气候变化背景下高温、花粉与大气污染对变应性鼻炎及哮喘的协同效应：一项为期20年的时间序列研究
2026/06/30
摘要
背景：气候变化使得极端高温、大气污染物与气源性变应原同步高发的频次持续攀升，但三类因素共同暴露产生的联合健康效应与协同致病效应相关证据仍较为匮乏。
目的：本亚牛旨在依托长期全科医师诊疗数据，量化气温、大气污染物、气传花粉对变应性鼻炎与哮喘发病的独立短期效应、联合短期效应及交互作用效应。
方法：本研究基于人群开展时间序列研究，纳入跨度 20 年的全科医师接诊数据，将日最高气温、细颗粒物（PM2.5）、臭氧、花粉日均浓度与变应性鼻炎、哮喘发病结局进行关联匹配。采用分布滞后非线性模型，在0-14天滞后期区间估算累积相对风险，以暴露中位数为参照，对比高暴露水平（第95百分位）的发病风险差异。通过分层分析评估效应修饰作用，运用交互超额相对风险（RERI）与归因比例（AP），量化极端暴露水平（第90、95百分位）下多因素联合暴露的相加交互作用强度。
结果：花粉暴露与变应性鼻炎发病呈强正向关联（RR=2.54，95%置信区间：2.40-2.69），同时与哮喘发病显著相关（RR=1.49，95%置信区间：1.38-1.61）。联合效应分析显示，极端高温叠加高浓度花粉共同暴露时，变应性鼻炎发病风险显著升高（RR=2.07，95%置信区间：1.77-2.41），相加尺度下存在明确协同交互效应（RERI=0.48，95% 置信区间：0.32-0.64；AP=0.23，95%置信区间：0.17-0.30）。同理，高浓度花粉联合臭氧暴露会提升变应性鼻炎患病风险（RR=2.03，95%置信区间：1.76-2.34），同样存在正向相加交互作用（RERI=0.40，95%置信区间：0.25-0.54；AP=0.20，95%置信区间：0.13-0.26）。高温-花粉、花粉-臭氧这两组暴露组合，在哮喘发病结局中同样呈现正向协同交互效应。
结论：本研究证实花粉是气候敏感性过敏性疾病发病的核心诱因，高温与臭氧可通过协同交互作用进一步放大花粉致病风险。研究结果提示，需构建多环境因子一体化预警体系，并在健康风险评估中充分考虑复合环境联合暴露的叠加危害。
Synergistic impacts of heat, pollen, and air pollution on allergic rhinitis and asthma under climate change: A 20-year time-series study.
Ali EA, Aerts R, Vaes B, Scheerens C, Beerten SG, Bruffaerts N, Duarte E, Pottelbergh GV.
Abstract
BACKGROUND:Climate changes are increasing the frequency of concurrent extremes in temperature, air pollution, and aeroallergens, yet evidence on their joint and synergistic health impacts remains limited.
OBJECTIVE:We aimed to quantify the independent, joint, and interactive short-term effects of temperature, air pollutants, and airborne pollen on allergic rhinitis and asthma using long-term general practitioner (GP) data.
METHODS:We conducted a population-based time-series study using 20 years of GP data. Daily maximum temperature, PM2.5, ozone, and pollen concentrations were linked to allergic rhinitis and asthma outcomes. We estimated cumulative relative risks (RR) over lag 0-14 days using distributed lag non-linear models, comparing high (95th percentile) versus median exposure levels. We evaluated effect modification through stratified analyses and quantified additive interaction for joint exposures at extreme levels (90th and 95th percentile) using relative excess risk due to interaction (RERI) and attributable proportion (AP).
RESULTS:Pollen exposure was strongly associated with allergic rhinitis (RR=2.54, 95% CI: 2.40-2.69) and with asthma (RR=1.49, 95% CI: 1.38-1.61). In joint-effects analyses, co-exposure to extreme heat and high pollen concentrations was associated with an increased risk of allergic rhinitis (RR= 2.07, 95% CI: 1.77-2.41), with clear evidence of synergistic interaction on the additive scale (RERI=0.48, 95% CI: 0.32-0.64, AP=0.23, 95% CI: 0.17-0.30). Similarly, co-exposure to high pollen and ozone was associated with elevated allergic rhinitis risk (RR = 2.03, 95% CI: 1.76-2.34), with positive additive interaction (RERI = 0.40, 95% CI: 0.25-0.54; AP = 0.20, 95% CI: 0.13-0.26). The same exposure combinations, heat-pollen and pollen-ozone, also exhibited positive synergistic interactions for asthma.
CONCLUSION: Our findings identify pollen as a central driver of climate-sensitive allergic morbidity, with heat and ozone acting as key amplifiers through synergistic interactions. Our findings highlight the need for integrated early-warning systems, and risk assessments that account for joint environmental exposures.
