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Luftverschmutzung und atopisches Ekzem

Systematisches Review der Erkenntnisse aus umweltepidemiologischen Studien
  • Ursula KrämerEmail author
  • Heidrun Behrendt
Leitthema
  • 51 Downloads

Zusammenfassung

Hintergrund

Unter zahlreichen Risikofaktoren für die Entstehung eines atopischen Ekzems (AE) wird neuerdings der Einfluss von Luftverschmutzung vermehrt diskutiert. Ein systematisches Review hierzu liegt aber bisher nicht vor.

Fragestellung

Welche Effekte von Außenluftverschmutzung (Partikel, Stickstoffoxide, Schwefeldioxid, Ozon oder allgemeine Straßenverkehrsemissionen) auf AE zeigen sich in einer systematischen Analyse verfügbarer umweltepidemiologischer Studien?

Methodik

Alle umweltepidemiologischen Studien zu AE und Luftverschmutzung aus der Literaturdatenbank PubMed wurden identifiziert, ihre wichtigsten Kenngrößen tabellarisch zusammengefasst, qualitativ nach Evidenzgraden beurteilt und beschrieben.

Ergebnisse

Es wurden 57 entsprechende Studien identifiziert. Nur in einer der 15 Querschnittstudien, bei denen die Exposition großräumig erfasst wurde, zeigte sich ein signifikanter Zusammenhang zwischen AE und Luftverschmutzung. Dagegen fanden sich signifikante positive Assoziationen von AE mit straßenverkehrsbedingten Emissionen – insbesondere aus LKWs – in 23 von 30 Studien mit kleinräumiger Expositionserfassung. Von diesen 30 Studien waren 14 Kohortenstudien (1-mal Erwachsene, 13-mal Geburtskohorten). Die einzige Kohortenstudie bei Erwachsenen zeigte eine Assoziation insbesondere mit einem intrinsischen AE. In ostasiatischen Geburtskohorten (alle in den letzten 3 Jahren veröffentlicht) war eine Verkehrsbelastung der Mutter während der Schwangerschaft mit einer erhöhten Inzidenz von AE beim Kind assoziiert. In den älteren Kohortenstudien aus Europa/USA war dies nicht so klar oder wurde nicht untersucht. In 5/5 Panelstudien (alle aus Korea) fand sich ein positiver Zusammenhang zwischen dem Schweregrad von Ekzem und der Außenluftbelastung.

Schlussfolgerung

In der systematischen Analyse umweltepidemiologischer Studien zeigte sich eine eher gute Evidenz dafür, dass Belastungen mit Straßenverkehrsemissionen, die kleinräumig variieren, die Prävalenz von AE erhöhen, während großräumige Belastung mit groben Partikeln (PM10) oder SO2 keinen Einfluss zeigte. Unter pathophysiologischen Aspekten scheinen Verkehrsemissionen sowohl über Einflüsse auf die Hautbarriere als auch auf die Aktivierung von Immunreaktionen zu wirken.

Schlüsselwörter

Straßenverkehrsemissionen Epidemiologie Außenluftverschmutzung LKW-Verkehr Mütterliche Belastung 

Air pollution and atopic eczema

Systematic review of findings from environmental epidemiological studies

Abstract

Background

Among the many risk factors for the development of atopic eczema (AE), the influence of air pollution has recently been discussed more often. A systematic review about this topic however is lacking.

Aims

Which effects of outdoor air pollution (particles, nitric oxides, sulfur dioxide, ozone or general traffic exhaust emissions) on AE can be demonstrated in a systematic analysis of available environmental epidemiologic studies?

Methods

All environmental epidemiologic studies on AE and air pollution found in the literature database PubMed were identified. The most important key figures of these studies were tabulated, the quality of evidence was graded and the studies described.

