Clinical Reviews in Allergy & Immunology

, Volume 57, Issue 3, pp 340–349 | Cite as

The Clinical Utility of Pollen Counts

  • Carmi Geller-Bernstein
  • Jay M. PortnoyEmail author


In this review, we describe how pollen counts are performed, the health effects caused by exposure to varying amounts of pollen, the clinical utility of reporting pollen counts to the public, and how that information can be used by patients who have allergies to improve their health. The public is very interested in pollen counts, particularly if the counts provide a forecast of expected pollen exposure for the next few days. Traditional pollen counts are labor-intensive; poorly distributed; and, since the counts are usually 1-day-old, do not provide forecasts that can be acted on. New methods that provide short- and long-term pollen forecasts can provide this information to allergic individuals so that they can respond to changing outdoor conditions. Studies of the relationship between artificial and natural exposure to pollen and development of symptoms have provided improved understanding into how much pollen it takes to cause symptoms. Thresholds for pollen counts that trigger symptoms vary by pollen type, sensitivity of the population, and interactions with other atmospheric exposures. Strategies to inform the public when the pollen count poses a health risk have been proposed along with computerized systems that provide personalized pollen alerts. The best performing public notification system was a “traffic light system” that reported pollen exposure as low, 0–30; intermediate, 31–50; or high, 51–150. This system outperformed other threshold systems used in Sweden and in Britain/Denmark. Continued improvements in pollen forecasting models combined with data provided by automated pollen counters and better public reporting should permit allergic individuals and urban planners to adapt effectively to changes in outdoor aeroallergen exposures.


Pollen Ragweed Allergic rhinitis 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

