Air pollution and exacerbation of skin itching and sleep disturbance in Iranian atopic dermatitis patients

  • Pegah Nakhjirgan
  • Masoumeh Mahmoodi
  • Homa KashaniEmail author
  • Alireza Firooz
  • Ramin Nabizadeh
  • Majid Kermani
  • Masud YunesianEmail author
Research article



For about three decades now, the number of people suffering from atopy including atopic dermatitis (AD) has been increasing in developed countries. Genetic background and environmental factors including air pollution play an effective role in its incidence. This study examined the association between air pollutants and exacerbation of AD symptoms including sleep disturbance and itching in AD patients of Tehran.


In this panel study, 31 patients with AD who admitted to Razi Hospital, dermatology hospital in Tehran, entered the research. Daily information including questions on disease symptoms (sleep disturbance, itching) and duration of outdoor stay (in hours) were collected using a questionnaire. The mean 24-h concentrations of PM2.5 and PM10 pollutants were obtained from the Air Quality Control Company. The relationship between the concentrations of the pollutants and exacerbation of the disease symptoms was investigated using the GEE (Generalized Estimating Equations) model.


There was a significant relationship between the concentrations of air pollutants and exacerbation of sleep disturbance and itching on the same day, before, and after adjusting the effects of the confounding variables, so that the estimated odds ratios (95% confidence interval) between PM10 and PM2.5 and exacerbation of itching were 1.06 (1.02–1.10) and 1.17 (1.07–1.28), respectively.


There was a significant statistical relationship between the concentration of particulate matter (PM2.5 and PM10) and exacerbation of sleep disturbance and itching. PM2.5 showed a stronger relationship with the exacerbation of symptoms compared to PM10.


Air pollution Atopic dermatitis Particulate matter Itching Sleep disturbance 



atopic dermatitis


Confidence intervals


Generalized Estimating Equations


National Climatic Data Center


Odds ratios


Particulate matter ≤2.5 μm in aerodynamic diameter


Particulate matter ≤10 μm in aerodynamic diameter


Scoring Atopic Dermatitis


Standard deviation



This research was financially supported by the Institute for Environmental Research (IER) of Tehran University of Medical Sciences (grant number 92-01-46-22328). We thank all the patients who participated in this research, and the Razi hospital staffs for their cooperation.

