Exposure to Motor Vehicle Traffic and Allergic Sensitization
Wyler, Catherine1; Braun-Fahrländer, Charlotte1; Künzli, Nino1; Schindler, Christian1; Ackermann-Liebrich, Ursula1; Perruchoud, André P2; Leuenberger, Philippe3; Wüthrich, Brunello4; the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) Team
From the 1Institute of Social and Preventive Medicine, University of Basel; 2Department of Internal Medicine, University Hospital Basel; 3Department of Pneumology, University Hospital Lausanne; and 4Allergy Unit, Department of Dermatology, University Hospital Zurich, Switzerland.
Submitted April 12, 1999; final version accepted December 14, 1999.
Address correspondence to: Charlotte Braun-Fahrländer, Institute of Social and Preventive Medicine, University of Basel, Steinengraben 49, CH-4051 Basel, Switzerland.
The Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) is part of Swiss National Research Program 26A supported by the Swiss National Science Foundation (Grants 4026-28099 and 3200-042532.94/1) and by the Federal Office of Education and Science. SAPALDIA Basel is part of the European Community Respiratory Health Survey.
We examined the association between the presence of an allergic sensitization and seasonal allergic diseases or symptoms and the exposure to road traffic in Basel, Switzerland. Traffic counts at the domiciles of subjects ranged from 24 to 32,504 cars per 24 hours, with a median of 1,624. To investigate the relation of road traffic and allergies, we matched the data of the traffic inventory of Basel with those of the 820 participants of the SAPALDIA study (Swiss Study on Air Pollution and Lung Diseases in Adults), ages 18–60 years, who had completed a detailed respiratory health questionnaire and had undergone allergy testing (skin prick tests and serologic examinations). We observed a positive association with a sensitization to pollen that was most pronounced among persons with a duration of residence of at least 10 years. The odds ratios (adjusted for educational level, smoking behavior, number of siblings, age, sex, and family history of atopy) for cars, contrasting four exposure categories with the lowest quartile as referent category, were 1.99 [95% confidence interval (CI) = 0.91–4.38], 2.47 (95% CI = 1.06–5.73), and 2.83 (95% CI = 1.26–6.31). These results suggest that living on busy roads is associated with a higher risk for a sensitization to pollen and could possibly be interpreted as an indication for interactions between pollen and air pollutants. We did not, however, find a similar relation between motor vehicle traffic and hay fever or seasonal allergic symptoms, and we saw no trend that increasing traffic exposure was associated with a rise in sensitization rates to indoor allergens.
Various studies have shown that air pollution can exacerbate symptoms 1 or reduce the dose of allergen needed to evoke an allergic response in persons with an already existing allergic disease. 2,3 But there also exist indications that air pollution may induce an allergic sensitization. Evidence for this hypothesis primarily results from a series of animal studies. Both nitrogen dioxide (NO2) and diesel exhaust seem to have an effect on the atopic status of guinea pigs and mice, 4–8 and results from in vitro experiments with human bronchial epithelial cells point in a similar direction. 9
A possible effect of air pollutants on atopic sensitization could also be due to modifications of aeroallergens in ambient air. Several researchers have reported that NO2 and diesel exhaust carbon particles can interact with pollen grains or allergen-bearing particles and, in turn, increase their allergenicity. 10–14
The results of epidemiologic studies investigating the relation of road traffic and allergies, however, are contradictory. A Japanese study has found that the prevalence rate of self-reported seasonal allergic rhinitis was highest among people living near a motorway lined with cedar trees. 15 Similarly, Weiland et al16 and Duhme et al, 17 who studied school children in two German cities, have observed that an increase in the frequency of truck traffic on the street of residence went along with a rising prevalence of allergic rhinitis. Concordant with these results are the recent findings of Ciccone and colleagues. 18 A small pilot study conducted in Germany suggested that children who spent more than 1 hour daily on a busy street were more likely to be sensitized to pollen than were other children. 19 In contrast to these results, a series of other epidemiologic studies found no relation between road traffic and allergies. 20–22
A weakness of these epidemiologic studies is the lack of objective markers for both traffic exposure and allergic diseases. Therefore, in the present study, we investigated whether there is an association between the exposure to motor vehicle traffic on the street of residence and the prevalence of atopic sensitization in a sample of adults by using objective measures for exposure and outcome.
Subjects and Methods
Study Population and Participation Rate
Basel-Stadt is an urban area with about 200,000 inhabitants, located in the northwestern part of Switzerland. In 1991, it was one of the eight areas that participated in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA). 23–25 Martin et al26 have described the methods of SAPALDIA elsewhere. The present study is based on the 1,075 (60%) Swiss participants of the Basel sample of SAPALDIA. The core questionnaire health assessments were identical to those of the European Community Respiratory Health Survey (ECRHS), 27 and SAPALDIA Basel was also a certified ECRHS center. In total, 948 (88.2%) of the study participants of the SAPALDIA center in Basel underwent allergy testing (skin prick tests and serologic examinations; see below), and for 820 (76.3%) we obtained additional information on the traffic density (private cars and trucks) at their home address.
