lu, C. and Xue, C. C. 2014. Topical application of Chinese herbal medicine for atopic
eczema: a systematic review with a meta-analysis. Dermatology 228: 294–302.
Guo, R., Pittler, M. H. and Ernst, E. 2007. Herbal medicines for the treatment of allergic rhinitis: a systematic review.
Annals of Allergy, Asthma & Immunology 99: 483–495.
Hoang, M. P., Chitsuthipakorn, W. and Snidvongs, K. 2021. Herbal medicines for allergic rhinitis: a systematic review
and meta-analysis. Current Allergy and Asthma Reports 21: 25.
Hussain, Z., Thu, H. E., Shuid, A. N., Kesharwani, P., Khan, S. and Hussain, F. 2017. Phytotherapeutic potential
of natural herbal medicines for the treatment of mild-to-severe atopic dermatitis: a review of human clinical
studies. Biomedicine & Pharmacotherpy 93: 596–608.
Jiang, C., Jiang, L. and Qin, Q. 2019. Conventional treatments plus acupuncture for asthma in adults and
adolescent: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine
2019: 9580670.
Kawamoto, Y., Ueno, Y., Nakahashi, E., Obayashi, M., Sugihara, K., Qiao, S. et al. 2016. Prevention of allergic
rhinitis by ginger and the molecular basis of immunosuppression by 6-gingerol through T cell inactivation. The
Journal of Nutritional Biochemistry 27: 112–122.
Kohn, C. M. and Paudyal, P. 2017. A systematic review and meta-analysis of complementary and alternative medicine
in asthma. European Respiratory Review 26: 160092.
Kozlov, V., Lavrenova, G., Savlevich, E. and Bazarkina, K. 2018. Evidence-based phytotherapy in allergic rhinitis.
Clinical Phytoscience 4: 23.
Kwon, C.-Y., Lee, B., Kim, S., Lee, J., Park, M. and Kim, N. 2020. Effectiveness and safety of herbal medicine
for atopic dermatitis: an overview of systematic reviews. Evidence-Based Complementary and Alternative
Medicine 2020: 4140692.
Lee, M. S., Pittler, M. H., Shin, B.-C., Kim, J.-I. and Ernst, E. 2009. Acupuncture for allergic rhinitis: a systematic
review. Annals of Allergy, Asthma, & Immunology 102: 269–279.
Li, J., Wang, Q., Liang, H., Dong, H., Li, Y., Ng, E. H. Y. et al. 2012. Biophysical characteristics of meridians and
acupoints: A systematic review. Evidence-Based Complementary and Alternative Medicine 2012: 793841.
Liu, C. F. and Chien, L. W. 2015. Efficacy of acupuncture in children with asthma: a systematic review. Italian Journal
of Pediatrics 41: 48.
Lohiya, P. B. and Lohiya, S. 2014. Acupuncture A Complete Textbook. Indian Academy of Acupuncture Science,
Aurangabad.
Maurer, N., Nissel, H., Egerbacher, M., Gornik, E., Schuller, P. and Traxler, H. 2019. Anatomical evidence of
acupuncture meridians in the human extracellular matrix: results from a macroscopic and microscopic
354 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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interdisciplinary multicentre study on human corpses. Evidence-Based Complementary and Alternative
Medicine 2019: 6976892.
McDonald, J. L., Cripps, A. W., Smith, P. K., Smith, C. A., Xue, C. C. and Golianu, B. 2013. The anti-inflammatory
effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model.
Evidence-Based Complementary and Alternative Medicine 2013: 591796.
Rani, A. S., Patnaik, S., Sulakshanaand, G. and Saidulu, B. 2012. Review of tylophora indica – an antiasthmatic plant.
FS Journal of Pharmacy Research 1(2): 20–21.
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R. et al. 2015. Clinical practice
guideline: Allergic rhinitis. Otolaryngology-Head and Neck Surgery 152 (1 Suppl): S1–S43.
Shergis, J. L., Wu, L., Zhang, A. L., Guo, X., Lu, C. and Xue, C. C. 2016. Herbal medicine for adults with asthma: a
systematic review. Journal of Asthma 0(0): 1–10.
Shi, Z., Song, T., Xie, J., Yan, Y. and Du, Y. 2017. The traditional chinese medicine and relevant treatment for the
efficacy and safety of atopic dermatitis: a systematic review and meta-analysis of randomized controlled trials.
