Rhinitis, sinusitis, and ocular allergy
Long-term air pollution exposure is associated with increased severity of rhinitis in 2 European cohorts

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Background

Very few studies have examined the association between long-term outdoor air pollution and rhinitis severity in adults.

Objective

We sought to assess the cross-sectional association between individual long-term exposure to air pollution and severity of rhinitis.

Methods

Participants with rhinitis from 2 multicenter European cohorts (Epidemiological Study on the Genetics and Environment on Asthma and the European Community Respiratory Health Survey) were included. Annual exposure to NO2, PM10, PM2.5, and PMcoarse (calculated by subtracting PM2.5 from PM10) was estimated using land-use regression models derived from the European Study of Cohorts for Air Pollution Effects project, at the participants’ residential address. The score of rhinitis severity (range, 0-12), based on intensity of disturbance due to symptoms reported by questionnaire, was categorized into low (reference), mild, moderate, and high severity. Polytomous logistic regression models with a random intercept for city were used.

Results

A total of 1408 adults with rhinitis (mean age, 52 years; 46% men, 81% from the European Community Respiratory Health Survey) were included. The median (1st quartile-3rd quartile) score of rhinitis severity was 4 (2-6). Higher exposure to PM10 was associated with higher rhinitis severity (adjusted odds ratio [95% CI] for a 10 μg/m3 increase in PM10: for mild: 1.20 [0.88-1.64], moderate: 1.53 [1.07-2.19], and high severity: 1.72 [1.23-2.41]). Similar results were found for PM2.5. Higher exposure to NO2 was associated with an increased severity of rhinitis, with similar adjusted odds ratios whatever the level of severity. Adjusted odds ratios were higher among participants without allergic sensitization than among those with, but interaction was found only for NO2.

Conclusions

People with rhinitis who live in areas with higher levels of pollution are more likely to report more severe nasal symptoms. Further work is required to elucidate the mechanisms of this association.

Section snippets

Study design and settings

Participants included in the analysis were those suffering from rhinitis at the second follow-up (2011-2013) of 2 large multicenter epidemiological European studies: the European Community Respiratory Health Survey (ECRHS) and the Epidemiological Study on the Genetics and Environment on Asthma (EGEA).

The EGEA18,19 (https://egeanet.vjf.inserm.fr/) is a French cohort of 2047 participants (patients with asthma—adults or children—enrolled from hospital chest clinics, their first-degree relatives,

Results

This study included 1408 participants from EGEA3 and ECRHS III with symptoms of rhinitis in the last 12 months, having available data on rhinitis severity score and individual air pollution estimates (Flowchart available in Fig 1).

A detailed description of the characteristics of the 1408 participants is reported in Table I, for all participants and according to the 4 levels of severity of rhinitis. ECRHS contributed with 81% of the study population. Participants were on average 52.3 years old,

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    The European Community Respiratory Health Survey (ECRHS) was supported by the European Commission, as part of its Quality-of-Life program. The following bodies funded the local studies in ECRHS III in this article: Belgium: Antwerp South, Antwerp City: Research Foundation Flanders (FWO), grant code G.0.410.08.N.10 (both sites); France: (All) Ministère de la Santé, Programme Hospitalier de Recherche Clinique (PHRC) national 2010; Grenoble: Comite Scientifique AGIRadom 2011; Paris: Agence Nationale de la Santé, Région Ile de France, domaine d’intérêt majeur; Germany: Erfurt: German Research Foundation (HE 3294/10-1); Italy: All Italian centers were funded by the Italian Ministry of Health, Chiesi Farmaceutici SpA; in addition, Verona was funded by the Cariverona Foundation, Education Ministry (MIUR); Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/00716 09/01511, PS09/02185, and PS09/03190), Servicio Andaluz de Salud, Sociedad Española de Neumología y Cirurgía Torácica (SEPAR 1001/2010); Barcelona: Fondo de Investigación Sanitaria (FIS PS09/00716); Galdakao: Fondo de Investigación Sanitaria (FIS 09/01511); Huelva: Fondo de Investigación Sanitaria (FIS PS09/02185) and Servicio Andaluz de Salud; Oviedo: Fondo de Investigación Sanitaria (FIS PS09/03190); Sweden: All centers were funded by the Swedish Heart and Lung Foundation, the Swedish Asthma and Allergy Association, the Swedish Association against Lung and Heart Disease; the Swedish Research Council for health, working life and welfare (FORTE); and United Kingdom: Medical Research Council (grant no. 92091). Support also provided by the National Institute for Health Research through the Primary Care Research Network. The Epidemiological Study on the Genetics and Environment on Asthma is funded in part by PHRC-Paris, PHRC-Grenoble, ANR 05-SEST-020-02/05-9-97, ANR-06-CEBS, ANR-CES-2009, Région Nord Pas-de-Calais, and Merck Sharp & Dohme. European Study of Cohorts for Air Pollution Effects Funding: The research leading to these results has received funding from the European Community’s Seventh Framework Program (FP7/2007-2011; under grant agreement no. 211250).

    Disclosure of potential conflict of interest: J. Just reports personal fees and grants from Novartis and Astrazeneca, and personal fees from GlaxoSmithKline, Sanofi, and ALK, outside the submitted work. J. Bousquet is a member of POLLAR (Impact of air POLLution on Asthma and Rhinitis, EIT Health). The rest of the authors declare that they have no relevant conflicts of interest.

    These authors contributed equally to this work.

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