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Venter ZS, Hassani A, Stange E, Schneider P, Castell N. Reassessing the role of urban green space in air pollution control. Proc Natl Acad Sci U S A 2024; 121:e2306200121. [PMID: 38285938 PMCID: PMC10861851 DOI: 10.1073/pnas.2306200121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/14/2023] [Indexed: 01/31/2024] Open
Abstract
The assumption that vegetation improves air quality is prevalent in scientific, popular, and political discourse. However, experimental and modeling studies show the effect of green space on air pollutant concentrations in urban settings is highly variable and context specific. We revisited the link between vegetation and air quality using satellite-derived changes of urban green space and air pollutant concentrations from 2,615 established monitoring stations over Europe and the United States. Between 2010 and 2019, stations recorded declines in ambient NO2, (particulate matter) PM10, and PM2.5 (average of -3.14% y-1), but not O3 (+0.5% y-1), pointing to the general success of recent policy interventions to restrict anthropogenic emissions. The effect size of total green space on air pollution was weak and highly variable, particularly at the street scale (15 to 60 m radius) where vegetation can restrict ventilation. However, when isolating changes in tree cover, we found a negative association with air pollution at borough to city scales (120 to 16,000 m) particularly for O3 and PM. The effect of green space was smaller than the pollutant deposition and dispersion effects of meteorological drivers including precipitation, humidity, and wind speed. When averaged across spatial scales, a one SD increase in green space resulted in a 0.8% (95% CI: -3.5 to 2%) decline in air pollution. Our findings suggest that while urban greening may improve air quality at the borough-to-city scale, the impact is moderate and may have detrimental street-level effects depending on aerodynamic factors like vegetation type and urban form.
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Affiliation(s)
| | | | - Erik Stange
- Norwegian Institute for Nature Research, Oslo0855, Norway
| | - Philipp Schneider
- The Climate and Environmental Research Institute NILU, Kjeller2027, Norway
| | - Núria Castell
- The Climate and Environmental Research Institute NILU, Kjeller2027, Norway
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Yusuf OM, Rextin AT, Ahmed B, Aman R, Anjum T, Mustafa S, Nasim M, Yusuf SO, Lin C, Zahra S, Pinnock H, Schwarze J. Association of asthma exacerbations with paper mulberry (Broussenetia papyrifera) pollen in Islamabad: An observational study. J Glob Health 2023; 13:04091. [PMID: 37651635 PMCID: PMC10471151 DOI: 10.7189/jogh.13.04091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Although the role of airborne plant pollen in causing allergic rhinitis has been established, the association of concentrations of paper mulberry (Broussenetia papyrifera) pollens in the air and incidence of asthma exacerbations has not, despite an observed increase in the number of asthma patients attending physician clinics and hospital Accident and Emergency (A&E) Departments during the paper mulberry pollen season. We aimed to assess the association between paper mulberry pollen concentrations (typically peaking in March each year) and asthma exacerbations in the city of Islamabad. Methods We used three approaches to investigate the correlation of paper mulberry pollen concentration with asthma exacerbations: A retrospective analysis of historical records (2000-2019) of asthma exacerbations of patients from the Allergy and Asthma Institute, Pakistan (n = 284), an analysis of daily nebulisations in patients attending the A&E Department of the Pakistan Institute of Medical Sciences (March 2020 to July 2021), a prospective peak expiratory flow rate (PEFR) diary from participants (n = 40) with or without asthma and with or without paper mulberry sensitisation. We examined associations between pollen data and asthma exacerbations using Pearson correlation. Results We found a strong positive correlation between mean paper mulberry pollen counts and clinical records of asthma exacerbations in patients sensitised to paper mulberry (Pearson correlation coefficient (r) = 0.86; P < 0.001), but not in non-sensitised patients (r = 0.32; P = 0.3). There was a moderate positive correlation between monthly nebulisation counts and pollen counts (r = 0.56; P = 0.03), and a strong negative correlation between percent predicted PEFR and pollen counts in sensitised asthma patients (r = -0.72, P < 0.001). However, these correlations were of low magnitude in the non-sensitised asthma (r = -0.16; P < 0.001) and sensitised non-asthma (r = -0.28; P < 0.001) groups. Conclusions Our three approaches to analysis all showed an association between high paper mulberry pollen concentration in Islamabad and asthma exacerbations. Predicting pollen peaks could enable alerts and mobilise strategies to proactively manage these peaks of asthma exacerbations.