To evaluate the representativeness of our final study population, we compared it with those 255 individuals without a complete dataset. For age, sex, and level of education, we did not observe any difference, but the excluded subjects reported hay fever and pollen-related symptoms more frequently. They did not, however, differ much with respect to the level of traffic exposure, based on a comparison of the final study population and the 128 of 255 subjects with information on traffic counts.
In correspondence to the ECRHS, SAPALDIA included a computer-supported interview. It covered questions on the personal and family history of respiratory and allergic diseases, on the home and work environments, and on active and passive smoking. We included the following variables in the present analyses:current hay fever, which required an affirmative answer to the question “Did you have hay fever this year or last year?”;seasonal rhinitis or conjunctivitis symptoms, defined as having at least one affirmative answer to the questions “When you are near trees, grass or flowers, or when there is a lot of pollen about, do you ever get a runny or stuffy nose or start to sneeze?” and “Do you ever get itchy or watering eyes?”; and seasonal asthma symptoms, which included at least one affirmative answer to the following questions: “When you are near trees, grass or flowers, or when there is a lot of pollen about, do you ever start to cough?”, “Do you ever start to wheeze?”, “Do you ever get a feeling of tightness in your chest?”, and “Do you ever start to feel short of breath?”. We performed the interviews throughout the year.
We assessed the sensitization to eight common aeroallergens (timothy grass, pellitory-of-the-wall, and birch pollen; house dust mite; cat and dog epithelia; and the molds Alternaria tenuis and Cladosporium herbarum) by skin prick tests using Phazet steel lancets (Kabi-Pharmacia, Uppsala, Sweden). 25 Additionally, we carried out a serologic screening test (Phadiatop, CAP FEIA system; Kabi-Pharmacia, Uppsala, Sweden).
We defined a sensitization to any allergen as a positive result in the Phadiatop test or at least one positive skin prick test reaction to any of the eight aeroallergens tested or both. A sensitization to pollen included at least one positive skin prick test reaction to the pollen of timothy grass (Phleum pratense), pellitory-of-the-wall, or birch, and a sensitization to any indoor allergen required at least one positive skin prick test reaction to house dust mite or cat or dog epithelia. We did not incorporate A. tenuis and C. herbarum in either of the latter two subcategories, because these molds cannot be assigned to the group of outdoor or indoor allergens unambiguously.
Assessment of Exposure
To determine the participants’ exposure to traffic at their domicile, we matched the data of the traffic inventory of the canton Basel-Stadt to each participant’s home address. This inventory contains information on average numbers of cars and trucks per hour passing a given address. Separate numbers are available for daytime (6 am to 10 pm) and nighttime (10 pm to 6 am). These data are based on a traffic model taking into account road capacities (that is, the size and maximum speed allowed on the road) and the quantity of commuter traffic as assessed in the National Census of 1980. This model is validated and updated by traffic counts every 3–4 years. The first complete inventory dates from 1987, and in the present analyses we used the most recent version, from 1994. 28
We aimed the statistical analyses at assessing potential associations between traffic exposure and the presence of an allergic sensitization or allergic diseases and symptoms.
First, we carried out univariate descriptive analyses of exposure and outcome variables. Second, we considered several different parameters containing information on the study participants’ socioeconomic status, family history of allergies, diseases and living conditions in childhood (for example, number of siblings), present living conditions (for example, year of construction and size of house), indoor air pollution (for example, gas stove or heating device) and work place exposure. The three variables educational level, smoking behavior (nonsmoker, smoker, or ex-smoker), and number of siblings turned out to be associated both with the presence of atopy and the traffic density, and we included them in multivariate logistic regression models. Several authors 29,30 have previously described an inverse association between the prevalence of an atopic sensitization and the number of siblings. In addition, we controlled for age (by a cubic polynomial) and sex of the study participants as well as their family history of atopy. We performed the regression analyses with the traffic counts categorized into quartiles; owing to a cluster of identical traffic counts between the first and second quartiles, it was not possible to divide the sample into four identical categories. For each sample considered, we also computed covariate-adjusted prevalences in the different categories of traffic exposure by inserting the respective sample mean of each covariate other than traffic exposure into the logistic regression model and varying the level of exposure. We then included the traffic counts as a continuous variable and obtained an approximately linear relation between the logit of the prevalence of a “sensitization to pollen” and the traffic frequency when considering the latter on a logarithmic scale. We used locally weighted regression (LOESS) to assess and graphically represent this relation. On the assumption that our measure of exposure might be more valid for women and long-term residents, we stratified by duration of residency (with a cutoff of 10 years, which lies between the mean and the median) and by gender. We carried out all calculations with the software packages SAS version 6.12and S-PLUS version 4.0.
The mean age of the study participants was 41.1 years (standard deviation = 11.9 years), and 49.1% of the subjects were female. The prevalence of an allergic sensitization varied greatly depending on the allergens tested: 38.4% (315 per 820) were sensitized to any allergen, 25.5% (209 per 819) to pollen, and 14.5% (118 per 815) to any indoor allergen. The prevalence of allergic manifestations was 21.8% (178 per 818) for current hay fever, 33.3% (273 per 820) for seasonal rhinitis or conjunctivitis symptoms, and 13.0% (107 per 820) for seasonal asthma symptoms. The traffic counts at the domiciles of the study participants ranged from 24 to 32,504 cars per 24 hours, with a median of 1,624 and a mean of 3,707. For trucks, the counts ranged from 0 to 4,744 per 24 hours, with a median of 104 and a mean of 296 trucks per 24 hours.