Results

A total of 57 studies were identified. Only one of the 15 cross-sectional studies with a large-scale exposure assessment found a significant association between AE and air pollution. In contrast 23 of 30 studies with small-scale exposure assessment found a significant association between AE and traffic related emissions—especially from trucks. Of the 30 studies, 14 were cohort studies (1 adult, 13 birth cohorts). The sole adult cohort found an association with intrinsic AE. In the East Asian cohorts (all published since 2015), an association between maternal exposure to traffic-related pollution and incidence of AE in the offspring was found. This was less clear in cohorts from Europe/US or simply not investigated. In 5/5 panel studies (all from South Korea), symptom severity of AE was found to be significantly and positively related to outdoor air pollution.

Conclusions

In a systematic analysis of environmental epidemiologic studies about air pollution and AE rather good evidence was found that, based on small-scale exposure measurements, especially truck traffic emissions increased AE prevalence, while large-scale exposure to larger particles (PM10) or SO2 was without effect. Considering pathophysiologic aspects traffic exhaust emissions seem to affect both skin barrier function and activation of immune responses.

Keywords

Road traffic emissions Epidemiology Outdoor air pollution Truck traffic Maternal exposure 

Notes

Danksagung

Wir danken Herrn Professor Dr. Dr. Johannes Ring, München, für die kritische Durchsicht des Manuskriptes und Ausführungen zur Nomenklatur.