Evidence-Based Complementary and Alternative Medicine 2017: 6026434.
Shin, H. S., See, H.-J., Jung, S. Y., Choi, D. W., Kwon, D.-A., Bae, M.-J. et al. 2015. Turmeric (Curcuma Longa)
attenuates food allergy symptoms by regulating type 1/type 2 helper T cells (Th1/Th2) balance in a mouse model
of food allergy. Journal of Ethnopharmacology 175: 21–29.
Tan, H. Y., Lenon, G. B., Zhang, A. L. and Xue, C. C. 2015. Efficacy of acupuncture in the management of atopic
dermatitis: a systematic review. Clinical and Experimental Dermatology 40(7): 711–716.
Thandar, Y., Gray, A., Botha, J. and Mosam, A. 2017. Topical herbal medicines for atopic eczema: a systematic review
of randomized controlled trials. British Journal of Dermatology 176(2): 330–343.
Wang, H. Liang, Dong, H., Li, Y., Ng, E. H. Y. et al. 2012. Biophysical characteristics of meridians and acupoints: a
systematic review. Evidence-Based Complementary and Alternative Medicine 2012: 793841.
Wang, J. and Li, X.-M. 2012. Chinese herbal therapy for the treatment of food allergy. Current Allergy and Asthma
Reports 12(4): 332–338.
Wang, Z., Zhen-Zhen, W., Geliebter, J., Tiwari, R. and Li, X.-M. 2021. Traditional Chinese medicine for food allergy
and eczema. Annals of Allergy, Asthma, and Immunology 126(6): 639–654.
Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B. et al. 2013. Adverse events of acupuncture: a
systematic review of case reports. Evidence-Based Complementary and Alternative Medicine 2013: 581203.
Yan, J., An, Y., Wang, L.-S. and Yang, S. 2015. Acupoint stimulation for chronic urticaria: a systematic review of
randomized controlled trials. European Journal of Integrative Medicine 7: 586–592.
Yao, Q., Li, S., Liu, X., Qin, Z. and Liu, Z. 2016. The effectiveness and safety of acupuncture for patients with chronic
urticaria: a systematic review. BioMed Research International 2016: 5191729.
Yin, Z., Geng, G., Xu, G., Zhao, L. and Liang, F. 2020. Acupuncture methods for allergic rhinitis: a systematic review
and bayesian meta-analysis of randomized controlled trials. Chinese Medicine 15: 109.
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review and meta-analysis of clinical randomized controlled trials. Evidence-Based Complementary and
Alternative Medicine 2015: 208690.
Zhang, J., Zhang, Y., Huang, X., Lan, K., Hu, L., Chen, Y. et al. 2020. Different acupuncture therapies for allergic
rhinitis: overview of systematic reviews and network meta-analysis. Evidence-Based Complementary and
Alternative Medicine 2020: 8363027.
Zheng, Z., Sun, Z., Shou, X. and Zhou, Z. 2018. Efficacy of Chinese herbal medicine in treatment of allergic rhinitis
in children: a meta-analysis of 19 randomized controlled trials. Journal of International Medical Research
46(10): 4006–4018.
Zhu, L., Kim, Y. and Yang, Z. 2018. The application of auriculotherapy to the treatment of chronic spontaneous
urticaria: a systematic review and meta-analysis. Journal of Acupuncture and Meridian Studies 11(6): 343–354.
Chapter 14
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Controversial Techniques in the
Practice of Allergy
Hugo Van Bever1,* and Pudupakkam K. Vedanthan
2
Introduction
The prevalence of allergic diseases is still increasing worldwide in both developed and developing
countries. Unfortunately, mainly in developing countries, there are not enough trained medical and
paramedical personnel in this field of allergy. Due to this, and due to a large degree of ignorance
about allergy in the general population—including wrong expectations on treatment—tests
have been developed without any scientific background and only for financial benefits. These
non-scientific diagnostic tests are very popular on social media, their spread seems unstoppable, and
the list of tests is still growing (Ansotegui 2019).
Doctors, patients, and parents of allergic children should be aware of this. These tests have
“no value” and most of them are very expensive. Moreover, the results of these tests lead to
non-correct diagnoses and treatments, such as the prescription of extensive diets, which might be
very troublesome (for the whole family) and harmful for the child, even leading to malnutrition.
