Healthy Planet, Healthier People: EAACI's Integrated Planetary Health Strategy for Asthma, Allergies and Immune Diseases

The European Academy of Allergy and Clinical Immunology (EAACI) is poised to lead a groundbreaking initiative in Planetary Health, addressing the rising burden of asthma, allergies and immunological diseases. This endeavour aligns with several visions of EU projects, presenting a timely opportunity for investment and transformative action in this critical field. Planetary Health acknowledges the intricate interdependencies between human well-being and the ecosystems we inhabit. Climate change, pollution, biodiversity loss and lifestyle shifts are reshaping the prevalence and severity of asthma, allergies and immunological diseases [1, 2]. Tackling these challenges demands a holistic strategy that integrates environmental sustainability into prevention, healthcare and public policy. EAACI's Planetary Health framework is built on three interdependent pillars: (1) Environmental Threats, (2) Health Consequences, and (3) Strategies for Mitigation and Adaptation (Figure 1). Together, they provide a comprehensive roadmap for understanding and addressing the multifactorial drivers of allergic and immunological diseases in a changing world. The first pillar, environmental threats, encompasses a wide range of factors that contribute to the increasing burden of asthma, allergies and immunological diseases [3]. Climate change, with its extreme weather events and rising temperatures, significantly exacerbates these conditions [4]. Air pollution, particularly airborne particulates, interacts with allergens in airway epithelium with increased potency. Urbanisation contributes to the effect of heat islands and alters our exposure to natural environments, while changes in nutrition and lifestyle further impact our immune systems [5]. Occupational exposures and environmental injustice amplify vulnerability among specific populations, exacerbating the overall disease burden [6]. The second pillar represents the consequences on health. Loss of biodiversity highlights the critical role that diverse ecosystems play in supporting human health. As we lose biodiversity, we disrupt the microbial ecosystems essential for proper immune development [7]. This loss is compounded by the growing threat of antibiotic resistance, which weakens our defences against infections that can worsen allergic conditions. Environmental stressors lead to epithelial barrier disruption and epigenetic changes, potentially amplifying health risks across generations [8]. The environmental stressors and their demonstrated health consequences underscore the urgency of developing effective mitigation and adaptation strategies. What is the EAACI Planetary Health initiative proposal? The third pillar outlines a proactive mitigation and adaptation strategy, focusing on nature-based solutions, sustainable healthcare and inclusive policy reform. Among others, nature-based approaches, such as increasing low-allergenic green spaces, can simultaneously reduce allergen exposure and foster biodiversity recovery [7] or improve air quality [9]. Public awareness campaigns and educational initiatives are crucial in promoting sustainable practices and eco-friendly healthcare options. Policy measures prioritising equity ensure that vulnerable populations receive adequate protection from environmental risks [10]. Whilst in the context of the three pillars we are seeing the environment as a threat; it is also important to acknowledge environmental factors as potential protective influences. The human body interacts continuously with the wider ecosystem through air, food and microbial exchange, and this connection supports immune balance. In modern urbanisation, reduced contact with nature can weaken this balance. Reintroducing natural elements into daily life, especially in urban environments, can help restore healthy microbial and psychological connections that promote immune resilience [11, 12]. To guide action, EAACI has formulated a Decalogue—a ten-principle framework that articulates the connections between environmental exposures and allergic or immune-mediated conditions (Figure 2). These principles address modifiable environmental factors and offer evidence-informed pathways for prevention and advocacy. These principles begin with the fundamental importance of air quality, highlighting how exposure to pollutants like particulate matter, nitrogen dioxide, and ozone exacerbates respiratory conditions. This leads naturally to a discussion of climate change impacts, including longer pollen seasons and more frequent extreme weather events, which intensify risks for individuals with asthma and allergies. It also explores how biodiversity loss in urban environments alters microbial exposure crucial for immune system development, linking to the synergistic effects of pollen and air pollution that amplify allergic responses. Nutrition emerges as a key factor, with diets rich in antioxidants and omega-3 fatty acids supporting immune