Einhaltung ethischer Richtlinien

Interessenkonflikt

U. Krämer und H. Behrendt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Aguilera I, Pedersen M, Garcia-Esteban R et al (2013) Early-life exposure to outdoor air pollution and respiratory health, ear infections, and eczema in infants from the INMA study. Environ Health Perspect 121:387–392PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Ahn K (2014) The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol 134:993–999 (discussion 1000)PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Al-Sahab B, Atoui M, Musharrafieh U et al (2008) Epidemiology of eczema among Lebanese adolescents. Int J Public Health 53:260–267PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Altug H, Gaga EO, Dogeroglu T et al (2013) Effects of air pollution on lung function and symptoms of asthma, rhinitis and eczema in primary school children. Environ Sci Pollut Res Int 20:6455–6467PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Anderson HR, Ruggles R, Pandey KD et al (2010) Ambient particulate pollution and the world-wide prevalence of asthma, rhinoconjunctivitis and eczema in children: phase one of the International Study of Asthma and Allergies in Childhood (ISAAC). Occup Environ Med 67:293–300PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Annesi-Maesano I, Caillaud D, Lavaud F et al (2009) Exposure to fine air particles and occurrence of allergic diseases: results of ISAAC-France phase 2. Arch Pediatr 16:299–305PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Belugina IN, Yagovdik NZ, Belugina OS et al (2018) Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus. J Eur Acad Dermatol Venereol 32:1977–1985PubMedCrossRefGoogle Scholar
  8. 8.
    Biagini Myers JM, Wang N, Lemasters GK et al (2010) Genetic and environmental risk factors for childhood eczema development and allergic sensitization in the CCAAPS cohort. J Invest Dermatol 130:430–437PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Bieber T (2008) Atopic dermatitis. N Engl J Med 358:1483–1494PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Bieber T, D’erme AM, Akdis CA et al (2017) Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? J Allergy Clin Immunol 139:S58–S64PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Brauer M, Hoek G, Smit HA et al (2007) Air pollution and development of asthma, allergy and infections in a birth cohort. Eur Respir J 29:879–888PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Brauer M, Hoek G, Van Vliet P et al (2002) Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. Am J Respir Crit Care Med 166:1092–1098PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Brunekreef B, Stewart AW, Anderson HR et al (2009) Self-reported truck traffic on the street of residence and symptoms of asthma and allergic disease: a global relationship in ISAAC phase 3. Environ Health Perspect 117:1791–1798PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Castaneda AR, Pinkerton KE, Bein KJ et al (2018) Ambient particulate matter activates the aryl hydrocarbon receptor in dendritic cells and enhances Th17 polarization. Toxicol Lett 292:85–96PubMedCrossRefGoogle Scholar
  15. 15.
    Chen F, Lin Z, Chen R et al (2018) The effects of PM2.5 on asthmatic and allergic diseases or symptoms in preschool children of six Chinese cities, based on China, Children, Homes and Health (CCHH) project. Environ Pollut 232:329–337PubMedCrossRefGoogle Scholar
  16. 16.
    Deng Q, Lu C, Li Y et al (2016) Exposure to outdoor air pollution during trimesters of pregnancy and childhood asthma, allergic rhinitis, and eczema. Environ Res 150:119–127PubMedCrossRefGoogle Scholar
  17. 17.
    Dockery DW, Pope CA 3rd, Xu X et al (1993) An association between air pollution and mortality in six U.S. cities. N Engl J Med 329:1753–1759PubMedCrossRefGoogle Scholar
  18. 18.
    Duhme H, Weiland SK, Rudolph P et al (1998) Asthma and allergies among children in West and East Germany: a comparison between Munster and Greifswald using the ISAAC phase I protocol. International Study of Asthma and Allergies in Childhood. Eur Respir J 11:840–847PubMedCrossRefGoogle Scholar
  19. 19.
    Effner R, Hiller J, Eyerich S et al (2017) Cytochrome P450s in human immune cells regulate IL-22 and c‑Kit via an AHR feedback loop. Sci Rep 7:44005PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Flohr C, Weiland SK, Weinmayr G et al (2008) The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood phase two. J Allergy Clin Immunol 121:141–147.e4PubMedCrossRefGoogle Scholar
  21. 21.
    Furue M, Tsuji G, Mitoma C et al (2015) Gene regulation of filaggrin and other skin barrier proteins via aryl hydrocarbon receptor. J Dermatol Sci 80:83–88PubMedCrossRefGoogle Scholar
  22. 22.