To investigate a possible association between motor vehicle traffic and allergic conditions, we determined crude and adjusted odds ratios of an atopic sensitization for different exposure categories, with the lowest quartile as referent category. We saw no trend that increasing traffic exposure was related to a rise in sensitization rates to any allergen or any indoor allergen. People living at locations with an intermediate or high traffic density, however, were more likely to be sensitized to pollen than people living on quiet roads. The analyses yielded the highest odds ratios for the association between traffic exposure and a sensitization to pollen, but there was no indication of a clear dose-response relation (Table 1).
When we stratified the data by duration of residence, again sensitization to pollen showed the highest odds ratios. Individuals who had been living at their domicile for at least 10 years showed odds ratios ranging from 1.99 [95% confidence interval (CI) = 0.91–4.38] to 2.83 (95% CI =1.26–6.31) for increased exposure to cars, and a comparable picture emerged for exposure to trucks. Moreover, there was some suggestion of a growing risk with increasing frequency of cars (Table 2).
We also performed the multivariate logistic regression analyses including the logarithmically transformed traffic counts as a continuous variable. The qualitative differences we observed were similar to the previous results. We found no association with sensitization rates to any allergen or any indoor allergen. For subjects with a long duration of residence and the prevalence of a sensitization to pollen, however, we found an average odds ratio of 1.19 to be associated with a doubling in the number of cars per 24 hours (95% CI = 1.03–1.38) and of 1.14 for a doubling in the number of trucks per 24 hours (95% CI = 1.02–1.28). When we did the analyses for men and women separately, the corresponding odds ratios were 1.11 (95% CI = 0.90–1.37) and 1.30 (95% CI = 1.04–1.63), respectively.
Figure 1 shows the relation between the natural logarithm of the odds ratio of pollen sensitization and the natural logarithm of car frequency as estimated by locally weighted regression. We observed an increase in the odds ratio over the full range of exposure with an S-shaped deviation from linearity in the middle range of exposure to traffic counts.
To investigate the clinical relevance of these findings, we studied the relation between traffic exposure and hay fever, as well as pollen-related rhinitis and asthma symptoms. For these outcomes, however, we did not observe a clear association with traffic exposure (Table 3).
Our findings suggest that traffic exposure is associated with a sensitization to pollen. The association was more pronounced among people with a long duration of residence. We evaluated whether the S-shaped deviation from linearity seen in Figure 1 might be due to confounding by one of the variables assessed in our study, but because we saw this “trough” in all of our sensitivity analyses, we consider it to be unlikely that one specific, uncontrolled confounder might have caused it. On the other hand, chance alone may not be a sufficient explanation either. Hay fever and pollen-related rhinitis and asthma symptoms were not associated with motor vehicle traffic, nor could we observe such a relation for a sensitization to any allergen or any indoor allergen.
The fact that a sensitization to pollen and not a sensitization to any indoor allergen appeared to be associated with traffic exposure is especially interesting in connection with research done on interactions between pollen and air pollutants. In vitro, gaseous pollutants such as NO2, SO2, and CO seem to modify the allergenic proteins held in the pollen grain wall, and Ruffin and co-workers 11 have suggested that this modification might increase the potential of the pollen grains to cause allergic disease. Also, Behrendt and colleagues 13 have found that pollen collected from trees near roads with heavy traffic had particulate matter adhering to them, whereas pollen from park trees did not. The same team also carried out experimental studies and concluded that in vitro exposure of pollen grains to particles changed the morphologic structure of the pollen, which, in turn, could induce a local allergen release. 14 Knox and co-workers, 12 on the other hand, have observed that under in vitro conditions, certain allergen-bearing particles could bind to diesel exhaust carbon particles, leading to a concentration of many allergens on one particle. In the natural environment, such an accumulation could increase the potential of these allergen molecules to sensitize individuals. Thus, exposure to motor vehicle traffic may be increasing sensitization to pollen in comparison with other allergens, without increasing the overall prevalence of sensitization at all.
A small pilot study conducted in Nordrhein-Westfalen (Germany) supports the findings of these experimental studies. In line with our results, Krämer and colleagues 19 have observed a positive association between road traffic and a sensitization to pollen. The authors had asked the parents of 6-year-olds about their children’s daily exposure to motor vehicle traffic and found that children who spent more than 1 hour daily on a street with motor vehicle traffic were more likely to be sensitized to pollen (as assessed by radioallergosorbent test) than other children.