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Affiliation(s)
| | - Aimal T Rextin
- The Allergy & Asthma Institute, Islamabad, Pakistan
- National University of Science and Technology, Islamabad, Pakistan
| | | | - Rubina Aman
- The Allergy & Asthma Institute, Islamabad, Pakistan
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | - Mehwish Nasim
- The Allergy & Asthma Institute, Islamabad, Pakistan
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Chun Lin
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Summan Zahra
- The Allergy & Asthma Institute, Islamabad, Pakistan
| | - Hillary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jürgen Schwarze
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
- Child Life and Health, Centre for Inflammation Research, The University of Edinburgh, Edinburgh, United Kingdom
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Mani K, Miller R, Lin J, Shahani J, Jariwala S. Trends in seasonal pollen and asthma-related morbidity among adults and children in a U.S. high-density urban center, 2001-2020. J Asthma 2023; 60:784-793. [PMID: 35758000 DOI: 10.1080/02770903.2022.2094804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyze the long-term trends in pollen counts and asthma-related emergency department visits (AREDV) in adult and pediatric populations in the Bronx. METHODS Daily values of adult and pediatric AREDV were retrospectively obtained from three major Bronx hospitals using ICD-10 codes and pollen counts were obtained from the Armonk station from 2001-2020. Wilcoxon Ranked Sum was applied to compare median values, while Spearman correlation was employed to examine the association between these variables, for both decades and each season. RESULTS The median value of pediatric AREDV increased by 200% from the 1st to 2nd decade (p < 0.001) and AREDV peak shifted from predominantly the spring season in the 1st decade to the fall and winter seasons in the 2nd decade. Seasonal patterns were consistent over 20 years with summer AREDV lower than all other seasons (9 vs. 17 per day) (p < 0.001). Spring tree pollen peaks were correlated with AREDV peaks (rho = 0.34) (p < 0.001). Tree pollen exceeding 100 grains/m3 corresponded to a median of 19.0 AREDVs while all other tree pollen (0 - 99 grains/m3) corresponded to a median of 15.0 AREDVs (p < 0.001). AREDVs sharply declined in 2020, coinciding with the emergence of COVID-19. CONCLUSIONS Pollen and AREDVs peak earlier in the spring and are more strongly interconnected, while asthma rates among children are rapidly rising, particularly in the fall and winter. These findings can advise targeted awareness campaigns for better management of asthma related morbidity.
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Affiliation(s)
- Kyle Mani
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Raphael Miller
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Allergy and Immunology, Bronx, NY, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, The Bronx, NY, USA
| | | | - Sunit Jariwala
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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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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Ravindra K, Goyal A, Mor S. Pollen allergy: Developing multi-sectorial strategies for its prevention and control in lower and middle-income countries. Int J Hyg Environ Health 2022; 242:113951. [PMID: 35334435 DOI: 10.1016/j.ijheh.2022.113951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
Pollen allergy is considered a major public health problem that causes morbidity and subsequently affects a patient's quality of life. Pollen due to their large size cannot enter the thoracic regions of the respiratory tract but can affect the nasopharyngeal mucous membrane. At the same time, the submicronic-pollen particles can act as respirable particles reaching deeper into the upper airways leading to exacerbation of asthma, chronic obstructive pulmonary disease (COPD) and other allergic reactions. Based on the existing literature, expanding evidence shows that climate change and air pollutants could affect the pollen number, morphology, season, allergen content, and distribution pattern. Hence, this will influence the prevalence and occurrence of allergies linked to pollen exposure. Being a part of biogenic pollutants, pollen allergens are not expected to diminish in the foreseeable future. Therefore, it is imperative that steps need to be strengthened to improve and optimize preventive/adaptive strategies. This paper aims to review the major causes of widespread allergy, identify the major gaps, and suggest key preventive/adaptive measures to address the onset and exacerbation of pollen-related allergic diseases with a major focus on lower and middle-income countries. The study also discusses how-to implement the prevention and control measures at the individual, health care communities and organizations, Local Governments, National/International Governments levels to decrease the risk of illnesses associated with pollen allergy.
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Akshi Goyal
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India.
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Clemons R, Kong M, Jawad K, Feygin Y, Caperell K. The Impact of Converting a Power Plant from Coal to Natural Gas on Pediatric Acute Asthma. J Asthma 2022; 59:2441-2448. [PMID: 35038390 DOI: 10.1080/02770903.2021.2022159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: Air pollutants play a pivotal role in the frequency and severity of asthma symptoms. As cleaner air initiatives are increasingly being implemented, it is important to appraise how these changes relate to acute pediatric asthma. The objective of this study is to evaluate the effect of a Gas and Electric Company's transition from using coal to natural gas as their fuel source on pediatric asthma-related illnesses in Louisville, KY.Methods: Data were collected for children 2-17 years old from a large regional healthcare system, for which an asthma-related primary diagnosis was present between April 1, 2013 and April 1, 2018. Using an interrupted time series design, we analyzed monthly rates of asthma-related visits to urgent care (UC) and emergency departments (ED). Segmented Poisson regression models were used to assess whether the power company's transition was associated with changes in trends of asthma-related visits.Results: There were a total of 7,735 subjects who met inclusion criteria. Prior to the complete factory transition from coal to natural gas, the mean monthly rate for asthma-related visits was 163.9. After the transition, we observed a significant decrease to a mean monthly rate of 100.3 asthma-related visits (p < 0.001). In addition, the proportion of inpatient (23.7% vs. 30.5%, p < 0.001) visits significantly increased, while ED & UC (76.3 vs. 69.5%, p < 0.001) were significantly decreased.Conclusion: Converting an electrical power plant from coal to natural gas lead to a profound and sustained decrease in pediatric acute asthma exacerbation in Louisville, KY.
