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Katz DSW, Zigler CM, Bhavnani D, Balcer-Whaley S, Matsui EC. Pollen and viruses contribute to spatio-temporal variation in asthma-related emergency department visits. ENVIRONMENTAL RESEARCH 2024; 257:119346. [PMID: 38838752 PMCID: PMC11268730 DOI: 10.1016/j.envres.2024.119346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Asthma exacerbations are an important cause of emergency department visits but much remains unknown about the role of environmental triggers including viruses and allergenic pollen. A better understanding of spatio-temporal variation in exposure and risk posed by viruses and pollen types could help prioritize public health interventions. OBJECTIVE Here we quantify the effects of regionally important Cupressaceae pollen, tree pollen, other pollen types, rhinovirus, seasonal coronavirus, respiratory syncytial virus, and influenza on asthma-related emergency department visits for people living near eight pollen monitoring stations in Texas. METHODS We used age stratified Poisson regression analyses to quantify the effects of allergenic pollen and viruses on asthma-related emergency department visits. RESULTS Young children (<5 years of age) had high asthma-related emergency department rates (24.1 visits/1,000,000 person-days), which were mainly attributed to viruses (51.2%). School-aged children also had high rates (20.7 visits/1,000,000 person-days), which were attributed to viruses (57.0%), Cupressaceae pollen (0.7%), and tree pollen (2.8%). Adults had lower rates (8.1 visits/1,000,000 person-days) which were attributed to viruses (25.4%), Cupressaceae pollen (0.8%), and tree pollen (2.3%). This risk was spread unevenly across space and time; for example, during peak Cuppressaceae season, this pollen accounted for 8.2% of adult emergency department visits near Austin where these plants are abundant, but 0.4% in cities like Houston where they are not; results for other age groups were similar. CONCLUSIONS Although viruses are a major contributor to asthma-related emergency department visits, airborne pollen can explain a meaningful portion of visits during peak pollen season and this risk varies over both time and space because of differences in plant composition.
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Affiliation(s)
- Daniel S W Katz
- The Department of Population Health and Data Sciences, Dell Medical School, University of Texas at Austin, United States; The School of Integrative Plant Science, Cornell University, United States.
| | - Corwin M Zigler
- The Department of Statistics and Data Sciences, Dell Medical School, University of Texas at Austin, United States
| | - Darlene Bhavnani
- The Department of Population Health and Data Sciences, Dell Medical School, University of Texas at Austin, United States
| | - Susan Balcer-Whaley
- The Department of Population Health and Data Sciences, Dell Medical School, University of Texas at Austin, United States
| | - Elizabeth C Matsui
- The Department of Population Health and Data Sciences, Dell Medical School, University of Texas at Austin, United States
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Weeda LJZ, Bradshaw CJA, Judge MA, Saraswati CM, Le Souëf PN. How climate change degrades child health: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 920:170944. [PMID: 38360325 DOI: 10.1016/j.scitotenv.2024.170944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children. OBJECTIVES We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research. METHODS We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes. RESULTS Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.
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Affiliation(s)
- Lewis J Z Weeda
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
| | - Corey J A Bradshaw
- Global Ecology | Partuyarta Ngadluku Wardli Kuu, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia; Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, EpicAustralia.org.au, Australia
| | - Melinda A Judge
- Telethon Kids Institute, Perth, Western Australia, Australia; Department of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia
| | | | - Peter N Le Souëf
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia
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Zhaobin S, Yuxin Z, Xingqin A, Na G, Ziming L, Shuwen Z, Yinglin L, Wenxi R, Yaqin B, Jingyi X, Shihong L. Effects of airborne pollen on allergic rhinitis and asthma across different age groups in Beijing, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169215. [PMID: 38086478 DOI: 10.1016/j.scitotenv.2023.169215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
In the context of global warming and rapid urbanization, pollen has become a significant public health concern for Chinese citizens. However, there is a paucity of epidemiological research on the impact of pollen on allergen-linked diseases, such as allergic rhinitis and asthma, in China. Using data from the Beijing Chaoyang Hospital between 2013 and 2019, which included allergic rhinitis and asthma incidence, meteorological records, and air pollution data, we employed a Generalized Additive Model (GAM) to examine the relationship between overall and type-specific pollen concentrations in relation to varying population exposures. We found that increased overall pollen concentrations significantly increased the risks of allergic rhinitis and asthma in diverse populations. Notably, the risk of allergic rhinitis was higher than that of asthma at equivalent pollen concentrations. Seasonal trends indicated that spring pollen peaks, primarily from trees, were associated with a lower risk of both allergic rhinitis and asthma than autumn peaks, predominantly from weeds. This study underscores the importance of identifying pollen species that pose heightened risks to different demographic groups across seasons, thereby providing targeted interventions for public health agencies.
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Affiliation(s)
- Sun Zhaobin
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China.
| | - Zhao Yuxin
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - An Xingqin
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Gao Na
- Department of Respiratoryand Critical Care Medicine, Yulin No. 2 Hospital, Yulin 719000, China; Department of Allergy, Yulin No.2 Hospital, Yulin 719000, China
| | - Li Ziming
- Beijing Weather Forecast Center, Beijing 100089, China
| | - Zhang Shuwen
- College of Traditional Chinese Medicine and College of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Liang Yinglin
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Ruan Wenxi
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Bu Yaqin
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Xin Jingyi
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Li Shihong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
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4
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Simunovic M, Boyle J, Erbas B, Baker P, Davies JM. Airborne grass pollen and thunderstorms influence emergency department asthma presentations in a subtropical climate. ENVIRONMENTAL RESEARCH 2023; 236:116754. [PMID: 37500047 DOI: 10.1016/j.envres.2023.116754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Grass pollen is considered a major outdoor aeroallergen source worldwide. It is proposed as a mechanism for thunderstorm asthma that lightning during thunderstorms promotes electrical rupture of pollen grains that leads to allergic airway inflammation. However, most evidence of associations between grass pollen and asthma comes from temperate regions. The objective of this study was to investigate short-term associations between airborne grass pollen exposure and asthma emergency department presentations in a subtropical population. METHODS Episode level public hospital presentations for asthma (2016-2020) were extracted for greater Brisbane, Australia, from Queensland Health's Emergency Data Collection. Concentrations of airborne pollen were determined prospectively using a continuous flow volumetric impaction sampler. Daily time series analysis using a generalised additive mixed model were applied to determine associations between airborne grass pollen concentrations, and lightning count data, with asthma presentations. RESULTS Airborne grass pollen showed an association with asthma presentations in Brisbane; a significant association was detected from same day exposure to three days lag. Grass pollen exposure increased daily asthma presentations up to 48.5% (95% CI: 12%, 85.9%) in female children. Lightning did not modify the effect of grass pollen on asthma presentations, however a positive association was detected between cloud-to-cloud lightning strikes and asthma presentations (P = 0.048). CONCLUSION Airborne grass pollen exposure may exacerbate symptoms of asthma requiring urgent medical care of children and adults in a subtropical climate. This knowledge indicates an opportunity for targeted management of respiratory allergic disease to reduce patient and health system burden. For the first time, an influence of lightning on asthma was detected in this context. The outcomes support a need for continued pollen monitoring and surveillance of thunderstorm asthma risk in subtropical regions.
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Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Justin Boyle
- Australian E-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Philip Baker
- School of Public Health and Social Work, Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia; Office of Research, Metro North Hospital and Health Services, Herston, Queensland, Australia.
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Zhao Y, Sun Z, Xiang L, An X, Hou X, Shang J, Han L, Ye C. Effects of pollen concentration on allergic rhinitis in children: A retrospective study from Beijing, a Chinese megacity. ENVIRONMENTAL RESEARCH 2023; 229:115903. [PMID: 37080269 DOI: 10.1016/j.envres.2023.115903] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
With global climate change and rapid urbanization, the prevalence of allergic diseases caused by pollen is rising dramatically worldwide with unprecedented complexity and severity, especially for children in mega-cities. However, because of the lack of long time-series pollen concentrations data, the accurate evaluation of the impact of pollen on allergic rhinitis (AR) was scarce in the Chinese metropolis. A generalized additive model was used to assess the effect of pollen concentration on pediatric AR outpatient visits in Beijing from 2014 to 2019. A stratified analysis of 10 pollen species and age-gender-specific groups was also conducted during the spring and summer-autumn peak pollen periods separately. Positive associations between pollen concentration and pediatric AR varied with the season and pollen species were detected. Although the average daily pollen concentration is higher during the spring tree pollen peak, the influence was stronger at the summer-autumn weed pollen peak with the maximum relative risk 1.010 (95% CI 1.009, 1.011), which was higher than the greatest relative risk, 1.003 (95% CI 1.002, 1.004) in the spring peak. The significant adverse effects can be sustained to lag10 during the study period, and longer in the summer-autumn peak (lag13) than in the spring peak (lag8). There are thresholds for the health effects and they varied between seasons. The significant effect appeared when the pollen concentration was higher than 3.74 × 105 grain·m-2·d-1 during the spring tree pollen peaks and 4.70 × 104 grain·m-2·d-1 during the summer-autumn weed pollen peaks. The stratified results suggested that the species-specific effects were heterogeneous. It further highlights that enough attention should be paid to the problem of pollen allergy in children, especially school-aged children aged 7-18 years and weed pollen in the summer-autumn peak pollen period. These findings provide a more accurate reference for the rational coordination of medical resources and improvement of public health.
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Affiliation(s)
- Yuxin Zhao
- Nanjing University of Information Science & Technology, School of Atmospheric Physics Nanjing, 210044, Jiangsu Province, China; State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing, 100081, China; Key Laboratory of Urban Meteorology, China Meteorological Administration, Beijing 100089, China
| | - Zhaobin Sun
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing, 100081, China; Key Laboratory of Urban Meteorology, China Meteorological Administration, Beijing 100089, China
| | - Li Xiang
- Children's National Medical Center, Department of Anaphylaxis, Beijing Children's Hospital- Capital Medical University, Key Laboratory of Pediatric Major Diseases-Ministry of Education, National Clinical Medical Research Center for Respiratory Diseases, Beijing, 100045, China.
| | - Xingqin An
- State Key Laboratory of Severe Weather of CMA, Chinese Academy of Meteorological Sciences, Beijing, 100081, China.
| | - Xiaoling Hou
- Children's National Medical Center, Department of Anaphylaxis, Beijing Children's Hospital- Capital Medical University, Key Laboratory of Pediatric Major Diseases-Ministry of Education, National Clinical Medical Research Center for Respiratory Diseases, Beijing, 100045, China
| | - Jing Shang
- Key Laboratory of Urban Meteorology, China Meteorological Administration, Beijing 100089, China
| | - Ling Han
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Caihua Ye
- Beijing Meteorological Service Center, Beijing Meteorological Bureau, Beijing, 100089, China
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6
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Lappe BL, Ebelt S, D'Souza RR, Manangan A, Brown C, Saha S, Harris D, Chang HH, Sole A, Scovronick N. Pollen and asthma morbidity in Atlanta: A 26-year time-series study. ENVIRONMENT INTERNATIONAL 2023; 177:107998. [PMID: 37290290 PMCID: PMC10600739 DOI: 10.1016/j.envint.2023.107998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Compared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. OBJECTIVES We evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993-2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5-17, 18-64, 65+), and insurance status (Medicaid vs non-Medicaid). METHODS Speciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0-2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. RESULTS From 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1-8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993-2000), in younger people, and in Black patients; however, results varied by pollen taxa. CONCLUSIONS Some, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.
