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Interactive effects of allergens and air pollution on respiratory health: A systematic review

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Title: Interactive effects of allergens and air pollution on respiratory health: A systematic review
Authors: Lam, H
Jarvis, D
Fuertes, E
Item Type: Journal Article
Abstract: Background Studies have demonstrated an adverse role of outdoor allergens on respiratory symptoms. It is unknown whether this effect is independent or synergistic of outdoor air pollutants. Methods We systematically reviewed all epidemiological studies that examined interaction effects between counts of outdoor airborne allergens (pollen, fungal spores) and air pollutants, on any respiratory health outcome in children and adults. We searched the MEDLINE, EMBASE and Scopus databases. Each study was summarized qualitatively and assessed for quality and risk of bias (International Prospective Register for Systematic Reviews, registration number CRD42020162571). Results Thirty-five studies were identified (15 timeseries, eight case-crossovers, 11 panels and one cohort study), of which 12 reported a significant statistical interaction between an allergen and air pollutant. Eight interactions were related to asthma outcomes, including one on lung function measures and wheeze, three to medical consultations for pollinosis and one to allergic symptoms (nasal, ocular or bronchial). There was no consensus as to which allergen or air pollutant is more likely to interact. No study investigated whether interactions are stronger in atopic individuals. Conclusion Despite strong evidence from small experimental studies in humans, only a third of studies identified significant allergen-pollutant interactions using common epidemiological study designs. Exposure misclassification, failure to examine subgroups at risk, inadequate statistical power or absence of population-level effects are possible explanations.
Issue Date: 25-Feb-2021
Date of Acceptance: 16-Nov-2020
URI: http://hdl.handle.net/10044/1/85752
DOI: 10.1016/j.scitotenv.2020.143924
ISSN: 0048-9697
Publisher: Elsevier
Journal / Book Title: Science of the Total Environment
Volume: 757
Copyright Statement: © 2020 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Imperial College London
Keywords: Fungal Spore
Air Pollutants
Air Pollution
Cohort Studies
Environmental Sciences
Publication Status: Published
Article Number: ARTN 143924
Online Publication Date: 2020-12-04
Appears in Collections:Department of Infectious Diseases
National Heart and Lung Institute

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