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Affiliation(s)
- Robert Clemons
- Pediatric Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Maiying Kong
- Bioinformatics and Biostatistics, University of Louisville, Louisville, United States
| | - Kahir Jawad
- School of Public Health and Information Sciences, Biostatistics, University of Louisville, Louisville, United States
| | - Yana Feygin
- School of Public Health and Information Sciences, Biostatistics, University of Louisville, Louisville, United States
| | - Kerry Caperell
- Pediatric Emergency Medicine, University of Louisville School of Medicine, Louisville, United States
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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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Sapkota A, Dong Y, Li L, Asrar G, Zhou Y, Li X, Coates F, Spanier AJ, Matz J, Bielory L, Breitenother AG, Mitchell C, Jiang C. Association Between Changes in Timing of Spring Onset and Asthma Hospitalization in Maryland. JAMA Netw Open 2020; 3:e207551. [PMID: 32663309 PMCID: PMC7339136 DOI: 10.1001/jamanetworkopen.2020.7551] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Ongoing climate change is affecting the health of communities across the globe. While direct consequences, including morbidity and mortality tied to increases in the frequency of extreme weather events, have received significant attention, indirect health effects, particularly those associated with climate change-driven disruptions in ecosystems, are less understood. OBJECTIVE To investigate how ongoing changes in the timing of spring onset related to climate change are associated with rates of asthma hospitalization in Maryland. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 29 257 patients with asthma used general additive (quasi Poisson) and mixed-effect (negative binomial) models to investigate the association between changes in the timing of spring onset, detected using satellite observations, and the risk of asthma hospitalization in Maryland from 2001 to 2012. Data analysis was conducted from January 2016 to March 2019. EXPOSURES Phenology data, derived from the National Aeronautics and Space Administration's Moderate Resolution Imaging Spectroradiometer, were used to calculate location-specific median dates for start of season from 2001 to 2012. How the start of season for a given year and location deviated from the long-term average was calculated and categorized as very early, early, normal, or late. MAIN OUTCOMES AND MEASURES Daily asthma hospitalization in Maryland during the spring season (ie, March to May). RESULTS There were 108 358 total asthma hospitalizations during the study period, of which 29 257 (27.0%; 14 379 [49.1%] non-Hispanic black patients; 17 877 [61.1%] women) took place during springtime. In the unadjusted model, very early (incident rate ratio [IRR], 1.17; 95% CI, 1.07-1.28) and late (IRR, 1.07; 95% CI, 1.00-1.15) onset of spring were associated with increased risk of asthma hospitalization. When the analysis was adjusted for extreme heat events and concentrations of particulate matter with an aerodynamic diameter less than 2.5 μm, the risk remained significant for very early spring onset (IRR, 1.10; 95% CI, 1.02-1.20) but not for late spring onset (IRR, 1.03; 95% CI, 0.97-1.11). CONCLUSIONS AND RELEVANCE These results suggest that ongoing changes in the timing of spring onset, which are related to climate variability and change, are associated with asthma hospitalization. Given the high burden of allergic diseases and the number of individuals sensitized to tree pollen, these findings serve as a wake-up call to public health and medical communities regarding the need to anticipate and adapt to the ongoing changes in the timing and severity of the spring allergy season.
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Affiliation(s)
- Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park
| | - Yan Dong
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China
| | - Linze Li
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China
| | - Ghassem Asrar
- Joint Global Change Research Institute, Pacific Northwest National Laboratory, College Park, Maryland
| | - Yuyu Zhou
- Department of Geological and Atmospheric Sciences, Iowa State University, Ames
| | - Xuecao Li
- Department of Geological and Atmospheric Sciences, Iowa State University, Ames
| | - Frances Coates
- Aerobiology Research Laboratories, Nepean, Ontario, Canada
| | | | | | - Leonard Bielory
- Department of Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
- Center for Environmental Prediction, Rutgers University, New Brunswick, New Jersey
| | - Allison G. Breitenother
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park
- Environmental Health Bureau, Maryland Department of Health, Baltimore
| | - Clifford Mitchell
- Environmental Health Bureau, Maryland Department of Health, Baltimore
| | - Chengsheng Jiang
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park
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Urban Trees and Human Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124371. [PMID: 32570770 PMCID: PMC7345658 DOI: 10.3390/ijerph17124371] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 12/21/2022]
Abstract
The urban forest is a green infrastructure system that delivers multiple environmental, economic, social and health services, and functions in cities. Environmental benefits of urban trees are well understood, but no review to date has examined how urban trees affect human health. This review provides a comprehensive summary of existing literature on the health impacts of urban trees that can inform future research, policy, and nature-based public health interventions. A systematic search used keywords representing human health, environmental health, and urban forestry. Following screening and appraisal of several thousand articles, 201 studies were conceptually sorted into a three-part framework. Reducing Harm, representing 41% of studies, includes topics such as air pollution, ultraviolet radiation, heat exposure, and pollen. Restoring Capacities, at 31%, includes attention restoration, mental health, stress reduction, and clinical outcomes. Building Capacities, at 28%, includes topics such as birth outcomes, active living, and weight status. The studies that were reviewed show substantial heterogeneity in purpose and method yet indicate important health outcomes associated with people’s exposure to trees. This review will help inform future research and practice, and demonstrates why urban forest planning and management should strategically promote trees as a social determinant of public health.
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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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Shin JY, Han MJ, Cho C, Kim KR, Ha JC, Oh JW. Allergenic Pollen Calendar in Korea Based on Probability Distribution Models and Up-to-Date Observations. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:259-273. [PMID: 32009321 PMCID: PMC6997285 DOI: 10.4168/aair.2020.12.2.259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
Purpose The pollen calendar is the simplest forecasting method for pollen concentrations. As pollen concentrations are liable to seasonal variations due to alterations in climate and land-use, it is necessary to update the pollen calendar using recent data. To attenuate the impact of considerable temporal and spatial variability in pollen concentrations on the pollen calendar, it is essential to employ a new methodology for its creation. Methods A pollen calendar was produced in Korea using data from recent observations, and a new method for creating the calendar was proposed, considering both risk levels and temporal resolution of pollen concentrations. A probability distribution was used for smoothing concentrations and determining risk levels. Airborne pollen grains were collected between 2007 and 2017 at 8 stations; 13 allergenic pollens, including those of alder, Japanese cedar, birch, hazelnut, oak, elm, pine, ginkgo, chestnut, grasses, ragweed, mugwort and Japanese hop, were identified from the collected grains. Results The concentrations of each pollen depend on locations and seasons due to large variability in species distribution and their environmental condition. In the descending order of concentration, pine, oak and Japanese hop pollens were found to be the most common in Korea. The pollen concentrations were high in spring and autumn, and those of oak and Japanese hop were probably the most common cause of allergy symptoms in spring and autumn, respectively. High Japanese cedar pollen counts were observed in Jeju, while moderate concentrations were in Jeonju, Gwangju and Busan. Conclusions A new methodology for the creation of a pollen calendar was developed to attenuate the impact of large temporal and spatial variability in pollen concentrations. This revised calendar should be available to the public and allergic patients to prevent aggravation of pollen allergy.
