An, Ouyang, Zhang World Allergy Organization Journal (2023) 16:100762

http://doi.org/10.1016/j.waojou.2023.100762

Open Access
Impact of airborne pollen concentration and
meteorological factors on the number of
outpatients with allergic rhinitis
Yusan An, MDa, Yuhui Ouyang, MD, PHDa,b and Luo Zhang, MD, PHDa,b,c*

ABSTRACT
The prevalence of allergic rhinitis (AR) caused by pollen allergen is high in northern China. This
study analyzed the allergen detection results of patients with AR in Beijing Tongren Hospital from
2016 to 2019, and evaluated the association between AR and seasonal airborne pollen concen-
tration and meteorological factors in Beijing, China. We found that AR patients caused by pollen
accounted for 61.18% (16 793/27 449) in AR patients. Among them, Artemisia pollen sensitive
patients accounted for 48.54% (13 325/27 449) of AR. We also found that the number of out-
patients diagnosed with AR is strongly correlated with seasonal airborne pollen concentration and
is influenced by meteorological factors, such as temperature and humidity. These results may help
clinicians and healthcare workers to be prepared for this influx of outpatients in the relevant
seasons.
Keywords: Allergic rhinitis, Airborne pollen concentration, Meteorological factors

Allergic rhinitis (AR) is a noninfectious chronic
disease of the nasal mucosa that is mainly medi-
ated by immunoglobulin (Ig) E after exposure to
allergens. According to allergen type, AR can be
divided into seasonal AR and perennial AR.1,2
Airborne pollen is associated with a specific
allergic response, including itching, sneezing, rhi-
norrhea, and nasal congestion.3 Meteorological
factors affect the length, intensity and timing of
the pollen season and have a significant impact
on patients with allergies; for example, the effect
a
Department of Allergy, Beijing Tongren Hospital, Capital Medical
University, Beijing 100730, China
*Corresponding author. Department of Allergy, Beijing Tongren Hospital,
Capital Medical University, No. 1, Dongjiaominxiang, Dongcheng District,
Beijing 100730, China,. E-mail: dr.luozhang@139.com
Full list of author information is available at the end of the article
http://doi.org/10.1016/j.waojou.2023.100762
Received 6 December 2022; Received in revised from 4 March 2023;
Accepted 8 March 2023
Online publication date xxx
1939-4551/© 2023 The Author(s). Published by Elsevier Inc. on behalf of
World Allergy Organization. This is an open access article under the CC BY
license (http://creativecommons.org/licenses/by/4.0/).
of temperature could contribute to the higher
seasonal AR symptom score.4
Patients diagnosed with AR in the outpatient
department of Beijing Tongren Hospital between
January 1, 2016 and October 30, 2019 were
included in the study. A diagnosis of AR is defined
by symptoms of sneezing or nasal running, itching,
or congestion for at least 2 years in the absence of
a cold or flu. Further detection of serum specific
IgE (sIgE) was used as a standard for definite
diagnosis. Pollen allergens include spring tree
mixed pollen (Salicaceae and Ulmaceae) and
autumn weed pollen (Artemisia, Humulus and
Ambrosia) common in Beijing. Daily airborne pol-
len concentration was obtained from the average
of the pollen observation stations in 12 districts of
Beijing by using a gravity-settling pollen trap.
Meteorological data was measured by the Beijing
Meteorological Office.
A total of 27 449 patients were diagnosed with
AR in our hospital from 2016 to 2019 (sIgE>0.35
IU/mL, duplicate cases were excluded). Of these,
61.18% (16 793 cases) of patients were pollen
 2 An, Ouyang, Zhang World Allergy Organization Journal (2023) 16:100762
http://doi.org/10.1016/j.waojou.2023.100762

