Associations of Exposure to Nitrogen Oxides with Prevalent Asthma and Other Atopic Diseases in Israel
Open accessAbstract
Childhood exposure to nitrogen oxides (NOx) is considered a risk factor for the onset of asthma. However, associations of this exposure with other atopic diseases and factors that modify this association are less clear. We aimed to study associations between exposure to NOx and the prevalence of atopic diseases in Israeli adolescents using a cross-sectional design. The study population comprised all Israeli-born adolescents whose medical status was evaluated for mandatory military recruitment during 1967–2017 (n = 2,523,745), of whom 5.9% had prevalent asthma. We based the exposure assessments on a land-use regression model and estimated associations using multivariable logistic regression models. Across all periods, mean exposure to NOx from birth to adolescence was associated with prevalent asthma at the examination in a dose-response manner, with an odds ratio for the upper quintile of 1.61 (95% CI: 1.56–1.67), in comparison to the lowest quintile. Associations were stronger in males and in lower socioeconomic strata. We found the strongest associations for asthma with comorbid rhinitis, with an almost twofold increase in the odds of upper versus lower quintile of exposure (odds ratio = 1.96, 95% CI: 1.82–2.11). Rhino-conjunctivitis and allergic atopic dermatitis suggested a possible threshold level with NOx. Capsule Summary: Research indicates that half of the global population will suffer from an allergic condition at some point in life. Childhood exposure to nitrogen oxides is a risk factor for the onset of asthma. The association between exposure and allergic diseases other than asthma is unclear. We demonstrate a strong, dose-response relationship between exposure and a group of allergic outcomes, using data comprising 2.5 million subjects over 50 years. The large health benefits from clean air should motivate governments to prioritize mitigation measures.
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In 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 [43]
The Introduction reports evidence linking air pollutants, including NOx, to atopic dermatitis, while cautioning that the findings need confirmation. The Results describe exposure averaged from birth to adolescence in Israeli adolescents, but report no typical exposure–response pattern for atopic dermatitis across the four lowest NOx quintiles. This source supports a qualified long-term NOx association, not significant associations with different criteria pollutants or a short-term relationship. (LLM, conf=0.83)
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“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.”
- Authors
- Lev Bar-Or, R., Levy, I., Twig, G., Broday, D. M., Lyubarsky, A., Derazne, E., Tzur, D., Simon, B., Levin, N., Gileles-Hillel, A., Bentur, L., & Raz, R.
- Affiliations
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 9112102, Israel
- Ministry of Environmental Protection (IL)
- Tel Aviv University (IL)
- Technion – Israel Institute of Technology (IL)
- Israel Defense Forces Medical Corps (IL)
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Pediatric Pulmonology Unit, Department of Pediatrics & The Wohl Institute for Translational Medicine, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Rambam Health Care Campus (IL)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Raz, Raanan
- ORCID
- Venue
- Environments
- Publisher
- MDPI AG
- Published
- 2021-10-19
- Volume
- 8
- Issue
- 10
- Pages
- 110
- ISSN
- 2076-3298 (ISSN-L)
- OpenAlex
- W3205418616
- Cited by
- 2
- References
- 49
- Citations by year
- 2026: 1 · 2023: 1
- FWCI
- 0.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Environments (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- nitrogen oxides, childhood air pollution exposure, asthma prevalence, atopic diseases, rhinitis, rhinoconjunctivitis, dose-response relationship, adolescents, socioeconomic status, sex differences, air quality, land use regression
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