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This ambitious study, conducted over a period of four years, assessed 27,863 patients and compared levels of allergic rhinitis (AR) or chronic rhinosinusitis (CRS) with the levels of air pollution recorded, as assessed by levels of particulate matter (PM10). They found significant variance in all of the potential confounding factors recorded, such as age, gender, occupation, smoking history, education level, obesity, residence, household income and asthma, so adjusted for these in their analysis, and found a statistically significant difference in the prevalence of AR as pollution levels changed – the higher the pollution, the more AR was seen. The same was true for rates of CRS – notably a higher prevalence of the condition in areas of pollution but, once all confounding variables were accounted for, the difference was not statistically significant. In terms of the endoscopic findings, the results again become statistically significant – a significantly higher rate of pale mucosa and watery rhinorrhea in areas with high pollution levels. Interestingly, there was no correlation between rates of high pollution and total serum IgE levels or specific IgE levels, which is surprising as AR is inflammation of the nasal mucosa mediated by allergen-specific IgE. The authors postulate that the mechanism of exacerbation of the AR is by modulation of the immunologic response of allergen-specific IgE sensitisation. The huge volume of patients surveyed in this study is impressive, and the findings significant. As pollution levels rise across the world as climate change worsens, this is serious food for thought, as we can expect quality of life to worsen for the large number of patients already suffering with AR unless something can be done to reduce pollution levels.

Association between concentration of air pollutants and prevalence of inflammatory sinonasal diseases: A nationwide cross-sectional study.
Han M, Choi SJ, Jeong Y, et al.
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Joanna Stephens

United Lincolnshire Hospitals NHS Trust, UK.

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