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Affiliation(s)
- Brooke L Lappe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arie Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Brown
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shubhayu Saha
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Office of Climate Change and Health Equity, Department of Health and Human Services, Washington DC, USA
| | - Drew Harris
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adam Sole
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Chelabi K, Osmanlliu E, Gravel J, Drouin O, Tse SM. The effect of the COVID-19 pandemic on pediatric asthma-related emergency department visits and hospital admissions in Montréal, Quebec: a retrospective cohort study. CMAJ Open 2023; 11:E152-E159. [PMID: 36787991 PMCID: PMC9933991 DOI: 10.9778/cmajo.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Asthma is a chronic respiratory condition that affects 10% of Canadian children and is often exacerbated by viral respiratory infections, prompting concerns about the severity of SARS-CoV-2 disease in children with asthma. We compared sociodemographic and clinical characteristics of children presenting to the emergency department and the incidence of these visits, before and during the pandemic. METHODS We included children aged 0 to 17 years presenting with asthma to 2 tertiary pediatric emergency departments in Montréal, Quebec, between the prepandemic (Jan. 1, 2017, to Mar. 31, 2020) and pandemic (Apr. 1, 2020, to June 30, 2021) periods. We compared the number of emergency department visits and hospital admissions with an interrupted time series analysis and compared the sociodemographic characteristics based on the Canadian Index of Multiple Deprivation (CIMD) and clinical characteristics (including triage level, intensive care admissions, etc.) with Mann-Whitney and χ2 tests. RESULTS We examined 22 746 asthma-related emergency department visits. During the pandemic, a greater proportion of patients presented a triage level 1 or 2 (19.3% v. 14.7%) and were admitted to the intensive care unit (2.5% v. 1.3%). The patients' CIMD quintile distributions did not differ between the 2 periods. We found a 47% decrease (relative risk [RR] 0.53, 95% confidence interval [CI] 0.37 to 0.76) in emergency department visits and a 49% decrease (RR 0.51, 95% CI 0.34 to 0.76) in hospital admissions during the pandemic. INTERPRETATION The decrease in asthma-related emergency department visits was observed through the third wave of the pandemic, but children presented with a higher acuity and with no identified sociodemographic changes. Future studies are required to understand individual behaviours that may have led to the increased acuity at presentation observed in this study.
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Affiliation(s)
- Khadidja Chelabi
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Esli Osmanlliu
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Jocelyn Gravel
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Olivier Drouin
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Sze Man Tse
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Nitschke M, Dear KBG, Venugopal K, Lyne KMR, Jersmann HPA, Simon DL, Spurrier N. Association between grass, tree and weed pollen and asthma health outcomes in Adelaide, South Australia: a time series regression analysis. BMJ Open 2022; 12:e066851. [PMID: 36414301 PMCID: PMC9723903 DOI: 10.1136/bmjopen-2022-066851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. DESIGN Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. SETTING Metropolitan Adelaide, South Australia. PARTICIPANTS Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0-17 years), 22 114, 39 813 and 3774, respectively. OUTCOME MEASURES The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m3. RESULTS In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children's asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. CONCLUSION Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health campaigns to provide effective public health prevention.
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Affiliation(s)
- Monika Nitschke
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Kamalesh Venugopal
- Prevention and Population Health, Wellbeing SA, Adelaide, South Australia, Australia
| | - Katrina Margaret Rose Lyne
- Health Protection and Licensing Services, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Hubertus Paul Anton Jersmann
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Leslie Simon
- Health Protection and Licensing Services, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
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10
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Ragweed pollen concentration predicts seasonal rhino-conjunctivitis and asthma severity in patients allergic to ragweed. Sci Rep 2022; 12:15921. [PMID: 36151263 PMCID: PMC9508093 DOI: 10.1038/s41598-022-20069-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
In this work, we investigate the correlation between ragweed pollen concentration and conjunctival, nasal, and asthma symptom severity in patients allergic to ragweed pollen using ambient pollen exposure in the Milan area during the 2014 ragweed season We calculate the pollen/symptom thresholds and we assess the effectiveness of ragweed allergen immunotherapy (AIT). A total of 66 participants allergic to ragweed (Amb a 1) were enrolled in the study and divided into two groups: AIT treated (24) and no AIT treated (42). Pollen counts and daily symptom/medication patient diaries were kept. Autoregressive distributed lag models were used to develop predictive models of daily symptoms and evaluate the short-term effects of temporal variations in pollen concentration on the onset of symptoms. We found significant correlations between ragweed pollen load and the intensity of symptoms for all three symptom categories, both in no AIT treated (τ = 0.341, 0.352, and 0.721; and ρ = 0.48, 0.432, and 0.881; p-value < 0.001) and in AIT treated patients (\documentclass[12pt]{minimal}
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\begin{document}$$\tau$$\end{document}τ= 0.46, 0.610, and 0.66; and ρ = 0.692, 0.805, and 0.824; p-value < 0.001). In both groups, we observed a positive correlation between the number of symptoms reported and drug use. Mean symptom levels were significantly higher in no AIT treated than in AIT treated patients (p-value < 0.001) for all symptom categories. Pollen concentration thresholds for the four symptom severity levels (low, medium–low, medium–high and high) were calculated. Ragweed pollen concentration is predictive of symptom severity in patients with a ragweed (Amb a 1) allergy. Patients treated with AIT had significantly reduced mean symptom levels compared to those without AIT.
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Joint association between ambient air pollutant mixture and pediatric asthma exacerbations. Environ Epidemiol 2022; 6:e225. [PMID: 36249268 PMCID: PMC9556053 DOI: 10.1097/ee9.0000000000000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Exposure to air pollutants is known to exacerbate asthma, with prior studies focused on associations between single pollutant exposure and asthma exacerbations. As air pollutants often exist as a complex mixture, there is a gap in understanding the association between complex air pollutant mixtures and asthma exacerbations. We evaluated the association between the air pollutant mixture (52 pollutants) and pediatric asthma exacerbations. Method This study focused on children (age ≤ 19 years) who lived in Douglas County, Nebraska, during 2016-2019. A seasonal-scale joint association between the outdoor air pollutant mixture adjusting for potential confounders (temperature, precipitation, wind speed, and wind direction) in relation to pediatric asthma exacerbation-related emergency department (ED) visits was evaluated using the generalized weighted quantile sum (qWQS) regression with repeated holdout validation. Results We observed associations between air pollutant mixture and pediatric asthma exacerbations during spring (lagged by 5 days), summer (lag 0-5 days), and fall (lag 1-3 days) seasons. The estimate of the joint outdoor air pollutant mixture effect was higher during the summer season (adjusted-βWQS = 1.11, 95% confidence interval [CI]: 0.66, 1.55), followed by spring (adjusted-βWQS = 0.40, 95% CI: 0.16, 0.62) and fall (adjusted-βWQS = 0.20, 95% CI: 0.06, 0.33) seasons. Among the air pollutants, PM2.5, pollen, and mold contributed higher weight to the air pollutant mixture. Conclusion There were associations between outdoor air pollutant mixture and pediatric asthma exacerbations during the spring, summer, and fall seasons. Among the 52 outdoor air pollutant metrics investigated, PM2.5, pollen (sycamore, grass, cedar), and mold (Helminthosporium, Peronospora, and Erysiphe) contributed the highest weight to the air pollutant mixture.
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Batra M, Vicendese D, Newbigin E, Lambert KA, Tang M, Abramson MJ, Dharmage SC, Erbas B. The association between outdoor allergens - pollen, fungal spore season and high asthma admission days in children and adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1393-1402. [PMID: 33615917 DOI: 10.1080/09603123.2021.1885633] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Periods when asthma admissions peaks have serious implications for asthma sufferers and hospitals. We assessed the association between aeroallergen exposure and childhood asthma peak periods during two grass pollen seasons using the Melbourne Air Pollen Children and Adolescent Health (MAPCAH) study conducted in Melbourne, Australia. Two peak periods were identified. Effect modifications by atopy and sex were considered. All pollen 2 days prior was associated with increased odds of these peak periods. Same day fungal spores, but not pollen, were important. Grass at lag 2 was associated with increased odds 1.03 (95%CI 1.01, 1.05) as was the same day Alternaria 1.02 (1.00, 1.04) per spore/m3 for boys. In addition to pollen, fungal spores particularly Alternaria may result in days of high exacerbations during pollen seasons. Further guidance is needed to better prepare families/carers with information about the increased risk of asthma attacks in children prior to pollen seasons.
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Affiliation(s)
- Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Don Vicendese
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Edward Newbigin
- School of BioSciences, The University of Melbourne, Melbourne, Australia
| | - Katrina A Lambert
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Mimi Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, The Royal Children's HospitalVictoria, Melbourne, Australia
| | - Michael J Abramson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Faculty of Public Health, Universitas AirLangga, Surabaya, Indonesia
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13
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Bozigar M, Lawson AB, Pearce JL, Svendsen ER, Vena JE. Using Bayesian time-stratified case-crossover models to examine associations between air pollution and "asthma seasons" in a low air pollution environment. PLoS One 2021; 16:e0260264. [PMID: 34879071 PMCID: PMC8654232 DOI: 10.1371/journal.pone.0260264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. Most health effects studies of air pollution use meteorological (e.g., warm/cool) or astronomical (e.g., solstice/equinox) definitions of seasons despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden (i.e., “asthma seasons”). We introduce asthma seasons to elucidate whether air pollutants are associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. Within a Bayesian time-stratified case-crossover framework, we quantify seasonal associations between highly resolved estimates of six criteria air pollutants, two weather variables, and asthma ED visits among 66,092 children ages 5–19 living in South Carolina (SC) census tracts from 2005 to 2014. Results show that coarse particulates (particulate matter <10 μm and >2.5 μm: PM10-2.5) and nitrogen oxides (NOx) may contribute to asthma ED visits across years, but are particularly implicated in the highest-burden fall asthma season. Fine particulate matter (<2.5 μm: PM2.5) is only associated in the lowest-burden summer asthma season. Relatively cool and dry conditions in the summer asthma season and increased temperatures in the spring and fall asthma seasons are associated with increased ED visit odds. Few significant associations in the medium-burden winter and medium-high-burden spring asthma seasons suggest other ED visit drivers (e.g., viral infections) for each, respectively. Across rural and urban areas characterized by generally low air pollution levels, there are acute health effects associated with particulate matter, but only in the summer and fall asthma seasons and differing by PM size.