Compliance with ethical standards

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lipozenčić J, Wolf R. Atopic dermatitis: an update and review of the literature. Dermatol Clin. 2007;25(4):605–12.Google Scholar
  2. 2.
    Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121(4):947–954.Google Scholar
  3. 3.
    Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733–43.Google Scholar
  4. 4.
    Jenerowicz D, Silny W, Danczak-Pazdrowska A, Polanska A, Osmola-Mankowska A, Olek-Hrab K. Environmental factors and allergic diseases. Ann Agric Environ Med. 2012;19(3):475–81.Google Scholar
  5. 5.
    Arnedo-Pena A, García-Marcos L, Urueña IC, Monge RB, Suárez-Varela MM, Canflanca IM, et al. Air pollution and recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years. Arch Bronconeumol ((English Edition). 2009;45(5):224–9.Google Scholar
  6. 6.
    Takizawa H. Impact of air pollution on allergic diseases. Korean J Intern Med. 2011;26(3):262–73.Google Scholar
  7. 7.
    Solé D, Camelo-Nunes I, Wandalsen G, Pastorino A, Jacob C, Gonzalez C, et al. Prevalence of symptoms of asthma, rhinitis, and atopic eczema in Brazilian adolescents related to exposure to gaseous air pollutants and socioeconomic status. J Investig Allergol Clin Immunol. 2007;17(1):6–13.Google Scholar
  8. 8.
    Kim E-H, Kim S, Lee JH, Kim J, Han Y, Kim Y-M, et al. Indoor air pollution aggravates symptoms of atopic dermatitis in children. PLoS One. 2015;10(3):1–9.Google Scholar
  9. 9.
    Kim Y-M, Kim J, Han Y, Jeon B-H, Cheong H-K, Ahn K. Short-term effects of weather and air pollution on atopic dermatitis symptoms in children: a panel study in Korea. PLoS One. 2017;12(4):210–8.Google Scholar
  10. 10.
    D'amato G, Cecchi L. Effects of climate change on environmental factors in respiratory allergic diseases. Clin Exp Allergy. 2008;38(8):1264–74.Google Scholar
  11. 11.
    Kantor R, Kim A, Thyssen JP, Silverberg JI. Association of atopic dermatitis with smoking: a systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(6):1119–25.Google Scholar
  12. 12.
    Lee JH, Suh J, Kim EH, Cho JB, Park HY, Kim J, et al. Surveillance of home environment in children with atopic dermatitis: a questionnaire survey. Asia Pac Allergy. 2012;2(1):59–66.Google Scholar
  13. 13.
    Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66(1):8–16.Google Scholar
  14. 14.
    Park H, Kim K. Association of perceived stress with atopic dermatitis in adults: a population-based study in Korea. Int J Environ Res Public Health. 2016;13(8):760.Google Scholar
  15. 15.
    Sybilski AJ, Zalewska M, Furmańczyk K, Lipiec A, Krzych-Fałta E, Samoliński B. The prevalence of sensitization to inhalant allergens in children with atopic dermatitis. Allergy Asthma Proc. 2015;36:e81–e5.Google Scholar
  16. 16.
    Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, Moustafa M, MacGowan A, et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene–environment interactions. J Allergy Clin Immunol. 2006;118(1):3–21.Google Scholar
  17. 17.
    Alvarenga TM, Caldeira AP. Quality of life in pediatric patients with atopic dermatitis. J Pediatr. 2009;85(5):415–20.Google Scholar
  18. 18.
    Chang Y-S, Chou Y-T, Lee J-H, Lee P-L, Dai Y-S, Sun C, et al. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics. 2014;134:397–405.Google Scholar
  19. 19.
    Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010;14(6):359–69.Google Scholar
  20. 20.
    Ben-Gashir MA, Seed PT, Hay RJ. Quality of life and disease severity are correlated in children with atopic dermatitis. Br J Dermatol. 2004;150(2):284–90.Google Scholar
  21. 21.
    Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017;23(8):115–23.Google Scholar
  22. 22.
    Chamlin SL, Cella D, Frieden IJ, Williams ML, Mancini AJ, Lai J-S, et al. Development of the childhood atopic dermatitis impact scale: initial validation of a quality-of-life measure for young children with atopic dermatitis and their families. J Investig Dermatol. 2005;125(6):1106–11.Google Scholar
  23. 23.
    Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014;134(5):993–9.Google Scholar
  24. 24.
    Ciencewicki J, Trivedi S, Kleeberger SR. Oxidants and the pathogenesis of lung diseases. J Allergy Clin Immunol. 2008;122(3):456–68.Google Scholar
  25. 25.
    Song S, Paek D, Lee K, Lee Y-M, Lee C, Park C, et al. Effects of ambient fine particles on pulmonary function in children with mild atopic dermatitis. Arch Environ Occup Health. 2013;68(4):228–34.Google Scholar