On the Internet, one can find many data and negative comments from many health authorities, and
non-profit organizations on these tests (Wüthrich 2006). Not many reviews on non-diagnostic tests
in allergy have been published. Hence, the readers are encouraged to refer to the articles in the
attached bibliography for a detailed version of these procedures.
(The purpose of this text is to warn doctors, patients, and parents of allergic children about these
tests, allowing/asking them to avoid the usage of these tests.)
The commonly used non-diagnostic tests can be divided into two groups: tests in vivo and
tests in vitro.
Applied Kinesiology: Muscle Testing for Allergies
The idea of this test is that every organ dysfunction is accompanied by a specific muscle weakness,
which enables diseases to be diagnosed through muscle-testing procedures. The concepts of applied
kinesiology (Figure 1) do not conform to scientific data about the causes or treatments of diseases,
1
National University, Singapore.
2
University of Colorado, Denver, Colorado USA.
* Corresponding author: paevbhps@nus.ed.sg
In Vivo Tests
356 Textbook of Diagnostic and Therapeutic Procedures in Allergy
Figure 1. Applied Kinesiology
Figure 2. Electro-Dermal Tests Have No Value in
Diagnosing Allergy
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Figure 1. Applied kinesiology.
and controlled studies have found no difference between the results with test substances (usually
food) and with a placebo.
Electrodermal Skin Testing, Bioresonance and Dubious Devices
Some physicians, neuropaths, dentists and chiropractors use “electrodiagnostic” devices
(Figure 2) to help select the treatment they prescribe, which usually include homeopathic products.
The devices they use are simply resistance-measuring instruments and the effectiveness or accuracy
of these devices was never shown.
“Bioresonance” is based on the belief that human beings as well as any substances in the
environment, such as allergens, emit electromagnetic waves, which may be either “good” or “bad.”
These waves can only be measured by specific bioresonance devices, but it was shown that the
devices are not capable of measuring the electromagnetic wave presumed to be involved. Controlled
studies failed to show any diagnostic or therapeutic value of bioresonance in adults suffering from
allergic rhinitis and in children with eczema.
Figure 2. Electro-dermal tests have no value in diagnosing allergy.
Controversial Techniques in the Practice of Allergy 357
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Provocative and Neutralizing Testing (Subcutaneous)
This is a method used for both the diagnosis and treatment of allergic disorders. The allergen is
injected subcutaneously in different concentrations and the patient is asked whether he/she is
experiencing “any” symptoms. If the answer is affirmative, it is followed by an injection of either a
“stronger” or “weaker” concentration to neutralize the symptoms. There has been no immunologic
mechanism involved that has been demonstrated nor any clinical correlation has been established.
Provocative and Neutralizing Testing (Sublingual)
This was first described by Hansel in 1941 for the diagnosis and treatment of food allergy. Three
drops of 1:100 dilution of the food antigen are placed under the patient’s tongue, and the symptoms
are assessed. The same procedure is repeated for the next suspected food antigen till the patient
is fully assessed. Once the provocation is completed, the same antigen is diluted, and three drops
are placed under the tongue for neutralization of symptoms. Several clinical trials have not been
convincing. No immunological changes have been recorded.
Rinkel’s Method of Skin Titration for Immunotherapy
Increasing concentrations of the antigen are placed by intradermal technique. The weakest dilution
producing the positive wheal and flare reaction is considered the concentration for therapy. Dosage
is started at 0.05 ml of that concentration with a maximum dose of 0.50 ml of the same weak
dilution. This dose is claimed to relieve the symptoms within 4 hours. Controlled trials have proved
that the Rinkel technique of allergen immunotherapy is equal to a placebo.
Urine Auto-Injection Therapy
The patient’s urine is collected, sterilized by boiling and injected in varying doses between
0.25–5.00 ml intramuscular at different intervals. This method of treatment has no rationale and may
have the risk of the development of autoimmunity.
Hair Analysis
This test assumes that food allergies cause nutritional deficiencies (e.g., zinc magnesium), which is
untrue. In a study, the test could not distinguish allergic from nom-allergic subjects.