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Affiliation(s)
- Ju Young Shin
- Applied Meteorology Research Division, National Institute of Meteorological Sciences, Seogwipo, Korea
| | - Mae Ja Han
- Applied Meteorology Research Division, National Institute of Meteorological Sciences, Seogwipo, Korea
| | - Changbum Cho
- Applied Meteorology Research Division, National Institute of Meteorological Sciences, Seogwipo, Korea
| | - Kyu Rang Kim
- Applied Meteorology Research Division, National Institute of Meteorological Sciences, Seogwipo, Korea.
| | - Jong Chul Ha
- Applied Meteorology Research Division, National Institute of Meteorological Sciences, Seogwipo, Korea
| | - Jae Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea.
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Li Z, Xu X, Thompson LA, Gross HE, Shenkman EA, DeWalt DA, Huang IC. Longitudinal Effect of Ambient Air Pollution and Pollen Exposure on Asthma Control: The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study. Acad Pediatr 2019; 19:615-623. [PMID: 31128384 PMCID: PMC8981069 DOI: 10.1016/j.acap.2019.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/18/2019] [Accepted: 03/31/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although exposure to air pollution and pollen is associated with asthma exacerbation and increased health care use, longitudinal effects of fine particulate matter 2.5 (PM2.5), ozone (O3), and pollen exposure on asthma control status in pediatric patients are understudied. This study investigated effects of exposure to PM2.5, O3, and pollen on asthma control status among pediatric patients with asthma. METHODS A total of 229 dyads of pediatric patients with asthma and their parents were followed for 15 months. The Asthma Control and Communication Instrument was used to measure asthma control, which was reported weekly by parents during a 26-week period. PM2.5 and O3 data were collected from the US Environmental Protection Agency Air Quality System. Pollen data were obtained from Intercontinental Marketing Services Health. Mean air pollutant and pollen exposures within 7 days before the reporting of asthma control were used to estimate weekly exposures for each participant. Linear mixed-effects models were performed to test associations of PM2.5, O3, and pollen exposure with asthma control status. Sensitivity analyses were performed to evaluate the robustness of findings by different exposure monitoring days per week and distances between monitoring sites and participants' residences. RESULTS Elevated PM2.5 concentration and pollen severity were associated with poorer asthma control status (P < .05), yet elevated O3 concentration was marginally associated with better asthma control (P < .1). CONCLUSIONS Poorer asthma control status was associated with elevated PM2.5 and pollen severity. Reducing harmful outdoor environmental ambient exposure may improve asthma outcomes in children and adolescents.
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Affiliation(s)
- Zheng Li
- College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN, USA
| | - Xiaohui Xu
- Department of Epidemiology and Statistics, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Lindsay A. Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Heather E. Gross
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Darren A. DeWalt
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - I-Chan Huang
- College of Nursing and Health Professions, Valparaiso University, Valparaiso, Ind (Z Li); Department of Epidemiology and Statistics, School of Public Health, Texas A&M Health Science Center, College Station (X Xu); Departments of Pediatrics (LA Thompson); Health Outcomes & Biomedical Informatics (EA Shenkman), College of Medicine, University of Florida, Gainesville; Cecil G. Sheps Center for Health Services Research (HE Gross); Department of Medicine, School of Medicine (DA DeWalt), University of North Carolina at Chapel Hill; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tenn (I-C Huang).
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13
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Wu PC, Su HJ, Lung SCC, Chen MJ, Lin WP. Pollen of Broussonetia papyrifera: An emerging aeroallergen associated with allergic illness in Taiwan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:804-810. [PMID: 30677945 DOI: 10.1016/j.scitotenv.2018.11.324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Pollen has long been recognized as a major allergen, having diverse patterns of allergenicity caused by differences in climate, geography, and vegetation. Our research aimed to explore the role of a regionally dominant pollen in Taiwan, Broussonetia papyrifera, on clinical sensitization and daily 5collected and extracted for a skin prick test on 30 volunteers recruited from a medical college. Daily atmospheric pollen levels were measured using a Burkard 7-day volumetric trap. The association between daily atmospheric pollen levels and clinic visits for allergic illness was examined using a generalized additive model with a normal assumption. After excluding four participants with a positive response to a negative control, 10 participants (38.4%) were determined to be sensitive to B. papyrifera pollen extract. The three-day lagged concentration of B. papyrifera pollen exhibited the highest risk of daily asthma visits (relative risk [RR] = 1.166, 95% confidence interval [CI]: 1.014-1.341) and allergic rhinitis visits (RR = 1.119, 95% CI: 0.916-1.367) when the pollen increased equally in magnitude to its mean. Our study is the first to provide evidence indicating that the most dominant airborne pollen in Taiwan, B. papyrifera, plays a major role in sensitization and clinic visits for asthma and allergic rhinitis, thus highlighting the need to integrate aeroallergen monitoring with clinical diagnosis.