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Affiliation(s)
- Matthew Bozigar
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Erik R. Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
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Roblin DW, Jones JW, Fuller CH. Pollen Exposure and Associated Healthcare Utilization: A Population-based Study Using Health Maintenance Organization Data in the Washington, DC, Area. Ann Am Thorac Soc 2021; 18:1642-1649. [PMID: 33794139 PMCID: PMC8522299 DOI: 10.1513/annalsats.202008-976oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: Most studies of the healthcare utilization impact of pollen exposure have focused on emergency department visits or hospital admissions. However, other frequent but lower cost services-phone calls and e-mails to providers and office visits-may also be affected. Objectives: The objective of our study was to estimate the impact of tree and grass pollen exposures on respiratory-related healthcare utilization across a range of medical services, including calls and e-mails to providers, nonurgent face-to-face visits, urgent and emergent care visits, and hospitalizations. Methods: We conducted a retrospective observational study of daily tree and grass pollen counts linked to electronic health records of Kaiser Permanente beneficiaries in the metropolitan Washington, DC, area for 2013-2014. Results: The proportion of Kaiser Permanente beneficiaries with respiratory-related healthcare utilization was significantly greater (for P ⩽ 0.05) given a 1 standard deviation increase in same-day pollen exposure. For tree pollen, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.77% (95% confidence interval [CI], 0.07-4.17%) for urgent and emergent care visits to 12.84% (95% CI, 11.02-14.65%) for provider calls/e-mails. For grass pollen exposure, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.42% (95% CI, 0.39-2.46) for provider face-to-face visits to 11.09% (95% CI, 9.26-12.92) for provider calls/e-mails. Conclusions: Increased pollen exposure was associated with increases in healthcare utilization across a range of services, with relatively higher increases in provider calls/e-mails and lower increases in emergent or acute care. If climate change increases intensity and geographic scope of pollen exposure as predicted and if this study's estimates of association of peak pollen exposure on healthcare utilization are generalizable, then the impact of climate change on healthcare utilization may be significant.
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Affiliation(s)
- Douglas W. Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland
| | - Jordan W. Jones
- Economic Research Service, U.S. Department of Agriculture, Kansas City, Missouri; and
| | - Christina H. Fuller
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia
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15
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Schramm PJ, Brown CL, Saha S, Conlon KC, Manangan AP, Bell JE, Hess JJ. A systematic review of the effects of temperature and precipitation on pollen concentrations and season timing, and implications for human health. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1615-1628. [PMID: 33877430 PMCID: PMC9016682 DOI: 10.1007/s00484-021-02128-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/22/2021] [Accepted: 04/04/2021] [Indexed: 05/19/2023]
Abstract
Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to "wash out" effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals.
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Affiliation(s)
- P J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA.
| | - C L Brown
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - S Saha
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - K C Conlon
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA
| | - A P Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - J E Bell
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - J J Hess
- Departments of Emergency Medicine, Environmental and Occupational Health Sciences, and Global Health, and the Center for Health and the Global Environment, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
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16
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De Roos AJ, Kenyon CC, Zhao Y, Moore K, Melly S, Hubbard RA, Henrickson SE, Forrest CB, Diez Roux AV, Maltenfort M, Schinasi LH. Ambient daily pollen levels in association with asthma exacerbation among children in Philadelphia, Pennsylvania. ENVIRONMENT INTERNATIONAL 2020; 145:106138. [PMID: 32961469 DOI: 10.1016/j.envint.2020.106138] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/07/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Pollen from trees, grasses, and weeds can trigger asthma exacerbation in sensitized individuals. However, there are gaps in knowledge about the effects, such as the relative risks from different plant taxa and threshold levels of effect. We aimed to describe the local association between pollen and asthma exacerbation among children in the City of Philadelphia, and to evaluate whether effects are modified by children's characteristics and clinical factors (e.g., child's age, race/ethnicity, comorbidities). We conducted a time-stratified case-crossover study of pediatric (age <18 years) asthma exacerbation, with cases identified through electronic health records (EHR) of the Children's Hospital of Philadelphia (CHOP) health system from March through October in the years 2011-2016. Daily pollen counts were obtained from the local National Allergy Bureau certified pollen counter. We applied conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between the pollen level (vs. none detected) and odds of asthma exacerbation, adjusting for temperature, relative humidity, and holidays. We estimated same-day exposure effects, as well as effects from exposure lagged by up to 5 days. There were 35,040 asthma exacerbation events during the study period, with the majority occurring among black, non-Hispanic children (81.8%) and boys (60.4%). We found increased odds of asthma exacerbation among Philadelphia children in association with tree pollen, both for total tree pollen and most individual tree types. Increased odds from total tree pollen were observed at the lowest levels studied (≤5 grains/m3, unlagged, OR = 1.06, 95% CI: 1.02, 1.10), and exhibited a positive exposure-response pattern of effect; tree pollen levels above 1000 grains/m3 (unlagged) were associated with 64% increased odds of asthma exacerbation (95% CI: 1.45, 1.84). Grass pollen was associated with asthma exacerbation only at levels above the 99th percentile (52 grains/m3), which occurred, on average, two days per year during the study period (with 2-day lag, OR = 1.38, 95% CI: 1.19, 1.60). There was an inverse association (reduced asthma exacerbation) with ragweed pollen that was consistent across analyses. Pollen from other weeds was associated with increased odds of asthma exacerbation, without a clear exposure-response pattern (2-day lag, significant increases ranging from 8% to 19%). Increased odds from tree pollen and weeds (other than ragweed) were higher among children with allergic rhinitis. While there are known benefits from urban vegetation for human health, there are risks as well. It is important to note, however, that pollen is released during a limited time frame each year, and advisories informed by local data can enable susceptible individuals to avoid outdoor exposure on high-risk days.
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Affiliation(s)
- Anneclaire J De Roos
- Department of Environmental & Occupational Health, Dornsife School of Public Health, Drexel University, 3215 Market St, 6(th) floor, Philadelphia, PA 19104, United States.
| | - Chén C Kenyon
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399, United States
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, 7th floor, Philadelphia, PA 19104, United States
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, 7th floor, Philadelphia, PA 19104, United States
| | - Steve Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, 7th floor, Philadelphia, PA 19104, United States
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania School of Medicine, 604 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Sarah E Henrickson
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399, United States
| | - Christopher B Forrest
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399, United States
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, 7th floor, Philadelphia, PA 19104, United States
| | - Mitchell Maltenfort
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399, United States
| | - Leah H Schinasi
- Department of Environmental & Occupational Health, Dornsife School of Public Health, Drexel University, 3215 Market St, 6(th) floor, Philadelphia, PA 19104, United States
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The Impact of Climate Change on Pollen Season and Allergic Sensitization to Pollens. Immunol Allergy Clin North Am 2020; 41:97-109. [PMID: 33228876 DOI: 10.1016/j.iac.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pollens are a major cause of seasonal allergic diseases. Weather may alter the production of pollens. Increased atmospheric temperatures lead to earlier pollination of many plants and longer duration of pollination, resulting in extended pollen seasons, with early spring or late winter. Longer pollen seasons increase duration of exposure, resulting in more sensitization, and higher pollen concentrations may lead to more severe symptoms. Climate changes in contact to pollens may affect both allergic sensitization and symptom prevalence with severity. The future consequences of climate change, however, are speculative, because the influence on humans, is complex.
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Shrestha SK, Lambert KA, Erbas B. Ambient pollen concentrations and asthma hospitalization in children and adolescents: a systematic review and meta-analysis. J Asthma 2020; 58:1155-1168. [PMID: 32419541 DOI: 10.1080/02770903.2020.1771726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ObjectiveWe aimed to conduct a systematic review examining the association between outdoor pollen and childhood asthma hospitalizations.Data SourceA systematic search of articles in MEDLINE, EMBASE, CINAHL, ProQuest Central, Web of Science and Google Scholar published to 18 July 2019.Study selection: Studies that presented data on pollen exposure and childhood asthma hospitalization were included and evaluated for potential risk of bias by two independent authors. Random effects meta-analysis was performed where possible.ResultsA total of 1048 records were identified, and twelve studies included in the review. The synthesis suggested possible associations between outdoor pollen, especially for grass and birch and childhood asthma hospitalization. However, the results varied widely across geographical areas and settings for other pollen taxa. The meta-analysis of the case-crossover studies showed a positive association between grass and childhood asthma hospitalization, an increase in 10 grass pollen grains/m3 was associated with a 3% increase in childhood asthma admission (OR = 1.03; 95%CI:1.01, 1.04), but the pooled estimate was not significant for timeseries studies. The meta-analysis of the timeseries studies for birch pollen showed an increase in 10 pollen grains/m3 being significantly associated with a Mean Percentage Change (MPC) in childhood asthma admissions (MPC= 0.85; 95%CI:0.40, 1.30).Conclusion: Globally, grass and birch pollen are important triggers of childhood asthma hospitalization, but the association could not be ascertained for other pollen taxa. Pollen is a major environmental trigger of asthma exacerbations and more focus on early interventions to reduce this burden needs to be considered.
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Affiliation(s)
- Som Kumar Shrestha
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Katrina Anne Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Olaniyan T, Dalvie MA, Röösli M, Naidoo RN, Künzli N, de Hoogh K, Berman D, Parker B, Leaner J, Jeebhay MF. Short term seasonal effects of airborne fungal spores on lung function in a panel study of schoolchildren residing in informal settlements of the Western Cape of South Africa. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 260:114023. [PMID: 32018199 DOI: 10.1016/j.envpol.2020.114023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/05/2019] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The individual effects of biological constituents of particulate matter (PM) such as fungal spores, on lung function in children are not well known. This study investigated the seasonal short-term effect of daily variation in Alternaria and Cladosporium fungal spores on lung function in schoolchildren. METHODS This panel study evaluated 313 schoolchildren in informal settlements of the Western Cape of South Africa, exposed to spores of two commonly encountered fungi, Alternaria and Cladosporium species. The children provided forced-expiratory volume in 1-s (FEV1) and peak-expiratory flow (PEF) measurements thrice daily for two consecutive school-weeks in summer and winter. Daily PM10 levels, from a stationary ambient air quality monitor and fungal spore levels using spore traps were measured in each study area throughout the year. The effects of Alternaria and Cladosporium spores, on lung function were analysed for lag periods up to five-days, adjusting-for PM10, other pollen exposures, study area, and other host and meteorological factors. Same-day exposure-response curves were computed for both fungal species. RESULTS There was more variability in Alternaria spores level with noticeable peaks in summer. There were consistent lag-effects for Alternaria on PEF compared to Cladosporium, with the largest PEF deficit observed in winter (mean deficit: 13.78 L/min, 95%CI: 24.34 to -3.23 L/min) per 10spores/m3 increase in Alternaria spores on lag day-2. Although there were no observable lag-effects for Alternaria and Cladosporium on FEV1, same-day effects of Cladosporium spores on FEV1 was present across both seasons. Threshold effects of Alternaria on both PEF and FEV1 deficits were apparent at levels of 100 spores/m3, but could not be explored for Cladosporium beyond the levels observed during the study. CONCLUSION The study provides evidence for the independent effects of daily exposure to ambient fungal spores of Alternaria and Cladosporium on lung function deficits, more especially in winter for PEF.
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Affiliation(s)
- Toyib Olaniyan
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | | | - Nino Künzli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Dilys Berman
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Bhawoodien Parker
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, South Africa.
| | - Joy Leaner
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, South Africa.
| | - Mohamed F Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Division of Occupational Medicine, University of Cape Town, Cape Town, South Africa.