In the present study, we did not observe much of an association between road traffic and hay fever or seasonal rhinitis, conjunctivitis, or asthma symptoms, which limits the clinical relevance of our results. This finding contrasts with the findings of epidemiologic studies in Germany 16,17 and Italy, 18 which did observe an association between the traffic density on the street of residence (especially the frequency of truck traffic) and the prevalence of allergic rhinitis. Other studies, however, failed to find a relation between motor vehicle traffic and hay fever 20,22 or doctor’s diagnosis of allergy. 21 The studies identifying a positive association between road traffic and allergies all used self-reported measures of exposure, so an information bias could have readily occurred. A positive relation of traffic exposure with a sensitization to pollen but not with clinical symptoms could, theoretically, be due to a “healthy resident” effect; that is, individuals with allergic symptoms might have chosen to move away from busy streets. Alternatively, subjects may have been sensitized but have not spent sufficient time at or close to their homes during heavy traffic times to have had symptoms. A cross-sectional study such as ours has serious limitations for testing this hypothesis. The fact, however, that the relation between traffic exposure and a sensitization to pollen was stronger in those who had been living at the same address for more than 10 years and was slightly enhanced in females, who might spend more time close to their homes, argues in favor of a real effect. In this context, it would have been informative to stratify by job status as well, but because the percentage of unemployed people is low in Switzerland, the analyses were hampered by the small size. Although early childhood is an important time span for the induction of an atopic sensitization, 31 our results indicate that environmental exposure in adulthood may still be relevant. Alternatively, residency at the same address for more than 10 years may be correlated with childhood exposure.
We examined whether the results of our study could be due to selection bias. We observed little difference with regard to exposure between those we included and those we did not include in the final study population; thus, we consider selection bias to be an unlikely explanation for our results.
Misclassification of exposure could have resulted from our use of the traffic density at the home address as an indicator for exposure to motor vehicle traffic. This parameter cannot serve as an accurate measure of total exposure, because adults spend a substantial fraction of their time outside their homes, at their work places, or in transit. For most persons, however, exposure at home is an important constituent of overall exposure and may serve as a reasonable proxy measure of total exposure. It is also conceivable that those living on busy roads may have additional exposures at their work places. The observed relation between traffic and pollen sensitization may therefore in part be due to additional exposures and not just to traffic exposure at home. Self-reported work place exposure to airborne irritants, however, was not among the predictor variables strongly associated with atopy in our preliminary univariate analyses.
Alternatively, living on a street with high traffic exposure might be correlated with additional lifestyle factors leading to an atopic sensitization, which we have not adjusted for in the analyses. Uncontrolled confounding is therefore another possible bias that we cannot completely rule out. Nevertheless, we tested more than 30 potential confounders and included those showing an association with both exposure and outcome in the logistic regression analyses. Moreover, we observed a stronger association between traffic exposure and a sensitization after inclusion of these potential confounders.
Although we stratified for the duration of residence, we only used one set of exposure parameters, namely the 1994 version of the traffic inventory of the canton Basel-Stadt. According to the agency for air hygiene of Basel, however, traffic density within the city of Basel remained fairly constant over the past 10 years but increased considerably on the highways surrounding the city.
We used traffic density as a proxy measure for traffic-related air pollution. Traffic density has a relatively strong correlation with NO2, and there is evidence that the traffic density is even more highly correlated with primary air pollutants such as NO and CO 32 and with particle number counts. 33 The association between traffic counts and particulate matter less than 10 μm in aerodynamic diameter, however, seems not to be pronounced. In Switzerland, most cars are powered by gasoline, whereas trucks tend to be powered by diesel fuel. Because in our data the frequencies of cars and trucks were highly correlated (correlation coefficient = 0.88), however, we could not achieve a clear-cut separation of these two types of motor vehicles in the statistical analyses.
Important misclassification of disease is unlikely, because we used information from serologic examinations and skin prick tests to assess sensitization rates. The results of skin prick tests, however, may be influenced by fieldworker performance, which could lead to some nondifferential misclassification of disease. 34,35
In conclusion, the results of our study indicate that living on busy roads might confer a higher risk for a sensitization to pollen, but we did not observe an association between traffic density at the home address and prevalence of a sensitization to indoor allergens or hay fever and seasonal allergic symptoms.
1. Ussetti P, Roca J, Agusti AGN, Montserrat JM, Rodriguez-Roisin R, Agusti-Vidal A. Another asthma outbreak in Barcelona: role of oxides of nitrogen. Lancet 1984; 1 (8369):156.
2. Molfino NA, Wright SC, Katz I, Tarlo S, Silverman F, McClean PA, Szalai JP, Raizenne M, Slutsky AS, Zamel N. Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. Lancet 1991; 338:199–203.
3. Jörres R, Nowak D, Magnussen H. The effect of ozone exposure on allergen responsiveness in subjects with asthma or rhinitis. Am J Respir Crit Care Med 1996; 153:56–64.
4. Matsumara Y. The effects of ozone, nitrogen dioxide, and sulfur dioxide on the experimentally induced allergic respiratory disorder in guinea pigs. Am Rev Respir Dis 1970; 102:430–447.
5. Muranaka M, Suzuki S, Koizumi K, Takafuji S, Miyamoto T, Ikemori R, Tokiwa H. Adjuvant activity of diesel-exhaust particulates for the production of IgE antibody in mice. J Allergy Clin Immunol 1986; 77:616–623.
6. Takafuji S, Suzuki S, Koizumi K, Tadokoro K, Miaymoto T, Ikemori R, Muranaka M. Diesel-exhaust particulates inoculated by the intranasal route have an adjuvant activity for IgE production in mice. J Allergy Clin Immunol 1987; 79:639–645.
7. Takano H, Yoshikawa T, Ichinose T, Miyabara Y, Imaoka K, Sagai M. Diesel exhaust particles enhance antigen-induced airway inflammation and local cytokine expression in mice. Am J Respir Crit Care Med 1997; 156:36–42.
