Harmful Effects of Ambient Nitrogen Dioxide on Atopic Dermatitis: Comparison of Exposure Assessment Based on Monitored Concentrations and Modeled Estimates
Open accessAbstract
Precise exposure assessment of air pollutants is crucial in epidemiologic studies to ensure valid estimates of health effects. We conducted a longitudinal study to evaluate the role of air quality monitoring (AQM) measurements and high-resolution modeling outcomes focusing on nitrogen dioxide (NO2) exposure and atopic dermatitis (AD). A total of 128 young children with AD in Seoul Metropolitan Area, Korea, were recruited as a panel. We estimated the participants’ exposure to NO2 for four months, from 1 April through 31 July 2014 based on (1) monitored levels from 60 AQM stations located at varying distances from residential areas (AQM station-based NO2, AQM-NO2) and (2) estimates from a community multi-scale air quality (CMAQ) modeling system with a high-resolution (1 × 1 km) (CMAQ-NO2). We then compared the effect of AQM-NO2 on AD symptoms with that of CMAQ-NO2. The average distance between the participants’ residences and the nearest AQM station was 2.03 ± 1.06 km, ranging from 0.28 km to 5.73 km. Based on AQM-NO2, the AD symptoms increased by 10.28% (95% confidence interval (CI): 3.24, 17.79) with an increase of 10 ppb of NO2. The effect estimates of CMAQ-NO2 were similar to those of AQM-NO2 when assessed in patients living within 3 km from the nearest AQM station. Even within 1 km, the CI estimate obtained from the CMAQ was much narrower than from AQM (44.18–49.54 vs. 7.02–64.75). However, the association of AQM-NO2 with AD symptoms of patients living beyond 3 km was not positive, whereas that of CMAQ-NO2 maintained positive. In conclusion, exposure to ambient NO2 is significantly associated with aggravation of AD symptoms in young children. In addition, our study suggests that exposure assessment of NO2 using measurement data obtained from monitoring stations far from residential locations can lead to misclassification bias.
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Studies on atopic dermatitis severity showed a significant increase in atopic dermatitis symptom severity with an increase in PM10, NO2, and O3.
“These studies showed a significant increase in AD symptom severity with an increase in PM10, NO2, and O3 [19, 41, 57].”
From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [41]
Section 3.3 (page unavailable) reports that higher NO₂ was significantly associated with more AD symptoms in children. The Introduction also reports a significant PM₁₀ association, but the Discussion only says O₃ is associated with symptoms; this paper does not establish a significant increase for O₃. Its main analysis concerns the presence of daily symptoms, rather than a measured increase in overall AD severity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies based on similar populations, but with different periods, study designs and/or statistical analysis, obtained contrasting results.
“Accordingly, studies based on similar populations, but with different periods, study designs and/or statistical analysis, obtained contrasting results [41, 44, 47, 53, 55, 61, 90, 91, 94, 95].”
From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [41]
The Discussion (page unavailable) reports contrasting NO₂–atopic dermatitis associations when two exposure-assessment methods were applied to the same subgroup. That supports the general point that methodological differences can yield contrasting results, but the paper does not establish that separate studies of similar populations differed because of their study periods, designs, or statistical analyses. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn the present review, atopic dermatitis has shown a significant association with different criteria pollutants in both short- and long-term relationships, but the strength of association might vary.
“In the present review, we [37] found that AD has shown a significant association with different criteria pollutants; both in short- [19, 38–42] and long-term relationships [32, 43–46]; however, the strength of the association might vary.”
From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [41]
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- Authors
- Kim, Y.-M., Oh, I., Kim, J., Kang, Y.-H., & Ahn, K.
- Affiliations
- Samsung Medical Center (KR)
- University of Ulsan (KR)
- Ajou University (KR)
- Corresponding author
- Ahn, Kangmo
- Venue
- Atmosphere
- Publisher
- MDPI AG
- Published
- 2020-08-28
- Volume
- 11
- Issue
- 9
- Pages
- 921
- ISSN
- 2073-4433 (ISSN-L)
- OpenAlex
- W3082437921
- Cited by
- 7
- References
- 33
- Citations by year
- 2026: 2 · 2025: 1 · 2023: 2 · 2021: 2
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Atmosphere (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- the Ministry of Environment, Republic of Korea (2013001360002)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- nitrogen dioxide, atopic dermatitis, air pollution exposure assessment, air quality monitoring stations, misclassification bias, young children
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