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A systematic review of threshold values of pollen concentrations for symptoms of allergy

Abstract

Pollen threshold values used in public warning systems are intended to inform people of the risk of developing allergy symptoms. However, there is no consensus about which pollen concentrations provoke allergy symptoms. The aim of this systematic review was the evaluation of studies investigating the relationship between pollen concentrations (alder, ash, birch, hazel, mugwort and ragweed) and the number of cases in which participants visited a doctor, drug consumption and allergy symptoms. This systematic literature review is registered in PROSPERO (CRD42019112369). A PubMed search was applied and enriched by consultation with experts and a snowball strategy. The included studies were checked for risk of bias (RoB), and extensive data were extracted and compared. Of 511 studies, 22 were eligible according to the previously established inclusion criteria, and 17 from these showed a low RoB. The strongest evidence was reported for ash (Fraxinus) pollen, where an increase of number of doctor’s visits at an interquartile range (IQR) of 18–28 grains/m3 was detected by three studies. Five studies about birch (Betula) pollen showed a threshold value of 45 grains/m3 for increased drug consumption. The evidence of a threshold value was limited for alder (Alnus), hazel (Corylus), mugwort (Artemisia) and ragweed (Ambrosia) pollen. The inconsistent results concerning all types of pollen, except ash pollen, can be the result of multiple factors, e.g., age, gender, allergen content of pollen and individual sensitivity. These influencing factors should be investigated more closely in future research.

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Acknowledgements

The research group thanks the following persons for their great support: Conny Höflich; Environmental Medicine and Health Effects Assessment, Federal Environment Agency, Corrensplatz 1, 14195 Berlin, Germany. Wolfgang Straff; Environmental Medicine and Health Effects Assessment, Federal Environment Agency, Corrensplatz 1, 14195 Berlin, Germany. Klaus Koch; State building authority Amberg-Sulzbach (StBA AS), Gabelsbergerstr. 2, 92637 Weiden in Upper Palatinate, Germany. Additionally, the research group would like to thank all student assistants/research assistants for their great commitment: Sarah Georgi, Sagun Magar, Lena Mandlik

Funding

The German project LUPO was funded by the Bavarian State Ministry of Health and Care and coordinated by the Bavarian Health and Food Safety Authority.

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NS-M, HM, IM, PS, JB, K-CB, SB-O, JB, AD, JH, MK, DN, SW-R, AW, MZ, CH, SK and SH contributed to conceptualization. NS-M, HM and IM performed the literature search. NS-M, HM, IM, PS, K-CB, SB-O', JB, AD, JH, MK, DN, AW, CH, SK and SH were involved in methodology. NS-M, HM, IM, PS, AW, CH, SK and SH analyzed the data. NS-M, HM, IM and SK drafted the article. IM, PS, JB, K-CB, SB-O'R, JB, AD, JH, MK, DN, SW-R, AW, MZ, CH, SK and SH revised the article. NS-M, HM, IM, PS, JB, K-CB, SB-O', JB, AD, JH, MK, DN, SW-R, AW, MZ, CH, SK and SH contributed to final approval. NS-M, HM, IM, PS, JB, K-CB, SB-O', JB, AD, JH, MK, DN, SW-R, AW, MZ, CH, SK and SH contributed to agreement to account for all aspects of the work. NS-M, K-CB, SB-O', AD, JH, DN, CH, SK and SH were involved in supervision. NS-M and HM are the first authors. SK and SH are the senior authors

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Correspondence to Isabella Mittermeier.

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Conflict of interest

K.C. Bergmann who is the author of paper (Bergmann et al., 2016), J. Buters who is the author of papers (Buters et al., 2018), (Buters et al., 2015) and (Buters et al., 2012) and A. Damialis who is the author of paper (Damialis et al., 2019) included in this review declare that there is no conflict of interest.

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Nadine Steckling-Muschack and Hanna Mertes should be considered as joint first author. Susanne Kutzora and Stefanie Heinze should be considered as joint senior author.

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Steckling-Muschack, N., Mertes, H., Mittermeier, I. et al. A systematic review of threshold values of pollen concentrations for symptoms of allergy. Aerobiologia 37, 395–424 (2021). https://doi.org/10.1007/s10453-021-09709-4

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Keywords

  • Aeroallergens
  • Conjunctivitis
  • Pollen
  • Rhinitis
  • Systematic review
  • Pollen thresholds