A systematic review of the role of grass pollen and fungi in thunderstorm asthma

Idrose, Nur Sabrina; Dharmage, Shyamali C.; Lowe, Adrian J.; Lambert, Katrina A.; Lodge, Caroline; Abramson, Michael J.; Douglass, Jo A; Newbigin, Ed; Erbas, Bircan

doi:10.1016/j.envres.2019.108911

Cited by 46 publications

(35 citation statements)

References 37 publications

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“…At a community level, in addition to asthma hospitalizations, 15 outdoor pollen has been shown to trigger thunderstorm asthma events 16,17 . Under extreme weather conditions, pollen is hypothesized to rupture into small inhalable particles capable of triggering asthma even in individuals without a documented clinical history of asthma 18‐21 .…”

Section: Introductionmentioning

confidence: 99%

Outdoor pollen‐related changes in lung function and markers of airway inflammation: A systematic review and meta‐analysis

Idrose

Walters

Zhang

et al. 2021

Clin Experimental Allergy

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Background Experimental challenge studies have shown that pollen can have early and delayed effects on the lungs and airways. Here, we qualitatively and quantitatively synthesize the evidence of outdoor pollen exposure on various lung function and airway inflammation markers in community‐based studies. Methods Four online databases were searched: Medline, Web of Science, CINAHL and Google Scholar. The search strategy included terms relating to both exposure and outcomes. Inclusion criteria were human‐based studies published in English that were representative of the community. Additionally, we only considered cross‐sectional or short‐term longitudinal studies which investigated pollen exposure by levels or season. Study quality assessment was performed using the Newcastle‐Ottawa scale. Meta‐analysis was conducted using random‐effects models. Results We included 27 of 6551 studies identified from the search. Qualitative synthesis indicated associations between pollen exposure and predominantly type‐2 inflammation in both the upper and lower airways, but little evidence for lung function changes. People with ever asthma and/or seasonal allergic rhinitis (SAR) were at higher risk of such airway inflammation. Meta‐analysis confirmed a positive relationship between pollen season, eosinophilia and eosinophil cationic protein (ECP) in people with ever SAR but the results between studies were highly variable. Heterogeneity was reduced after further subgrouping by age, and the forest plots indicated that eosinophilic airway inflammation to outdoor pollen exposure increased with age. Conclusion Among people with ever asthma and ever SAR, exposure to increased ambient pollen triggers type‐2 upper and lower airway inflammation rather than a non‐specific or innate inflammation. These findings can lead to the formulation of specific pollen immunotherapy for susceptible individuals. Future research should be directed towards investigating lagged associations and effect modifications using larger and more generalized populations. Systematic review registration CRD42020146981 (PROSPERO).

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Section: Introductionmentioning

confidence: 99%

Outdoor pollen‐related changes in lung function and markers of airway inflammation: A systematic review and meta‐analysis

Idrose

Walters

Zhang

et al. 2021

Clin Experimental Allergy

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“…Exposure to temperate grass pollen is being recognized as an increasingly important trigger for acute asthma including thunderstorm asthma 3‐5 . Temperate grass pollen contains several allergens, particularly Groups 1 and 5, which have considerable homology across grass species 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Is short‐term exposure to grass pollen adversely associated with lung function and airway inflammation in the community?

Idrose

Tham

Lodge

et al. 2020

Allergy

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Background The association between grass pollen exposure and early markers of asthma exacerbations such as lung function changes and increase in airway inflammation is limited. We investigated the associations between short‐term grass pollen exposure and lung function and airway inflammation in a community‐based sample, and whether any such associations were modified by current asthma, current hay fever, pollen sensitization, age, and other environmental factors. Methods Cross‐sectional and short‐term analyses of data from the Melbourne Atopy Cohort Study (MACS) participants (n = 936). Lung function was assessed using spirometry. Airway inflammation was assessed by fractional exhaled nitric oxide (FeNO) and exhaled breath condensate pH and nitrogen oxides (NOx). Daily pollen counts were collected using a volumetric spore trap. The associations were examined by linear regression. Results Higher ambient levels of grass pollen 2 days before (lag 2) were associated with lower mid‐forced expiratory flow (FEF25%‐75%) and FEV1/FVC ratio (Coef. [95% CI] = −119 [−226, −11] mL/s and −1.0 [−3.0, −0.03] %, respectively) and also 3 days before (lag 3). Increased levels of grass pollen a day before (lag 1) were associated with increased FeNO (4.35 [−0.1, 8.7] ppb) and also at lag 2. Adverse associations between pollen and multiple outcomes were greater in adults with current asthma, hay fever, and pollen sensitization. Conclusion Grass pollen exposure was associated with eosinophilic airway inflammation 1‐2 days after exposure and airway obstruction 2‐3 days after exposure. Adults and individuals with asthma, hay fever, and pollen sensitization may be at higher risk.

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“…However, green spaces may also produce and emit allergenic pollen (Cariñanos et al 2017;Kasprzyk et al 2019;Lara et al 2019). An increasing number of studies has found that allergenic pollen, in combination with air pollution and other agents such as fungal spores, endotoxins and mycotoxins, may initiate airway inflammation and trigger allergic and nonallergic asthma, asthma medication sales and hospital admissions for asthma (Dadvand et al 2014;Erbas et al 2013;Erbas et al 2018;Guilbert et al 2018;Lambert et al 2017;Lambert et al 2019;Idrose et al 2020). Housing quality and other dimensions of socioeconomic status may also affect respiratory health and are, like air pollution, potential confounders of the association between green space, asthma prevalence and asthma medication sales (Donaldson et al 2000;Casas et al 2016;Hughes et al 2017;Orellano et al 2017 ;Sahni et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium

Aerts

Dujardin

Nemery

et al. 2020

Environmental Research

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Background: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous.Objective: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium.Methods: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6-12 and 13-18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region.Results: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15-0.17; garden, β = 0.13-0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10-0.14; garden, β = 0.07-0.09). There was no association between OAD medication sales and forest cover.Conclusions: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green

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A systematic review of the role of grass pollen and fungi in thunderstorm asthma

Cited by 46 publications

References 37 publications

Outdoor pollen‐related changes in lung function and markers of airway inflammation: A systematic review and meta‐analysis

Outdoor pollen‐related changes in lung function and markers of airway inflammation: A systematic review and meta‐analysis

Is short‐term exposure to grass pollen adversely associated with lung function and airway inflammation in the community?

Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium

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