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20
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Katz DS, Batterman SA. Allergenic pollen production across a large city for common ragweed ( Ambrosia artemisiifolia). LANDSCAPE AND URBAN PLANNING 2019; 190:103615. [PMID: 32831442 PMCID: PMC7442281 DOI: 10.1016/j.landurbplan.2019.103615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Predictions of airborne allergenic pollen concentrations at fine spatial scales require information on source plant location and pollen production. Such data are lacking at the urban scale, largely because manually mapping allergenic pollen producing plants across large areas is infeasible. However, modest-sized field surveys paired with allometric equations, remote sensing, and habitat distribution models can predict where these plants occur and how much pollen they produce. In this study, common ragweed (Ambrosia artemisiifolia) was mapped in a field survey in Detroit, MI, USA. The relationship between ragweed presence and habitat-related variables derived from aerial imagery, LiDAR, and municipal data were used to create a habitat distribution model, which was then used to predict ragweed presence across the study area (392 km2). The relationship between inflorescence length and pollen production was used to predict pollen production in the city. Ragweed occurs in 1.7% of Detroit and total pollen production is 312 × 1012 pollen grains annually, but ragweed presence was highly heterogeneous across the city. Ragweed was predominantly found in in vacant lots (75%) and near demolished structures (48%), and had varying associations with land cover types (e.g., sparse vegetation, trees, pavement) detected by remote sensing. These findings also suggest several management strategies that could help reduce levels of allergenic pollen, including appropriate post-demolition management practices. Spatially-resolved predictions for pollen production will allow mechanistic modeling of airborne allergenic pollen and improved exposure estimates for use in epidemiological and other applications.
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Affiliation(s)
- Daniel S.W. Katz
- Corresponding author at: 6653 SPH 1, 1415 Washington Heights Rd., Ann Arbor, MI 48109, USA. (D.S.W. Katz), (S.A. Batterman)
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21
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Bundle N, Verlander NQ, Morbey R, Edeghere O, Balasegaram S, de Lusignan S, Smith G, Elliot AJ. Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012-2016. J Epidemiol Community Health 2019; 73:825-831. [PMID: 31262728 DOI: 10.1136/jech-2018-211936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/12/2019] [Accepted: 05/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND : Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England. METHODS : Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression. RESULTS : BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5-3 times higher in the BTS excess period, with a significantly higher effect among children aged 0-4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years. CONCLUSION: We found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.
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Affiliation(s)
- Nick Bundle
- United Kingdom Field Epidemiology Training Programme, Public Health England, London, UK.,Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Neville Q Verlander
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Obaghe Edeghere
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Sooria Balasegaram
- Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Simon de Lusignan
- Research & Surveillance Centre, Royal College of General Practitioners, London, UK.,Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
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22
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Neumann JE, Anenberg SC, Weinberger KR, Amend M, Gulati S, Crimmins A, Roman H, Fann N, Kinney PL. Estimates of Present and Future Asthma Emergency Department Visits Associated With Exposure to Oak, Birch, and Grass Pollen in the United States. GEOHEALTH 2019; 3:11-27. [PMID: 31106285 PMCID: PMC6516486 DOI: 10.1029/2018gh000153] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 05/18/2023]
Abstract
Pollen is an important environmental cause of allergic asthma episodes. Prior work has established a proof of concept for assessing projected climate change impacts on future oak pollen exposure and associated health impacts. This paper uses additional monitor data and epidemiologic functions to extend prior analyses, reporting new estimates of the current and projected future health burden of oak, birch, and grass pollen across the contiguous United States. Our results suggest that tree pollen in the spring currently accounts for between 25,000 and 50,000 pollen-related asthma emergency department (ED) visits annually (95% confidence interval: 14,000 to 100,000), roughly two thirds of which occur among people under age 18. Grass pollen in the summer season currently accounts for less than 10,000 cases annually (95% confidence interval: 4,000 to 16,000). Compared to a baseline with 21st century population growth but constant pollen, future temperature and precipitation show an increase in ED visits of 14% in 2090 for a higher greenhouse gas emissions scenario, but only 8% for a moderate emissions scenario, reflecting projected increases in pollen season length. Grass pollen, which is more sensitive to changes in climatic conditions, is a primary contributor to future ED visits, with the largest effects in the Northeast, Midwest, and Southern Great Plains regions. More complete assessment of the current and future health burden of pollen is limited by the availability of data on pollen types (e.g., ragweed), other health effects (e.g., other respiratory disease), and economic consequences (e.g., medication costs).
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Affiliation(s)
| | | | - Kate R. Weinberger
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | | | | | | | | | - Neal Fann
- U.S. Environmental Protection Agency, Research Triangle ParkNorth CarolinaUSA
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23
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Bousquet J, Anto JM, Annesi-Maesano I, Dedeu T, Dupas E, Pépin JL, Eyindanga LSZ, Arnavielhe S, Ayache J, Basagana X, Benveniste S, Venturos NC, Chan HK, Cheraitia M, Dauvilliers Y, Garcia-Aymerich J, Jullian-Desayes I, Dinesh C, Laune D, Dac JL, Nujurally I, Pau G, Picard R, Rodo X, Tamisier R, Bewick M, Billo NE, Czarlewski W, Fonseca J, Klimek L, Pfaar O, Bourez JM. POLLAR: Impact of air POLLution on Asthma and Rhinitis; a European Institute of Innovation and Technology Health (EIT Health) project. Clin Transl Allergy 2018; 8:36. [PMID: 30237869 PMCID: PMC6139902 DOI: 10.1186/s13601-018-0221-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/12/2018] [Indexed: 12/31/2022] Open
Abstract
Allergic rhinitis (AR) is impacted by allergens and air pollution but interactions between air pollution, sleep and allergic diseases are insufficiently understood. POLLAR (Impact of air POLLution on sleep, Asthma and Rhinitis) is a project of the European Institute of Innovation and Technology (EIT Health). It will use a freely-existing application for AR monitoring that has been tested in 23 countries (the Allergy Diary, iOS and Android, 17,000 users, TLR8). The Allergy Diary will be combined with a new tool allowing queries on allergen, pollen (TLR2), sleep quality and disorders (TRL2) as well as existing longitudinal and geolocalized pollution data. Machine learning will be used to assess the relationship between air pollution, sleep and AR comparing polluted and non-polluted areas in 6 EU countries. Data generated in 2018 will be confirmed in 2019 and extended by the individual prospective assessment of pollution (portable sensor, TLR7) in AR. Sleep apnea patients will be used as a demonstrator of sleep disorder that can be modulated in terms of symptoms and severity by air pollution and AR. The geographic information system GIS will map the results. Consequences on quality of life (EQ-5D), asthma, school, work and sleep will be monitored and disseminated towards the population. The impacts of POLLAR will be (1) to propose novel care pathways integrating pollution, sleep and patients' literacy, (2) to study sleep consequences of pollution and its impact on frequent chronic diseases, (3) to improve work productivity, (4) to propose the basis for a sentinel network at the EU level for pollution and allergy, (5) to assess the societal implications of the interaction. MASK paper N°32.
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Affiliation(s)
- Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
- INSERM U 1168, VIMA : Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France
- Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
- Euforea, Brussels, Belgium
- Charité, Berlin, Germany
- CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Josep M. Anto
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM and UPMC Sorbonne Universités, Medical School Saint Antoine, Paris, France
| | | | | | - Jean-Louis Pépin
- Université Grenoble Alpes, Laboratoire HP2, INSERM, U1042 Grenoble, France
- CHU de Grenoble, Grenoble, France
| | | | | | - Julia Ayache
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France
- Memory and Cognition Laboratory, Institute of Psychology, Paris Descartes University, Sorbonne Paris Cité, Boulogne Billancourt, France
| | - Xavier Basagana
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France
- Mines ParisTech CRI - PSL Research University, Fontainebleau, France
| | - Nuria Calves Venturos
- Direction de la Recherche, Innovation et Valorisation, Université Grenoble Alpes, Grenoble, France
| | | | | | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Département de Neurologie, Hôpital Gui-de-Chauliac Inserm U1061, Unité des Troubles du Sommeil, Montpellier, France
| | | | - Ingrid Jullian-Desayes
- Université Grenoble Alpes, Laboratoire HP2, INSERM, U1042 Grenoble, France
- CHU de Grenoble, Grenoble, France
| | | | | | | | | | | | - Robert Picard
- Conseil Général de l’Economie Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
| | - Xavier Rodo
- Climate and Health Program and ISGlobal and ICREA, Barcelona, Spain
| | - Renaud Tamisier
- Université Grenoble Alpes, Laboratoire HP2, INSERM, U1042 Grenoble, France
- CHU de Grenoble, Grenoble, France
| | | | | | | | - Joao Fonseca
- Center for Health Technology and Services Research- CINTESIS, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- MEDIDA, Lda, Porto, Portugal
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Oliver Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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24
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Witonsky J, Abraham R, Toh J, Desai T, Shum M, Rosenstreich D, Jariwala SP. The association of environmental, meteorological, and pollen count variables with asthma-related emergency department visits and hospitalizations in the Bronx. J Asthma 2018; 56:927-937. [PMID: 30207818 DOI: 10.1080/02770903.2018.1514627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To better understand how meteorological variables, air quality variables, and pollen counts collectively contribute to asthma-related emergency department visits (AREDV) and asthma-related hospitalizations (ARH) among pediatric and adult patients in the New York City borough of the Bronx. Methods: The numbers of daily adult and pediatric AREDV and ARH from 2001 to 2008 were obtained from three Bronx hospitals. After removing outliers, interpolating missing data, and standardizing variable values by scaling the data using z-scores, data were analyzed using Spearman rank tests and linear regression models for the full year and each season. Results: There were a total of 42,065 AREDV and 1,664 ARH at both Bronx hospitals. With the exception of a spring peak in AREDVs, AREDVs and ARHs follow a cyclical pattern, climbing in the fall, plateauing in the winter, dropping in the spring, and reaching a low in the summer. Among the 11 air quality, meteorological, and pollen count variables, temperature and tree pollen made the greatest contribution to AREDV with scaled coefficients of -0.337 and 0.311 respectively; equating to an additional AREDV for every 5.0-unit decrease in temperature and an additional AREDV for every 186.0-unit increase in tree pollen. These two variables were confirmed to have independent associations with AREDV prior to the data interpolation. Grass pollen was also found to have a relatively large contribution to AREDV during the summer with a scaled coefficient of 0.314, equating to an additional AREDV for every 2.3-unit increase in grass pollen. Conclusion: There are distinct peaks of increased AREDVs that are closely associated with increased tree pollen counts in the spring and decreasing temperatures in the fall. Early anticipation of these air quality, meteorological, and pollen factor changes based on ongoing surveillance could potentially guide clinical practice and minimize AREDVs in the Bronx.
