title: The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012.
abstract: BACKGROUND
  Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits.
  
  
  METHODS
  Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012. Multi-day impacts of pollen on the outcomes (0-3 days and 0-7 days for the medication sales and ED visits, respectively) were estimated using a distributed lag Poisson time-series model adjusting for temporal trends, day-of-week, weather, and air pollution. For asthma syndrome ED visits, age groups were also analyzed. Year-to-year variation in the average peak dates and the 10th-to-90th percentile duration between pollen and the outcomes were also examined with Spearman's rank correlation.
  
  
  RESULTS
  Mid-spring pollen types (maple, birch, beech, ash, oak, and sycamore/London planetree) showed the strongest significant associations with both outcomes, with cumulative rate ratios up to 2.0 per 0-to-98th percentile pollen increase (e.g., 1.9 [95% CI: 1.7, 2.1] and 1.7 [95% CI: 1.5, 1.9] for the medication sales and ED visits, respectively, for ash). Lagged associations were longer for asthma syndrome ED visits than for the medication sales. Associations were strongest in children (ages 5-17; e.g., a cumulative rate ratio of 2.6 [95% CI: 2.1, 3.1] per 0-to-98th percentile increase in ash). The average peak dates and durations of some of these mid-spring pollen types were also associated with those of the outcomes.
  
  
  CONCLUSIONS
  Tree pollen peaking in mid-spring exhibit substantive impacts on allergy, and asthma exacerbations, particularly in children. Given the narrow time window of these pollen peak occurrences, public health and clinical approaches to anticipate and reduce allergy/asthma exacerbation should be developed.
authors: New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA. kito1@health.nyc.gov.
authors: Kazuhiko
authors: K
authors: Ito
authors: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA. krw2114@cumc.columbia.edu.
authors: Kate R
authors: KR
authors: Weinberger
authors: Louis Calder Center, Biological Field Station, Fordham University, Armonk, New York, NY, 10504-1104, USA. grobinson@fordham.edu.|Department of Natural Sciences, Fordham College at Lincoln Center, 113 West 60th Street, New York, NY, 10023, USA. grobinson@fordham.edu.
authors: Guy S
authors: GS
authors: Robinson
authors: Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1512, New York, NY, 10029, USA. perry.sheffield@mssm.edu.
authors: Perry E
authors: PE
authors: Sheffield
authors: New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA. rlall@health.nyc.gov.
authors: Ramona
authors: R
authors: Lall
authors: New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA. rmathes@health.nyc.gov.
authors: Robert
authors: R
authors: Mathes
authors: ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA. zev@zevross.com.
authors: Zev
authors: Z
authors: Ross
authors: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA. plk3@cumc.columbia.edu.
authors: Patrick L
authors: PL
authors: Kinney
authors: New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA. tmatte@health.nyc.gov.
authors: Thomas D
authors: TD
authors: Matte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D057985:Multi-Ingredient Cold, Flu, and Allergy Medications / Q000191:economics*; D009519:New York City / Q000453:epidemiology; D004366:Nonprescription Drugs / Q000191:economics; D011058:Pollen / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000485:Allergens; D057985:Multi-Ingredient Cold, Flu, and Allergy Medications; D004366:Nonprescription Drugs