  26. 26.
    Zhang S, Li G, Tian L, Guo Q, Pan X. Short-term exposure to air pollution and morbidity of COPD and asthma in East Asian area: a systematic review and meta-analysis. Environ Res. 2016;148:15–23.Google Scholar
  27. 27.
    Krutmann J, Liu W, Li L, Pan X, Crawford M, Sore G, et al. Pollution and skin: from epidemiological and mechanistic studies to clinical implications. J Dermatol Sci. 2014;76(3):163–8.Google Scholar
  28. 28.
    Jin S-P, Li Z, Choi EK, Lee S, Kim YK, Seo EY, et al. Urban particulate matter in air pollution penetrates into the barrier-disrupted skin and produces ROS-dependent cutaneous inflammatory response in vivo. J Dermatol Sci. 2018;91:175–83.Google Scholar
  29. 29.
    Pénard-Morand C, Charpin D, Raherison C, Kopferschmitt C, Caillaud D, Lavaud F, et al. Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren. Clin Exp Allergy. 2005;35(10):1279–87.Google Scholar
  30. 30.
    Song S, Lee K, Lee Y-M, Lee J-H, Lee SI, Yu S-D, et al. Acute health effects of urban fine and ultrafine particles on children with atopic dermatitis. Environ Res. 2011;111(3):394–9.Google Scholar
  31. 31.
    Hasunuma H, Ishimaru Y, Yoda Y, Shima M. Decline of ambient air pollution levels due to measures to control automobile emissions and effects on the prevalence of respiratory and allergic disorders among children in Japan. Environ Res. 2014;131:111–8.Google Scholar
  32. 32.
    Wang I-J, Tung T-H, Tang C-S, Zhao Z-H. Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health. 2016;219(1):66–71.Google Scholar
  33. 33.
    Morgenstern V, Zutavern A, Cyrys J, Brockow I, Koletzko S, Kramer U, et al. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med. 2008;177(12):1331–7.Google Scholar
  34. 34.
    Lee Y-L, Su H-J, Sheu H-M, Yu H-S, Guo YL. Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children. J Investig Dermatol. 2008;128(10):2412–20.Google Scholar
  35. 35.
    Diette GB, Hansel NN, Buckley TJ, Curtin-Brosnan J, Eggleston PA, Matsui EC, et al. Home indoor pollutant exposures among inner-city children with and without asthma. Environ Health Perspect. 2007;115(11):1665–9.Google Scholar
  36. 36.
    Oftedal B, Nystad W, Brunekreef B, Nafstad P. Long-term traffic-related exposures and asthma onset in schoolchildren in Oslo, Norway. Environ Health Perspect. 2009;117(5):839–44.Google Scholar
  37. 37.
    Dotterud L, Odland J, Falk E. Atopic diseases among schoolchildren in Nikel, Russia, an Arctic area with heavy air pollution. Acta Derm Venereol. 2001;81(3):198–201.Google Scholar
  38. 38.
    Stalder J, Taieb A, Atherton D, Bieber P, Bonifazi E, Broberg A, et al. Severity scoring of atopic dermatitis: the SCORAD index: consensus report of the european task force on atopic dermatitis. Dermatology. 1993;186(1):23–31.Google Scholar
  39. 39.
    Bakke JV, Wieslander G, Norback D, Moen BE. Eczema increases susceptibility to PM10 in office indoor environments. Arch Environ Occup Health. 2012;67(1):15–21.Google Scholar
  40. 40.
    Oh I, Lee J, Ahn K, Kim J, Kim Y-M, Sim CS, et al. Association between particulate matter concentration and symptoms of atopic dermatitis in children living in an industrial urban area of South Korea. Environ Res. 2018;160:462–8.Google Scholar
  41. 41.
    Tang K-T, Ku K-C, Chen D-Y, Lin C-H, Tsuang B-J, Chen Y-H. Adult atopic dermatitis and exposure to air pollutants—a nationwide population-based study. Ann Allergy Asthma Immunol. 2017;118(3):351–5.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Pegah Nakhjirgan
    • 1
  • Masoumeh Mahmoodi
    • 1
  • Homa Kashani
    • 2
    Email author
  • Alireza Firooz
    • 3
  • Ramin Nabizadeh
    • 1
  • Majid Kermani
    • 4
  • Masud Yunesian
    • 1
    • 5
    Email author
  1. 1.Department of Environmental Health Engineering, School of Public HealthTehran University of Medical SciencesTehranIran
  2. 2.Department of Research Methodology and Data Analysis, Institute for Environmental ResearchTehran University of Medical SciencesTehranIran
  3. 3.Center for Research and Training in Skin Diseases and LeprosyTehran University of Medical SciencesTehranIran
  4. 4.Department of Environmental Health Engineering, School of Public HealthIran University of Medical SciencesTehranIran
  5. 5.Center for Air Pollution Research, Institute for Environmental ResearchTehran University of Medical SciencesTehranIran

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