This was a review article and not a study involving human subjects, so IRB approval was not required.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pawankar R, Canonica W, Holgate S, Lockey R (2011) White book on allergy. World Allergy Association. Accessed on 23 July 2018.
  2. 2.
    CDC (2014) Summary health statistics for U.S. adults: National Health Interview Survey, 2012 (Tables 3 and 4). In: Vital and Health Statistics Report Series 10 Number 260 February 2014. Accessed 23 Dec 2017
  3. 3.
    CDC (2013) Summary health statistics for U.S. children: National Health Interview Survey, 2012, table 2. In: Vital and Health Statistics Report Series 10, Number 258 December 2013. Accessed 23 Dec 2017
  4. 4.
    •• Vandenplas O, Vinnikov D, Blanc PD, Agache I, Bachert C, Bewick M, Cardell LO, Cullinan P, Demoly P, Descatha A, Fonseca J, Haahtela T, Hellings PW, Jamart J, Jantunen J, Kalayci Ö, Price D, Samolinski B, Sastre J, Tian L, Valero AL, Zhang X, Bousquet J (2017) Impact of rhinitis on work productivity: a systematic review. J Allergy Clin Immunol Pract 6:1274–1286.e9. This systematic review documents the detrimental effect that rhinitis has on individuals who have it CrossRefPubMedGoogle Scholar
  5. 5.
    CDC (2010) National Ambulatory Medical Care Survey: 2010 Summary Tables. Accessed 23 Dec 2017
  6. 6.
    CDC (2015) Summary Health Statistics: National Health Interview Survey, 2015, Table 2. Accessed 23 Dec 2017
  7. 7.
    CDC (2015) National Center for Health Statistics, Fast facts- asthma. Accessed 23 Dec 2017
  8. 8.
    Lang K, Allen-Ramey F, Huang H, Rock M, Kaufman E, Dykewicz MS (2016) Health care resource use and associated costs among patients with seasonal versus perennial allergic rhinitis. Allergy Asthma Proc 37(5):103–111. CrossRefPubMedGoogle Scholar
  9. 9.
    Le Cann P, Paulus H, Glorennec P, Le Bot B, Frain S, Gangneux JP (2017) Home environmental interventions for the prevention or control of allergic and respiratory diseases: what really works. J Allergy Clin Immunol Pract 5(1):66–79. CrossRefPubMedGoogle Scholar
  10. 10.
    Jantunen J, Saarinen K (2009) Intrusion of airborne pollen through open windows and doors. Aerobiologia 25(3):193–201. CrossRefGoogle Scholar
  11. 11.
    Raynor G, Ogden E, Hayes J (1970) Dispersion and deposition of ragweed pollen from experimental sources. J Appl Meteorol 9(12):885–895CrossRefGoogle Scholar
  12. 12.
    Frei T (1997) Pollen distribution at high elevation in Switzerland: evidence for medium range transport. Grana 36:34–38. CrossRefGoogle Scholar
  13. 13.
    Frenz DA, Goswami AM, Murray LW, Lince NL (1998) A survey of television meteorologists about their sources for and understanding of pollen counts. Ann Allergy Asthma Immunol 81(5):439–442. CrossRefPubMedGoogle Scholar
  14. 14.
    Bousquet J, Agache I, Anto JM, Bergmann KC, Bachert C, Annesi-Maesano I, Bousquet PJ, D'Amato G, Demoly P, de Vries G, Eller E, Fokkens WJ, Fonseca J, Haahtela T, Hellings PW, Just J, Keil T, Klimek L, Kuna P, Lodrup Carlsen KC, Mösges R, Murray R, Nekam K, Onorato G, Papadopoulos NG, Samolinski B, Schmid-Grendelmeier P, Thibaudon M, Tomazic P, Triggiani M, Valiulis A, Valovirta E, van Eerd M, Wickman M, Zuberbier T, Sheikh A (2017) Google Trends terms reporting rhinitis and related topics differ in European countries. Allergy 72(8):1261–1266. CrossRefPubMedGoogle Scholar
  15. 15.
    Wang XY, Tian ZM, Ning HY, Wang XY (2017) The ambient pollen distribution in Beijing urban area and its relationship with consumption of outpatient anti-allergic prescriptions. Eur Rev Med Pharmacol Sci 21(3 Suppl):108–115PubMedGoogle Scholar
  16. 16.
    Gesualdo F, Stilo G, D’Ambrosio A, Carloni E, Pandolfi E, Velardi P et al (2015) Can twitter be a source of information on allergy? Correlation of pollen counts with tweets reporting symptoms of allergic rhinoconjunctivitis and names of antihistamine drugs. PLoS One 10(7):e0133706. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Portnoy J, Barnes C (2003) Clinical relevance of spore and pollen counts. Immunol Allergy Clin N Am 23(3):389–410 vi CrossRefGoogle Scholar
  18. 18.
    Frenz DA, Murray LW, Boire AA (1999) A summary of the atmospheric surveys published in the United States allergy literature, 1966-1996. Ann Allergy Asthma Immunol 82(6):543–547. CrossRefPubMedGoogle Scholar
  19. 19.
