Domenico Rizzo, a baker in Sicily, long sweated out the heat. Through years of stifling Italian summers, Rizzo (40) refused to install air-conditioning units in his bakery, fearing the cold air would make his muscles ache.

Three years ago, he finally surrendered, setting up one wall-mounted air conditioner in the bakery, using the unit mainly to dehumidify the store rather than to cool it. (Air conditioning, he said, dries out the bread.)

At home, he has also succumbed to the necessity of air conditioning at night to cool down after a day pulling bread rolls and loaves out of ovens. Rizzo complains that the air “hurts my shoulders, my neck, and I have all kinds of cramps”.

But, he adds, “How can you live without it?”

For generations, Italians shunned air conditioning as a threat to their health, amid scientific research that found people who live in air-conditioned environments reported more respiratory problems than those who don’t. Many Italians shared the belief that a “colpo d’aria”, or “blast of air”, could give you a crick in the neck, tonsillitis, headaches, muscle cramps and all kinds of respiratory ailments.

But with the country experiencing steadily rising temperatures – August was Italy’s hottest on record, according to the National Research Council, and scorching heat continued into September – an increasing number of Italians are adopting artificial cooling, even if they are convinced such systems make them feel unwell.

The percentage of households in Italy that have installed air conditioning grew to 56 per cent in 2024, the last year for which data is available, from just under 30 per cent in 2013, according to government statistics. During that time, Italy’s average August temperature rose more than 10 per cent, and the amount of energy Italian households used for air-cooling rose faster than most other European countries.

In Sicily, the southern island off the toe of the Italian boot, the rise has been even steeper than the national average. About three out of four Sicilian households have installed air-conditioning units, up from roughly one in three in 2013.

The brutal reality of unstinting heatwaves has forced a cultural shift in a country where homeowners usually weather the summer sun with open windows and fans, diners prefer to eat outside even in the hottest months, and doctors advise patients to avoid getting too close to chilled air.

In Agrigento, a hilltop town in Sicily known for its temple ruins, rectangular air-conditioning boxes dot the walls of buildings.

Many residents are, like Rizzo, still begrudging of their acceptance.

Emilia Pisciotto, a beachside-bar owner, grew up without air conditioning, and she says she still doesn’t like it. When her husband turns the unit on at home, the air gives her a headache and stuffs up her sinuses, she says. But Pisciotto has to admit that as temperatures have skyrocketed, she needs it.

In times gone by, “We were used to the heat,” says Pisciotto (65), sitting outside her bar as a warm sea breeze blows across the terrace. “But this is exceptional. For a few years we just haven’t been able to breathe.”

There is medical science to back up the long-standing Italian gripes about air conditioning. According to Giovanni Leoni, vice-president of the National Federation of the Orders of Medical Doctors and Dentists, air conditioning can dry out sinuses, causing sore throats, runny noses or headaches. Moving quickly from the hot outdoors to the extremely cold indoors, Leoni says, can induce muscle cramps.

The key, he says, is to keep rooms to about 25 degrees, and to avoid sitting too long or sleeping close to direct blasts of chilled air. As long as people use air conditioning “correctly and in moderation”, Leoni adds, “it’s essential these days.”

In the United States, people have long been more tolerant of the trade-off between the risks and benefits of air conditioning, says Brad J Uren, an associate professor of emergency medicine at the University of Michigan.

Air conditioning might dry out the eyes, nose, throat, mouth and skin, Uren says, “but you consider the effects of heat-related illness and heatstroke, and that is deadly”.

Although air conditioning units have become cheaper, their broader usage has driven up average summer utility bills for consumers.

Italian households spent an average of nearly €450 from late spring to the end of August on energy bills, up 25 per cent from 2021, according to data from the Italian Association of Utility Managers, a trade group. That surge was partly driven by higher electricity prices caused by the war in Iran – but Federico Bevilacqua, president of the association, says the higher bills were also clearly “a consequence of this scorching heat”.

To rein in electricity bills, most hotels and temporary rental owners in Agrigento have installed card-key systems that automatically turn off lights and air conditioning when a guest leaves, says Michele Sodano, Agrigento’s mayor.

Air conditioning also has a cost for the environment, energy and climate experts say: cooling units not only tax electricity grids but lead to more carbon emissions, which in turn can fuel more extreme weather.

Air conditioning is a classic example of “maladaptation, where you adapt to the changing climate by essentially using a solution that increases the problem in the first place”, says Steven Bland, an urban expert at the World Resources Institute, a think tank in London that focuses on climate issues.

For now, a few air conditioning holdouts remain in his city.

Patrizia Prado, owner of a gallery filled mostly with her own artistic creations, says she did not believe in air conditioning for anything other than some hospital wards or people with heart issues.

Standing behind a table in her palpably stuffy shop, she says most people relied on artificial cooling “not because of a need, but because it’s convenient”. Air conditioning, she adds, is just “a habit that’s been formed”.

Instead of using cooling systems, she suggests people should wear natural fibres, sweat out their toxins and enjoy “the flow of natural air”.

This article originally appeared in The New York Times.