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Affiliation(s)
- Jonathan Witonsky
- a Department of Pediatrics, University of California , San Francisco , CA , USA ; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Abraham
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Jennifer Toh
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Tulsi Desai
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Mili Shum
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - David Rosenstreich
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Sunit P Jariwala
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
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25
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Shrestha SK, Katelaris C, Dharmage SC, Burton P, Vicendese D, Tham R, Abramson MJ, Erbas B. High ambient levels of grass, weed and other pollen are associated with asthma admissions in children and adolescents: A large 5-year case-crossover study. Clin Exp Allergy 2018; 48:1421-1428. [PMID: 29975808 DOI: 10.1111/cea.13225] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pollen is an important aeroallergen that triggers asthma exacerbations in children, but we know little about the impact of different pollen types in cities with varying climatic conditions and pollen seasons. OBJECTIVES We aimed to assess the role of ambient level of different types of pollen on a large time series of child and adolescent asthma hospitalizations in Sydney, Australia. METHODS Childhood asthma hospitalization and the daily ambient pollen concentrations of different species were collected in South-West Sydney. With a bidirectional case-crossover design, we fitted conditional logistic regression models to measure the associations between instantaneous and up to 3 days lagged effects of pollen concentrations on asthma hospitalizations after controlling for potential confounders and testing for interactions. RESULTS A total of 2098 children, more boys (59.7%) and 2-5 years old (62.6%), were hospitalized due to asthma. The geometric mean concentration of Cupressus, 7.88 [5.02] grains/m3 , was the highest during the study period. The increase from 75th to 90th percentile of grass (OR = 1.037, 95% CI 1.005-1.070), weed other than Plantago species (OR = 1.053, 95% CI 1.009-1.098) and unclassified pollen (OR = 1.034, 95% CI 1.010-1.058) were significantly associated with the odds of asthma hospitalizations. Boys were at greater risk of asthma exacerbations associated with grass (OR = 1.046, 95% CI 1.003-1.090) and unclassified pollen (OR = 1.041, 95% CI 1.010-1.073). There was evidence of effect modification by age groups for Cupressus, conifer, total tree and total pollen. CONCLUSIONS Although boys are more vulnerable to grass pollen, weed, and other pollen are also important triggers of asthma exacerbations in all children and adolescents. These findings are important for urban green space planning and the development of pollen monitoring systems for families with children at risk of asthma exacerbations during peak pollen seasons.
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Affiliation(s)
- Som K Shrestha
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | | | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Pamela Burton
- Department of Medicine, Campbelltown Hospital, Sydney, NSW, Australia
| | - Don Vicendese
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Rachel Tham
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
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26
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Erbas B, Jazayeri M, Lambert KA, Katelaris CH, Prendergast LA, Tham R, Parrodi MJ, Davies J, Newbigin E, Abramson MJ, Dharmage S. Outdoor pollen is a trigger of child and adolescent asthma emergency department presentations: A systematic review and meta-analysis. Allergy 2018; 73:1632-1641. [PMID: 29331087 DOI: 10.1111/all.13407] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the context of increased asthma exacerbations associated with climatic changes such as thunderstorm asthma, interest in establishing the link between pollen exposure and asthma hospital admissions has intensified. Here, we systematically reviewed and performed a meta-analysis of studies on pollen and emergency department (ED) attendance. METHODS A search for studies with appropriate search strategy in MEDLINE, EMBASE, Web of Science and CINAHL was conducted. Each study was assessed for quality and risk of bias. The available evidence was summarized both qualitatively and meta-analysed using random-effects models when moderate heterogeneity was observed. RESULTS Fourteen studies were included. The pollen taxa investigated differed between studies, allowing meta-analysis only of the effect of grass pollen. A statistically significant increase in the percentage change in the mean number of asthma ED presentations (MPC) (pooled results from 3 studies) was observed for an increase in 10 grass pollen grains per cubic metre of exposure 1.88% (95% CI = 0.94%, 2.82%). Time series studies showed positive correlations between pollen concentrations and ED presentations. Age-stratified studies found strongest associations in children aged 5-17 years old. CONCLUSION Exposure to ambient grass pollen is an important trigger for childhood asthma exacerbations requiring ED attendance. As pollen exposure is increasingly a problem especially in relation to thunderstorm asthma, studies with uniform measures of pollen and similar analytical methods are necessary to fully understand its impact on human health.
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Affiliation(s)
- B. Erbas
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - M. Jazayeri
- Department of Mathematics and Statistics; La Trobe University; Bundoora Vic. Australia
| | - K. A. Lambert
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - C. H. Katelaris
- Department of Medicine, Immunology and Allergy; Campbelltown Hospital; Western Sydney University; Campbelltown NSW Australia
| | - L. A. Prendergast
- Department of Mathematics and Statistics; La Trobe University; Bundoora Vic. Australia
| | - R. Tham
- Allergy and Lung Health Unit; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
| | - M. J. Parrodi
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - J. Davies
- Institute of Health and Biomedical Innovation; Queensland University of Technology; South Brisbane Qld Australia
| | - E. Newbigin
- School of Biosciences; University of Melbourne; Melbourne Vic. Australia
| | - M. J. Abramson
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
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27
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Sierra-Heredia C, North M, Brook J, Daly C, Ellis AK, Henderson D, Henderson SB, Lavigne É, Takaro TK. Aeroallergens in Canada: Distribution, Public Health Impacts, and Opportunities for Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1577. [PMID: 30044421 PMCID: PMC6121311 DOI: 10.3390/ijerph15081577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/04/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Aeroallergens occur naturally in the environment and are widely dispersed across Canada, yet their public health implications are not well-understood. This review intends to provide a scientific and public health-oriented perspective on aeroallergens in Canada: their distribution, health impacts, and new developments including the effects of climate change and the potential role of aeroallergens in the development of allergies and asthma. The review also describes anthropogenic effects on plant distribution and diversity, and how aeroallergens interact with other environmental elements, such as air pollution and weather events. Increased understanding of the relationships between aeroallergens and health will enhance our ability to provide accurate information, improve preventive measures and provide timely treatments for affected populations.
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Affiliation(s)
| | - Michelle North
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H7, Canada.
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Jeff Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M3H 5T4, Canada.
| | - Christina Daly
- Air Quality Health Index, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Anne K Ellis
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Dave Henderson
- Health and Air Quality Services, Environment and Climate Change Canada, Gatineau, QC K1A 0H3, Canada.
| | - Sarah B Henderson
- Environmental Health Services, BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON K1A 0K9, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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28
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Sundaresan AS, Schneider G, Reynolds J, Kirchner HL. Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data. Appl Clin Inform 2018; 9:528-540. [PMID: 30040112 PMCID: PMC6051766 DOI: 10.1055/s-0038-1666994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome.
Objective
We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population.
Methods
We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset.
Results
There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms.
Conclusion
We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.
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Affiliation(s)
- Agnes S Sundaresan
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, United States.,Medicine Institute, Geisinger Health System, Danville, Pennsylvania, United States
| | - Gargi Schneider
- MedPeds Program, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Joy Reynolds
- Lewis Katz School of Medicine at Temple University, Temple University, Philadelphia, Pennsylvania, United States
| | - H Lester Kirchner
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States.,Department of Clinical Sciences, Geisinger Commonwealth School of Medicine, Geisinger Health System, Scranton, Pennsylvania, United States.,Department of Pediatrics, Global and Immigrant Health Section, Baylor College of Medicine, Houston, Texas, United States
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29
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Guilbert A, Cox B, Bruffaerts N, Hoebeke L, Packeu A, Hendrickx M, De Cremer K, Bladt S, Brasseur O, Van Nieuwenhuyse A. Relationships between aeroallergen levels and hospital admissions for asthma in the Brussels-Capital Region: a daily time series analysis. Environ Health 2018; 17:35. [PMID: 29642904 PMCID: PMC5896062 DOI: 10.1186/s12940-018-0378-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/28/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Outdoor pollen grain and fungal spore concentrations have been associated with severe asthma exacerbations at the population level. The specific impact of each taxon and the concomitant effect of air pollution on these symptoms have, however, still to be better characterized. This study aimed to investigate the short-term associations between ambient concentrations of various aeroallergens and hospitalizations related to asthma in the Brussels-Capital Region (Belgium), an area recording especially high rates of admissions. METHODS Based on administrative records of asthma hospitalizations and regular monitoring of 11 tree/herbaceous pollen taxa and 2 fungal spore taxa, daily time series analyses covering the 2008-2013 period were performed. Effects up to 6 days after exposure were captured by combining quasi-Poisson regression with distributed lag models, adjusting for seasonal and long-term trends, day of the week, public holidays, mean temperature and relative humidity. Effect modification by age and air pollution (PM, NO2, O3) was tested. RESULTS A significant increase in asthma hospitalizations was observed for an interquartile range increase in grass (5.9%, 95% CI: 0.0, 12.0), birch (3.2%, 95% CI: 1.1, 5.3) and hornbeam (0.7%, 95% CI: 0.2, 1.3) pollen concentrations. For several taxa including grasses, an age modification effect was notable, the hospitalization risk tending to be higher in individuals younger than 60 years. Air pollutants impacted the relationships too: the risk appeared to be stronger for grass and birch pollen concentrations in case of high PM10 and O3 concentrations respectively. CONCLUSIONS These findings suggest that airborne grass, birch and hornbeam pollen are associated with severe asthma exacerbations in the Brussels region. These compounds appear to act in synergy with air pollution and to more specifically affect young and intermediate age groups. Most of these life-threatening events could theoretically be prevented with improved disease diagnosis/management and targeted communication actions.
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Affiliation(s)
- Ariane Guilbert
- Health and Environment Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Bianca Cox
- Centre for Environmental Sciences, Hasselt University, Campus Diepenbeek Agoralaan Gebouw D, 3590 Diepenbeek, Belgium
| | - Nicolas Bruffaerts
- Mycology and Aerobiology Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Lucie Hoebeke
- Mycology and Aerobiology Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Ann Packeu
- Mycology and Aerobiology Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Marijke Hendrickx
- Mycology and Aerobiology Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Koen De Cremer
- Health and Environment Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Sandrine Bladt
- Laboratory and Air Quality Department, Brussels Environment, Avenue du Port 86c-3000, 1000 Brussels, Belgium
| | - Olivier Brasseur
- Laboratory and Air Quality Department, Brussels Environment, Avenue du Port 86c-3000, 1000 Brussels, Belgium
| | - An Van Nieuwenhuyse
- Health and Environment Unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
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Romero-Morte J, Rojo J, Rivero R, Fernández-González F, Pérez-Badia R. Standardised index for measuring atmospheric grass-pollen emission. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 612:180-191. [PMID: 28850837 DOI: 10.1016/j.scitotenv.2017.08.139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Grass pollen is the main cause of pollen allergy in Europe, and-given its marked allergenic potential and elevated airborne concentrations-constitutes a major public health risk. This study sought to identify the grass species triggering allergies during the highest-risk periods, and to measure the contribution of each species to airborne grass pollen concentrations. This type of research is particularly useful with a view to optimising the prevention and diagnosis of pollen allergies and developing the most effective immunological treatments. To that end, a total of 28 species potentially responsible for allergies were analysed. In order to assess the potential contribution of these species to overall airborne pollen concentrations, an index was designed (Pollen Contribution Index) based on the following parameters for each species: flowering phenology, pollen grain size (polar and equatorial axes), abundance of the species in the area and pollen production. The species contributing most to airborne pollen concentrations were, in order: Dactylis glomerata subsp. hispanica, Lolium rigidum, Trisetum paniceum and Arrhenatherum album. These species all shared certain features: small grain size (and thus greater buoyancy in air), high pollen production and considerable abundance. This Index was applied to a case study in a Mediterranean-climate area of the central Iberian Peninsula, but could equally be applied to other areas and other allergenic pollens. Findings showed that a small number of species were responsible for most airborne grass pollen.