背景：气候变化使得极端高温、大气污染物与气源性变应原同步高发的频次持续攀升，但三类因素共同暴露产生的联合健康效应与协同致病效应相关证据仍较为匮乏。
目的：本亚牛旨在依托长期全科医师诊疗数据，量化气温、大气污染物、气传花粉对变应性鼻炎与哮喘发病的独立短期效应、联合短期效应及交互作用效应。
方法：本研究基于人群开展时间序列研究，纳入跨度 20 年的全科医师接诊数据，将日最高气温、细颗粒物（PM2.5）、臭氧、花粉日均浓度与变应性鼻炎、哮喘发病结局进行关联匹配。采用分布滞后非线性模型，在0-14天滞后期区间估算累积相对风险，以暴露中位数为参照，对比高暴露水平（第95百分位）的发病风险差异。通过分层分析评估效应修饰作用，运用交互超额相对风险（RERI）与归因比例（AP），量化极端暴露水平（第90、95百分位）下多因素联合暴露的相加交互作用强度。
结果：花粉暴露与变应性鼻炎发病呈强正向关联（RR=2.54，95%置信区间：2.40-2.69），同时与哮喘发病显著相关（RR=1.49，95%置信区间：1.38-1.61）。联合效应分析显示，极端高温叠加高浓度花粉共同暴露时，变应性鼻炎发病风险显著升高（RR=2.07，95%置信区间：1.77-2.41），相加尺度下存在明确协同交互效应（RERI=0.48，95% 置信区间：0.32-0.64；AP=0.23，95%置信区间：0.17-0.30）。同理，高浓度花粉联合臭氧暴露会提升变应性鼻炎患病风险（RR=2.03，95%置信区间：1.76-2.34），同样存在正向相加交互作用（RERI=0.40，95%置信区间：0.25-0.54；AP=0.20，95%置信区间：0.13-0.26）。高温-花粉、花粉-臭氧这两组暴露组合，在哮喘发病结局中同样呈现正向协同交互效应。
结论：本研究证实花粉是气候敏感性过敏性疾病发病的核心诱因，高温与臭氧可通过协同交互作用进一步放大花粉致病风险。研究结果提示，需构建多环境因子一体化预警体系，并在健康风险评估中充分考虑复合环境联合暴露的叠加危害。
（中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校）
（Environ Int. 2026 Jul;213:110330. doi: 10.1016/j.envint.2026.110330.）
（Environ Int. 2026 Jul;213:110330. doi: 10.1016/j.envint.2026.110330.）
Synergistic impacts of heat, pollen, and air pollution on allergic rhinitis and asthma under climate change: A 20-year time-series study.
Ali EA, Aerts R, Vaes B, Scheerens C, Beerten SG, Bruffaerts N, Duarte E, Pottelbergh GV.
Abstract
BACKGROUND:Climate changes are increasing the frequency of concurrent extremes in temperature, air pollution, and aeroallergens, yet evidence on their joint and synergistic health impacts remains limited.
OBJECTIVE:We aimed to quantify the independent, joint, and interactive short-term effects of temperature, air pollutants, and airborne pollen on allergic rhinitis and asthma using long-term general practitioner (GP) data.
METHODS:We conducted a population-based time-series study using 20 years of GP data. Daily maximum temperature, PM2.5, ozone, and pollen concentrations were linked to allergic rhinitis and asthma outcomes. We estimated cumulative relative risks (RR) over lag 0-14 days using distributed lag non-linear models, comparing high (95th percentile) versus median exposure levels. We evaluated effect modification through stratified analyses and quantified additive interaction for joint exposures at extreme levels (90th and 95th percentile) using relative excess risk due to interaction (RERI) and attributable proportion (AP).
RESULTS:Pollen exposure was strongly associated with allergic rhinitis (RR=2.54, 95% CI: 2.40-2.69) and with asthma (RR=1.49, 95% CI: 1.38-1.61). In joint-effects analyses, co-exposure to extreme heat and high pollen concentrations was associated with an increased risk of allergic rhinitis (RR= 2.07, 95% CI: 1.77-2.41), with clear evidence of synergistic interaction on the additive scale (RERI=0.48, 95% CI: 0.32-0.64, AP=0.23, 95% CI: 0.17-0.30). Similarly, co-exposure to high pollen and ozone was associated with elevated allergic rhinitis risk (RR = 2.03, 95% CI: 1.76-2.34), with positive additive interaction (RERI = 0.40, 95% CI: 0.25-0.54; AP = 0.20, 95% CI: 0.13-0.26). The same exposure combinations, heat-pollen and pollen-ozone, also exhibited positive synergistic interactions for asthma.
CONCLUSION: Our findings identify pollen as a central driver of climate-sensitive allergic morbidity, with heat and ozone acting as key amplifiers through synergistic interactions. Our findings highlight the need for integrated early-warning systems, and risk assessments that account for joint environmental exposures.
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EAACI过敏与哮喘环境科学指南——减轻花粉暴露对呼吸道过敏影响的基于证据的预防和公共卫生行动建议
