Sulfur dioxide and exacerbation of allergic respiratory diseases: A time-stratified case-crossover study

Vesna Tomić-Spirić; Gordana Kovačević; Jelena Marinković; Janko Janković; Anđa Ćirković; Ana Milošević Đerić; Nenad Relić; Slavenka Janković

doi:10.4103/jrms.JRMS_6_20

Sulfur dioxide and exacerbation of allergic respiratory diseases: A time-stratified case-crossover study

J Res Med Sci. 2021 Nov 29:26:109. doi: 10.4103/jrms.JRMS_6_20. eCollection 2021.

Authors

Vesna Tomić-Spirić^{1

2}, Gordana Kovačević³, Jelena Marinković⁴, Janko Janković⁵, Anđa Ćirković⁴, Ana Milošević Đerić³, Nenad Relić⁶, Slavenka Janković⁷

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Clinic for Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia.
³ Department of Internal Medicine, General Hospital Užice, Užice, Serbia.
⁴ Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁶ Department of Otorhinolaryngology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia.
⁷ Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Abstract

Background: Strong epidemiological evidence suggests that air pollution plays a significant role in the exacerbation of allergic respiratory diseases. This study aimed to assess the potential relationship between daily levels of sulfur dioxide (SO₂) and emergency department (ED) visits for allergic diseases.

Materials and methods: Data regarding ED visits for allergic respiratory diseases were routinely collected from the EDs in the Zlatibor district, and the General Hospital, Užice. The daily average concentrations of SO₂ were obtained from the regional automatic air quality monitoring stations. All data were collected from June 2012 to July 2014. A time-stratified case-crossover design was used. Crude odds ratios (ORs) and ORs adjusted for weather conditions were calculated using conditional logistic regression.

Results: Statistically significant associations were seen between 0-day lagged exposure to SO₂ and ED visits for all allergic diseases (OR = 1.62; 95% confidence interval [CI]: 1.05-2.48; P = 0.028) and between 2-day lagged exposure to SO₂ and ED visits for asthma with allergic rhinitis (OR = 2.00; 95% CI: 1.03-3.88; P = 0.042). These results were adjusted for temperature, temperature², and humidity.

Conclusion: Our results suggest that short-term exposure to SO₂ conferred an increased risk of ED visits for allergic respiratory diseases, particularly for asthma with concomitant allergic rhinitis.

Keywords: Air pollution; allergic respiratory diseases; emergency departments; sulfur dioxide.