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Evaluation of evidence for interaction between PM2.5 and aeroallergens on childhood asthma exacerbation in Philadelphia, PA, 2011 to 2016
Journal article   Peer reviewed

Evaluation of evidence for interaction between PM2.5 and aeroallergens on childhood asthma exacerbation in Philadelphia, PA, 2011 to 2016

Wanyu Huang, Leah H. Schinasi, Chén C. Kenyon, Amy H. Auchincloss, Kari Moore, Steven Melly, Lucy F. Robinson, Christopher B. Forrest and Anneclaire J. De Roos
Environmental research, v 234, 116395
Oct 2023
DOI: https://doi.org/10.1016/j.envres.2023.116395
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Aeroallergen Asthma exacerbation Children Interaction PM2.5
Fine particulate matter (PM2.5) and aeroallergens (i.e., pollen, molds) are known triggers of asthma exacerbation. Despite mechanistic evidence suggesting synergistic effects between PM2.5 and asthma exacerbation, little epidemiologic work has been performed in children, which has exhibited inconsistency. We conducted a time-series study to explore their interactions using electronic health records (EHR) data in Philadelphia, PA, for asthma diagnoses in outpatient, emergency department [ED], and inpatient settings. Daily asthma exacerbation cases (28,540 asthma exacerbation case encounters) were linked to daily ambient PM2.5 and daily aeroallergen levels during the aeroallergen season of a six-year period (mid-March to October 2011–2016). Asthma exacerbation counts were modeled using quasi-Poisson regression, where PM2.5 and aeroallergens were fitted with distributed lag non-linear functions (lagged from 0 to 14-days), respectively, when modeled as the primary exposure variables. Regression models were adjusted for mean daily temperature/relative humidity, long-term and seasonal trends, day-of-week, and major U.S. holidays. Increasing gradient of RR estimates were observed for only a few primary exposure risk factors [PM2.5 (90th vs. 5th percentile)/aeroallergens (90th percentile vs. 0)], across different levels of effect modifiers. For example, RRs for the association between late-season grass pollen (lag1) and asthma exacerbation were higher at higher levels of PM2.5, 5-days preceding the exacerbation event (low PM2.5: RR = 1.01, 95% CI: 0.93–1.09; medium PM2.5: 1.04, 95% CI: 0.96–1.12; high PM2.5: 1.09, 95% CI: 1.01–1.19). However, most of the highest RRs for aeroallergens were instead observed for days with low- or medium- PM2.5 levels; likewise, when PM2.5 was modeled as the primary exposure with aeroallergens as the effect modifier. Most of the RR estimates did not exhibit gradients that suggested synergism, and were of relatively high imprecision. Overall, our study suggested no evidence for interactions between PM2.5 and aeroallergens in their relationships with childhood asthma exacerbation. Highlights • Little evidence was suggested, overall, for interactions between PM2.5 and aeroallergens in their relationship with childhood asthma exacerbation. • RRs exhibited increasing gradients for the association between late-season weed/grass pollen and asthma exacerbation across PM2.5 levels, supporting synergism. • Continued reduction of PM2.5 levels and improvement of aeroallergen monitoring networks are encouraged by the study.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#11 Sustainable Cities and Communities
#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Environmental Sciences
Public, Environmental & Occupational Health
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