草花粉引起的花粉症症状负担：对公共卫生预警阈值的启示。

文献信息

中文摘要

背景： 本研究量化了草花粉暴露与过敏性鼻炎（AR）症状发作之间的滞后关联，包括哮喘与非哮喘亚组之间的差异。方法：数据包括来自25,194名唯一识别的智能手机应用程序用户的114,834条自我报告的AR症状。报告是在澳大利亚墨尔本连续七个草花粉季节（2017-2023年）前瞻性收集的。我们调整了气象、空气质量和其他随时间变化的协变量。使用准泊松回归模型结合分布滞后非线性模型（DLNM），检验0-7天的滞后效应。结果：在“低”暴露日（19粒/m3），当暴露在3天滞后期内累积建模时，观察到草暴露与任何严重程度的每日AR发病率之间存在关联（RR 1.31，95% CI 1.16-1.47）。较高的草浓度与滞后1天的风险增加相关，风险从19粒/m3时的RR 1.08（95% CI 0.99-1.17）上升到150粒/m3时的RR 1.19（95% CI 1.09-1.29）。到滞后2天时，风险恢复到非显著基线。哮喘患者、报告用药的用户以及报告更严重症状的用户在较晚滞后期表现出升高的风险。风险升高的幅度和持续时间因年龄和性别的分层模型而异。结论：我们提供了新的群体水平证据，表明草花粉主要在暴露当天触发过敏性鼻炎症状，即使在传统上被归类为“低”的浓度下也是如此，而哮喘患者和其他敏感群体的症状风险持续时间更长。本研究强调了改进沟通和早期预警系统的价值，以更好地支持对即使低水平暴露也敏感的人群。

英文摘要

This study quantifies the lagged association between grass pollen exposure and the onset of allergic rhinitis (AR) symptoms, including differences between asthmatic and non-asthmatic subgroups. Data included 114,834 self-reported AR symptoms collected from 25,194 uniquely identified users of a smartphone application. Reports were gathered prospectively for seven consecutive grass pollen seasons (2017-2023) in Melbourne. We adjusted for meteorological, air quality, and other time-varying covariates. A quasi-Poisson regression model combined with a distributed lag non-linear model (DLNM) was used, testing 0-7 days lagged effects. An association between grass exposure and daily AR incidence of any severity was observed on "low" exposure days (19 grains/m3), when exposure was modeled cumulatively across a 3-day lag period (RR 1.31, 95% CI 1.16-1.47). Higher grass concentrations were associated with increased risk at lag-1, with risk rising from RR 1.08 (95% CI 0.99-1.17) at 19 grains/m3 to RR 1.19 (95% CI 1.09-1.29) at 150 grains/m3. By lag-2, risk returned to a non-significant baseline. Asthmatics, users reporting medication use, and users reporting more severe symptoms exhibited elevated risk at later lags. The magnitude and duration of elevated risk varied across stratified models by age and sex. We provide new population-level evidence that grass pollen triggers allergic rhinitis symptoms predominately on the day of exposure, even at concentrations traditionally classified as "low", with symptom risk persisting longer in asthmatics and other sensitive groups. This study highlights the value of refining communication and early-warning systems to better support individuals who are sensitive to even low levels of exposure.