allergens sIgE positive, and among these, Arte- Supplementary Table 1). This change was 50
1 misia pollen allergen positive patients accounted consistent with the change in the average daily 51
2 for 48.54% (13 325/27 449), Ambrosia, Humulus airborne pollen concentration. 52
3 and tree mixed pollen positive patients accounted 53
for 25.09%, 24.01% and 14.87%, respectively. Data related to outpatients with AR, air airborne 54
4 pollen concentration, and meteorological factors
5 There were no differences between the sexes. 55
There was a significantly higher rate of sIgE posi- were analyzed using the generalized additive 56
6 model (GAM). The model takes daily AR visits as
7 tivity in patients aged 21–40 years than that in 57
other age groups (P < 0.01), which is similar to the response variables and uses a spline smoothing 58
8 function to fit nonlinear independent variables into
9 results of previous studies by Warm et al and 59
Jeong et al.5,6 Table 1 shows the characteristics of time-series data, including time, daily average 60
10 temperature, daily average relative humidity, daily
11 the participants. 61
average wind speed, and daily average atmo- 62
12 The daily number of patients diagnosed with AR spheric pressure.7 After the core model was
13 63
and the daily average airborne pollen concentra- established, a pollen concentration variable was 64
14 tion in Beijing are shown in Fig. 1a. The peak introduced. The specific form of the model is:
15 65
16 66
17 67
ln[E(yi)] ¼ b*pollen þ s(temperature,df1)þs(pressure,df2)þs(windspeed,df3)þs(humidity, df4) 68
18
þs(time, df5)þa 69
19
20 70
21 number of patients diagnosed with AR from 71
22 March to May and from August to September, in where yi is the number of AR visits on day i; E(yi) is 72
23 line with the pollen peak and the number of the expected number of AR visits on day i; b the 73
24 patients in August and September, were linear regression coefficient estimated by the 74
25 significantly different from those in other months generalized additive model; pollen, airborne 75
26 (P < 0.01; detailed data are shown in pollen concentration; s, spline smoothing 76
27 77
28 78
79
29 Study population (complete data) (n ¼ 27,449)
30 80
31 Sex: male, n (%); female, n (%) 14,208(51.76); 13,241(48.24) 81
82
32 Age(y), Mean  SD 37.9  19.7
33 83
34 Patients with pollen positive results, n (%) 16,793/27,449(61.18) 84
35 Artemisia allergen positive patients, n 13,325(48.54%) 85
Ambrosia allergen positive patients, n 6887(25.09%) 86
36 Humulus allergen positive patients, n 6591(24.01%)
37 87
38 Tree mixed pollen allergen * positive patients, n 4083(14.87%) 88
39 89
Age(y), n (%)
40 90
5 1818 (6.62%) 91
41 6–10 3442 (12.54%)
42 11–15 1934 (7.05%) 92
43 16–20 1066 (3.88%) 93
44 21–30 6205** (22.61%) 94
31–40 6985** (25.45%) 95
45 41–50 3078 (11.21%)
46 96
51–60 1939 (7.06%)
47 61 982 (3.58%) 97
48 98
Table 1. Characteristics of the study population Notes: Significance of age differences among patients who tested positive for sIgE in each age group
49 was analyzed by chi-square (c2) analysis. n, number of patients. * Tree mixed pollen allergen include Salicaceae and Ulmaceae.
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17 Fig. 1 (a) Trends of daily average airborne pollen concentration and number of patients diagnosed with AR from 2016 to 2019. (b) Expose- 68
18 response relationship between daily outpatient visits of patients with AR and date. (c) Expose-response relationship between daily 69
outpatient visits of patients with AR and airborne pollen concentration. The red function curve and confidence interval represent spring,
19 and the black function curve and confidence interval represent summer. (d) Expose-response relationship between daily outpatient visits of 70
20 patients with AR and meteorological factor average temperature. (e) Expose-response relationship between daily outpatient visits of 71
patients with AR and meteorological factor average humidity. The effect of a temperature, humidity, date, and pollen increase on the x-axis
21 leads to an outpatients increase on the y-axis, expressed as “ln (RR)” (natural logarithm of the risk ratio)
72
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function; df1w df5, degrees of freedom of spline number of pollen grains increased by 50 pollen/
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smoothing function; time, time variable; 1,000 mm,2 the RR of outpatient visits for AR was
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temperature, average daily temperature; 1.020 (95% CI: 0.537–1.314), that is, the number
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humidity, average daily humidity; pressure, of outpatient visits on the same day increased by
27 78
average daily air pressure; windspeed, average 2.0% (Fig. 1c).
28 79
daily wind speed; a, residual. Using the
29 The effect of average temperature on the num- 80
generalized estimating equation model, the
30 ber of outpatient visits showed double peaks, with 81
exposure–response relationship between pollen
31
and daily outpatient visits of patients with AR was the highest point at 9–12  C and above 22  C. 82
32 These 2 points were consistent with the tempera- 83
analyzed, and the results showed a significant
33 ture at the beginning of the pollen season in spring 84
association.
34 and autumn in Beijing (Fig. 1d). We also analyzed 85
35 the effect of air humidity on the number of AR 86
36 From the GAM, the relationship between the outpatient visits. The number of AR outpatient 87
37 time of year and the number of outpatient visits of visits decreased with increasing humidity. This 88
38 patients with AR was analyzed. The peak of the AR result is related to the precipitation of pollen 89
39 patients occurred around Day 90 and Day 240 of particles caused by the increase in air humidity 90
40 the year, in line with the airborne pollen concen- and decrease in pollen concentration and 91
41 tration time (Fig. 1b). Furthermore, our results sensitization, which is consistent with the results 92
42 showed that the effect of pollen on outpatient of previous studies8,9 (Fig. 1e). 93
43 visits in patients is linear. In spring (March to 94
44 May), when the number of pollen grains This study showed in a time-series analysis that 95
45 increased by 50 pollen/1,000 mm,2 the relative pollen has an increasing effect on the number of 96
46 risk (RR) of outpatient visits for AR was 1.048 outpatient visits of AR patients, which means that 97
47 (95% CI: 0.662–1.409), that is, outpatient visits on during natural exposure, increasing amounts of 98
48 the same day could increase by 4.8%. In summer pollen elicit symptoms as the season progresses, 99
49 and autumn (August to September), when the and the number of outpatient visits is therefore 100
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 4 An, Ouyang, Zhang World Allergy Organization Journal (2023) 16:100762
http://doi.org/10.1016/j.waojou.2023.100762