8. Miyabara Y, Takano H, Ichinose T, Lim H, Sagai M. Diesel exhaust enhances allergic airway inflammation and hyperresponsiveness in mice. Am J Respir Care Med 1998; 157:1138–1144.
9. Devalia JL, Bayram H, Rusznak C, Calderón M, Sapsford RJ, Abdelaziz MA, Wang J, Davies RJ. Mechanisms of pollution-induced airway disease:in vitro
studies in the upper and lower airways. Allergy 1997; 52(suppl 38):45–51.
10. Emberlin J. Interaction between air pollutants and aeroallergens. Clin Exp Allergy 1995; 25(suppl 3):33–39.
11. Ruffin J, Liu MY, Sessoms R, Banerjee S, Banerjee UC. Effects of certain atmospheric pollutants (SO2
and CO) on the soluble amino acids, molecular weight and antigenicity of some airborne pollen grains. Cytobios 1986; 46:119–129.
12. Knox RB, Suphioglu C, Taylor P, Desai R, Watson HC, Peng JL, Bursill LA. Major grass pollen allergen Lol p1 binds to diesel exhaust particles: implications for asthma and air pollution. Clin Exp Allergy 1997; 27:246–251.
13. Behrendt H, Becker WM, Friedrichs KH, Darsow U, Tomingas R. Interaction between aeroallergens and airborne particulate matter. Int Arch Allergy Immunol 1992; 99:425–428.
14. Behrendt H, Becker WM, Fritzsche C, Sliwa-Tomczok W, Tomczok J, Friedrichs KH, Ring J. Air pollution and allergy: experimental studies on modulation of allergen release from pollen by air pollutants. Int Arch Allergy Immunol 1997; 113:69–74.
15. Ishizaki T, Koizumi K, Ikemori R, Ishiyama Y, Kushibiki E. Studies of prevalence of Japanese cedar pollinosis among the residents in a densely cultivated area. Ann Allergy 1987; 58:265–270.
16. Weiland SK, Mundt KA, Rückmann A, Keil U. Self-reported wheezing and allergic rhinitis in children and traffic density on street of residence. Ann Epidemiol 1994; 4:243–247.
17. Duhme H, Weiland SK, Keil U, Kraemer B, Schmid M, Stender M, Chambless L. The association between self-reported symptoms of asthma and allergic rhinitis and self-reported traffic density on street of residence in adolescents. Epidemiology 1996; 7:578–582.
18. Ciccone G, Forastiere F, Agabiti N, Biggeri A, Bisanti L, Chellini E, Corbo G, Dell’Orco V, Dalmasso P, Volante TF, Galassi C, Piffer S, Renzoni E, Rusconi F, Sestini P, Viegi G. Road traffic and adverse respiratory effects in children. Occup Environ Med 1998; 55:771–778.
19. Krämer U, Behrendt H, Dolgner R, Kainka-Stänicke E, Oberbarnscheidt J, Sidaoui H, Schlipköter HW. Auswirkung der Umweltbelastung auf allergologische Parameter bei 6-jährigen Kindern. In: Ring J, ed. Epidemiologie Allergischer Erkrankungen. Munich: MMV-Verlag, 1991; 165–177.
20. Wjst M, Reitmeir P, Dold S, Wulff A, Nicolai T, Freifrau von Loeffelholz-Colberg E, von Mutius E. Road traffic and adverse effects on respiratory health in children. BMJ 1993; 307:596–600.
21. Oosterlee A, Drijver M, Lebret E, Brunekreef B. Chronic respiratory symptoms in children and adults living along streets with high traffic density. Occup Environ Med 1996; 53:241–247.
22. Studnicka M, Hackl E, Pischinger J, Fangmeyer C, Haschke N, Kühr J, Urbanek R, Neumann M, Frischer T. Traffic-related NO2
and the prevalence of asthma and respiratory symptoms in seven year olds. Eur Respir J 1997; 10:2275–2278.
23. Ackermann-Liebrich U, Leuenberger P, Schwartz J, Schindler C, Monn C, Bolognini G, Bongard JP, Brändli O, Domenighetti G, Elssasser S, Grize L, Karrer W, Keller R, Keller-Wossidlo H, Künzli N, Martin BW, Medici TC, Perruchoud AP, Schöni MH, Tschopp JM, Villiger B, Wüthrich B, Zellweger JP, Zemp E. Lung function and long term exposure to air pollutants in Switzerland: Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) Team. Am J Respir Crit Care Med 1997; 155:122–129.
24. Leuenberger P, Schwartz J, Ackermann-Liebrich U, Blaser K, Bolognini G, Bongard JP, Brändli O, Braun P, Bron C, Brutsche M, Domenighetti G, Elsasser S, Guldimann P, Hollenstein C, Hufschmid P, Karrer W, Keller R, Keller-Wossidlo H, Künzli N, Lüthi JC, Martin BW, Medici T, Perruchoud AP, Radaelli A, Schindler C, Schoeni MH, Solari G, Tschopp JM, Villiger B, Wüthrich B, Zellweger JP, Zemp E. Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Am J Respir Crit Care Med 1994; 150:1222–1228.
