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Boser, M. ; Damialis, A.* ; Knote, C.* ; Seemann, M. ; Traidl-Hoffmann, C. ; Plaza, M.P.

Pollen exposure and asthma-related outpatient emergency treatments: A multicenter time series analysis using automated pollen monitoring in Bavaria, Germany.

Environ. Int. 214:110426 (2026)

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Airborne pollen is a key driver of allergy-induced asthma exacerbations. Its relevance is expected to further increase due to climate change, which influences pollen season timing, intensity, and allergenicity. However, taxon-specific asthma risks associated with pollen exposure remain insufficiently quantified. We considered asthma-related outpatient emergency treatments (ICD-10: J45, J46) from the Bavarian Association of Statutory Health Insurance Physicians (KVB) in three metropolitan areas: Augsburg, Munich, and Nuremberg. Daily pollen concentrations for the taxa Alnus, Betula, Corylus, and Poaceae were obtained from the electronic Pollen Information Network (ePIN). We employed a multicenter time-series analysis using quasi-Poisson regression with Distributed Lag Non-Linear Models (DLNMs) to account for non-linear and delayed effects. Pollen effects were modelled at low, medium and high exposure levels. We adjusted for seasonality, public holidays, day of the week and potential confounders such as temperature, relative humidity and air pollution. We estimated taxon-specific attributable fractions (AFs) to assess the asthma burden during the pollen season. High Betula concentrations were associated with an increased risk of asthma treatments (RR: 1.64, 95% CI [1.41,1.90]), while Poaceae showed significant effects at medium (RR: 1.19, 95% CI [1.03,1.38]) and high concentrations (RR: 1.41, 95% CI [1.17,1.70]). While the effect of Betula was strongest on the day of exposure, the Poaceae effect peaked on day two after exposure. During the respective pollen season, AFs for Betula varied from 10.24% (95% CI [1.01,18.50]) in Augsburg to 17.75% (95% CI [9.72,24.80]) in Nuremberg, while the respective AFs for Poaceae ranged between 14.25% (95% CI [4.46,22.84]) in Munich and 18.84% (95% CI [7.21,28.88]) in Augsburg. Betula and Poaceae pollen contribute substantially to asthma-related outpatient emergency treatments in Bavaria, especially during the main pollen season. Our findings underscore the importance of automated, real-time pollen monitoring to support targeted public health interventions and timely warning systems.

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Publication type Article: Journal article

Document type Scientific Article

Keywords Asthma ; Climate Change ; Environmental Epidemiology ; Pollen ; Time Series Analysis; Air-pollution; Exacerbations; Temperature; Pollutants; Responses

ISSN (print) / ISBN 0160-4120

e-ISSN 1873-6750

Journal Environment International

Quellenangaben Volume: 214, Article Number: 110426

Publisher Elsevier

Publishing Place The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England

Reviewing status Peer reviewed

Institute(s) Institute of Environmental Medicine (IEM)

Grants EXTREME project of the Bavarian State Ministry of Health, Care and Prevention (StMGPP)
IMPACCT project of the Federal Ministry of Research, Technology and Space (BMFTR)