    Gehring U, Wijga AH, Brauer M et al (2010) Traffic-related air pollution and the development of asthma and allergies during the first 8 years of life. Am J Respir Crit Care Med 181:596–603PubMedCrossRefGoogle Scholar
  23. 23.
    Haarmann-Stemmann T, Esser C, Krutmann J (2015) The Janus-faced role of aryl hydrocarbon receptor signaling in the skin: consequences for prevention and treatment of skin disorders. J Invest Dermatol 135:2572–2576PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Haas K, Weighardt H, Deenen R et al (2016) Aryl hydrocarbon receptor in keratinocytes is essential for murine skin barrier integrity. J Invest Dermatol 136:2260–2269PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Hasunuma H, Ishimaru Y, Yoda Y et al (2014) 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 131:111–118PubMedCrossRefGoogle Scholar
  26. 26.
    Heinrich J, Hoelscher B, Wjst M et al (1999) Respiratory diseases and allergies in two polluted areas in East Germany. Environ Health Perspect 107:53–62PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Herbarth O, Fritz GJ, Rehwagen M et al (2006) Association between indoor renovation activities and eczema in early childhood. Int J Hyg Environ Health 209:241–247PubMedCrossRefGoogle Scholar
  28. 28.
    Hidaka T, Ogawa E, Kobayashi EH et al (2017) The aryl hydrocarbon receptor AhR links atopic dermatitis and air pollution via induction of the neurotrophic factor artemin. Nat Immunol 18:64–73PubMedCrossRefGoogle Scholar
  29. 29.
    Huang CC, Wen HJ, Chen PC et al (2015) Prenatal air pollutant exposure and occurrence of atopic dermatitis. Br J Dermatol 173:981–988PubMedCrossRefGoogle Scholar
  30. 30.
    Huls A, Abramson MJ, Sugiri D et al (2018) Non-atopic eczema in elderly women—impact of air pollution and genes. J Allergy Clin Immunol.  https://doi.org/10.1016/j.jaci.2018.09.031 CrossRefPubMedGoogle Scholar
  31. 31.
    Huls A, Klumper C, Macintyre EA et al (2018) Atopic dermatitis: interaction between genetic variants of GSTP1, TNF, TLR2, and TLR4 and air pollution in early life. Pediatr Allergy Immunol 29:596–605PubMedCrossRefGoogle Scholar
  32. 32.
    Janssen NA, Brunekreef B, Van Vliet P et al (2003) The relationship between air pollution from heavy traffic and allergic sensitization, bronchial hyperresponsiveness, and respiratory symptoms in Dutch schoolchildren. Environ Health Perspect 111:1512–1518PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Jedrychowski W, Perera F, Maugeri U et al (2011) Effects of prenatal and perinatal exposure to fine air pollutants and maternal fish consumption on the occurrence of infantile eczema. Int Arch Allergy Immunol 155:275–281PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Jin SP, Li Z, Choi EK et al (2018) Urban particulate matter in air pollution penetrates into the barrier-disrupted skin and produces ROS-dependent cutaneous inflammatory response in vivo. J Dermatol Sci.  https://doi.org/10.1016/j.jdermsci.2018.04.015 CrossRefPubMedGoogle Scholar
  35. 35.
    Johansson SG, Bieber T, Dahl R et al (2004) Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113:832–836PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Kathuria P, Silverberg JI (2016) Association of pollution and climate with atopic eczema in US children. Pediatr Allergy Immunol 27:478–485PubMedCrossRefGoogle Scholar
  37. 37.
    Kim D, Seo S, Min S et al (2018) A closer look at the bivariate association between ambient air pollution and allergic diseases: the role of spatial analysis. Int J Environ Res Public Health.  https://doi.org/10.3390/ijerph15081625 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kim H, Park Y, Park K et al (2016) Association between pollen risk indexes, air pollutants, and allergic diseases in Korea. Osong Public Health Res Perspect 7:172–179PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Kim HO, Kim JH, Cho SI et al (2013) Improvement of atopic dermatitis severity after reducing indoor air pollutants. Ann Dermatol 25:292–297PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Kim HO, Kim JH, Chung BY et al (2014) Increased expression of the aryl hydrocarbon receptor in patients with chronic inflammatory skin diseases. Exp Dermatol 23:278–281PubMedCrossRefGoogle Scholar
  41. 41.
    Kim J, Kim EH, Oh I et al (2013) Symptoms of atopic dermatitis are influenced by outdoor air pollution. J Allergy Clin Immunol 132:495–498.e1PubMedCrossRefGoogle Scholar
  42. 42.
    Kim YM, Kim J, Han Y et al (2017) Short-term effects of weather and air pollution on atopic dermatitis symptoms in children: a panel study in Korea. PLoS ONE 12:e175229PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Kim YM, Kim J, Jung K et al (2018) The effects of particulate matter on atopic dermatitis symptoms are influenced by weather type: application of spatial synoptic classification (SSC). Int J Hyg Environ Health 221:823–829PubMedCrossRefGoogle Scholar