health, in contrast to the inflammatory effects of ultra-processed foods. Indoor environments, often overlooked, significantly impact asthma and allergies through poor air quality and allergen accumulation. The principle linking diet and immune health stresses how balanced diets promote a diverse and healthy gut microbiome, which plays a critical role in reducing allergy susceptibility. This complements the microbiome and early-life immunity principle, underscoring that exposure to a wide range of microbes during infancy and childhood is essential for optimal immune development. Together, these nutritional and microbial factors establish a foundation for long-term immune resilience and reduced risk of allergic and immune-mediated diseases. Chemical exposures, particularly endocrine disruptors, are addressed for their role in disrupting immune responses. This connects to the principle of antibiotic resistance, which not only threatens treatment efficacy but also disrupts the gut microbiome essential for immune function. Occupational risks are highlighted, emphasising the need for protective measures in workspaces exposed to allergens or irritants. The importance of early-life microbial exposure in shaping long-term immune tolerance underscores the microbiome principle. Sustainable healthcare practices, a key principle of the Decalogue, focus on minimising the environmental footprint of medical care while maintaining or enhancing patient outcomes. Examples include adopting energy-efficient facilities, reducing single-use plastics and promoting the use of eco-friendly diagnostic protocols. These approaches exemplify how healthcare systems can contribute to environmental protection and public health simultaneously. The Decalogue concludes with calls for sustainable healthcare practices and prevention through policy and education, demonstrating EAACI's commitment to a comprehensive approach. An additional principle on equity, resilience and innovation acknowledges the disproportionate impact of environmental risks on vulnerable populations and the potential of digital tools—such as environmental monitoring sensors, artificial intelligence-based exposure models, and digital health platforms—to support immune resilience through personalised prevention and adaptive healthcare strategies [10, 13]. Moving forward, EAACI recognises that addressing the complex challenges of Planetary Health requires a collaborative, multidisciplinary approach. We invite professionals from diverse fields—healthcare, governance, policymaking, research, education, urban planning, and technology development, as well as patients and members of the public—to engage with this initiative. By combining expertise and perspectives, we can develop more effective strategies for managing asthma, allergies and immunological diseases in our changing environment. EAACI is organising various platforms for knowledge exchange and action planning to facilitate this collaboration. These include structural changes with a specific working group, multidisciplinary meetings, educational webinars, workshops and public awareness campaigns. For example, EAACI's Planetary Health initiative is supported by dedicated working groups which convene experts across clinical, environmental, and policy fields. EAACI regularly hosts thematic congress sessions, webinars, and workshops to disseminate knowledge and foster collaboration. Through these efforts, we aim to promote health in sustainable urban environments and advance the goals of Planetary Health through an actionable collaborative network that engages professionals, policymakers, researchers and the public. The Planetary Health initiative represents a paradigm shift: by embedding environmental consciousness into asthma, allergy and immune diseases care, we foster sustainable solutions that benefit both people and the planet. Let us seize this opportunity to reimagine health in harmony with nature—driven by equity, guided by science, and powered by collective resolve. All authors contributed to the writing and critical review of the manuscript. A.M., I.A.M., J.W.-S., J.H., J.A.L., M.M.E., M.H.S. and M.J.T. report no conflicts of interest. C.A. has received research grants from the Swiss National Science Foundation, European Union (EU CURE, EU Syn-Air-G), Novartis Research Institutes (Basel, Switzerland), Stanford University (Redwood City, California), Seed Health (Boston, USA), AO Research Institute (Davos, Switzerland) and SciBase (Stockholm, Sweden). He is the Co-Chair for the EAACI Guidelines on Environmental Science in Allergic Diseases and Asthma; Chair of the EAACI Epithelial Cell Biology Working Group. He serves on the Advisory Boards of Sanofi/Regeneron (Bern, Switzerland, New York, USA), Stanford University Sean Parker Asthma Allergy Center (CA, USA), Novartis (Basel, Switzerland), GlaxoSmithKline (Zurich, Switzerland), Bristol-Myers Squibb (New York, USA), Seed Health (Boston, USA), and SciBase (Stockholm, Sweden). C.A. is the Editor-in-Chief of Allergy. The authors have nothing to report.