Grass pollen as a trigger of emergency department presentations and hospital admissions for respiratory conditions in the subtropics: A systematic review

Šimunović, Marko; Dwarakanath, Divya; Addison-Smith, Beth; Susanto, Nugroho Harry; Erbas, Bircan; Baker, Philip; Davies, Janet M.

doi:10.1016/j.envres.2020.109125

Cited by 16 publications

(7 citation statements)

References 38 publications

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“…[15][16][17] During winter months, environmental influences such as viral respiratory infections may impact on asthma ED presentations. 18 Respiratory allergens such as grass pollen, 19 mould spores 20 or house dust mites 21 have previously shown an association with allergic asthma outside the winter period. Outdoor aeroallergens, such as grass pollen, may partly contribute to the observed results.…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal characteristics of asthma emergency department presentations in diverse geographical and climatic regions, Queensland, Australia

Šimunović

Boyle

Baker

et al. 2020

Emerg Medicine Australasia

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Objective: Sudden acute episodes of asthma exacerbation are often treated by hospital EDs. It is hypothesised that determinants of acute asthma would differ across geographic regions. The objective of the present study was to detail seasonality, trends and spatiotemporal patterns of asthma ED presentations across Queensland (QLD), Australia, a state covering 1.8 million square kilometres, spanning multiple climates. Methods: Six years of routinely collected data (2012 to 2017) from 28 major QLD public hospitals were extracted from Queensland Health's Emergency Data Collection. The dataset contained individual, episodelevel asthma-like diagnoses of ED presentations. Seasonality and trends of acute asthma were assessed through multiplicative time-series analysis. Results: The study consisted of 2192 days with a total of 65 012 asthma ED presentations in QLD. The 6-year average daily incidence rate was 270 asthma ED presentations per 100 000 population. The highest morbidity of asthma ED presentations occurred during the southern hemisphere winter months. Children showed a higher incidence rate compared to adults with males experiencing a higher incidence compared to females up until the age of 13, after which an inversion was observed persisting through adulthood. Seasonality of asthma ED presentations differed with latitude across QLD. Conclusion: Asthma-related ED presentations exhibit spatiotemporal variation across QLD, which appears to be related to climate. Furthermore, aeroallergens and respiratory viruses may be responsible for asthma ED peaks outside the winter period. Socioeconomic status may influence asthma ED presentation rates between regions. This knowledge can guide ongoing management and assist public health policy response.

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Section: Discussionmentioning

confidence: 99%

Spatiotemporal characteristics of asthma emergency department presentations in diverse geographical and climatic regions, Queensland, Australia

Šimunović

Boyle

Baker

et al. 2020

Emerg Medicine Australasia

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“…To date, three systematic reviews [ 8 , 13 , 33 ] have evaluated the relationship between ambient pollen and childhood asthma hospital attendances, in which ambient grass and birch pollen were reported to be important risk factors, but only in non-subtropical climates.…”

Section: Short-term Impact Of Pollen On Adverse Respiratory Outcomesmentioning

confidence: 99%

“…Simunovic et al [ 13 ], who assessed asthma ED presentations and hospitalisations in subtropical climates, reported little to no evidence of an association with grass pollen on the same day or lagged in the six studies that assessed children only. A meta-analysis was not possible for this review.…”

Section: Short-term Impact Of Pollen On Adverse Respiratory Outcomesmentioning

confidence: 99%

“…For example, the main allergenic pollen family in the Southern Mediterranean is nettle weed [ 11 ], but grass is prominent in other temperate regions such as northern Europe and Australia [ 12 ]. Temperate grasses (e.g., Pooideae ) dominate in cooler climates, while subtropical grasses (e.g., Panicoideae and Chloridoideae ) dominate in subtropical climates [ 13 ]. Although allergenic pollen only account for approximately 20–30% of the total annual pollen load, they are abundant during the species’ flowering seasons [ 14 ], thereby triggering symptoms.…”

