Impact of Residential Greeness Exposure on the Development of Allergic Diseases and Asthma and on Asthma Control-A Systematic Review for the EAACI Guidelines of Environmental Science for Allergic Diseases and Asthma

Ioana Agache¹, Graciela J Balbin-Ramon^{2

3}, Fiorella Karina Fernandez Saenz², Ivan Sola-Arnau^{2

4}, Pablo Alonso-Coello^{2

4

5}, Tari Haahtela⁶, Claudia Traidl-Hoffmann⁷, Liam O'Mahony⁸, Athanasios Damialis⁹, Antti Lauerma⁶, Kari C Nadeau¹⁰, Isabella Pali-Schöll^{11

12}, Oscar Palomares¹³, Harald Renz^{14

15

16}, Jurgen Schwarze¹⁷, Donata Vercelli^{18

19

20

21}, Carlos Canelo-Aybar^{2

4}, Marek Jutel^{22

23}, Cezmi A Akdis²⁴

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Iberoamerican Cochrane Centre, Barcelona, Spain.
³ Jose Casimiro Ulloa Emergency Hospital, Lima, Peru.
⁴ Institut de Recerca Sant Pau (IIB Sant Pau), Barcelona, Spain.
⁵ CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁷ Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
⁸ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
⁹ Terrestrial Ecology and Climate Change, Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
¹⁰ John Rock Professor of Climate and Population Studies, Department of Environmental Health, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹¹ The Interuniversity Messerli Research Institute, University of Veterinary Medicine and Medical University Vienna, Vienna, Austria.
¹² Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹³ Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain.
¹⁴ Institute of Laboratory Medicine, German Center for Lung Research (DZL) and the Lung Centre of the Universities of Giessen and Marburg (UGMLC), Philipps University Marburg, Marburg, Germany.
¹⁵ Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
¹⁶ Tongji Medical School, Shanghai, China.
¹⁷ Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.
¹⁸ Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA.
¹⁹ Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA.
²⁰ BIO5 Institute, University of Arizona, Tucson, Arizona, USA.
²¹ Arizona Center for the Biology of Complex Diseases, University of Arizona, Tucson, Arizona, USA.
²² Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.

PMID: 40632014
DOI: 10.1111/all.16653

Impact of Residential Greeness Exposure on the Development of Allergic Diseases and Asthma and on Asthma Control-A Systematic Review for the EAACI Guidelines of Environmental Science for Allergic Diseases and Asthma

Ioana Agache et al. Allergy. 2025 Nov.

. 2025 Nov;80(11):3027-3042.

doi: 10.1111/all.16653. Epub 2025 Jul 9.

Authors

Affiliations

¹ Faculty of Medicine, Transylvania University, Brasov, Romania.
² Iberoamerican Cochrane Centre, Barcelona, Spain.
³ Jose Casimiro Ulloa Emergency Hospital, Lima, Peru.
⁴ Institut de Recerca Sant Pau (IIB Sant Pau), Barcelona, Spain.
⁵ CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁷ Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
⁸ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
⁹ Terrestrial Ecology and Climate Change, Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
¹⁰ John Rock Professor of Climate and Population Studies, Department of Environmental Health, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹¹ The Interuniversity Messerli Research Institute, University of Veterinary Medicine and Medical University Vienna, Vienna, Austria.
¹² Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹³ Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain.
¹⁴ Institute of Laboratory Medicine, German Center for Lung Research (DZL) and the Lung Centre of the Universities of Giessen and Marburg (UGMLC), Philipps University Marburg, Marburg, Germany.
¹⁵ Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
¹⁶ Tongji Medical School, Shanghai, China.
¹⁷ Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.
¹⁸ Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA.
¹⁹ Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA.
²⁰ BIO5 Institute, University of Arizona, Tucson, Arizona, USA.
²¹ Arizona Center for the Biology of Complex Diseases, University of Arizona, Tucson, Arizona, USA.
²² Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.

PMID: 40632014
DOI: 10.1111/all.16653

Abstract

The role of residential greenness exposure (RGE) in prevention and control of allergic diseases remains controversial. This systematic review evaluated the association between RGE and the risk of developing asthma, allergic rhinitis (AR), food allergy, atopic dermatitis (AD), and asthma control. MEDLINE and EMBASE searches retrieved 17 cohort and case-control longitudinal studies (12 for asthma, 6 AR, 1 food allergy, 1 ad). Risk of bias was assessed with ROBINS-E, and certainty of evidence with GRADE. Data were meta-analyzed using adjusted odds ratios (aORs) with random-effects models. For "ever asthma" and "ever AR" a non-significant protective trend of RGE was observed (aOR 0.92, 95% CI 0.72-1.18; aOR 0.61; 95% CI 0.24-1.55). For "current asthma" RGE was associated with increased risk (aOR 1.17, 95% CI 1.04-1.33), with no clear association for "current AR" (aOR 1.03; 95% CI 0.80-1.32). Prenatal RGE reduced the risk of "ever asthma" (aOR 0.94, 95% CI 0.93-0.950) and AD (aOR 0.996, 95% CI 0.993-0.999). RGE increased the risk for peanut (aOR 1.78, 95% CI 1.13-2.82) and egg allergy (aOR 1.38, 95% CI [1.05-1.82]). Reduced RGE decreased asthma control (OR: 2.662, 95% CI [1.043-6.799]). Potential benefits or potential harms of RGE should be judged in a context-specific manner.

Keywords: GRADE; allergy; asthma; guideline; residential greeness exposure; systematic review.

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References

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Impact of Residential Greeness Exposure on the Development of Allergic Diseases and Asthma and on Asthma Control-A Systematic Review for the EAACI Guidelines of Environmental Science for Allergic Diseases and Asthma

Affiliations

Impact of Residential Greeness Exposure on the Development of Allergic Diseases and Asthma and on Asthma Control-A Systematic Review for the EAACI Guidelines of Environmental Science for Allergic Diseases and Asthma

Authors

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Abstract

References

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LinkOut - more resources

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Medical

Research Materials