Iridology
Here, it is assumed that changes in the iris may suggest underlying systemic disease, including
allergy. There’s absolutely no scientific evidence for this.
In summary, the in vivo tests described above are used to diagnose non-existent health problems,
select inappropriate treatments and defraud insurance companies. The practitioners who use them
are either delusional, dishonest or both. These tests should be confiscated and the practitioners who
use them should be prosecuted.
In Vitro Tests
Cytotoxic Testing: ALCAT TEST
The ALCAT test (test for cellular responses to foreign substances) has been launched in several
countries for diagnosing so-called “non-IgE-mediated hypersensitivities.” The promotion is mainly
“for detecting adverse reactions to foods by advanced technology.” The ALCAT test is a more
sophisticated version of the previous “cytotoxic or leukocytotoxic testing,” which was stopped in
the USA by government actions of the FDA, after a negative statement of the American Academy
358 Textbook of Diagnostic and Therapeutic Procedures in Allergy
Figure 3. IGG4 and IgE Profile of Food Allergy
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of Allergy, Asthma and Immunology (AAAAI), concluding that cytotoxic testing is ineffective for
diagnosing food or inhalant allergies.
The basic principle of the ALCAT test is measurement changes in white blood cell
diameter after challenges with foods, molds, food additives, environmental chemicals, dyes and
pharmaco-active agents in foods, antibiotics and other medications in vitro. The blood cells are
passed through a narrow channel and are measured by an electronic instrument permitting to count
instantaneously the number of cells, ranging from the smallest to the largest. The information
brochure stated that the system has proven to be extremely reproducible and sensitive. On the
company homepage, some references are listed, mainly from papers presented at congresses or
articles in non-peer-reviewed journals. Therefore, it can be concluded that the ALCAT test system is
relying on unproven statements that lack scientific and clinical proof of efficacy and is a test system
that has no value in diagnosing allergic diseases in children.
Determination of Allergen-Specific IgG and IgG4
Specific IgG and IgG4 (which is a subclass of IgG) can be found in both adults and children in many
different physiological (normal) and pathological (abnormal) conditions and their levels mainly
Summary Report of the Food Allergy Profile
Figure 3. IGG4 and IgE profile of food allergy.
Controversial Techniques in the Practice of Allergy 359
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“reflect contact with allergens (exposure to allergens)” and is in no way a measurement of the
disease. Determination of allergen-specific IgG or IgG4 with different methods alone “does not
prove the existence of an underlying allergy,” as positive tests can also be found in healthy subjects.
In most cases, the patient’s serum is sent to a laboratory that performs tests to identify the specific
IgE antibodies. The laboratory will automatically formulate the allergy vaccine based on these
results and the vaccine is mailed back to the practitioner for initiation of an allergen immunotherapy
program. Hence, there is a total lack of professionalism in this approach to patient needs.
The “Food Allergy Profile”
Now several alternative doctors use the so-called “food allergy profile IgE and IgG” against more
than 100 types of food (Figure 3). The results are given in color with a scale of reactivity (0+ to
3+). The patient receives the information about results and therapy in the form of a “True Relief
Guide” with instructions based on the first phase of an “Elimination Diet” of the IgG-positive
foods and a second phase with a “Rotation Diet Schedule.” In this second phase, foods that are
not eliminated are allowed. The procedure lacks all scientific evidence and “can be dangerous” if a
true IgE-mediated allergy is still present after the avoidance phase. Obviously, such a sophisticated
guide is impressive for patients and parents, and together with the charisma of their healthcare
providers using these mystic elimination, rotation and reintroduction diets, some placebo effects can
be expected. However, no scientific evidence of any use of this method has been shown.
The Role of Food Additives and Hyperkinesis
Most studies done to evaluate the relationship between food additives, dyes and hyperactivity and
learning disability syndromes have been inconclusive. This area continues to be controversial, and
diets should not be used here.
Remote Practice of Allergy
The patient’s serum is sent to a laboratory to identify the specific IgE antibodies. The laboratory will
automatically formulate the allergy vaccine based on these results and the vaccine is mailed back to
the practitioner for initiation of an allergen immunotherapy program. The sIgE may not have been
validated; there are no steps taken to correlate patients’ clinical picture with the sIgE profile. Hence,
there is a complete lack of professionalism in this approach to patients’ needs. Only a well-trained
allergy specialist is capable of correlating a patient’s clinical history and presentation with either an
allergy skin test or in vitro sIgE data to formulate the proper management of the case (Shapiro and
Anderson 1988).