1 increased. Furthermore, weed pollen in summer Ethics approval and informed consent 52
2 and autumn had a greater impact on AR patient The study was approved by the Medical Ethics Committee 53
of Beijing TongRen Hospital (version number: TRECLY
3 visits than spring tree pollen, which indicates that 54
2020-076_). The research tool based on the hospital
4 weed pollen, such as Artemisia pollen, has a internal registration network did not collect information to 55
5 stronger sensitization. These results are consistent identify patients. Therefore, the working data file does not 56
6 with those of previous epidemiological studies contain any identifying information other than gender and 57
7 showing a higher prevalence of weed allergy in age. That is, no names, addresses, or other distinguishing 58
8 northern China.2,10 information. Therefore, no written informed consent was 59
provided for this study.
9 60
In addition to pollen, ambient temperature and Consent for publication
10 61
humidity are also important factors that affect the All authors gave their consent for publication.
11 62
number of outpatients with AR. Studies have
12 Declaration of competing interest 63
shown that dry and cold air damages the nasal The authors declare that they have no competing interests.
13 64
mucosa.11 In northern China, springtime
14 65
temperatures are low and dry, causing allergic
15 Appendix ASupplementary data 66
symptoms and increasing the number of patients
16 Supplementary data to this article can be found online at 67
with AR. Guillam et al showed that the onset of
17 https://doi.org/10.1016/j.waojou.2023.100762. 68
respiratory pollen allergy is also related to
18 Author details 69
individual susceptibility, lag of onset time, pollen a
19 Department of Allergy, Beijing Tongren Hospital, Capital 70
residue in the environment, concentration of Medical University, Beijing 100730, China bBeijing Key
20 71
chemical air pollutants, and other factors.12 Laboratory of Nasal Diseases, Beijing Institute of
21 72
Therefore, although this study could observe the Otolaryngology, Beijing 100005, China cResearch Unit of
22 Diagnosis and Treatment of Chronic Nasal Diseases, Chinese 73
correlation between atmospheric pollen
23 Academy of Medical Sciences, Beijing, China. 74
concentration and the incidence of allergic
24 75
diseases, it did not find an obvious lag effect of
25 76
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