    Frenz DA (1999) Comparing pollen and spore counts collected with the Rotorod Sampler and Burkard spore trap. Ann Allergy Asthma Immunol 83(5):341–347; quiz 8-9. CrossRefPubMedGoogle Scholar
  20. 20.
    Frenz DA (2000) The effect of windspeed on pollen and spore counts collected with the Rotorod Sampler and Burkard spore trap. Ann Allergy Asthma Immunol 85(5):392–394. CrossRefPubMedGoogle Scholar
  21. 21.
    Xiao X, Fu A, Xie X, Kang M, Hu D, Yang P, Liu Z (2013) An investigation of airborne allergenic pollen at different heights. Int Arch Allergy Immunol 160(2):143–151. CrossRefPubMedGoogle Scholar
  22. 22.
    • Sikoparija B, Skjoth CA, Celenk S, Testoni C, Abramidze T, Alm Kubler K et al (2017) Spatial and temporal variations in airborne Ambrosia pollen in Europe. Aerobiologia (Bologna) 33(2):181–189. paper documents the variations in pollen concentrations across Europe providing justification for enhanced predictive models and a denser distribution of pollen stations CrossRefGoogle Scholar
  23. 23.
    Kosisky SE, Marks MS, Yacovone MA, Nelson MR (2011) Determination of ranges for reporting pollen aeroallergen levels in the Washington, DC, metropolitan area. Ann Allergy Asthma Immunol 107(3):244–250. CrossRefPubMedGoogle Scholar
  24. 24.
    Barnes C, Pacheco F, Landuyt J, Hu F, Portnoy J (2001) The effect of temperature, relative humidity and rainfall on airborne ragweed pollen concentrations. Aeerobiologia 17(1):61–68. CrossRefGoogle Scholar
  25. 25.
    Barnes C, Pacheco F, Landuyt J, Hu F, Portnoy J (2001) Hourly variation of airborne ragweed pollen in Kansas City. Ann Allergy Asthma Immunol 86(2):166–171. CrossRefPubMedGoogle Scholar
  26. 26.
    Smith M, Jager S, Berger U, Sikoparija B, Hallsdottir M, Sauliene I et al (2014) Geographic and temporal variations in pollen exposure across Europe. Allergy 69(7):913–923. CrossRefPubMedGoogle Scholar
  27. 27.
    • D’Amato M, Annesi-Maesano I, Molino A, Mormile M, Vitale C, Vatrella A, Sanduzzi A, D’Amato G (2017) Thunderstorm and asthma outbreaks during pollen season. Epidemiol Prev 41(3–4):208–211. phenomenon of thunderstorm asthma caused by exposure to large amounts of pollen at ground level has been well described and provides further justification to enhance pollen forecasting technologies CrossRefPubMedGoogle Scholar
  28. 28.
    Burge HA (1992) Monitoring for airborne allergens. Ann Allergy 69(1):9–18PubMedGoogle Scholar
  29. 29.
    Bastl K, Berger M, Bergmann KC, Kmenta M, Berger U (2017) The medical and scientific responsibility of pollen information services. Wien Klin Wochenschr 129(1–2):70–74. CrossRefPubMedGoogle Scholar
  30. 30.
    Geller-Bernstein C, Keynan N, Bejerano A, Shomer-Ilan A, Dolev Z, Radosh V, Waisel Y (1989) Sensitization to pollens in a changing environment: Israel. Allerg Immunol (Paris) 21(8):293–296Google Scholar
  31. 31.
    Mikhail S, Olga R, Roberto A (2017) Multi-model ensemble simulations of olive pollen distribution in Europe in 2014. Atmos Chem Phys 17(20):12341–12360CrossRefGoogle Scholar
  32. 32.
    Bastl K, Kmenta M, Geller-Bernstein C, Berger U, Jager S (2015) Can we improve pollen season definitions by using the symptom load index in addition to pollen counts? Environ Pollut 204:109–116. CrossRefPubMedGoogle Scholar
  33. 33.
    Sofiev M (2017) On impact of transport conditions on variability of the seasonal pollen index. Aerobiologia (Bologna) 33(1):167–179. CrossRefGoogle Scholar
  34. 34.
    Kasprzyk I, Walanus A (2014) Gamma, Gaussian and logistic distribution models for airborne pollen grains and fungal spore season dynamics. Aerobiologia (Bologna) 30(4):369–383. CrossRefGoogle Scholar
  35. 35.
    Voukantsis D, Berger U, Tzima F, Karatzas K, Jaeger S, Bergmann KC (2015) Personalized symptoms forecasting for pollen-induced allergic rhinitis sufferers. Int J Biometeorol 59(7):889–897. CrossRefPubMedGoogle Scholar
  36. 36.
    • Kmenta M, Zetter R, Berger U, Bastl K (2016) Pollen information consumption as an indicator of pollen allergy burden. Wien Klin Wochenschr 128(1–2):59–67. use of social media to study health conditions is a nacent field that is likely to become more important over time CrossRefPubMedGoogle Scholar
  37. 37.
    Bergmann K, Zuberbier T, Augustin J, Mucke H, Straff W (2012) Climate change and pollen allergy: cities and municipalities should take people suffering from pollen allergy into account when planting in public spaces. Allergo J 21(2):103–107CrossRefGoogle Scholar