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Affiliation(s)
- Pei-Chih Wu
- Department of Occupational and Safety and Health, Chang Jung Christian University, Taiwan, ROC
| | - Huey-Jen Su
- Department of Environmental and Occupational Health, National Cheng Kung University, Taiwan, ROC.
| | | | - Mu-Jean Chen
- Department of Environmental and Occupational Health, National Cheng Kung University, Taiwan, ROC; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Wei-Ping Lin
- Department of Environmental and Occupational Health, National Cheng Kung University, Taiwan, ROC
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14
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Sharma KI, Abraham R, Mowrey W, Toh J, Rosenstreich D, Jariwala S. The association between pollutant levels and asthma-related emergency department visits in the Bronx after the World Trade Center attacks. J Asthma 2018; 56:1049-1055. [PMID: 30359141 DOI: 10.1080/02770903.2018.1531989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To examine the potential impact of the World Trade Center (WTC) attacks on asthma-related emergency department visits (AREDV) in the New York City borough of the Bronx. Methods: We obtained daily nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3) values from the National Climatic Data Center's collection station in the Bronx from 1999 and 2002, a year before and after the WTC attacks. We compared daily AREDV and pollutant levels between 1999 and 2002 using the Wilcoxon signed rank sum test. We considered each season separately due to seasonal variations of AREDV and pollutants. We then used multiple linear regression models to assess the relationships between the changes in AREDV and the changes in pollutants from 1999 to 2002 in each season. Results: There were statistically significant increases from 1999 to 2002 in the daily NO2 in the summer. Significant increases for daily SO2 and O3 values from 1999 to 2002 occurred in all seasons. Significant increases occurred in daily AREDV values in the spring and fall. Multiple linear regression analyses showed that increases in the daily O3 values were significantly associated with increases in AREDV from 1999 to 2002 in the summer season. Conclusion: We observed a possible association between the WTC attacks and significant increases in O3 and SO2 for all seasons, and NO2 for the summer. AREDV significantly increased following the WTC attacks. Increases in daily O3 values were significantly associated with increases in AREDV in the summer season.
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Affiliation(s)
- Kunwar Ishan Sharma
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Abraham
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennifer Toh
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Rosenstreich
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunit Jariwala
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
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15
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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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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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17
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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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18
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Alcock I, White M, Cherrie M, Wheeler B, Taylor J, McInnes R, Otte Im Kampe E, Vardoulakis S, Sarran C, Soyiri I, Fleming L. Land cover and air pollution are associated with asthma hospitalisations: A cross-sectional study. ENVIRONMENT INTERNATIONAL 2017; 109:29-41. [PMID: 28926750 DOI: 10.1016/j.envint.2017.08.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is increasing policy interest in the potential for vegetation in urban areas to mitigate harmful effects of air pollution on respiratory health. We aimed to quantify relationships between tree and green space density and asthma-related hospitalisations, and explore how these varied with exposure to background air pollution concentrations. METHODS Population standardised asthma hospitalisation rates (1997-2012) for 26,455 urban residential areas of England were merged with area-level data on vegetation and background air pollutant concentrations. We fitted negative binomial regression models using maximum likelihood estimation to obtain estimates of asthma-vegetation relationships at different levels of pollutant exposure. RESULTS Green space and gardens were associated with reductions in asthma hospitalisation when pollutant exposures were lower but had no significant association when pollutant exposures were higher. In contrast, tree density was associated with reduced asthma hospitalisation when pollutant exposures were higher but had no significant association when pollutant exposures were lower. CONCLUSIONS We found differential effects of natural environments at high and low background pollutant concentrations. These findings can provide evidence for urban planning decisions which aim to leverage health co-benefits from environmental improvements.
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Affiliation(s)
| | | | - Mark Cherrie
- University of Edinburgh, United Kingdom; University of Exeter, United Kingdom
| | | | | | - Rachel McInnes
- MetOffice, United Kingdom; University of Exeter, United Kingdom
| | | | - Sotiris Vardoulakis
- Institute of Occupational Medicine, United Kingdom; Public Health England, United Kingdom; University of Exeter, United Kingdom
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Abstract
Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child's neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships between neighborhood-level factors and asthma morbidity in urban children. Three literature databases were searched using the terms "asthma," "child," "neighborhood," and "urban." The articles included were organized into six themes within the larger domains of prevalence, physical, and social factors. Literature tables provide in-depth analysis of each article and demonstrate a need for strengthening analysis methods. The current research points to the necessity for a multilevel study to analyze neighborhood-level factors that are associated with increased asthma morbidity in urban children. School nurse clinicians, working within children's neighborhoods, are uniquely positioned to assess modifiable neighborhood-level determinants of health in caring for children with asthma.
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Affiliation(s)
| | - Arlene Butz
- Johns Hopkins School of Medicine, General Pediatric and Adolescent Medicine, Baltimore, MD, USA
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20
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Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America. Can Respir J 2017; 2017:8921917. [PMID: 28239256 PMCID: PMC5292365 DOI: 10.1155/2017/8921917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM2.5 and CO were consistent across studies. The link between asthma and O3 varied across seasons. Regional variation exists in the role of SO2. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM10-2.5, PM10, O3, NO2, SO2, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.
