Epidemiology and Health

Original Article

Association between long-term PM_2.5 exposure and risk of urticaria and allergic rhinitis in Korean children: a nationwide longitudinal cohort study: Young A Park, Hyemin Jang, Whanhee Lee, Jongmin Oh, Jung Won Lee, Hae Soon Kim, Jung Eun Choi, Rosie Lee, AiMS-CREATE, Ji Hyen Lee, Eun-Hee Ha; Epidemiol Health. 2026;48:e2026020. Published online May 7, 2026; DOI: https://doi.org/10.4178/epih.e2026020

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Abstract Summary PDF: Abstract
OBJECTIVES
Exposure to air pollutants is well established as being associated with the development and exacerbation of asthma. However, relatively few studies have examined the relationship between fine particulate matter (PM2.5) exposure and the risk of urticaria and allergic rhinitis (AR). Therefore, this study aimed to investigate the associations between long-term PM2.5 exposure and the risks of urticaria and AR.
METHODS
We analyzed data from the Korean National Health Insurance Service–National Sample Cohort spanning 2002 to 2019. The cohort included individuals enrolled from birth and followed until the onset of urticaria or AR. Annual PM2.5 exposure was estimated using validated machine learning–based prediction models with high spatial resolution across mainland Korea. At the initial healthcare visit, urticaria and AR were identified based on primary diagnostic codes from the 10th revision of the International Classification of Diseases. Cox proportional hazards models with time-varying exposures and confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risks associated with a 5 μg/m3 increase in annual PM2.5 concentration.
RESULTS
During follow-up, 364,227 individuals aged 0–18 years at enrollment were included, among whom 151,508 developed urticaria and 258,041 developed AR. The mean PM2.5 concentration at baseline was 29.6 μg/m3 (standard deviation, 3.1). The HR per 5 μg/m3 increase in annual PM2.5 concentration was 1.02 (95% CI, 1.01 to 1.03) for urticaria and 1.06 (95% CI, 1.05 to 1.07) for AR.
CONCLUSIONS
In this nationwide cohort, long-term exposure to PM2.5 was associated with the incidence of urticaria and AR. These findings provide important evidence for strategies aimed at preventing urticaria and AR in children.; Summary

Korean summary
장기간 PM2.5 노출은 국내 소아·청소년의 두드러기 및 알레르기비염 발생 위험 증가와 관련이 있었다. 전국 단위 코호트 연구에서 PM2.5 노출이 높을수록 알레르기질환 발생 위험이 증가하는 경향을 보였다. 본 연구 결과는 소아 알레르기질환 예방을 위한 대기질 개선의 중요성을 시사한다.

Key Message
Long-term exposure to PM2.5 was associated with increased risks of urticaria and allergic rhinitis in Korean children and adolescents. In this nationwide cohort study, higher PM2.5 exposure was consistently linked to a greater risk of developing allergic diseases. These findings underscore the importance of air quality improvement for the prevention of pediatric allergic diseases.

Cohort Profile

Cohort profile: the Ewha Birth and Growth Study: Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Jeong Choi, Ui Jeong Kim, Hyun Jin Park, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eui-Jung Kim, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2021;43:e2021016. Published online February 22, 2021; DOI: https://doi.org/10.4178/epih.e2021016

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Abstract Summary PDF Supplementary Material

Abstract

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Summary

Korean summary
이화영아성장코호트는 만성질환 예방을 위한 생애초기 위험인자에 대한 근거를 제공하기 위해 2001년에 시작되었습니다. 이화영아성장코호트는 국내에서 선도적인 장기 추적관찰 연구로, 소아기 건강과 관련된 산전 및 출생 시 특징, 소아기 대사와 관련된 유전적 혹은 후성학적 특성, 내분비 장애물질 노출에 따른 영향, 소아기의 식이패턴과 같은 다양한 연구결과들을 발표하였습니다. 추후 청년기의 자료 수집을 계획하고 있으며, 우리의 연구결과는 만성질환 예방을 위한 중재 개발에 기여할 것으로 기대됩니다.