  44. 44.
    Kramer U, Behrendt H, Dolgner R et al (1999) Airway diseases and allergies in East and West German children during the first 5 years after reunification: time trends and the impact of sulphur dioxide and total suspended particles. Int J Epidemiol 28:865–873PubMedCrossRefGoogle Scholar
  45. 45.
    Kramer U, Koch T, Ranft U et al (2000) Traffic-related air pollution is associated with atopy in children living in urban areas. Epidemiology 11:64–70PubMedCrossRefGoogle Scholar
  46. 46.
    Kramer U, Sugiri D, Ranft U et al (2009) Eczema, respiratory allergies, and traffic-related air pollution in birth cohorts from small-town areas. J Dermatol Sci 56:99–105PubMedCrossRefGoogle Scholar
  47. 47.
    Kramer U, Weidinger S, Darsow U et al (2005) Seasonality in symptom severity influenced by temperature or grass pollen: results of a panel study in children with eczema. J Invest Dermatol 124:514–523PubMedCrossRefGoogle Scholar
  48. 48.
    Krutmann J, Liu W, Li L et al (2014) Pollution and skin: from epidemiological and mechanistic studies to clinical implications. J Dermatol Sci 76:163–168PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Kwon JH, Kim E, Chang MH et al (2015) Indoor total volatile organic compounds exposure at 6 months followed by atopic dermatitis at 3 years in children. Pediatr Allergy Immunol 26:352–358PubMedCrossRefGoogle Scholar
  50. 50.
    Larrieu S, Lefranc A, Gault G et al (2009) Are the short-term effects of air pollution restricted to cardiorespiratory diseases? Epidemiol Rev 169:1201–1208Google Scholar
  51. 51.
    Lee JY, Lamichhane DK, Lee M et al (2018) Preventive effect of residential green space on infantile atopic dermatitis associated with prenatal air pollution exposure. Int J Environ Res Public Health.  https://doi.org/10.3390/ijerph15010102 CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Lee YL, Li CW, Sung FC et al (2007) Increasing prevalence of atopic eczema in Taiwanese adolescents from 1995 to 2001. Clin Exp Allergy 37:543–551PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Lee YL, Li CW, Sung FC et al (2007) Environmental factors, parental atopy and atopic eczema in primary-school children: a cross-sectional study in Taiwan. Br J Dermatol 157:1217–1224PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Lee YL, Su HJ, Sheu HM et al (2008) Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children. J Invest Dermatol 128:2412–2420PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Li A, Fan L, Xie L et al (2018) Associations between air pollution, climate factors and outpatient visits for eczema in West China Hospital, Chengdu, south-western China: a time series analysis. J Eur Acad Dermatol Venereol 32:486–494PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Li Q, Yang Y, Chen R et al (2016) Ambient air pollution, meteorological factors and outpatient visits for eczema in Shanghai, China: a time-series analysis. Int J Environ Res Public Health.  https://doi.org/10.3390/ijerph13111106 CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Liu W, Cai J, Huang C et al (2016) Associations of gestational and early life exposures to ambient air pollution with childhood atopic eczema in Shanghai, China. Sci Total Environ 572:34–42PubMedCrossRefGoogle Scholar
  58. 58.
    Lu C, Deng L, Ou C et al (2017) Preconceptional and perinatal exposure to traffic-related air pollution and eczema in preschool children. J Dermatol Sci 85:85–95PubMedCrossRefGoogle Scholar
  59. 59.
    Meerpohl JJ, Langer G, Perleth M et al (2012) GRADE guidelines: 3. Rating the quality of evidence (confidence in the estimates of effect). Z Evid Fortbild Qual Gesundhwes 106:449–456PubMedCrossRefGoogle Scholar
  60. 60.
    Morgenstern V, Zutavern A, Cyrys J et al (2008) Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med 177:1331–1337PubMedCrossRefGoogle Scholar
  61. 61.
    Ngoc LTN, Park D, Lee Y et al (2017) Systematic review and meta-analysis of human skin diseases due to particulate matter. Int J Environ Res Public Health.  https://doi.org/10.3390/ijerph14121458 CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Oh I, Lee J, Ahn K et al (2018) Association between particulate matter concentration and symptoms of atopic dermatitis in children living in an industrial urban area of South Korea. Environ Res 160:462–468PubMedCrossRefGoogle Scholar
  63. 63.
    Penard-Morand C, Charpin D, Raherison C et al (2005) Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren. Clin Exp Allergy 35:1279–1287PubMedCrossRefGoogle Scholar
  64. 64.
    Penard-Morand C, Raherison C, Charpin D et al (2010) Long-term exposure to close-proximity air pollution and asthma and allergies in urban children. Eur Respir J 36:33–40PubMedCrossRefGoogle Scholar
  65. 65.