  38. 38.
    Grote M, Vrtala S, Niederberger V, Wiermann R, Valenta R, Reichelt R (2001) Release of allergen-bearing cytoplasm from hydrated pollen: a mechanism common to a variety of grass (Poaceae) species revealed by electron microscopy. J Allergy Clin Immunol 108(1):109–115. CrossRefPubMedGoogle Scholar
  39. 39.
    Bastl K, Kmenta M, Pessi AM, Prank M, Saarto A, Sofiev M, Bergmann KC, Buters JTM, Thibaudon M, Jäger S, Berger U (2016) First comparison of symptom data with allergen content (Bet v 1 and Phl p 5 measurements) and pollen data from four European regions during 2009-2011. Sci Total Environ 548-549:229–235. CrossRefPubMedGoogle Scholar
  40. 40.
    Barnes C, Schreiber K, Pacheco F, Landuyt J, Hu F, Portnoy J (2000) Comparison of outdoor allergenic particles and allergen levels. Ann Allergy Asthma Immunol 84(1):47–54. CrossRefPubMedGoogle Scholar
  41. 41.
    Day JH, Ellis AK, Rafeiro E, Ratz JD, Briscoe MP (2006) Experimental models for the evaluation of treatment of allergic rhinitis. Ann Allergy Asthma Immunol 96(2):263–277; quiz 77-8, 315. CrossRefPubMedGoogle Scholar
  42. 42.
    Ellis A, Ratz J, Day A, Day J (2010) Factors that affect the allergic rhinitis response to ragweed allergen exposure. Ann Allergy Asthma Immunol 104:293–298CrossRefGoogle Scholar
  43. 43.
    •• Ellis AK, Soliman M, Seteacy L, French S (2016) Comparison of responses to different pollen challenges in the environmental exposure unit (EEU). Ann Allergy Asthma Immunol 117:S13. The environmental exposure unit (EEU) is likely to be a more important source of information regarding the health effects of pollen and other aeroallergens over time–S14CrossRefGoogle Scholar
  44. 44.
    Ellis AK, Steacy LM, Joshi A, Bhowmik S, Raut A (2016) Efficacy of the novel nasal steroid S0597 tested in an environmental exposure unit. Ann Allergy Asthma Immunol 117(3):310–317. CrossRefPubMedGoogle Scholar
  45. 45.
    Ziska LH, Gebhard DE, Frenz DA, Faulkner S, Singer BD, Straka JG (2003) Cities as harbingers of climate change: common ragweed, urbanization, and public health. J Allergy Clin Immunol 111(2):290–295CrossRefGoogle Scholar
  46. 46.
    Annesi-Maesano I, Rouve S, Desqueyroux H, Jankovski R, Klossek JM, Thibaudon M, Demoly P, Didier A (2012) Grass pollen counts, air pollution levels and allergic rhinitis severity. Int Arch Allergy Immunol 158(4):397–404. CrossRefPubMedGoogle Scholar
  47. 47.
    D’Amato G, Liccardi G, D'Amato M (2000) Environmental risk factors (outdoor air pollution and climatic changes) and increased trend of respiratory allergy. J Investig Allergol Clin Immunol 10(3):123–128PubMedGoogle Scholar
  48. 48.
    Rapiejko P, Stanlaewicz W, Szczygielski K, Jurkiewicz D (2007) Threshold pollen count necessary to evoke allergic symptoms. Otolaryngol Pol 61(4):591–594CrossRefGoogle Scholar
  49. 49.
    DellaValle CT, Triche EW, Leaderer BP, Bell ML (2012) Effects of ambient pollen concentrations on frequency and severity of asthma symptoms among asthmatic children. Epidemiology 23(1):55–63. CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Caillaud DM, Martin S, Segala C, Besancenot JP, Clot B, Thibaudon M, French Aerobiology Network (2012) Nonlinear short-term effects of airborne Poaceae levels on hay fever symptoms. J Allergy Clin Immunol 130(3):812–4.e1. CrossRefPubMedGoogle Scholar
  51. 51.
    Frankland, AW. The pollen count and the patient. Ind J Aerobiol. 3:1–6Google Scholar
  52. 52.
    Kiotseridis H, Cilio CM, Bjermer L, Tunsater A, Jacobsson H, Dahl A (2013) Grass pollen allergy in children and adolescents-symptoms, health related quality of life and the value of pollen prognosis. Clin Transl Allergy 3:19. CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Comtois P, Gagnon L (1988) Concentration pollenique et frequence des symptoms de pollinose: une method pour determiner les seuils cliniques. Rev Fr Allergol 28:279–286Google Scholar
  54. 54.
    Negrini AC, Arobba D (1992) Allergenic pollens and pollinosis in Italy: recent advances. Allergy 47(4 Pt 2):371–379CrossRefGoogle Scholar
  55. 55.
    Florido JF, Delgado PG, de San Pedro BS, Quiralte J, de Saavedra JM, Peralta V et al (1999) High levels of Olea europaea pollen and relation with clinical findings. Int Arch Allergy Immunol 119(2):133–137. CrossRefPubMedGoogle Scholar
  56. 56.