Conclusion
Physicians need to be aware of these above-mentioned techniques that are still being practiced in
the community. The public is unaware of the pitfalls associated with such unproven techniques of
diagnosis and treatment. Proper advice and education will steer away such susceptible patients and
families from undergoing unnecessary expenses and modalities of unproven methods of treatment.
Glossary of Abbreviations
ALCAT – Antigen Leukocyte Antibody Test
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Further Suggested Reading
Allergy panel. 1987. Council on Scientific papers: in vivo diagnostic testing and immunotherapy for allergy.
Report I Part I JAMA 258: 1363–1367.
Allergy panel. 1987. Council on Scientific Affairs: in vivo diagnostic testing and immunotherapy for allergy.
Report I Part 2 JAMA 258: 1505–1508.
Allergy Panel. 1987. Council on Scientific Affairs: In vitro testing for allergy. Report 2. JAMA 258: 1639–1643.
American Academy of allergy. 1981. Position statements: controversial techniques. J. Allergy Clin. Immunol.
67: 333–338.
References
Ansotegui, I. J., Melioli, G., Canonica, G. W., Caraballo, L., Villa, E., Ebisawa, M. et al. 2020. IgE Allergy Diagnostics
and Other Relevant Tests in Allergy, A World Allergy Organization Position Paper. WAO Jour.
Shapiro, G. and Anderson, J. 1988. Controversial techniques in allergy. Pediatrics Dec 1988 82(6): 935–937.
Wüthrich, B. 2005. Unproven techniques in allergy diagnosis. J. Invest. Allergol. Clin. Immunol. 15: 86–90.
Chapter 15
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Aerobiology for Clinicians
Saibal Moitra1,* and Kavitha B.
2
Introduction
The atmosphere around us contains a panoply of bio-particulate matter, which impacts our
respiratory epithelium resulting in varied responses among different individuals. This consists of
infectious particles, like bacteria, viruses and fungi, and non-infectious particles, like pollen grains,
fungal spores, dust mite particles, animal dander, insect-derived particles, etc.
The collective term for the study of this airborne bio-particulate matter is called “aerobiology”
and is used since 1930. The term was coined by American plant pathologist Fred Campbell Meier.
Present-day aerobiology originated much earlier through the famous experiments of Spallanzani in
1776, but it is only in the last 50 years that it has emerged as a specialized multidisciplinary branch
of science. With the inception of the International Biological Program (IBP) in 1954, the term has
been extended to include all airborne materials of biological significance. Thus, it encompasses
not only bio-particulates but also pollutants that exert specific biological effects. Edmonds and
Benninghoof in 1973 described aerobiology as a scientific and multidisciplinary approach focused
on the transport of organisms and biologically significant materials.
The majority of the aerobiological studies are carried out with reference to the “aerobiological
triangle” (Figure 1). This is the path followed by an airborne particle, which is from source to release,
dispersion, deposition and impact. The environmental factors affect each stage of this pathway and
hence lead to geographical and temporal differences.
Aerobiological investigations are broadly classified into outdoor or extramural aerobiology and
indoor or intramural aerobiology. Barometric pressure, the density of air and temperature decrease
in the outdoor air with increasing height from the sea level. There is a microscopically thin layer
of air known as a laminar boundary layer near the ground above, which is a variable turbulent
boundary layer through which dispersion of most of the particles occurs and this extends up to the
stratosphere. In addition, differential heating from Earth’s surface on sunny days leads to pockets of
air that are warmer than the surrounding air and which rise upwards as thermals lead to much wider
and higher dispersal of various components of air spora. The indoor air or the microclimate inside
the buildings is different and less variable than outdoor air leading to more homogeneous air spora
compared to outdoors. The importance of these studies with respect to human health is paramount.
1
Adjunct Professor and Senior Consultant, Division of Allergy and Immunology, Department of Respiratory Medicine,
Apollo Multi Specialty Hospitals, Kolkata, India
2
Associate Professor, Department of Microbiology, Government Science College (Autonomous), Nrupathnga Road,
Bengaluru, Karnataka, India.
* Contributing author: saibal.moitra@icloud.com
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