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Wang H, Matusik M, Wunderlich R, Hanson SE, Babich K, Samad L, Qian AM, McMillin SE, Ye X, Zhang S, Liu Y, Chen X, Li Z, Lin H, Zhu H, Wang X. Short-Term Ambient Air Pollution and Urticaria in Guangzhou, China: Estimating the Association and Population Attributable Fraction. TOXICS 2023; 11:949. [PMID: 38133350 PMCID: PMC10747676 DOI: 10.3390/toxics11120949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Limited evidence is available regarding the association between acute exposure to ambient air pollutants and the risk of urticaria, even though the skin is an organ with direct contact with the external environment. This study utilized generalized additive models to investigate the association between particulate matter with an aerodynamic diameter smaller than 10 μm (PM10) and 2.5 μm (PM2.5), nitrogen dioxide (NO2) and sulfur dioxide (SO2), and daily outpatient visits for urticaria in Guangzhou, China from 2013 to 2017. We also estimated the attributable fraction of urticaria outpatient visits due to air pollution. A total of 216,648 outpatient visits due to urticaria occurred during the study period. All air pollutants were significantly associated with an increased excess risk of urticaria. Each 10 μg/m3 increase in PM2.5, PM10, NO2, and SO2 was associated with an increase of 1.23% (95% CI: 0.42%, 2.06%), 0.88% (95% CI: 0.28%, 1.49%), 3.09% (95% CI: 2.16%, 4.03%), and 2.82% (95% CI: 0.93%, 4.74%) in hospital visits for urticaria at lag05, respectively. It was estimated that 3.77% (95% CI: 1.26%, 6.38%), 1.91% (95% CI: 0.60%, 3.26%), 6.36% (95% CI: 4.38%, 8.41%), and 0.08% (95% CI: 0.03%, 0.14%) of urticaria outpatient visits were attributable to PM2.5, PM10, NO2, and SO2 using the World Health Organization's air quality guideline as the reference. Relatively stronger associations were observed during the cold season. This study indicates that short-term air pollution may play a significant role in outpatient visits for urticaria, and that such relationships could be modified by season.
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Affiliation(s)
- Huanli Wang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Morgan Matusik
- University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | | | - Sarah E. Hanson
- Bureau of Communicable Disease Control and Prevention, Missouri Department of Health and Senior Services, Jefferson City, MO 63103, USA
| | - Kelly Babich
- Connecticut Department of Public Health, Office of Public Health Preparedness and Response, Hartford, CT 06134, USA
| | - Lilianne Samad
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Aaron M. Qian
- Department of Psychology, College of Arts and Sciences, Saint Louis University, Saint Louis, MO 63108, USA
| | | | - Xingdong Ye
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Sanquan Zhang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Yumei Liu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Xiaoyin Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Zhenjie Li
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huilan Zhu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Liu X, Cao Y, Wang W. Burden of and Trends in Urticaria Globally, Regionally, and Nationally from 1990 to 2019: Systematic Analysis. JMIR Public Health Surveill 2023; 9:e50114. [PMID: 37883176 PMCID: PMC10636626 DOI: 10.2196/50114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Urticaria presents a significant global health challenge due to its sudden onset and potential for severe allergic reactions. Past data on worldwide prevalence and incidence is inconsistent due to differing study methodologies, regional differences, and evolving diagnostic criteria. Past studies have often provided broad ranges instead of specific figures, underscoring the necessity for a cohesive global perspective to inform public health strategies. OBJECTIVE We aimed to assess the global burden of urticaria using the 2019 Global Burden of Disease (GBD) study data and systematically analyze urticaria prevalence, incidence, and disability-adjusted life years (DALYs) at global, regional, and national levels, thereby informing more effective prevention and treatment strategies. METHODS We analyzed the global, regional, and national burden of urticaria from 1990 to 2019 using the 2019 GBD study coordinated by the Institute for Health Metrics and Evaluation. Estimations of urticaria prevalence, incidence, and DALYs were derived using DisMod-MR 2.1, a Bayesian meta-regression tool. The Socio-demographic Index (SDI) was used to correlate development status with health outcomes. The GBD's division of the world into 21 regions and 204 countries and territories facilitated a comprehensive assessment. Age-standardized estimated annual percentage changes were generated for urticaria metrics to quantify temporal trends, with age standardization adjusting for potential confounding from age structure. RESULTS From 1990 to 2019, the global age-standardized prevalence, incidence, and DALY rates of urticaria showed marginal changes. In 2019, 65.14 million individuals were affected, with a prevalence rate of 841.88 per 100,000 population. The DALY rate was 50.39 per 100,000 population. Compared to 1990, the global age-standardized prevalence, incidence, and DALY rates saw increases of 2.92, 4.84, and 0.31 per 100,000 population, respectively. Women persistently had higher rates than men. At a regional level in 2019, low-middle SDI regions exhibited the highest age-standardized metrics, whereas high SDI regions reported the lowest. Central Europe showed the highest rates, contrasting with Western Europe's lowest rates. Nationally, urticaria prevalence in 2019 varied dramatically, from a low of 27.1 per 100,000 population in Portugal to a high of 92.0 per 100,000 population in Nepal. India reported the most DALYs at 749,495.9, followed by China, Pakistan, and the United States. Agewise data showed higher rates in younger age groups, which diminished with age and then experienced a slight resurgence in the oldest populations. This pattern was pronounced in women and younger populations, with the largest rises seen in those aged less than 40 years and the smallest in those aged more than 70 years. CONCLUSIONS Urticaria remains a significant global health issue, with considerable variation across regions, countries, and territories. The increased burden among women, the rising burden in younger populations, and the regional differences in disease burden call for tailored interventions and policies to tackle this emerging public health issue.
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Affiliation(s)
- Xiaoli Liu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Cao
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Wenhui Wang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
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Kim SH, Moon JY, Park HS, Shin YS. The Role of Di(2-Ethylhexyl) Phthalate as an Exacerbating Factor in Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:339-343. [PMID: 35557498 PMCID: PMC9110918 DOI: 10.4168/aair.2022.14.3.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
Phthalates are one of the most commonly used endocrine disruptors and have been considered a risk factor for respiratory disease including asthma. However, it is not yet known how they are related to urticaria. We investigated the association between phthalate exposure and urticaria in 10 healthy controls and 20 adult patients with active urticaria. The urinary levels of mono-n-butyl phthalate (MnBP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) were measured by using high performance liquid chromatography tandem mass spectrometry, and mast cell releasability was determined after phthalate treatment. The levels of phthalate metabolites, especially di-ethylhexyl phthalate (DEHP), are significantly increased in the urine of patients with urticaria compared to the healthy controls. The release of β-hexosaminidase in human mast cells is more significantly increased by MnBP, mono-benzyl phthalate, MEHHP, and MECPP compared to the negative controls; interestingly, the highest secretion of β-hexosaminidase is observed after the lowest stimulation of MECPP. Phthalates, including DEHP, may act as aggravating factors for chronic spontaneous urticaria and can be used as potential therapeutic targets in future studies.
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Affiliation(s)
- Seo-Hee Kim
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
| | - Ji-young Moon
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Seob Shin
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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