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. 2015 Feb;114(2):126-33.
doi: 10.1016/j.anai.2014.10.020. Epub 2014 Dec 10.

Traffic pollution is associated with early childhood aeroallergen sensitization

Christopher D Codispoti  1 , Grace K LeMasters  2 , Linda Levin  2 , Tiina Reponen  2 , Patrick H Ryan  3 , Jocelyn M Biagini Myers  4 , Manuel Villareal  5 , Jeff Burkle  2 , Sherry Evans  5 , James E Lockey  2 , Gurjit K Khurana Hershey  4 , David I Bernstein  5
Affiliations

Traffic pollution is associated with early childhood aeroallergen sensitization

Christopher D Codispoti et al. Ann Allergy Asthma Immunol. 2015 Feb.

Abstract

Background: No large, prospective, epidemiologic study has investigated the association between diesel exhaust particle (DEP) exposure and early aeroallergen sensitization and allergic rhinitis (AR) at 4 years of age.

Objective: To determine how exposure to traffic exhaust during infancy is associated with aeroallergen sensitization and AR at 4 years of age and the predictive utility of the wheal area at 1 to 3 years of age on AR at 4 years of age.

Methods: Infants born to aeroallergen sensitized parents were evaluated annually with skin prick tests to 15 aeroallergens with measurement of wheal areas. At 4 years of age, AR was defined as at least one positive aeroallergen skin prick test result and the presence of sneezing and a runny nose without a cold or flu. Infant (DEP) exposure was estimated using data from 27 air sampling monitors and a land use regression model.

Results: Complete data were available for 634 children at 4 years of age. Prevalence of AR increased annually from 6.9% to 21.9%. A positive trend was observed for high DEP exposure and aeroallergen sensitization at 2 and 3 years of age (odds ratio, 1.40; 95% confidence interval, 0.97-2.0) and (odds ratio, 1.35; 95% confidence interval, 0.98-1.85) but not with AR. At 2 years of age, every 1-mm(2) increase in the wheal area of timothy and Alternaria significantly increased the odds of AR at 4 years of age. At 3 years of age, every 1-mm(2) increase in the wheal area of fescue, dog, and Penicillium significantly increased the odds of AR at 4 years of age.

Conclusion: DEP exposure enhances the risk of early aeroallergen sensitization. Aeroallergen wheal area at 2 and 3 years of age is associated with AR at 4 years of age.

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Figures

Figure 1
Figure 1. Prevalence of allergic rhinitis, aeroallergen sensitization and rhinitis during the first four years of life among the 634 subjects that had complete clinical and skin test data at year four
Allergic rhinitis prevalence increased during the four years of the study. While rhinitis symptoms remained stable during the study, the prevalence of aeroallergen sensitization increased.
Figure 1
Figure 1. Prevalence of allergic rhinitis, aeroallergen sensitization and rhinitis during the first four years of life among the 634 subjects that had complete clinical and skin test data at year four
Allergic rhinitis prevalence increased during the four years of the study. While rhinitis symptoms remained stable during the study, the prevalence of aeroallergen sensitization increased.
Figure 2
Figure 2. Percentage of aeroallergen sensitivities among allergic rhinitis children at ages one to four
Figure 2
Figure 2. Percentage of aeroallergen sensitivities among allergic rhinitis children at ages one to four
Figure 3
Figure 3. Directed Acyclic Graph of showing how diesel exhaust particle (DEP) exposure in age one (≥66th tile, < 66th tile) confounds aeroallergen sensitization at age one and allergic rhinitis (AR) at age four
DEP affects aeroallergen sensitivity at earlier ages, which successively are associated with AR at age four (A-C). DEP appears to be protective of AR at age four (red line in A-C). However, DEP is actually increasing the likelihood of aeroallergen sensitivity at ages two and three, which then increases the risk of AR (black lines in B and C). The age one multivariable model (A) included ethnicity, breastfeeding duration, Fel D1 (low, medium, and high). The age two multivariable model (B) included ethnicity, breastfeeding duration, children in the home at age one. The age multivariable model (C) included breastfeeding duration at age three. Breastfeeding duration, and breastfeeding duration*ethnicity interaction at age one were further evaluated to assess previous age three findings.
Figure 3
Figure 3. Directed Acyclic Graph of showing how diesel exhaust particle (DEP) exposure in age one (≥66th tile, < 66th tile) confounds aeroallergen sensitization at age one and allergic rhinitis (AR) at age four
DEP affects aeroallergen sensitivity at earlier ages, which successively are associated with AR at age four (A-C). DEP appears to be protective of AR at age four (red line in A-C). However, DEP is actually increasing the likelihood of aeroallergen sensitivity at ages two and three, which then increases the risk of AR (black lines in B and C). The age one multivariable model (A) included ethnicity, breastfeeding duration, Fel D1 (low, medium, and high). The age two multivariable model (B) included ethnicity, breastfeeding duration, children in the home at age one. The age multivariable model (C) included breastfeeding duration at age three. Breastfeeding duration, and breastfeeding duration*ethnicity interaction at age one were further evaluated to assess previous age three findings.
Figure 3
Figure 3. Directed Acyclic Graph of showing how diesel exhaust particle (DEP) exposure in age one (≥66th tile, < 66th tile) confounds aeroallergen sensitization at age one and allergic rhinitis (AR) at age four
DEP affects aeroallergen sensitivity at earlier ages, which successively are associated with AR at age four (A-C). DEP appears to be protective of AR at age four (red line in A-C). However, DEP is actually increasing the likelihood of aeroallergen sensitivity at ages two and three, which then increases the risk of AR (black lines in B and C). The age one multivariable model (A) included ethnicity, breastfeeding duration, Fel D1 (low, medium, and high). The age two multivariable model (B) included ethnicity, breastfeeding duration, children in the home at age one. The age multivariable model (C) included breastfeeding duration at age three. Breastfeeding duration, and breastfeeding duration*ethnicity interaction at age one were further evaluated to assess previous age three findings.
Figure 4
Figure 4. Odds ratios of developing allergic rhinitis at age four by percentiles of sum of informative allergen wheal areas* from multivariable regression model at ages one, two and three
*Allergen wheal areas that were included in the final multivariable model for the corresponding year were: Year 2: Timothy, Alternaria. Year 3: Maple, Fescue, Dog, Penicillium.
Figure 4
Figure 4. Odds ratios of developing allergic rhinitis at age four by percentiles of sum of informative allergen wheal areas* from multivariable regression model at ages one, two and three
*Allergen wheal areas that were included in the final multivariable model for the corresponding year were: Year 2: Timothy, Alternaria. Year 3: Maple, Fescue, Dog, Penicillium.
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