    Pujades-Rodriguez M, Mckeever T, Lewis S et al (2009) Effect of traffic pollution on respiratory and allergic disease in adults: cross-sectional and longitudinal analyses. BMC Pulm Med 9:42PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Ring J (2016) Atopic dermatitis eczema. Springer, ChamGoogle Scholar
  67. 67.
    Schafer T, Dirschedl P, Kunz B et al (1997) Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring. J Am Acad Dermatol 36:550–556PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Schafer T, Vieluf D, Behrendt H et al (1996) Atopic eczema and other manifestations of atopy: results of a study in East and West Germany. Allergy 51:532–539PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Schikowski T, Sugiri D, Ranft U et al (2005) Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir Res 6:152PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Schnass W, Huls A, Vierkotter A et al (2018) Traffic-related air pollution and eczema in the elderly: findings from the SALIA cohort. Int J Hyg Environ Health 221:861–867PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Seo S, Kim D, Min S et al (2016) GIS-based association between PM10 and allergic diseases in Seoul: implications for health and environmental policy. Allergy Asthma Immunol Res 8:32–40PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Silverberg JI, Thyssen JP, Paller AS et al (2017) What’s in a name? Atopic dermatitis or atopic eczema, but not eczema alone. Allergy 72:2026–2030PubMedCrossRefGoogle Scholar
  73. 73.
    Sole D, Camelo-Nunes IC, Wandalsen GF et al (2007) 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 17:6–13PubMedGoogle Scholar
  74. 74.
    Solis-Soto MT, Patino A, Nowak D et al (2013) Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province—Bolivia: a cross-sectional study. Environ Health 12:95PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Song S, Lee K, Lee YM et al (2011) Acute health effects of urban fine and ultrafine particles on children with atopic dermatitis. Environ Res 111:394–399PubMedCrossRefGoogle Scholar
  76. 76.
    Steen-Johnsen J, Bolle R, Holt J et al (1995) Impact of pollution and place of residence on atopic diseases among schoolchildren in Telemark County, Norway. Pediatr Allergy Immunol 6:192–199PubMedCrossRefGoogle Scholar
  77. 77.
    Sultz HA, Feldman JG, Schlesinger ER et al (1970) An effect of continued exposure to air pollution on the incidence of chronic childhood allergic disease. Am J Public Health Nations Health 60:891–900PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Tang KT, Ku KC, Chen DY et al (2017) Adult atopic dermatitis and exposure to air pollutants—a nationwide population-based study. Ann Allergy Asthma Immunol 118:351–355PubMedCrossRefGoogle Scholar
  79. 79.
    Wang IJ, Tung TH, Tang CS et al (2016) Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health 219:66–71PubMedCrossRefGoogle Scholar
  80. 80.
    Weidinger S, Beck LA, Bieber T et al (2018) Atopic dermatitis. Nat Rev Dis Primers 4:1PubMedCrossRefGoogle Scholar
  81. 81.
    Weiland SK, Mutius E, Keil U et al (1999) Die Internationale Studie zu Asthma und Allergien im Kindesalter (ISAAC) Forschungsstrategien, Methoden und Ausblick. Allergologie 22:7Google Scholar
  82. 82.
    Werner S, Buser K, Kapp A et al (2002) The incidence of atopic dermatitis in school entrants is associated with individual life-style factors but not with local environmental factors in Hannover, Germany. Br J Dermatol 147:95–104PubMedCrossRefGoogle Scholar
  83. 83.
    Wilhelm M, Eberwein G, Holzer J et al (2007) Influence of industrial sources on children’s health—hot spot studies in North Rhine Westphalia, Germany. Int J Hyg Environ Health 210:591–599PubMedCrossRefGoogle Scholar
  84. 84.
    Williams H, Flohr C (2006) How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol 118:209–213PubMedCrossRefGoogle Scholar
  85. 85.
    Wuthrich B, Schmid-Grendelmeier P (2003) The atopic eczema/dermatitis syndrome. Epidemiology, natural course, and immunology of the IgE-associated („extrinsic“) and the nonallergic („intrinsic“) AEDS. J Investig Allergol Clin Immunol 13:1–5PubMedPubMedCentralGoogle Scholar
  86. 86.
    Yi SJ, Shon C, Min KD et al (2017) Association between exposure to traffic-related air pollution and prevalence of allergic diseases in children, Seoul, Korea. Biomed Res Int 2017:4216107PubMedPubMedCentralGoogle Scholar
  87. 87.
    Zhou C, Baiz N, Banerjee S et al (2013) The relationships between ambient air pollutants and childhood asthma and eczema are modified by emotion and conduct problems. Ann Epidemiol 23:778–783PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.IUF – Leibniz Institut für Umweltmedizinische ForschungDüsseldorfDeutschland
  2. 2.Zentrum Allergie & Umwelt (ZAUM)Technische Universität und Helmholtz Zentrum MünchenMünchenDeutschland

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