EU policies impacting asthma

Air pollution is of major concern for allergy and respiratory health, including asthma. Activities involving the burning of fossil fuels, such as certain industrial activities, power generation, vehicle emissions and household heating and cooking, as well as natural phenomena (i.e. volcanic eruptions or dust storms) can potentially cause respiratory diseases. However, air pollution does not know borders so most outdoor air pollution sources remain beyond the control of individuals and require action by regional, national and international policymakers.

Some policies that could potentially lower air pollution include support for cleaner transport and mobility options, energy-efficient housing, improved waste management in urban areas and overall urban planning and policies aimed at reducing agricultural waste incineration, forest fires and some agro-forestry activities.

The European Commission addresses risk factors contributing to the onset of respiratory diseases from different perspectives such as rules regarding tobacco products and air quality, climate change, and actions on improving indoor air quality.

In 2013, the European Commission presented the Clean Air Policy Package which is meant to reduce the health effects of air pollution by 52% by 2030, in other words to reduce the annual level of premature deaths linked to air pollution from currently over 400 000 to 200 000 in 2030. This is to be achieved among others through a revised National Emission Ceilings Directive (NEC Directive). The European Commission is also currently assessing the performance of the two complementary  EU Ambient Air Quality Directives.

Further, in 2015 the Directive to reduce pollution from medium-sized combustion installations entered into force. Emissions from sectors are also reduced via source legislation such as the directives on Industrial Emissions (Directive 2010/75/EU of the European Parliament and of the Council), Non-Road Mobile Machinery , Ecodesign and the Euro vehicle standards.)

Indoor air pollution is generated by a variety of sources, including human activity such as smoking, fuel used for heating or cooking, the use of cleaning materials, pollution by buildings i.e. poor ventilation, dust or dampness. 1 in 6 Europeans live in a damp or mouldy building, which increases their chances of getting illnesses such as asthma.

As part of the Clean Energy for All Europeans package, the Commission proposed an update to the Energy Performance of Buildings Directive to help promote the use of smart technology in buildings, to streamline existing rules and accelerate building renovation. On 19 June 2018 Directive (2018/844/EU) amending the Energy Performance of Buildings Directive was published. The revised provisions entered into force on 9 July 2018. This revision introduces changes to the current Directive aimed at accelerating the cost-effective renovation of existing buildings, with the vision of a decarbonised building stock by 2050 and the mobilisation of investments.)

Tobacco smoke is linked to asthma flare-ups, as it irritates the airways, making them swollen, narrow, and filled with mucus, similarly to what happens during an asthma flare-up.

At EU level, the main provisions of the EU Tobacco Products Directive 2014/40/EU include mandatory combined health warnings on packs, a prohibition on characterising flavours in certain products and on promotional elements on packs. The provisions of the Directive are expected to lead to a 2% reduction in tobacco consumption in the EU over 5 years.

The EU Directive 2011/64 regulating minimum excise duty rates for tobacco products is currently under review with the aim to achieve a level of taxation which would contribute to reducing the overall number of smokers in the EU and achieve a better level of public health protection.

In addition to the Directives, the European Commission also implements EU-wide anti-smoking campaigns (such as ‘Ex-smokers are unstoppable’), promotes and monitors national tobacco control measures, such as smoke-free environment laws, and oversees EU compliance with the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC). )

EU policies impacting allergy

Since the dawn of industrialisation, there has been a significant increase in allergic diseases such as asthma and contact dermatitis, as people become increasingly exposed to many more chemicals than ever before.

The EU tries to identify sensitizers based on data collected by industry on the substances available on the market. This data, together with information from several other sources, is then screened and when a new potential substance of concern is identified, suitable risk management measures can be put in place. For example, where substances are known to cause allergies, the EU may restrict their use to protect consumers and workers.

All chemical products commercialised in the EU need an authorisation from competent bodies. In many cases, their composition are directly monitored and assessed by EU agencies i.e. the European Food Safety Authority (EFSA), the European Medicines Agency (EMA) or the European Chemicals Agency (ECHA). These agencies are supposed to help the European Union adopt and implement new policies to warrant the safety and quality of the products, by providing scientific and technical support.

An integrated system was established for the registration, evaluation, authorisation and restriction of chemicals (REACH) together with ECHA. REACH requires companies manufacturing and importing chemicals to evaluate the risks resulting from the use of those chemicals to take the necessary steps to manage any identified risk. The industry needs to prove that the chemicals produced and placed on the market are safe.)