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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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Ito K, Weinberger KR, Robinson GS, Sheffield PE, Lall R, Mathes R, Ross Z, Kinney PL, Matte TD. The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012. Environ Health 2015; 14:71. [PMID: 26310854 PMCID: PMC4549916 DOI: 10.1186/s12940-015-0057-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/16/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits. METHODS Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012. Multi-day impacts of pollen on the outcomes (0-3 days and 0-7 days for the medication sales and ED visits, respectively) were estimated using a distributed lag Poisson time-series model adjusting for temporal trends, day-of-week, weather, and air pollution. For asthma syndrome ED visits, age groups were also analyzed. Year-to-year variation in the average peak dates and the 10th-to-90th percentile duration between pollen and the outcomes were also examined with Spearman's rank correlation. RESULTS Mid-spring pollen types (maple, birch, beech, ash, oak, and sycamore/London planetree) showed the strongest significant associations with both outcomes, with cumulative rate ratios up to 2.0 per 0-to-98th percentile pollen increase (e.g., 1.9 [95% CI: 1.7, 2.1] and 1.7 [95% CI: 1.5, 1.9] for the medication sales and ED visits, respectively, for ash). Lagged associations were longer for asthma syndrome ED visits than for the medication sales. Associations were strongest in children (ages 5-17; e.g., a cumulative rate ratio of 2.6 [95% CI: 2.1, 3.1] per 0-to-98th percentile increase in ash). The average peak dates and durations of some of these mid-spring pollen types were also associated with those of the outcomes. CONCLUSIONS Tree pollen peaking in mid-spring exhibit substantive impacts on allergy, and asthma exacerbations, particularly in children. Given the narrow time window of these pollen peak occurrences, public health and clinical approaches to anticipate and reduce allergy/asthma exacerbation should be developed.
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Affiliation(s)
- Kazuhiko Ito
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA.
| | - Kate R Weinberger
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA.
| | - Guy S Robinson
- Louis Calder Center, Biological Field Station, Fordham University, Armonk, New York, NY, 10504-1104, USA.
- Department of Natural Sciences, Fordham College at Lincoln Center, 113 West 60th Street, New York, NY, 10023, USA.
| | - Perry E Sheffield
- Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1512, New York, NY, 10029, USA.
| | - Ramona Lall
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA.
| | - Robert Mathes
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA.
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA.
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA.
| | - Thomas D Matte
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA.
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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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Lockett GA, Patil VK, Soto-Ramírez N, Ziyab AH, Holloway JW, Karmaus W. Epigenomics and allergic disease. Epigenomics 2014; 5:685-99. [PMID: 24283882 DOI: 10.2217/epi.13.68] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Allergic disease development is affected by both genes and the environment, and epigenetic mechanisms are hypothesized to mediate these environmental effects. In this article, we discuss the link between the environment, DNA methylation and allergic disease, as well as questions of causality inherent to analyses of DNA methylation. From the practical side, we describe characteristics of allergic phenotypes and contrast different epidemiologic study designs used in epigenetic research. We examine methodological considerations, how best to conduct preprocessing and analysis of DNA methylation data sets, and the latest methods, technologies and discoveries in this rapidly advancing field. DNA methylation and other epigenetic marks are firmly entwined with allergic disease, a link that may hold the basis for future allergic disease diagnosis and treatment.
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Affiliation(s)
- Gabrielle A Lockett
- Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Risk factors for nonwork-related adult-onset asthma and occupational asthma: a comparative review. Curr Opin Allergy Clin Immunol 2014; 14:84-94. [PMID: 24535141 DOI: 10.1097/aci.0000000000000042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To identify the similarities and differences between nonwork-related adult-onset and occupational asthma from various literature sources published between 2010 and 2013, with respect to the epidemiology, phenotypic manifestations, and risk factors for the disease. RECENT FINDINGS The incidence of adult-onset asthma from pooled population studies is estimated to be 3.6 per 1000 person-years in men and 4.6 cases per 1000 person-years in women. In adults with new-onset asthma, occupational asthma is a common asthma phenotype. Work-related factors are estimated to account for up to 25% of adult cases of asthma and occupational asthma comprising about 16% of adult-onset asthma cases. The review finds that nonwork-related adult-onset asthma is a heterogenous entity and that environmental exposure factors (aside from occupational exposures) appear to have a lesser role than host factors when compared with occupational asthma. SUMMARY Large-scale general population studies are needed to identify the similarities and differences between nonwork-related adult-onset and occupational asthma, which may enable a better understanding of these entities and promote efforts towards holistic management approaches for these asthma phenotypes.
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Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, Bousquet J, Calderón M, Compalati E, Durham SR, van Wijk RG, Larenas-Linnemann D, Nelson H, Passalacqua G, Pfaar O, Rosário N, Ryan D, Rosenwasser L, Schmid-Grendelmeier P, Senna G, Valovirta E, Van Bever H, Vichyanond P, Wahn U, Yusuf O. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J 2014; 7:6. [PMID: 24679069 PMCID: PMC3983904 DOI: 10.1186/1939-4551-7-6] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 02/07/2023] Open
Abstract
We have prepared this document, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2013 Update", according to the evidence-based criteria, revising and updating chapters of the originally published paper, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2009", available at http://www.waojournal.org. Namely, these comprise: "Mechanisms of sublingual immunotherapy;" "Clinical efficacy of sublingual immunotherapy" - reporting all the data of all controlled trials published after 2009; "Safety of sublingual immunotherapy" - with the recently published Grading System for adverse reactions; "Impact of sublingual immunotherapy on the natural history of respiratory allergy" - with the relevant evidences published since 2009; "Efficacy of SLIT in children" - with detailed analysis of all the studies; "Definition of SLIT patient selection" - reporting the criteria for eligibility to sublingual immunotherapy; "The future of immunotherapy in the community care setting"; "Methodology of clinical trials according to the current scientific and regulatory standards"; and "Guideline development: from evidence-based medicine to patients' views" - including the evolution of the methods to make clinical recommendations.Additionally, we have added new chapters to cover a few emerging crucial topics: "Practical aspects of schedules and dosages and counseling for adherence" - which is crucial in clinical practice for all treatments; "Perspectives and new approaches" - including recombinant allergens, adjuvants, modified allergens, and the concept of validity of the single products. Furthermore, "Raising public awareness about sublingual immunotherapy", as a need for our patients, and strategies to increase awareness of allergen immunotherapy (AIT) among patients, the medical community, all healthcare stakeholders, and public opinion, are also reported in detail.