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Affiliation(s)
- Jorge Romero-Morte
- Institute of Environmental Sciences (Botany), University of Castilla-La Mancha, E-45071 Toledo, Spain
| | - Jesús Rojo
- Institute of Environmental Sciences (Botany), University of Castilla-La Mancha, E-45071 Toledo, Spain.
| | - Rosario Rivero
- Institute of Environmental Sciences (Botany), University of Castilla-La Mancha, E-45071 Toledo, Spain
| | | | - Rosa Pérez-Badia
- Institute of Environmental Sciences (Botany), University of Castilla-La Mancha, E-45071 Toledo, Spain
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31
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Camacho I, Grinn-Gofroń A, Camacho R, Berenguer P, Sadyś M. Madeira-a tourist destination for asthma sufferers. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:1739-1751. [PMID: 27240963 DOI: 10.1007/s00484-016-1163-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
Madeira Island is a famous tourist destination due to its natural and climatic values. Taking into account optimal weather conditions, flora richness and access to various substrates facilitating fungal growth, we hypothesised a very high risk of elevated fungal spore and pollen grain concentrations in the air of Funchal, the capital of Madeira. Concentration levels of the most allergenic taxa were measured from 2003 to 2009, using a 7-day volumetric air sampler, followed by microscopy analysis. Dependence of bioaerosols on the weather conditions and land use were assessed using spatial and statistical tools. Obtained results were re-visited by a comparison with hospital admission data recorded at the Dr. Nélio Mendonça Hospital in Funchal. Our results showed that despite propitious climatic conditions, overall pollen grain and fungal spore concentrations in the air were very low and did not exceed any clinically established threshold values. Pollen and spore peak concentrations also did not match with asthma outbreaks in the winter. Identification of places that are "free" from biological air pollution over the summer, such as Madeira Island, is very important from the allergic point of view.
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Affiliation(s)
- Irene Camacho
- Life Science Competence Centre, Madeira University, Campus Universitário da Penteada, 9000-390, Funchal, Portugal.
| | - Agnieszka Grinn-Gofroń
- Department of Plant Taxonomy and Phytogeography, University of Szczecin, Wąska 13 Street, 71-415, Szczecin, Poland
| | - Roberto Camacho
- Life Science Competence Centre, Madeira University, Campus Universitário da Penteada, 9000-390, Funchal, Portugal
| | - Pedro Berenguer
- Centro de Química da Madeira (CQM), Madeira University, Campus Universitário da Penteada, 9000-390, Funchal, Portugal
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Sun X, Waller A, Yeatts KB, Thie L. Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006-2012. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 544:185-91. [PMID: 26657364 DOI: 10.1016/j.scitotenv.2015.11.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/23/2015] [Accepted: 11/20/2015] [Indexed: 05/27/2023]
Abstract
Pollen has been generally linked to an increased risk for asthma exacerbation. However, the delayed effect (lag), the length of effect duration, and the association heterogeneity by pollen types have not been well characterized. Short-term associations between ambient concentration of various pollen types (tree, grass, and weed) and emergency department (ED) visits for asthma were assessed using data in Wake County, North Carolina, during 2006-2012. Distributed lag nonlinear models (DLNM) were used to characterize the associations, while adjusting for air pollutants, meteorological, and temporal factors. A strong association between same-day tree pollen and asthma ED visits was detected. This association lasted four days, with a 4-day cumulative risk ratio (RR) up to 2.10 (3500 grains/m(3) vs. 0 grains/m(3), 95% confidence interval [CI]=1.21-3.65). The associations of asthma ED visits with weed pollen and grass pollen were weak, suggestively starting from lag 2 and lasting 3 days, with the strongest association a 3-day cumulative RR of 1.08 (32 grains/m(3) vs. 0 grains/m(3), 95% CI=1.01-1.15) and 1.05 (11 grains/m(3) vs. 0 grains/m(3), 95% CI=1.00-1.11). Our results indicate that the association of ambient pollen and asthma exacerbation vary by pollen type, both quantitatively and temporally. These findings have important implications for optimizing targeted allergic disease prevention and management, and helping understand the etiology of ambient exposure-induced allergic diseases.
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Affiliation(s)
- Xuezheng Sun
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Anna Waller
- Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, United States
| | - Karin B Yeatts
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Lauren Thie
- North Carolina Department of Health and Human Services, Raleigh, NC 27699, United States.
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El-Qutob D. Vaccine development and new attempts of treatment for ragweed allergy. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:41-7. [PMID: 25922684 DOI: 10.1177/2051013614565354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ragweeds are flowering plants in the genus Ambrosia in the aster family, Asteraceae. They are distributed in the tropical and subtropical regions of the New World, especially North America. Short ragweed is the most important weed. The ragweed flowering occurs late in the summer and the pollination period extends from the beginning of August to mid-October. Sensitization to ragweed pollen has risen in United States in the past decade and probably worldwide. The major allergenic compound in the pollen has been identified as Amb a 1. Ragweed allergies usually cause allergic rhinitis and asthma. Ragweed allergic patients may show signs of oral allergy syndrome caused by crossreactivity between ragweed allergens and food allergens. In the present article, an update about vaccine development and new knowledge for ragweed allergy is exhaustively revised.
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Affiliation(s)
- David El-Qutob
- University Hospital La Plana, Carretera Vila-Real to Burriana km 0.5, Vila-Real, 12540, Spain
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Albertine JM, Manning WJ, DaCosta M, Stinson KA, Muilenberg ML, Rogers CA. Projected carbon dioxide to increase grass pollen and allergen exposure despite higher ozone levels. PLoS One 2014; 9:e111712. [PMID: 25372614 PMCID: PMC4221106 DOI: 10.1371/journal.pone.0111712] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022] Open
Abstract
One expected effect of climate change on human health is increasing allergic and asthmatic symptoms through changes in pollen biology. Allergic diseases have a large impact on human health globally, with 10-30% of the population affected by allergic rhinitis and more than 300 million affected by asthma. Pollen from grass species, which are highly allergenic and occur worldwide, elicits allergic responses in 20% of the general population and 40% of atopic individuals. Here we examine the effects of elevated levels of two greenhouse gases, carbon dioxide (CO2), a growth and reproductive stimulator of plants, and ozone (O3), a repressor, on pollen and allergen production in Timothy grass (Phleum pratense L.). We conducted a fully factorial experiment in which plants were grown at ambient and/or elevated levels of O3 and CO2, to simulate present and projected levels of both gases and their potential interactive effects. We captured and counted pollen from flowers in each treatment and assayed for concentrations of the allergen protein, Phl p 5. We found that elevated levels of CO2 increased the amount of grass pollen produced by ∼50% per flower, regardless of O3 levels. Elevated O3 significantly reduced the Phl p 5 content of the pollen but the net effect of rising pollen numbers with elevated CO2 indicate increased allergen exposure under elevated levels of both greenhouse gases. Using quantitative estimates of increased pollen production and number of flowering plants per treatment, we estimated that airborne grass pollen concentrations will increase in the future up to ∼200%. Due to the widespread existence of grasses and the particular importance of P. pratense in eliciting allergic responses, our findings provide evidence for significant impacts on human health worldwide as a result of future climate change.
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Affiliation(s)
| | - William J. Manning
- Stockbridge School of Agriculture, University of Massachusetts, Amherst, MA 01003, United States of America
| | - Michelle DaCosta
- Stockbridge School of Agriculture, University of Massachusetts, Amherst, MA 01003, United States of America
| | - Kristina A. Stinson
- Department of Environmental Conservation, University of Massachusetts, Amherst, MA 01003, United States of America
| | - Michael L. Muilenberg
- Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, United States of America
| | - Christine A. Rogers
- Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, United States of America
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Kim J, Lim Y, Kim H. Outdoor temperature changes and emergency department visits for asthma in Seoul, Korea: A time-series study. ENVIRONMENTAL RESEARCH 2014; 135:15-20. [PMID: 25261859 DOI: 10.1016/j.envres.2014.07.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 05/22/2023]
Abstract
BACKGROUND Extreme temperatures and temperature changes are known indicators of climate change, and large temperature variations for several consecutive days may affect human health such as exacerbating respiratory symptoms. The objective of this study was to determine the association between outdoor temperature change and asthma-related emergency department visits. In particular, this study examined seasonality and identified susceptible populations, such as the elderly. METHODS The health data for asthma-related emergency department visits were collected from July 1, 2007, to December 31, 2010 in Seoul, Korea, through the National Emergency Department Information System of the National Emergency Medical Center and we defined temperature change as the absolute difference of mean temperature between the current day and the previous day. We applied generalized linear models with an allowance of over-dispersion for quantifying the estimated effects of temperature change on asthma-related emergency department visits, adjusting for meteorological conditions, air pollution, and time trend. RESULTS In general, temperature change was adversely associated with asthma-related emergency department visits, with a 1-unit increase of temperature change associated with a 3.5% (95% CI 0.7, 6.4%) increase in emergency department visits. In addition, seasonal variation after adjusting for mean temperature and diurnal temperature range had an adverse effect in spring, summer, and fall and a protective effect in winter. Patients aged ≥65 years experienced the most prominent effect during the fall, with a 17.9% (95% CI 4.1, 33.6%) increase in emergency department visits per 1-unit increase of temperature change, whereas the other seasons showed no statistically significant association. CONCLUSIONS Along with diurnal temperature range, temperature change may be an alternative indicator of climate change. Temperature change variables are well-known and easy to communicate with the public relative to the health effects of outdoor temperature fluctuations.
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Affiliation(s)
- Jayeun Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak Gu, Seoul 151-752, Republic of Korea.
| | - Younhee Lim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
| | - Ho Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak Gu, Seoul 151-752, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine 2014; 31 Suppl 10:K12-20. [PMID: 24331069 DOI: 10.1016/j.vaccine.2013.06.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/08/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. RESULTS Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). CONCLUSIONS There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations.