Cosmetics can lead to irritations of the skin, especially the delicate areas of the body where the skin is naturally thinner are most vulnerable to irritant reactions. Some cosmetics that can cause irritation include shampoo, soap, liquid foundation, mascara, face masks, toners and anti-ageing creams.  Allergic reactions involve the body’s immune system which is supposed to fight infections, but at times gets the wrong target – in this case an ingredient of the cosmetic, leading to i.a. allergic contact dermatitis/eczema.

The EU Regulation (EC) No 1223/2013 (Cosmetics Regulation) requires that only safe cosmetic products are placed on the EU market and therefore lays down a set of provisions which aim at ensuring a high level of protection of human health. The Regulation provides that the “responsible person” has to ensure that cosmetic products have undergone a safety assessment prior to their placing on the market and to keep up to date their cosmetic products’ safety report.

The Regulation requires a prior EU authorisation only for substances used in cosmetics as preservatives, colorants and UV-filters based on a safety assessment by the Scientific Committee on Consumer Safety (SCCS). The safety evaluations performed by the SCCS take into account, where relevant, the exposure of specific groups at potential risk such as children under three years of age and the possible induction of allergies.

However, the use in cosmetics (e.g. shampoos) of substances, which were not identified as sensitisers, may cause allergies when these substances are incorporated in a wide range of cosmetics or at high concentrations. In such a case the Commission may, after consulting the SCCS, adopt measures to restrict or ban their use.

Moreover, when cosmetic products posing serious risks to consumers are found in the market, Member States’ authorities take corrective actions and notify them through the Rapid Alert System for dangerous non-food products (RAPEX) to the Commission and the other Member States.)

1 in 5 Europeans suffer from food reactions and 7 million Europeans are allergic to some type of food. Allergies may cause several symptoms, such as gastro-intestinal problems, eczemas, hives, airway obstructions and cardiovascular shocks.

There is currently no available cure for food allergies, but the abstention from the allergen causing the reaction. Consequently, consumers suffering from allergies need to be able to easily identify the ingredients they are allergic to.

The European Union Regulation (EU) No 1169/2011 on the provision of food information to consumers establishes a legal framework with regard to information related to foodstuffs provided to consumers by food business operators at all stages of the food chain. The Regulation includes general principles, responsibilities as well as requirements governing food information and identifies a list of 14 allergens in its Annex II (eggs, milk, fish, crustaceans, molluscs, peanuts, tree nuts, sesame seeds, cereals containing gluten, soybeans, celery and celeriac, mustard, lupin and sulphites). Labels on food products must be emphasised and available at all time to consumers. The EU list of allergens is provided in its Annex II and has been set on the basis of a scientific opinion adopted by the European Food Safety Authority (EFSA).

The Regulation also envisages a systematic re-examination of the allergens list and, if necessary, it is to be updated on the basis of the most recent scientific knowledge. If compelling scientific evidence were to be published showing the severity of the allergenic character of a new good, the Commission or a Member State could ask EFSA to investigate this substance in more detail. )

In order to drive improvements in asthma and allergies, to better understand these diseases and to develop better treatments, investment in asthma and allergy research is necessary both at the EU and national levels. Research on respiratory diseases has been a priority throughout the Seventh Framework Programme for Research, Technological Development and Demonstration Activities (FP7) which has devoted over €100 million to 53 projects on allergy research in areas such as allergic asthma or food allergy.

Projects address disease pathway, treatments, diagnostics and technological developments in food production, and consist of collaborative research, blue sky research and support to researchers’ career via Marie Skłodowska-Curie actions. The current EU Framework Programme for Research and Innovation, Horizon 2020 supports 6 projects totaling €13.2 million to better understand allergies, develop new and safer therapies and improve allergen detection. Further funding opportunities may be provided, for instance under the “Health, demographic change and well-being” Societal Challenge.

Horizon Europe

With the ongoing EU Framework Programme for Research and Innovation ending in 2020, the European Commission’s published its proposal for the 9th Framework Programme for Research and Innovation, “Horizon Europe” with a budget allocated to health of €7.7 billion, an increase of 300 million from the €7.4 billion of Horizon 2020. This research framework programme is an important complement to the European Social Fund+, within which health policy is integrated, as part of the European Union’s multiannual financial framework. While budgetary negotiations on the next EU multiannual financial framework are ongoing, EFA, EAACI and the European Parliament Interest Group advocate to ensure that enough funding will be dedicated to addressing the challenges surrounding allergy and asthma.)