Abstract
Background
Pollen-induced allergic rhinitis increases significantly with age among children and adolescents and is associated with reduced quality of life due to symptom severity, social impacts, and decreased school performance. This study examines associations between pollen exposure and allergic rhinitis symptoms in German adolescents.
Methods
In the 15-year follow-up of the GINIplus and LISA birth cohorts at the Munich study area, monthly occurrence of nasal symptoms was assessed in 1594 participants. Pollen concentrations of birch, grass, ragweed, and mugwort between January 2010 and March 2014 were considered. Monthly individual pollen exposures (grains/m3) were assigned as the sum of all pollen types to which participants were sensitized. Associations between pollen exposure and monthly nasal symptoms were analyzed using adjusted generalized additive mixed-effect models.
Results
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| GAMM curves of the partial association of mean individual pollen exposure on probability of nasal symptom occurrence in the total study period. |
Conclusion
Even at low pollen concentrations, there is an increase in symptom probability of seasonal allergic rhinitis that remains elevated at high pollen concentrations in sensitized participants. Enhanced probability rates also remain in late seasons after the pollen peak. These findings show that allergic rhinitis patients cannot rely on high-pollen warnings but require accurate measurements to avoid exposure and allergic symptoms.
Key message
Allergic rhinitis is the most common allergic disease, affecting more than 400 million people worldwide. The condition often leads to significant reductions in quality of life due to symptom severity, impacts on social interactions, and decreased school performance. In Germany, the lifetime prevalence of seasonal allergic rhinitis (hay fever) among children and adolescents was reported to be 11% in 2018, increasing with age from childhood into adolescence. In this study, a non-linear association between individual pollen exposure and nasal symptoms in 15-year-old participants from the GINIplus and LISA birth cohorts in the Munich area was observed. This association was characterized by a significant increase at low pollen concentrations and a plateau onset at elevated concentrations. These findings highlight the importance of sensitive pollen monitoring to guide allergic rhinitis patients throughout the seasons. Informing patients that allergic symptoms can occur even at moderate or low pollen concentrations may support self-management and improve quality of life. A significant association between pollen exposure and nasal symptoms can also be assumed in the second half of the pollen season. Associations in pollen exposure and nasal symptoms differed between sensitization profiles within grass pollen seasons. Enhanced probability rates remain in late seasons after the pollen peak. Symptom probability increased stronger in participants sensitized to birch and grass compared to those sensitized to grass only during grass seasons. These findings indicate that allergic symptoms may need to be addressed even during periods of low to moderate pollen concentrations. Further studies are needed to explore biological mechanisms underlying the observed differences and should investigate whether comparable results are obtained when analyzing daily data in pollen exposure.
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