    Waisel Y, Mienis Z, Kosman E, Geller-Bernstein C (2004) The partial contribution of specific airborne pollen to pollen induced allergy. Aerobiologia 20:197–208CrossRefGoogle Scholar
  57. 57.
    Moriguchi H, Matsumoto M, Nishimoto Y, Kuwada K (2001) The development of a pollen information system for the improvement of QOL. J Med Investig 48(3–4):198–209Google Scholar
  58. 58.
    Stewart M (2008) Identification and management of undiagnosed and undertreated allergic rhinitis in adults and children. Clin Exp Allergy 38(5):751–760. ReviewCrossRefPubMedGoogle Scholar
  59. 59.
    Davies R, Smith L (1973) Forecasting the start and severity of the hay fever season. Clin Allergy 3(3):263–267CrossRefGoogle Scholar
  60. 60.
    Thibaudon M (2003) The pollen-associated allergic risk in France. Eur Ann Allergy Clin Immunol 35(5):170–172PubMedGoogle Scholar
  61. 61.
    Wayne P, Foster S, Connolly J, Bazzaz F, Epstein P (2002) Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. Ann Allergy Asthma Immunol 88(3):279–282. CrossRefPubMedGoogle Scholar
  62. 62.
    El Kelish A, Zhao F, Heller W, Durner J, Winkler JB, Behrendt H et al (2014) Ragweed (Ambrosia artemisiifolia) pollen allergenicity: SuperSAGE transcriptomic analysis upon elevated CO2 and drought stress. BMC Plant Biol 14:176. CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Rogers CA, Wayne PM, Macklin EA, Muilenberg ML, Wagner CJ, Epstein PR, Bazzaz FA (2006) Interaction of the onset of spring and elevated atmospheric CO2 on ragweed (Ambrosia artemisiifolia L.) pollen production. Environ Health Perspect 114(6):865–869CrossRefGoogle Scholar
  64. 64.
    Ziska L, Knowlton K, Rogers C, Dalan D, Tierney N, Elder MA, Filley W, Shropshire J, Ford LB, Hedberg C, Fleetwood P, Hovanky KT, Kavanaugh T, Fulford G, Vrtis RF, Patz JA, Portnoy J, Coates F, Bielory L, Frenz D (2011) Recent warming by latitude associated with increased length of ragweed pollen season in Central North America. Proc Natl Acad Sci U S A 108(10):4248–4251. CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Wolf J, O'Neill NR, Rogers CA, Muilenberg ML, Ziska LH (2010) Elevated atmospheric carbon dioxide concentrations amplify Alternaria alternata sporulation and total antigen production. Environ Health Perspect 118(9):1223–1228. CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Ziska LH, Beggs PJ (2012) Anthropogenic climate change and allergen exposure: the role of plant biology. J Allergy Clin Immunol 129(1):27–32. CrossRefPubMedGoogle Scholar
  67. 67.
    •• Lake IR, Jones NR, Agnew M, Goodess CM, Giorgi F, Hamaoui-Laguel L, Semenov MA, Solomon F, Storkey J, Vautard R, Epstein MM (2017) Climate change and future pollen allergy in Europe. Environ Health Perspect 125(3):385–391. paper attempts to quantify the consequences of climate change on pollen allergy in humans. It is estimated that ragweed allergy will increase and that the prevalence of sensitization will ore than double by mid century CrossRefPubMedGoogle Scholar
  68. 68.
    Scevkova J, Dusicka J, Hrubisko M, Micieta K (2015) Influence of airborne pollen counts and length of pollen season of selected allergenic plants on the concentration of sIgE antibodies on the population of Bratislava, Slovakia. Ann Agric Environ Med 22(3):451–455. CrossRefPubMedGoogle Scholar
  69. 69.
    Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, Caraballo L et al (2013) The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J 6(1):3–18. CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Latvala J, von Hertzen L, Lindholm H, Haahtela T (2005) Trends in prevalence of asthma and allergy in Finnish young men: nationwide study, 1966-2003. BMJ 330(7501):1186–1187. CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    D’Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M et al (2015) Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 8(1):25–52. CrossRefPubMedGoogle Scholar
  72. 72.
    NOAA (2017) Atmospheric CO2 at Mauna Loa obseratory. In: National Oceanic and Atmospheric Administration Earth System Research Laboratory Global Monitoring Division. National Oceanic & Atmospheric Administration. Accessed 13 Nov 2017

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Authors and Affiliations

  1. 1.Zabludovicz Center for Autoimmune DiseasesSheba Medical CenterRamat GanIsrael
  2. 2.Division of Allergy, Asthma & ImmunologyChildren’s Mercy HospitalKansas CityUSA

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