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37
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Gleason JA, Bielory L, Fagliano JA. Associations between ozone, PM2.5, and four pollen types on emergency department pediatric asthma events during the warm season in New Jersey: a case-crossover study. ENVIRONMENTAL RESEARCH 2014; 132:421-9. [PMID: 24858282 DOI: 10.1016/j.envres.2014.03.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND Asthma is one of the most common chronic diseases among school-aged children in the United States. Environmental respiratory irritants exacerbate asthma among children. Understanding the impact of a variety of known and biologically plausible environmental irritants and triggers among children in New Jersey - ozone, fine particulate matter (PM2.5), tree pollen, weed pollen, grass pollen and ragweed - would allow for informed public health interventions. METHODS Time-stratified case-crossover design was used to study the transient impact of ozone, PM2.5 and pollen on the acute onset of pediatric asthma. Daily emergency department visits were obtained for children aged 3-17 years with a primary diagnosis of asthma during the warm season (April through September), 2004-2007 (inclusive). Bi-directional control sampling was used to select two control periods for each case for a total of 65,562 inclusion days. Since the period of exposure prior to emergency department visit may be the most clinically relevant, lag exposures were investigated (same day (lag0), 1, 2, 3, 4, and 5 as well as 3-day and 5-day moving averages). Multivariable conditional logistic regression controlling for holiday, school-in-session indicator, and 3-day moving average for temperature and relative humidity was used to examine the associations. Odds ratios are based on interquartile range (IQR) increases or 10 unit increases when IQR ranges were narrow. Single-pollutant models as well as multipollutant models were examined. Stratification on gender, race, ethnicity and socioeconomic status was explored. RESULTS The associations with ozone and PM2.5 were strongest on the same day (lag0) of the emergency department visit (RR IQR=1.05, 95% CI 1.04-1.06) and (RR IQR=1.03, 95% CI 1.02-1.04), respectively, with a decreasing lag effect. Tree and weed pollen were associated with pediatric ED visits; the largest magnitudes of association was with the 5-day average (RR IQR=1.23, 95% CI 1.21-1.25) and (RR 10=1.13, 95% CI 1.12-1.14), respectively. Grass pollen was only minimally associated with the outcome while ragweed had a negative association. CONCLUSIONS The ambient air pollutant ozone is associated with increases in pediatric emergency department asthma visits during the warm weather season. The different pollen types showed different associations with the outcome. High levels of tree pollen appear to be an important risk factor in asthma exacerbations.
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Affiliation(s)
- Jessie A Gleason
- Environmental and Occupational Health Surveillance Program, New Jersey Department of Health, 135 East State Street, P.O. Box 369, Trenton, NJ 08625, USA.
| | - Leonard Bielory
- Robert Wood Johnson University Hospital, Center for Environmental Prediction, Rutgers University, 14 College Farm Road Room 243, New Brunswick, NJ 08901, USA.
| | - Jerald A Fagliano
- Environmental and Occupational Health Surveillance Program, New Jersey Department of Health, 135 East State Street, P.O. Box 369, Trenton, NJ 08625, USA.
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Rice MB, Thurston GD, Balmes JR, Pinkerton KE. Climate change. A global threat to cardiopulmonary health. Am J Respir Crit Care Med 2014; 189:512-9. [PMID: 24400619 DOI: 10.1164/rccm.201310-1924pp] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Recent changes in the global climate system have resulted in excess mortality and morbidity, particularly among susceptible individuals with preexisting cardiopulmonary disease. These weather patterns are projected to continue and intensify as a result of rising CO2 levels, according to the most recent projections by climate scientists. In this Pulmonary Perspective, motivated by the American Thoracic Society Committees on Environmental Health Policy and International Health, we review the global human health consequences of projected changes in climate for which there is a high level of confidence and scientific evidence of health effects, with a focus on cardiopulmonary health. We discuss how many of the climate-related health effects will disproportionally affect people from economically disadvantaged parts of the world, who contribute relatively little to CO2 emissions. Last, we discuss the financial implications of climate change solutions from a public health perspective and argue for a harmonized approach to clean air and climate change policies.
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Affiliation(s)
- Mary B Rice
- 1 Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts
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Charpin D, Caillaud D. Épidémiologie de l’allergie pollinique. Rev Mal Respir 2014; 31:365-74. [DOI: 10.1016/j.rmr.2013.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 12/31/2013] [Indexed: 02/02/2023]
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Cloutier-Hurteau B, Gauthier S, Turmel MC, Comtois P, Courchesne F. Trace elements in the pollen of Ambrosia artemisiifolia: what is the effect of soil concentrations? CHEMOSPHERE 2014; 95:541-9. [PMID: 24183625 DOI: 10.1016/j.chemosphere.2013.09.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/21/2013] [Accepted: 09/26/2013] [Indexed: 05/13/2023]
Abstract
Concentrations of nine trace elements (Ba, Cd, Cr, Cu, Mn, Ni, Pb, Tl and Zn) were measured in a plant bearing allergenic pollens (ragweed) and their transfers from soils to the roots and then to the pollens were investigated. The soil, roots and pollens collected from flowers were sampled at 26 urban sites. Soil pH, soil organic carbon and total-recoverable trace elements (TE) in soil, roots and pollens were measured. The three biogeochemical compartments are well discriminated according to their TE concentrations. The concentrations (in μg g(-1)) in pollens decreased as follow: Zn (59.5-205)>Mn (19.4-117)>Ba≈Cr≈Cu≈Ni≈Pb (0.54-27.7)>Cd (0.06-0.77)>>Tl (0.0015-0.0180). Mean elemental allocation within ragweed always favored roots over pollen but, at site level, inverse pattern is also observed mostly for Zn and slightly for Cu and Ni. Significant predictive models of TE concentrations in pollens were obtained using soil or root properties only for Cd, Ni and Pb. They all involved positive relationships between TE concentrations in pollens and in soil or roots. Estimates of short-term exposure of human to TE carried out by ragweed pollens indicate TE absorption of less than 50 ng, far below thresholds of air quality criteria. Investigating the TE chemistry of pollens is a required first step to validate the impact of TE in pollens on human health and on the prevalence and intensity of allergy symptoms and atopic diseases.
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Caillaud D, Toloba Y, Raobison R, Besancenot JP, Thibaudon M, Martin S, Segala C. [Health impact of exposure to pollens: A review of epidemiological studies]. Rev Mal Respir 2013; 31:142-9. [PMID: 24602681 DOI: 10.1016/j.rmr.2013.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/11/2013] [Indexed: 12/31/2022]
Abstract
The aim of this review is to describe the health impact of exposure to pollen based on recently published epidemiological studies. The methodology chapter, describes a review of the literature and outlines important elements of these studies: measurement of exposure to pollens, study types used, study populations and the health indicators related to pollen exposure. In this review, two types of studies have been used to assess the epidemiological evidence of short-term links between pollen exposure and hay fever or asthma. Ecological time-series studies use daily indicators of asthma exacerbations (emergency room admissions or hospitalizations), consultations for rhinitis or conjunctivitis, or anti-allergic drug consumption within general population. Panel studies relate measurements of pollen grain concentrations to nasal, ocular and bronchial symptom severity in a group of subjects sensitized to a specific pollen, monitored during the pollen season. In both cases, the studies show a relationship on a day-to-day basis between health indicators and daily rates of atmospheric pollen collected by a pollen trap. These studies take into account confounding factors, such as air pollution, weather factors and sometimes exposure to outdoor molds. Unlike earlier studies, more and more studies focus on the shape of the dose-response relationship and the lag between pollen exposure and symptoms. Only rarely, individual susceptibility factors, the clinical phenomenon of priming and polysensitization are reported. Thus, ecological time-series studies and panel studies assess respectively the impact of pollen exposure in the general population and in groups of sensitized patients. Using appropriate statistical tools, these studies provide insight into the shape of the dose-response relationship, with a potential threshold below which symptoms are absent, then a linear relationship for nasal, ocular and bronchial symptoms and a plateau where the symptoms do not increase despite the continued increase in pollen.
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Affiliation(s)
- D Caillaud
- Service de pneumologie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - Y Toloba
- Service de pneumologie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - R Raobison
- Service de pneumologie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J-P Besancenot
- Réseau national de surveillance aérobiologique (RNSA), 69960 Brussieu, France
| | - M Thibaudon
- Réseau national de surveillance aérobiologique (RNSA), 69960 Brussieu, France
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42
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Bernstein AS, Rice MB. Lungs in a warming world: climate change and respiratory health. Chest 2013; 143:1455-1459. [PMID: 23648909 DOI: 10.1378/chest.12-2384] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Climate change is a health threat no less consequential than cigarette smoking. Increased concentrations of greenhouse gases, and especially CO₂, in the earth's atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, temperature variability, air pollution, forest fires, droughts, and floods, all of which put respiratory health at risk. These changes in climate and air quality substantially increase respiratory morbidity and mortality for patients with common chronic lung diseases such as asthma and COPD and other serious lung diseases. Physicians have a vital role in addressing climate change, just as they did with tobacco, by communicating how climate change is a serious, but remediable, hazard to their patients.
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Affiliation(s)
- Aaron S Bernstein
- Center for Health and the Global Environment, Harvard School of Public Health, Boston, MA; Division of General Medicine, Boston Children's Hospital, Boston, MA.
| | - Mary B Rice
- Pulmonary Critical Care Unit, Massachusetts General Hospital, Boston, MA
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Kiotseridis H, Cilio CM, Bjermer L, Tunsäter A, Jacobsson H, Dahl A. Grass pollen allergy in children and adolescents-symptoms, health related quality of life and the value of pollen prognosis. Clin Transl Allergy 2013; 3:19. [PMID: 23799882 PMCID: PMC3699361 DOI: 10.1186/2045-7022-3-19] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/03/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION An association between pollen count (Poaceae) and symptoms is well known, but to a lesser degree the importance of priming and lag effects. Also, threshold levels for changes in symptom severity need to be validated. The present study aims to investigate the relationship between pollen counts, symptoms and health related quality of life (HRQL), and to validate thresholds levels, useful in public pollen warnings. MATERIAL AND METHODS Children aged 7-18 with grass pollen allergy filled out a symptom diary during the pollen season for nose, eyes and lung symptoms, as well as a HRQL questionnaire every week. Pollen counts were monitored using a volumetric spore trap. RESULTS 89 (91%) of the included 98 children completed the study. There was a clear association between pollen count, symptom severity and HRQL during the whole pollen season, but no difference in this respect between early and late pollen season. There was a lag effect of 1-3 days after pollen exposure except for lung symptoms. We found only two threshold levels, at 30 and 80 pollen grains/m(3) for the total symptom score, not three as is used today. The nose and eyes reacted to low doses, but for the lung symptoms, symptom strength did hardly change until 50 pollen grains/m(3). CONCLUSION Grass pollen has an effect on symptoms and HRQL, lasting up to 5 days after exposure. Symptoms from the lungs appear to have higher threshold levels than the eyes and the nose. Overall symptom severity does not appear to change during the course of season. Threshold levels need to be revised. We suggest a traffic light model for public pollen warnings directed to children, where green signifies "no problem", yellow signifies "can be problems, especially if you are highly sensitive" and red signifies "alert - take action".