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Affiliation(s)
- Giorgio Walter Canonica
- Respiratory and Allergy Clinic, DIMI—Department of Internal Medicine, University of Genoa, IRCCS Aou San Martino, Largo Rosanna Benzi 10, Genoa 1-16132, Italy
| | - Linda Cox
- Department of Medicine, Nova Southeastern University, College of Osteopathic Medicine, Davie Florida, USA
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Carlos E Baena-Cagnani
- Research Center for Respiratory Medicine (CIMER), Catholic University, Fundación LIBRA, Córdoba, Argentina
| | - Michael Blaiss
- Department of Pediatrics and Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sergio Bonini
- Department of Medicine, Second University of Naples, Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy
| | - Jean Bousquet
- Centre Hospitalier Regional Universitaire de Montpellier, Université de Montpellier, Montpellier, France
| | - Moises Calderón
- Section of Allergy and Clinical Immunology, Imperial College of London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Enrico Compalati
- Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Stephen R Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College of London, London, UK
| | - Roy Gerth van Wijk
- Department of Allergology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Harold Nelson
- National Jewish Health, University of Colorado – Denver School of Medicine, Denver, Colorado, USA
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genova, Italy
| | - Oliver Pfaar
- Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Nelson Rosário
- Pediatric Allergy and Immunology Division, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Dermot Ryan
- Academic Centre of Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Lanny Rosenwasser
- Children’s Mercy Hospital, University of Missouri – Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - Erkka Valovirta
- Department of Clinical Allergology and Pulmonary Diseases, University of Turku, Finland, and Allergy Clinic, Terveystalo, Turku, Finland
| | - Hugo Van Bever
- Department of Paediatrics, University Children’s Medical Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pakit Vichyanond
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ulrich Wahn
- Department of Pediatric Pneumology and Immunology, Charité, Humboldt University, Berlin, Germany
| | - Osman Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
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Jariwala S, Toh J, Shum M, de Vos G, Zou K, Sindher S, Patel P, Geevarghese A, Tavdy A, Rosenstreich D. The association between asthma-related emergency department visits and pollen and mold spore concentrations in the Bronx, 2001-2008. J Asthma 2013; 51:79-83. [PMID: 24131032 DOI: 10.3109/02770903.2013.853779] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence of asthma morbidity and mortality is highest among minority inner-city populations. Among New York City's five boroughs, the Bronx has the highest rate of asthma-related hospitalizations and mortality. Outdoor air pollutants have been associated with increased asthma-related ED visits (AREDV) in this borough. OBJECTIVE To better understand the contribution of pollen and mold to asthma severity in the Bronx. METHODS The numbers of daily adult and pediatric AREDV and asthma-related hospitalizations (ARH) from 2001 to 2008 were obtained from two Bronx hospitals. AREDV and ARH data were acquired retrospectively through the Clinical Looking Glass data analysis software. Daily counts for tree, grass and weed pollen and mold spore counts from March 2001 to October 2008 were obtained from the Armonk counting station. All data were statistically analyzed and graphed as daily values. RESULTS There were a total of 42 065 AREDV and 10 132 ARH at both Bronx hospitals. There were spring and winter peaks of increased AREDV. Tree pollen counts significantly correlated with total AREDV (rho = 0.3639, p < 0.001), and pediatric (rho = 0.33, p < 0.001) and adult AREDV (rho = 0.28, p < 0.001). ARH positively correlated with tree pollen counts (Spearman rho = 0.2389, p < 0.001). CONCLUSIONS There exists a significant association between spring AREDV and ARH and tree pollen concentrations in a highly urbanized area such as the Bronx. Early anticipation of spring pollen peaks based on ongoing surveillance could potentially guide clinical practice and minimize asthma-related ED visits in the Bronx.
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Vernon MK, Wiklund I, Bell JA, Dale P, Chapman KR. What do we know about asthma triggers? a review of the literature. J Asthma 2013; 49:991-8. [PMID: 23574397 DOI: 10.3109/02770903.2012.738268] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE For patients with asthma, exacerbations and poor control can result from exposure to environmental triggers, such as allergens and air particulates. This study reviewed the international literature to determine whether a global checklist of common asthma triggers might be feasible for use as a research or management tool in clinical practice. METHODS Literature published from 2002 to 2012 was identified through PubMed and EMBASE using the following search terms: asthma, asthma triggers, prevalence, among others. A total of 1046 abstracts were found; 85 articles were reviewed covering six continents (number of articles): Africa (1), Asia (22), Australia (1), Europe (27), North America (22), and South America (4). RESULTS The literature consistently pointed to asthma triggers as one contributor to poor asthma control. Frequently cited triggers were similar across countries/regions and included allergens (particularly pollens, molds, dust, and pet dander), tobacco smoke, exercise, air pollutants/particulates, weather patterns/changes, and respiratory infections. Definitions of asthma triggers, how triggers are taken into account in definitions of asthma control, and scientific inquiry into optimal management techniques for triggers were inconsistent and sparse. CONCLUSIONS Given the apparent importance of triggers in attaining and maintaining asthma control, empirical research concerning optimal trigger management is needed. Results demonstrate that asthma triggers are similar across continents, suggesting a global checklist of triggers for use in research and clinical practice would be feasible.
