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

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Abstract

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

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Acknowledgements

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

Funding

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

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Authors and Affiliations

  1. Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany

    Nadine Steckling-Muschack, Hanna Mertes, Paul Schutzmeier, Jana Becker, Stephan Böse-O′Reilly, Joachim Heinrich, Dennis Nowak, Caroline Herr & Stefanie Heinze

  2. Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060, Hall in Tyrol, Austria

    Nadine Steckling-Muschack & Stephan Böse-O′Reilly

  3. Department for Occupational and Environmental Medicine, Bavarian State Office for Health and Food Safety, Pfarrstr. 3, 80538, Munich, Germany

    Isabella Mittermeier, Sandra Walser-Reichenbach, Alisa Weinberger, Mihai Zamfir, Caroline Herr, Susanne Kutzora & Stefanie Heinze

  4. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany

    Jana Becker

  5. Allergy-Center Charité, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Luisenstr. 2, 10117, Berlin, Germany

    Karl-Christian Bergmann

  6. German Pollen Information Foundation, Robert-Koch-Platz 7, 10115, Berlin, Germany

    Karl-Christian Bergmann

  7. University Children’s Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany

    Stephan Böse-O′Reilly & Michael Kabesch

  8. ZAUM, Center of Allergy & Environment, German Center for Lung Research (DZL), Helmholtz Center Munich/Technische Universität München, Biedersteiner Str. 29, 80802, Munich, Germany

    Jeroen Buters

  9. Chair and Institute of Environmental Medicine, UNIKA‐T, Technical University of Munich and Helmholtz Zentrum München, Neusässer Str. 47, 86156, Augsburg, Germany

    Athanasios Damialis

  10. Comprehensive Pneumology Center (CPC) Munich, Member DZL, German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany

    Joachim Heinrich & Dennis Nowak

  11. Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 07 Bouverie Street, Carlton, Melbourne, VIC, 3053, Australia

    Joachim Heinrich

  12. Research and Development Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Prüfeningerstr. 21, 93049, Regensburg, Germany

    Michael Kabesch

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  1. Nadine Steckling-Muschack
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Contributions

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

Corresponding author

Correspondence to Isabella Mittermeier.

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Conflict of interest

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

Additional information

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

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

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