25. Wüthrich B, Schindler C, Leuenberger P, Ackermann-Liebrich U. Prevalence of atopy and pollinosis in the adult population of Switzerland (SAPALDIA Study). Int Arch Allergy Immunol 1995; 106:149–156.
26. Martin BW, Ackermann-Liebrich U, Leuenberger P, Künzli N, Zemp E, Keller R, Zellweger J, Wüthrich B, Monn C, Blaser K, Bolognini G, Bongard JP, Brändli O, Braun P, Defila C, Domenighetti G, Grize L, Karrer W, Keller-Wossidlo H, Medici TC, Peeters A, Perruchoud AP, Schindler C, Schoeni MH, Villiger B, et al. SAPALDIA: methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults. Soz Präventivmed 1997; 42:67–84.
27. Burney PG, Luczynska C, Chinn S, Jarvis D. The European Community Respiratory Health Survey. Eur Respir J 1994; 7:954–960.
28. Baudepartement Kanton Basel-Stadt, Bau- und Umweltschutzdirektion Kanton Basel-Landschaft. Gesamtverkehrsmodell der Region Basel: Kurzbericht. Kanton Basel, 1994:1–28.
29. Strachan DP. Hay fever, hygiene, and household size. BMJ 1989; 299:1259–1260.
30. Von Mutius E, Martínez FD, Fritzsch C, Nicolai T, Reitmeir P, Thiemann HH. Skin test reactivity and number of siblings. BMJ 1994; 308:692–695.
31. Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD, Holt PG. Development of allergen-specific T-cell memory in atopic and normal children. Lancet 1999; 353:196–200.
32. Helstab J, Keller M, Pulli R, Künzle T, Theis G, Moser HR. NO2
-Immissionen in den Kantonen Basel-Stadt und Basel-Landschaft 1995–2010, Lufthygiene amt beider, Basel, 1998.
33. Junker M, Kasper M, Röösli M, Camenzind M, Monn C, Künzli N, Theis G, Braun-Fahrländer C. Particle number profiles, particle mass distributions and particle bound PAH concentrations within the urban environment of Basel: an assessment as part of the BRISKA Project. Atmosph Environ (in press).
34. Chinn S, Jarvis D, Luczynska CM, Lai E, Burney PG. Measuring atopy in a multi-centre epidemiological study. Eur J Epidemiol 1996; 12:155–162.
35. Braun-Fahrländer C, Wüthrich B, Sennhauser FH, Vuille JC, and the SCARPOL team. Significant variations of skin prick test results between five fieldworkers in a multicentre study. In: Ring J, Behrendt H, Vieluf D, eds. New Trends in Allergy IV. Berlin: Springer-Verlag, 1996.
This article has been cited 86 time(s).
Journal of Allergy and Clinical ImmunologyChildhood allergic rhinitis, traffic-related air pollution, and variability in the GSTP1, TNF, TLR2, and TLR4 genes: Results from the TAG StudyJournal of Allergy and Clinical Immunology
Environmental HealthPolycyclic aromatic hydrocarbon exposure and pediatric asthma in children: a case-control studyEnvironmental Health
European Respiratory JournalUrban traffic and pollutant exposure related to respiratory outcomes and atopy in a large sample of childrenEuropean Respiratory Journal
European Respiratory JournalClimate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in TaiwanEuropean Respiratory Journal
Journal of Epidemiology and Community Health
Traffic related air pollution and incidence of childhood asthma: results of the Vesta case-control study
Journal of Epidemiology and Community Health, 58(1):
GranaVariability in protein content of pollen of Castor bean (Ricinus communis) before and after exposure to the air pollutants SO2 and NO2Grana
The effect of particles on allergic immune responses
Toxicological Sciences, 65(1):
Inhalation ToxicologyAdjuvant activity of ambient particulate matter in macrophage activity-suppressed, N-acetylcysteine-treated, iNOS- and IL-4-deficient miceInhalation Toxicology
Journal of Environmental MonitoringIndoor and outdoor air concentrations of BTEX and NO2: correlation of repeated measurementsJournal of Environmental Monitoring
AllergyAllergy to cypress pollenAllergy
Journal of Allergy and Clinical ImmunologyBiology of diesel exhaust effects on respiratory functionJournal of Allergy and Clinical Immunology
Environmental ResearchTraffic at residential address, respiratory health, and atopy in adults: the National German Health Survey 1998Environmental Research
Allergic Diseases and the Environment
Clinical overview: The changing pattern of clinical aspects of allergic diseases
Allergic Diseases and the Environment, 53():
ToxicologyThe IgE adjuvant effect of particles: characterisation of the primary cellular response in the draining lymph nodeToxicology
Journal of Investigational Allergology and Clinical Immunology
The effects of environmental pollution on the respiratory system of children in Western Macedonia, Greece
Journal of Investigational Allergology and Clinical Immunology, 15(2):
ThoraxExposure to environmental tobacco smoke and sensitisation in childrenThorax
Revue Des Maladies RespiratoiresAllergic respiratory diseases and outdoor air pollutionRevue Des Maladies Respiratoires
American Journal of Respiratory and Critical Care Medicine
Increased risk of allergy associated with the use of kerosene fuel in the home
American Journal of Respiratory and Critical Care Medicine, 164(9):
Current Allergy and Asthma Reports
Diesel fumes and the rising prevalence of atopy: An urban legend?