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Lovasi GS, O'Neil-Dunne JPM, Lu JWT, Sheehan D, Perzanowski MS, Macfaden SW, King KL, Matte T, Miller RL, Hoepner LA, Perera FP, Rundle A. Urban tree canopy and asthma, wheeze, rhinitis, and allergic sensitization to tree pollen in a New York City birth cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:494-500. [PMID: 23322788 PMCID: PMC3620770 DOI: 10.1289/ehp.1205513] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 01/14/2013] [Indexed: 05/19/2023]
Abstract
BACKGROUND Urban landscape elements, particularly trees, have the potential to affect airflow, air quality, and production of aeroallergens. Several large-scale urban tree planting projects have sought to promote respiratory health, yet evidence linking tree cover to human health is limited. OBJECTIVES We sought to investigate the association of tree canopy cover with subsequent development of childhood asthma, wheeze, rhinitis, and allergic sensitization. METHODS Birth cohort study data were linked to detailed geographic information systems data characterizing 2001 tree canopy coverage based on LiDAR (light detection and ranging) and multispectral imagery within 0.25 km of the prenatal address. A total of 549 Dominican or African-American children born in 1998-2006 had outcome data assessed by validated questionnaire or based on IgE antibody response to specific allergens, including a tree pollen mix. RESULTS Tree canopy coverage did not significantly predict outcomes at 5 years of age, but was positively associated with asthma and allergic sensitization at 7 years. Adjusted risk ratios (RRs) per standard deviation of tree canopy coverage were 1.17 for asthma (95% CI: 1.02, 1.33), 1.20 for any specific allergic sensitization (95% CI: 1.05, 1.37), and 1.43 for tree pollen allergic sensitization (95% CI: 1.19, 1.72). CONCLUSIONS Results did not support the hypothesized protective association of urban tree canopy coverage with asthma or allergy-related outcomes. Tree canopy cover near the prenatal address was associated with higher prevalence of allergic sensitization to tree pollen. Information was not available on sensitization to specific tree species or individual pollen exposures, and results may not be generalizable to other populations or geographic areas.
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Affiliation(s)
- Gina S Lovasi
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Antó JM. Recent advances in the epidemiologic investigation of risk factors for asthma: a review of the 2011 literature. Curr Allergy Asthma Rep 2013; 12:192-200. [PMID: 22422360 DOI: 10.1007/s11882-012-0254-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present review aims to identify and summarize epidemiologic investigations published during 2011 on the environmental risk factors for asthma. Potentially eligible papers were identified by a MEDLINE search. In total, 1,130 items were retrieved. Based on a broad definition of environment, the following topics were included: obesity, diet, vitamin D, air pollution, farming environment, and social factors. Some of the more relevant contributions included evidence that 1) obesity precedes asthma, 2) fruit consumption is longitudinally associated with a lower risk of asthma and atopy, 3) a comprehensive statewide smoking ban was followed by a reduction in hospital admissions for asthma, 4) asthma is one of the diseases showing the largest burdens due to environmental tobacco smoke, 5) traffic-related urban air pollution is associated with bronchial inflammation as measured by fractional exhaled nitric oxide and uncontrolled asthma, 6) aeroallergens and desert dust may contribute to the short-term effects of air pollution and asthma, and 7) maternal exposure to air pollution before and during pregnancy may alter the immune competence in offspring.
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Affiliation(s)
- Josep M Antó
- Centre for Research in Environmental Epidemiology, Barcelona Biomedical Research Park, Spain.
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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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Abstract
PURPOSE OF REVIEW Air pollution has been increasingly associated with diverse adverse health outcomes, including airway diseases. Data suggest that gene-environment interactions are important in this context. However, evidence regarding causal effects of exposure and development of allergic conditions specifically remains immature. We review the developments of the past 18 months regarding air pollution, genetics and epigenetics, and allergy. RECENT FINDINGS Conflicting evidence for air pollution as causative in the development of allergic disease persists. However, recent data support the associations between long-term exposure to traffic-related pollutants and newly developed sensitization in children. Studies from India and China demonstrate the global burden of health-related costs attributed to air pollutants and allergic diseases. The effect of exposure seems to be modified by coexposures of allergens as well as genetic variants, particularly those moderating response to oxidative stress. Potential links between exposures and epigenetic (DNA methylation) changes with consequences for disease development are also reinforced. SUMMARY Data over the past 18 months support prior literature that air pollutants cause exacerbation, and possibly onset, of allergic disease. Regarding the onset of asthma specifically, the evidence of causality has grown significantly, but it remains difficult to separate allergic from nonallergic asthma. Effect of modification by genetic variants and epigenetic changes warrants further study.
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Fabian MP, Stout NK, Adamkiewicz G, Geggel A, Ren C, Sandel M, Levy JI. The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model. Environ Health 2012; 11:66. [PMID: 22989068 PMCID: PMC3527278 DOI: 10.1186/1476-069x-11-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 09/06/2012] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date. METHODS We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold. RESULTS Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates. CONCLUSIONS We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.
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Affiliation(s)
- M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Amelia Geggel
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Cizao Ren
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Megan Sandel
- Department of General Pediatrics, Boston Medical University School of Medicine, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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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: 114] [Impact Index Per Article: 9.5] [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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[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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