Key Message
To provide evidence of early life risk factors for the prevention of chronic diseases, the Ewha Birth and Growth Study was started in 2001. The Ewha Birth and Growth cohort is a leading long-term follow-up study in Korea, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. We are planning to collect data for early adulthood, and our findings will contribute to the development of interventions to prevent chronic diseases.

Citations

Citations to this article as recorded by

Prospective association between handgrip strength in childhood and the metabolic syndrome score and insulin resistance indices in adolescence: an analysis based on the Ewha Birth and Growth Study
Seunghee Jun, Hyunjin Park, Hyelim Lee, Hye Ah Lee, Young Sun Hong, Hyesook Park
Epidemiology and Health.2025; 47: e2025001. CrossRef
Association between physical activity, sleep, and screen time and cardiometabolic risk factors among Brazilian adolescents: a cross-sectional analysis of a nationally representative sample
Diego Augusto Santos Silva, Tiago Rodrigues de Lima, Francisco de Assis Guedes de Vasconcelos, Katia Vergetti Bloch, Felipe Vogt Cureau, Mark Stephen Tremblay
BMC Public Health.2025;[Epub] CrossRef
Keun Lee (October 10, 1942 – May 14, 2024): a pioneering pediatrician in the field of developmental screening tests in Korea and a beloved teacher at Ewha Womans University College of Medicine
Su Jin Cho
The Ewha Medical Journal.2024;[Epub] CrossRef
Prospective association between phthalate exposure in childhood and liver function in adolescence: the Ewha Birth and Growth Cohort Study
Seonhwa Lee, Hye Ah Lee, Bohyun Park, Hyejin Han, Young Sun Hong, Eun Hee Ha, Hyesook Park
Environmental Health.2023;[Epub] CrossRef
BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
Ui-Jeong Kim, Eun Jeong Choi, Hyunjin Park, Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eun Hee Ha, Seungyoun Jung, Hyesook Park
Pediatric Research.2023; 94(1): 153. CrossRef
The Effect of Childhood Obesity or Sarcopenic Obesity on Metabolic Syndrome Risk in Adolescence: The Ewha Birth and Growth Study
Hyunjin Park, Seunghee Jun, Hye-Ah Lee, Hae Soon Kim, Young Sun Hong, Hyesook Park
Metabolites.2023; 13(1): 133. CrossRef
Synergistic effect of serum uric acid and body mass index trajectories during middle to late childhood on elevation of liver enzymes in early adolescence: Findings from the Ewha Birth and Growth Study
Sung Hee Lee, Eun Jeong Choi, Ui Jeong Kim, Hyunjin Park, Bomi Park, Hye Ah Lee, Hyesook Park, Linglin Xie
PLOS ONE.2023; 18(4): e0282830. CrossRef
The association between urinary cotinine level and metabolic syndrome profiles among adolescents: findings from the Ewha Birth and growth study
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BMC Public Health.2023;[Epub] CrossRef
The Mediating Effect of Inflammation between the Dietary and Health-Related Behaviors and Metabolic Syndrome in Adolescence
Ui-Jeong Kim, Eun-Jeong Choi, Hyunjin Park, Hye-Ah Lee, Bomi Park, Haesoon Kim, Youngsun Hong, Seungyoun Jung, Hyesook Park
Nutrients.2022; 14(11): 2339. CrossRef
Precision medicine via the integration of phenotype-genotype information in neonatal genome project
Xinran Dong, Tiantian Xiao, Bin Chen, Yulan Lu, Wenhao Zhou
Fundamental Research.2022; 2(6): 873. CrossRef
Association of participation in the Northern Finland Birth Cohort 1986 with mental disorders and suicidal behaviour
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Epidemiology and Health.2022; 44: e2022005. CrossRef
Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence
Eun Jeong Choi, Hye Ah Lee, Bomi Park, Bohyun Park, Hae Soon Kim, Young Sun Hong, Hyesook Park
Scientific Reports.2021;[Epub] CrossRef

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