Current Allergy and Asthma Reports, 3(2):
Environmental Health Risk III
Population exposure to urban highway traffic emissions
Environmental Health Risk III, 9():
International Journal of Health GeographicsTraffic exposure associated with allergic asthma and allergic rhinitis in adults. A cross-sectional study in southern SwedenInternational Journal of Health Geographics
Immunology and Allergy Clinics of North AmericaTraffic, outdoor air pollution, and asthmaImmunology and Allergy Clinics of North America
Journal of Exposure Analysis and Environmental EpidemiologyFive epidemiological studies on transport and asthma: Objectives, design and descriptive resultsJournal of Exposure Analysis and Environmental Epidemiology
ToxicologyPollution, environmental factors and childhood respiratory allergic diseaseToxicology
ThoraxRole of outdoor aeroallergens in asthma exacerbations: epidemiological evidenceThorax
Occupational and Environmental MedicineEffect of living close to a main road on asthma, allergy, lung function and chronic obstructive pulmonary diseaseOccupational and Environmental Medicine
Archives of Disease in Childhood
The health effects of fossil fuel derived particles
Archives of Disease in Childhood, 86(2):
Environmental Health PerspectivesThe relationship between air pollution from heavy traffic and allergic sensitization, bronchial hyperresponsiveness, and respiratory symptoms in Dutch schoolchildrenEnvironmental Health Perspectives
International Archives of Allergy and ImmunologyIncreasing prevalence of Japanese cedar pollinosis: A meta-regression analysisInternational Archives of Allergy and Immunology
Annals of Allergy Asthma & Immunology
Traffic and outdoor air pollution levels near residences and poorly controlled asthma in adults
Annals of Allergy Asthma & Immunology, 98(5):
International Journal of Health GeographicsThe importance of accurate road data for spatial applications in public health: customizing a road networkInternational Journal of Health Geographics
Environmental HealthInvestigating health effects in a community surrounding a road tunnel stack - a cross sectional studyEnvironmental Health
International Archives of Allergy and ImmunologyAcute effect of air pollution on respiratory complaints, exhaled NO and biomarkers in nasal lavages of allergic children during the pollen seasonInternational Archives of Allergy and Immunology
Environmental ResearchAssessment of exposure to traffic pollution using the ExTra index: study of validationEnvironmental Research
Journal of Exposure Analysis and Environmental EpidemiologyA review and evaluation of intraurban air pollution exposure modelsJournal of Exposure Analysis and Environmental Epidemiology
Clinical and Experimental AllergyLong-term exposure to background air pollution related to respiratory and allergic health in schoolchildrenClinical and Experimental Allergy
International Journal of Health GeographicsTraffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern SwedenInternational Journal of Health Geographics
Cancer Causes & ControlExposure to traffic emissions throughout life and risk of breast cancer: the Western New York Exposures and Breast Cancer (WEB) studyCancer Causes & Control
Environmental HealthSpatial analysis of air pollution and childhood asthma in Hamilton, Canada: comparing exposure methods in sensitive subgroupsEnvironmental Health
Environmental Health Perspectives
Epidemiologic evidence for asthma and exposure to air toxics: Linkages between occupational, indoor, and community air pollution research
Environmental Health Perspectives, 110():
Atmospheric EnvironmentAssessment of schoolchildren's exposure to traffic-related air pollution in the French Six Cities Study using a dispersion modelAtmospheric Environment
Journal of Toxicology and Environmental Health-Part B-Critical ReviewsNasal epithelial and inflammatory response to ozone exposure: A review of laboratory-based studies published since 1985Journal of Toxicology and Environmental Health-Part B-Critical Reviews
International Journal of Hygiene and Environmental Health
Exposure to road traffic enhances allergic skin wheat responses and increases plasma neuropeptides and neurotrophins in patients with atopic eczema dermatitis syndrome
International Journal of Hygiene and Environmental Health, 207(1):
American Journal of Respiratory and Critical Care MedicineTraffic-related air pollution near busy roads - The East Bay children's respiratory health studyAmerican Journal of Respiratory and Critical Care Medicine
Science of the Total EnvironmentCharacterization of a spatial gradient of nitrogen dioxide across a United States-Mexico border city during winterScience of the Total Environment
Journal of Investigational Allergology and Clinical Immunology
Serum interleukins 12 and 18 and immunoglobulin E concentrations and allergic symptoms in Japanese schoolchildren
Journal of Investigational Allergology and Clinical Immunology, 17(1):
Pediatric Allergy and ImmunologyHigh prevalence of atopy, but not of asthma, among children in an industrialized area in North Italy: The role of familial and environmental factors - a population-based studyPediatric Allergy and Immunology
Clinical and Experimental AllergyResidential outdoor air pollution and allergen sensitization in schoolchildren in Oslo, NorwayClinical and Experimental Allergy
Clinical and Experimental Allergy
Asthma and urban air pollution
Clinical and Experimental Allergy, 31(4):
Archives of Environmental Health
