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Threshold values of grass pollen (Poaceae) concentrations and increase in emergency department visits,hospital admissions,drug consumption and allergic symptoms in patients with allergic rhinitis: a systematic review |
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| Authors: | Becker Jana Steckling-Muschack Nadine Mittermeier Isabella Bergmann Karl-Christian Böse-O’Reilly Stephan Buters Jeroen Damialis Athanasios Heigl Katharina Heinrich Joachim Kabesch Michael Mertes Hanna Nowak Dennis Schutzmeier Paul Walser-Reichenbach Sandra Weinberger Alisa Korbely Christine Herr Caroline Heinze Stefanie Kutzora Susanne |
| Affiliation: | 1.Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany ;2.Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolst?dter Landstr. 1, 85764, Neuherberg, Germany ;3.Department of Public Health, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060, Hall in Tirol, Austria ;4.Department for Occupational and Environmental Medicine, Bavarian Health and Food Safety Authority, Pfarrstr. 3, 80538, Munich, Germany ;5.Allergy-Center Charité, Berlin Institute of Health, Charité – Universit?tsmedizin Berlin, Corporate member of Freie Universit?t Berlin, Humboldt-Universit?t Zu Berlin, Luisenstr. 2, 10117, Berlin, Germany ;6.German Pollen Information Foundation, Robert-Koch-Platz 7, 10115, Berlin, Germany ;7.University Children’s Hospital Regensburg (KUNO-Clinics), Clinic St. Hedwig, University of Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Germany ;8.Center of Allergy and Environment, Member of the German Center for Lung Research (DZL), ZAUM, Helmholtz Center Munich/Technische Universit?t München, Biedersteiner Str. 29, 80802, Munich, Germany ;9.Chair and Institute of Environmental Medicine, UNIKA‐T, Technical University of Munich and Helmholtz Zentrum München, Neus?sser Str. 47, 86156, Augsburg, Germany ;10.Comprehensive Pneumology Center (CPC) Munich, Member DZL, German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany ;11.Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 07 Bouverie St, Carlton, Melbourne, VIC, 3053, Australia ;12.Research and Development Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Prüfeningerstr. 21, 93049, Regensburg, Germany ; |
| Abstract: | Airborne grass (Poaceae) pollen measurements are used in public warning systems to inform people about the risk of allergic symptoms. However, there is no consensus about which exact thresholds of pollen concentrations provoke the allergic symptoms. The aim of this study was to review the relevant scientific information on the relationship between grass pollen concentrations and the occurrence of emergency department (ED) visits, hospital admissions (HA), drug consumption and allergic symptoms. Literature search was conducted by experts’ consultation and snowball strategy. Studies meeting the criteria for inclusion were assessed regarding their risk of bias (RoB). A high RoB resulted in exclusion of the study from data synthesis. Extensive data were extracted and qualitatively compared. The review is registered in PROSPERO. 32 Studies were eligible while 18 showed a low RoB and were qualitatively synthesised. Emergency department visits and hospital admissions were mostly investigated. Threshold values of 10 grains/m3 and 12 grains/m3 were reported for ED visits and HA. Evidence exists that an increase of 10 grains/m3 of air leads to a significant increase in adverse health outcomes. Especially at a three-day lag, adverse health effects were shown. Variations in exposure and outcome measurement make the definition of pollen thresholds difficult. As a consequence, no defined pollen threshold values could be identified. Studies with uniform exposure measures and statistical methods are necessary to gain a better understanding of the impact of grass pollen on human health. Determining personal thresholds could be beneficial for affected people. |
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