title: Residential greenness is differentially associated with childhood allergic rhinitis and aeroallergen sensitization in seven birth cohorts.
abstract: The prevalence of allergic rhinitis is high, but the role of environmental factors remains unclear. We examined cohort-specific and combined associations of residential greenness with allergic rhinitis and aeroallergen sensitization based on individual data from Swedish (BAMSE), Australian (MACS), Dutch (PIAMA), Canadian (CAPPS and SAGE), and German (GINIplus and LISAplus) birth cohorts (n = 13 016).
  
  
  
  Allergic rhinitis (doctor diagnosis/symptoms) and aeroallergen sensitization were assessed in children aged 6-8 years in six cohorts and 10-12 years in five cohorts. Residential greenness was defined as the mean Normalized Difference Vegetation Index (NDVI) in a 500-m buffer around the home address at the time of health assessment. Cohort-specific associations per 0.2 unit increase in NDVI were assessed using logistic regression models and combined in a random-effects meta-analysis.
  
  
  
  Greenness in a 500-m buffer was positively associated with allergic rhinitis at 6-8 years in BAMSE (odds ratio = 1.42, 95% confidence interval [1.13, 1.79]) and GINI/LISA South (1.69 [1.19, 2.41]) but inversely associated in GINI/LISA North (0.61 [0.36, 1.01]) and PIAMA (0.67 [0.47, 0.95]). Effect estimates in CAPPS and SAGE were also conflicting but not significant (0.63 [0.32, 1.24] and 1.31 [0.81, 2.12], respectively). All meta-analyses were nonsignificant. Results were similar for aeroallergen sensitization at 6-8 years and both outcomes at 10-12 years. Stratification by NO2 concentrations, population density, an urban vs rural marker, and moving did not reveal consistent trends within subgroups.
  
  
  
  Although residential greenness appears to be associated with childhood allergic rhinitis and aeroallergen sensitization, the effect direction varies by location.
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. elaine.fuertes@helmholtz-muenchen.de.
authors.forename: E
authors.initials: E
authors.lastname: Fuertes
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.|Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Markevych
authors.affiliation: Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Bowatte
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Gruzieva
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: U
authors.initials: U
authors.lastname: Gehring
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.affiliation: Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Berdel
authors.affiliation: Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany.
authors.forename: A
authors.initials: A
authors.lastname: von Berg
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bergström
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Brauer
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Brunekreef
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Brüske
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Carlsten
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Chan-Yeung
authors.affiliation: Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
authors.forename: S C
authors.initials: SC
authors.lastname: Dharmage
authors.affiliation: IUF - Leibniz Research Institute for Environmental Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.|Medical Faculty, Deanery of Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: IUF - Leibniz Research Institute for Environmental Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Klümper
authors.affiliation: Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.|Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, the Netherlands.
authors.forename: G H
authors.initials: GH
authors.lastname: Koppelman
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Edmonton, AB, Canada.|School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kozyrskyj
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Korek
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Kull
authors.affiliation: Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Lodge
authors.affiliation: Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Lowe
authors.affiliation: Department of Environmental Health, Public Health Ontario, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: MacIntyre
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Pershagen
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Standl
authors.affiliation: IUF - Leibniz Research Institute for Environmental Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Sugiri
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Wijga
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.|Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Heinrich
mesh_terms: D000485:Allergens / Q000276:immunology*; D002648:Child; D015331:Cohort Studies; D004777:Environment; D005260:Female; D006801:Humans; D007114:Immunization; D008297:Male; D063868:Patient Outcome Assessment; D012111:Residence Characteristics; D065631:Rhinitis, Allergic / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors
chemical_list: D000485:Allergens
keywords: allergic rhinitis; birth cohorts; greenness; normalized difference vegetation index; sensitization