Allergic susceptibility associated with diesel exhaust particle exposure: Clear as mud
Archives of Environmental Health, 57(3):
International Journal of Immunopathology and Pharmacology
Latex allergy and sensitization in cities: A survey in a population at risk
International Journal of Immunopathology and Pharmacology, 19(4):
International Journal of Occupational Medicine and Environmental HealthSerum Polycyclic Aromatic Hydrocarbons Among Children With and Without Asthma: Correlation to Environmental and Dietary FactorsInternational Journal of Occupational Medicine and Environmental Health
Pediatric Allergy and ImmunologyPolycyclic aromatic hydrocarbon metabolite levels and pediatric allergy and asthma in an inner-city cohortPediatric Allergy and Immunology
European Respiratory JournalRespiratory symptoms, atopy and bronchial hyperreactivity in professional firefightersEuropean Respiratory Journal
Journal of Exposure Science and Environmental EpidemiologyComparison of regression models with land-use and emissions data to predict the spatial distribution of traffic-related air pollution in RomeJournal of Exposure Science and Environmental Epidemiology
American Journal of Respiratory and Critical Care MedicineAtopic diseases, allergic sensitization, and exposure to traffic-related air pollution in childrenAmerican Journal of Respiratory and Critical Care Medicine
Polycyclic aromatic hydrocarbons, environmental tobacco smoke, and respiratory symptoms in an inner-city birth cohort
Salud Publica De Mexico
Environmental PM2.5 levels and distance from a heavy traffic road in Ciudad Juarez, Chihuahua, Mexico
Salud Publica De Mexico, 46(6):
Environment InternationalAdverse health effects of outdoor air pollutantsEnvironment International
Environmental Health Perspectives
Addressing community concerns about asthma and air toxics
Environmental Health Perspectives, 110():
Occupational and Environmental MedicineComparison between various indices of exposure to traffic-related air pollution and their impact on respiratory health in adultsOccupational and Environmental Medicine
Revue Des Maladies Respiratoires
The pollens we breath
Revue Des Maladies Respiratoires, 18(5):
Inhalation ToxicologySensitivity to ozone, diesel exhaust particles, and standardized ambient particulate matter in rats with a Listeria Monocytogenes-induced respiratory infectionInhalation Toxicology
Occupational and Environmental MedicineNO2 and children's respiratory symptoms in the PATY studyOccupational and Environmental Medicine
M S-Medecine Sciences
Air pollution and allergic airway diseases
M S-Medecine Sciences, 23(2):
Journal of Allergy and Clinical ImmunologyHealth effects of air pollutionJournal of Allergy and Clinical Immunology
Zeitschrift Fur Klinische Psychologie Und PsychotherapiePsychological aspects of allergic rhinitisZeitschrift Fur Klinische Psychologie Und Psychotherapie
Occupational and Environmental MedicineProximity of the home to roads and the risk of wheeze in an Ethiopian populationOccupational and Environmental Medicine
Swiss Medical Weekly
Ragweed (Ambrosia) progression and its health risks: will Switzerland resist this invasion?
Swiss Medical Weekly, 135():
GranaRelationship between the Peczely's large-scale weather types and airborne pollen grain concentrations for Szeged, HungaryGrana
International Journal of Hygiene and Environmental HealthUrban background particulate matter and allergic sensitization in adults of ECRHS IIInternational Journal of Hygiene and Environmental Health
Current Allergy and Asthma ReportsThe impact of air pollutants as an adjuvant for allergic sensitization and asthmaCurrent Allergy and Asthma Reports
Journal of Toxicology and Environmental Health-Part AAdjuvant activity of various diesel exhaust and ambient particles in two allergic modelsJournal of Toxicology and Environmental Health-Part A
Pediatric Allergy and Immunology
Self-reported traffic density and atopic disease in children. Results of the ISAAC Phase III survey in Muenster, Germany
Pediatric Allergy and Immunology, 15(4):
Revue D Epidemiologie Et De Sante Publique
Assessment of exposure to traffic pollution in epidemiological studies: a review
Revue D Epidemiologie Et De Sante Publique, 52(3):
Toxicology and Applied PharmacologyAdjuvant activity of ambient particulate matter of different sites, sizes, and seasons in a respiratory allergy mouse modelToxicology and Applied Pharmacology
Paediatric Respiratory ReviewsHealth effects of ambient air pollution in childrenPaediatric Respiratory Reviews
Bulletin De L Academie Nationale De Medecine
Traffic-related pollutants and their impact on allergic respiratory diseases
Bulletin De L Academie Nationale De Medecine, 193(6):
InternistAir pollutants in environmental medicine - Particles, diesel engine exhaust and passive smokingInternist
Atopy in Norwegian and Russian adults: a population-based study from the common border area
Indoor AirDo indoor pollutants and thermal conditions in schools influence student performance? A critical review of the literatureIndoor Air
Respiratory MedicineResidential proximity fine particles related to allergic sensitisation and asthma in primary school childrenRespiratory Medicine
Salud Publica De Mexico
Association between light absorption measurements of PM2.5 and distance from heavy traffic roads in the Mexico City metropolitan area
Salud Publica De Mexico, 55(2):
air pollution; allergies; pollen; traffic density
© 2000 Lippincott Williams & Wilkins, Inc.
Highlight selected keywords in the article text.