Section: Introductionmentioning

confidence: 99%

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A Review of the Respiratory Health Burden Attributable to Short-Term Exposure to Pollen

Idrose

Lodge

Erbas

et al. 2022

IJERPH

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Respiratory diseases such as asthma, allergic rhinitis (AR) and chronic obstructive pulmonary disease (COPD) affect millions worldwide and pose a significant global public health burden. Over the years, changes in land use and climate have increased pollen quantity, allergenicity and duration of the pollen season, thus increasing its impact on respiratory disease. Many studies have investigated the associations between short-term ambient pollen (i.e., within days or weeks of exposure) and respiratory outcomes. Here, we reviewed the current evidence on the association between short-term outdoor pollen exposure and thunderstorm asthma (TA), asthma and COPD hospital presentations, general practice (GP) consultations, self-reported respiratory symptoms, lung function changes and their potential effect modifiers. The literature suggests strong evidence of an association between ambient pollen concentrations and almost all respiratory outcomes mentioned above, especially in people with pre-existing respiratory diseases. However, the evidence on sub-clinical lung function changes, COPD, and effect modifiers other than asthma, hay fever and pollen sensitisation are still scarce and requires further exploration. Better understanding of the implications of pollen on respiratory health can aid healthcare professionals to implement appropriate management strategies.

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“…Asthma alone exhibits several endotypes 25,26 with common co‐existence with other diseases such as allergic rhinitis and atopic dermatitis. Several indoor triggers, such as house dust mites, 27 and outdoor triggers, such as aeroallergen exposure 28 and air pollutants, 29 as well as respiratory viruses 30 have shown an association with asthma ED visits and hospital admission and should be considered in further analysis of these data. Increasingly aeroallergens such as grass pollen have shown strong associations in temperate climates during the springtime 7,31 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of emergency patients admitted to hospital with asthma: A population‐based cohort study in Queensland, Australia

Šimunović

Erbas

Boyle

et al. 2021

Emerg Medicine Australasia

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Objective Patient characteristics with exacerbation of asthma accessing care in the ED who are at risk of hospital admission have not been determined in subtropical climates. The objective of the study was to investigate the spatiotemporal burden of asthma hospital admissions across Queensland (QLD) and model risk factors for asthma hospital admission following an ED visit. Methods Six years of routinely collected data (2012–2017) from 28 QLD public hospitals were extracted from Queensland Health's Emergency Data Collection. The dataset contained individual, episode‐level ED presentations having asthma‐like diagnoses, and an indicator of hospital admission, including to short‐stay unit (SSU). A generalised additive model was used to examine the risk of asthma hospital admission. Results Asthma hospital admissions increased from a weekly median of 79 (interquartile range [IQR] 66–99) in 2012 to 104 (IQR 81–135) in 2017. A higher incidence of asthma hospital admission was observed among males (median age 9, IQR 5–32) in childhood and females in adulthood (median age 32, IQR 11–51). Compared to the state capital Brisbane, the odds of asthma hospital admission ranged from 0.48 (95% CI 0.42–0.54) to 1.34 (95%CI 1.21–1.48) in other regions of QLD. Conclusion Asthma hospital admissions appear to be increasing in QLD, largely driven by utilisation of the SSU admissions for asthma. With large variation in both incidence and proportion admitted across different regions, routinely collected data can in part be used to understand risk factors for asthma‐related hospital admission following an ED presentation and further inform public health policy development.

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Grass pollen as a trigger of emergency department presentations and hospital admissions for respiratory conditions in the subtropics: A systematic review

Cited by 16 publications

References 38 publications

Spatiotemporal characteristics of asthma emergency department presentations in diverse geographical and climatic regions, Queensland, Australia

Spatiotemporal characteristics of asthma emergency department presentations in diverse geographical and climatic regions, Queensland, Australia

A Review of the Respiratory Health Burden Attributable to Short-Term Exposure to Pollen

Characteristics of emergency patients admitted to hospital with asthma: A population‐based cohort study in Queensland, Australia

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