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Affiliation(s)
- Hampus Kiotseridis
- Pediatric Clinic, Malmö, Skåne University Hospital, Lund University, Lund, Sweden ; Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Corrado M Cilio
- Pediatric Clinic, Malmö, Skåne University Hospital, Lund University, Lund, Sweden
| | - Leif Bjermer
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helene Jacobsson
- Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Aslög Dahl
- Departments of Biological and Environmental Sciences, Gothenburg University, Gothenburg, Sweden
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Ghosh D, Chakraborty P, Gupta J, Biswas A, Roy I, Das S, Gupta-Bhattacharya S. Associations between pollen counts, pollutants, and asthma-related hospital admissions in a high-density Indian metropolis. J Asthma 2013; 49:792-9. [PMID: 22978307 DOI: 10.3109/02770903.2012.716473] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The seasonal pattern of asthma-related hospitalization has often been correlated with ambient allergen/pollutant levels. OBJECTIVE To examine the relationship between asthma-related hospital admissions (ARHA) and outdoor pollen, spore, and pollutant levels for adult patients in a densely populated Indian megacity Kolkata. METHODS ARHA data were obtained from two major teaching hospitals of the city. Pollen and spores causing allergic sensitization were identified by skin prick tests (SPTs) among respiratory allergic subjects (N = 1353). Outdoor concentrations of aeroallergens were determined using a Burkard sampler for five consecutive years (2004-2009). Levels of NO(2), SO(2), suspended particulate matters (SPMs), and respirable particulate matters (RPMs) were made available by West Bengal Pollution Control Board (WBPCB, Government of West Bengal). Poisson multivariate Poisson regression (with adjustments for overdispersion) was used to model the data. Results. We found that ARHA in Kolkata increased with predictable regularity in March and September, while remaining low in January and July. SPT showed highly positive skin reactions with grass/weed and palm pollens in respiratory allergic patients, while Aspergilli spores also evoked good sensitivity. In our regression model, the airborne pollen types, Cheno-Amaranthaceae and Cyperaceae, and the inorganic pollutant, SO(2) and RPM, were significantly associated with ARHA (p < .05). CONCLUSION ARHA in the megacity of Kolkata shows two seasonal peaks that can be correlated with outdoor grass/weed pollen and RPM concentrations. In contrast, the city's ambient fungal spore counts were not found to be significantly associated.
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Affiliation(s)
- D Ghosh
- Division of Plant Biology, Bose Institute, Kolkata, India.
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45
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Bellanger AP, Bosch-Cano F, Millon L, Ruffaldi P, Franchi M, Bernard N. Reactions of airway epithelial cells to birch pollen grains previously exposed to in situ atmospheric Pb concentrations: a preliminary assay of allergenicity. Biol Trace Elem Res 2012; 150:391-5. [PMID: 22895809 DOI: 10.1007/s12011-012-9485-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/30/2012] [Indexed: 01/29/2023]
Abstract
A growing body of evidence suggests that interactions between pollen grains and environmental pollutants, especially air pollutants, could be of critical importance with regard to the increase in allergic responses observed in the past decades. Using birch pollen grains (BPG), a major allergy source in European countries, and lead (Pb), a highly toxic metal trace element (MTE) present in urban areas, the immune response of human epithelial cells exposed to BPG or to Pb-associated BPG was compared. The cellular response after exposure either to BPG, BPG exposed to 30 mg/L of Pb (BPG-30), or BPG exposed to 60 mg/L of Pb (BPG-60) was evaluated after two time lapses (2 and 6 h) by measuring mRNA levels of four mediators, including two inflammatory (interleukin-8 and interleukin-6) and two allergic (interleukin-5 [IL-5] and interleukin-13) cytokines. After 2 h of exposure, significant upregulation of the IL-5 gene was observed after exposure to BPG-60 in comparison with exposure to BPG and BPG-30 (N (IL-5) = 1.9, Mann-Whitney test, p = 0.003). After 6 h of exposure, significant upregulation of the IL-5 gene was observed after exposure to BPG-30 with N (IL-5) = 1.8 and to BPG-60 with N (IL-5) = 2.3 (Mann-Whitney test, p = 0.0029) in comparison with exposure to BPG. This first attempt to investigate the influence of pollution by MTE on pollen grain showed a dose-time-dependent increase in IL-5 gene expression after exposure to BPG combined to Pb.
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Affiliation(s)
- Anne-Pauline Bellanger
- Laboratoire Chrono-environnement, Université de Franche-Comté-CNRS/UMR 6249, 25030, Besançon, France.
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46
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Soyiri IN, Reidpath DD. Semistructured black-box prediction: proposed approach for asthma admissions in London. Int J Gen Med 2012; 5:693-705. [PMID: 22973117 PMCID: PMC3430118 DOI: 10.2147/ijgm.s34647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Asthma is a global public health problem and the most common chronic disease among children. The factors associated with the condition are diverse, and environmental factors appear to be the leading cause of asthma exacerbation and its worsening disease burden. However, it remains unknown how changes in the environment affect asthma over time, and how temporal or environmental factors predict asthma events. The methodologies for forecasting asthma and other similar chronic conditions are not comprehensively documented anywhere to account for semistructured noncausal forecasting approaches. This paper highlights and discusses practical issues associated with asthma and the environment, and suggests possible approaches for developing decision-making tools in the form of semistructured black-box models, which is relatively new for asthma. Two statistical methods which can potentially be used in predictive modeling and health forecasting for both anticipated and peak events are suggested. Importantly, this paper attempts to bridge the areas of epidemiology, environmental medicine and exposure risks, and health services provision. The ideas discussed herein will support the development and implementation of early warning systems for chronic respiratory conditions in large populations, and ultimately lead to better decision-making tools for improving health service delivery.
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Affiliation(s)
- Ireneous N Soyiri
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
- School of Public Health, University of Ghana, Accra, Ghana
| | - Daniel D Reidpath
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
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47
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Erbas B, Akram M, Dharmage SC, Tham R, Dennekamp M, Newbigin E, Taylor P, Tang MLK, Abramson MJ. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clin Exp Allergy 2012; 42:799-805. [PMID: 22515396 DOI: 10.1111/j.1365-2222.2012.03995.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have focused on the role of grass pollen on asthma emergency department (ED) presentations among children. None have examined whether a dose-response effect exists between grass pollen levels and these asthma exacerbations. OBJECTIVES To examine the association between increasing ambient levels of grass pollen and asthma ED presentations in children. To determine whether these associations are seen only after a thunderstorm, or whether grass pollen levels have a consistent influence on childhood asthma ED visits during the season. METHODS A short time series ecological study was conducted for asthma presentations to ED among children in Melbourne, Victoria, and grass pollen, meteorological and air quality measurements recorded during the selected 2003 period. A semi-parametric Poisson regression model was used to examine dose-response associations between daily grass pollen levels and mean daily ED attendance for asthma. RESULTS A smoothed plot suggested a dose-response association. As ambient grass pollen increased to about 19 grains/m(3) , the same day risk of childhood ED presentations also increased linearly (P < 0.001). Grass pollen levels were also associated with an increased risk in asthma ED presentations on the following day (lag 1, P < 0.001). CONCLUSION This is the first study to establish a clear relationship between increased risk of childhood asthma ED attendance and levels of ambient grass pollen below 20 grains/m(3) , independent of any impact of thunderstorm-associated asthma. These findings have important implications for patient care, such as asthma management programs that notify the general public regarding periods of high grass pollen exposure, as well as defining the timing of initiation of pollen immunotherapy.
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Affiliation(s)
- B Erbas
- School of Public Health, La Trobe University, Melbourne, VIC, Australia.
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48
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Darrow LA, Hess J, Rogers CA, Tolbert PE, Klein M, Sarnat SE. Ambient pollen concentrations and emergency department visits for asthma and wheeze. J Allergy Clin Immunol 2012; 130:630-638.e4. [PMID: 22840851 DOI: 10.1016/j.jaci.2012.06.020] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 05/14/2012] [Accepted: 06/18/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies report associations between aeroallergen exposure and asthma exacerbations. Aeroallergen burdens and asthma prevalence are increasing worldwide and are projected to increase further with climate change, highlighting the importance of understanding population-level relationships between ambient pollen concentrations and asthma. OBJECTIVE We sought to examine short-term associations between ambient concentrations of various pollen taxa and emergency department (ED) visits for asthma and wheeze in the Atlanta metropolitan area between 1993 and 2004. METHODS We assessed associations between the 3-day moving average (lag 0-1-2) of Betulaceae (except Alnus species), Cupressaceae, Quercus species, Pinaceae (except Tsuga species), Poaceae, and Ambrosia species pollen concentrations and daily asthma and wheeze ED visit counts, controlling for covarying pollen taxa and ambient pollutant concentrations. RESULTS We observed a 2% to 3% increase in asthma- and wheeze-related ED visits per SD increase in Quercus species and Poaceae pollen and a 10% to 15% increased risk on days with the highest concentrations (comparing the top 5% of days with the lowest 50% of days). An SD increase in Cupressaceae concentrations was associated with a 1% decrease in ED visits. The association for Quercus species pollen was strongest for children aged 5 to 17 years. Effects of Ambrosia species pollen on asthma exacerbations were difficult to assess in this large-scale temporal analysis because of possible confounding by the steep increase in circulating rhinoviruses every September. CONCLUSION Poaceae and Quercus species pollen contribute to asthma morbidity in Atlanta. Altered Quercus species and Poaceae pollen production caused by climate change could affect allergen-induced asthma morbidity in the southeastern United States.
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Affiliation(s)
- Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
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49
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[Respiratory allergens and asthma exacerbation]. Rev Mal Respir 2012; 29:810-9. [PMID: 22742468 DOI: 10.1016/j.rmr.2012.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/04/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Asthma exacerbations are characterized by a progressive aggravation of respiratory symptoms such as dyspnea, cough, wheezing or chest tightness. BACKGROUND The relationship between allergy and asthma exacerbations has been evaluated by epidemiological studies based on various criteria such as oral corticosteroid requirement, emergency room visits and hospital admission for asthma. Many studies have observed that deteriorating asthma can be related to increased exposure to allergens, particularly allergens from house dust mite, cockroach, cat, rodent, mold or pollen. Several studies have demonstrated that sensitization to respiratory allergens and allergen exposure increases the risk of exacerbation of asthma. When asthma exacerbations are work-related, occupational allergens may be implicated. CONCLUSIONS AND PERSPECTIVES Most studies provide evidence that allergen exposure contributes to the risk of asthma exacerbations, but other precipitating factors, such as viruses, can interact and increase the risk.
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50
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Cabauatan CR, Ramos JDA. Immunoglobulin E-binding reactivities of natural pollen grain extracts from selected grass species in the Philippines. Asia Pac Allergy 2012; 2:136-43. [PMID: 22701864 PMCID: PMC3345327 DOI: 10.5415/apallergy.2012.2.2.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 04/13/2012] [Indexed: 11/04/2022] Open
Abstract
Background Pollen grains have been reported to be present in the Philippine atmosphere but studies regarding their allergenicity are limited. Objective The present study aimed to profile the sensitization of allergic individuals to selected grass pollen species and to characterize the pollen proteins that may be responsible for this allergenic response. Methods The protein profile of the grass pollen extracts from Cynodon dactylon, Saccharum spontaneum, Sporobulus indicus, Chloris barbata, Oryza sativa, Imperata cylindrica, and Zea mays was analyzed by Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis. The specific-IgE profile of the allergic individuals and the allergenic potential of the pollen extracts were evaluated through Enzyme-linked Immunosorbent Assay and IgE immunoblotting. Results Sensitization of the allergic individuals to the pollen extracts was detected with I. cylindrica and O. sativa to be the most frequently recognized with more that 92% reactivity, whereas for C. dactylon and Z. mays, were found to have less than 25% reactivity. Conclusion Multiple IgE-binding proteins from S. indicus, S. spontaneum and C. barbata that were detected may be responsible for the allergic reactions among Filipino subjects.
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Affiliation(s)
- Clarissa R Cabauatan
- Center for Natural Sciences, School of Arts and Sciences, Saint Mary's University, Bayombong, Nueva Vizcaya 3700, Philippines
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