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The hazardous air may also hinder the government's drive to make the Kumbh Mela, or pitcher festival, a global tourism event.
Four sites in India rotate every three years hosting the Kumbh, the world's largest pilgrimage. The river baths, prayer, meditation and yoga sessions and other religious rituals are organised by sadhus and financially supported with public funds.
Tens of millions throng to the sites for a holy dip, many with little money, few provisions and nowhere to sleep.
The first of a series of royal baths took place before dawn on Tuesday, led by a procession of sadhus on tractor chariots and on foot, singing, drumming and blowing horns. The first to bathe were the naked, naga sadhus, whose bodies were covered with ash. Huge crowds followed them into the river, including Mili Mishra, a teacher from Prayagraj with her husband and two sons.
"We are not earning a livelihood. We think that if we bathe here," she said.
The exact dates and times of the baths, as well as the Kumbh itself, are determined by the cosmic alignment of the sun, moon and Jupiter.
The Indian government has for years provided security and free food and shelter for the poorest pilgrims.
The budget supplied thousands of toilets and urinals, public dormitories, and hundreds of water stations, as well as police, hospitals, 24-hour pharmacies and fire and ambulance services.
And like elsewhere in India, a person's comfort is determined by wealth and social standing.
The expansive campgrounds hosted everything from luxury "glamping" options that cost up to 35,000 rupees ($494) per night - private, tent "suites" with plush bedding and flush toilets - to a cot with a thin foam mattress in a public dormitory in a high-top tent that costs 200 rupees ($2.83) per night.
"I go to holy sites very often, but I'm used to them being very dirty. I have never seen this level of cleanliness measures at any other holy city," said Gita Mishra, 58, one of the guests at a public tent near the banks of the river.
When people waiting for a spot outside the tent learned it was full, they laid blankets around the periphery to sleep in the hazy open air.
Still others, including about 500 sanitation workers, pitched pup tents near a row of some of the toilets they are paid 300 rupees ($7) per day to clean.
The production of any Kumbh is a gargantuan task, particularly in the low-lying Indian army parade grounds in Prayagraj where the ritual baths take place. Regular summertime floods leave organizers only 40 to 50 days to erect the temporary city, according to city commissioner Ashish Goel.
But this year's public provisions are unprecedented.
"It's a very aspirational Kumbh Mela," Goel said.
The dust plumes encompassing the camp come from the sandy riverbanks, Goel said, and not from construction, which is banned during the 55-day festival. Still, in the city center outside of the fairgrounds, brick kilns send up clouds of PM 2.5, tiny particulate matter that can dangerously clog lungs.
Even with the construction ban, PM 2.5 levels in Prayagraj on Tuesday were more than six times what the World Health Organization considers safe, according to AQI India, an online air quality monitor.
India's cities are among the world's smoggiest.
The Indian government has announced a five-year program to cut air pollution by up to 30 percent from 2017 levels in the country's 102 worst-affected cities, including Prayagraj.
Key targets include reducing burning of field waste, firewood and charcoal, cleaning up thermal power and auto emissions and heavily polluting brick production and controlling dust from construction.
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