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

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.

Citations

Citations to this article as recorded by

The dual challenge of climate change in otolaryngology: Environmental impacts on airway diseases and emission reduction strategies in surgical care
Nuray Bayar Muluk
International Journal of Biometeorology.2026;[Epub] CrossRef

Data Profile

Data resource profile: the allergic disease database of the Korean National Health Insurance Service: Sunyong Yoo, Dong-Wook Kim, Young-Eun Kim, Jong Heon Park, Yeon-Yong Kim, Kyu-dong Cho, Mi-Ji Gwon, Jae-In Shin, Eun-Joo Lee; Epidemiol Health. 2021;43:e2021010. Published online January 21, 2021; DOI: https://doi.org/10.4178/epih.e2021010

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Abstract Summary PDF Supplementary Material

Abstract

Researchers have been interested in probing how the environmental factors associated with allergic diseases affect the use of medical services. Considering this demand, we have constructed a database, named the Allergic Disease Database, based on the National Health Insurance Database (NHID). The NHID contains information on demographic and medical service utilization for approximately 99% of the Korean population. This study targeted 3 major allergic diseases, including allergic rhinitis, atopic dermatitis, and asthma. For the target diseases, our database provides daily medical service information, including the number of daily visits from 2013 and 2017, categorized by patients’ characteristics such as address, sex, age, and duration of residence. We provide additional information, including yearly population, a number of patients, and averaged geocoding coordinates by eup, myeon, and dong district code (the smallest-scale administrative units in Korea). This information enables researchers to analyze how daily changes in the environmental factors of allergic diseases (e.g., particulate matter, sulfur dioxide, and ozone) in certain regions would influence patients’ behavioral patterns of medical service utilization. Moreover, researchers can analyze long-term trends in allergic diseases and the health effects caused by environmental factors such as daily climate and pollution data. The advantages of this database are easy access to data, additional levels of geographic detail, time-efficient data-refining and processing, and a de-identification process that minimizes the exposure of identifiable personal information. All datasets included in the Allergic Disease Database can be downloaded by accessing the National Health Insurance Service data sharing webpage (https://nhiss.nhis.or.kr).

Summary

Korean summary
알레르기질환DB는 환경적 변화와 의료이용 연관성 연구를 지원하기 위해 만들어진 누구나 다운로드 가능한 공개용DB이다. 알레르기질환DB는 한국 전국민의 사회인구학적 특성 및 의료이용 정보가 구축되어 있는 국민건강보험공단의 국민건강정보DB를 활용하여 구축되었다. 알레르기질환DB는 2013년~2017년 알레르기성 비염, 아토피, 천식 상병코드로 청구된 의료이용 정보를 제공하고 있으며, 이를 활용하여 특정 지역에 다양한 환경적 변화와 의료이용과의 연관성 연구 등에 활발히 활용될 것으로 기대된다.

Key Message
The Allergic Disease Database based on the National Health Insurance Data is constructed for analyzing how environmental factors affect the use of medical services. The database provides most Korean medical service information of allergic diseases, such as allergic rhinitis, atopic dermatitis, and asthma from 2013 and 2017. This information enables researchers to study how daily changes of environmental factors in certain regions would influence patients’ behavioral patterns of medical service utilization. Moreover, researchers can analyze the long-term trend of allergic diseases, and health effects caused by environmental factors such as daily climate and pollution data.

Citations

Citations to this article as recorded by

The effects of Helicobacter pylori eradication and development of immune-mediated disorder in children: a nationwide population-based study in Korea
You Ie Kim, Joon Sung Kim, Sang Yong Kim, Byung-Wook Kim
The Korean Journal of Internal Medicine.2026; 41(1): 85. CrossRef
Operational Definitions of Population, Intervention, Comparison, Outcome for Generating Real-World Evidence Using Korean Health Insurance Claims Sample Data in Integrative Medicine Research: A Methodological Guide
Haein Kim, Seungwon Shin
Perspectives on Integrative Medicine.2026; 5(2): 73. CrossRef
Analysis of optic neuritis risk in patients with allergic diseases
Jaeryung Kim, Kyungdo Han, Jin-hyung Jung, Sei Yeul Oh, Kyung-Ah Park, Ju-Hong Min
Scientific Reports.2025;[Epub] CrossRef
Evaluation of the Regulatory Required Post-Authorization Safety Study for Propacetamol: Nested Case-Control and Case-Time-Control Studies
Sungho Bea, Dongwon Yoon, Han Eol Jeong, Juhong Jung, Seung-Mok Park, Juhee Jeon, Young-Min Ye, Jae-Hyun Lee, Ju-Young Shin
Yonsei Medical Journal.2024; 65(2): 120. CrossRef
The relationship between exposure to environmental noise and risk of atopic dermatitis, asthma, and allergic rhinitis
Yongho Lee, Seunghyun Lee, Seula Park, Seong-Kyu Kang, June-Hee Lee, Dong-Wook Lee, Won-Jun Choi, Wanhyung Lee
Ecotoxicology and Environmental Safety.2023; 268: 115677. CrossRef
Increased risk of cataract surgery in patients with allergic disease: a population based cohort study
Ji-Sun Paik, Kyungdo Han, Gahee Nam, Sun-Kyoung Park, Ho Sik Hwang, Yoon Hong Chun, Kyung-Sun Na
Scientific Reports.2022;[Epub] CrossRef

Original Article

Distribution of House Dust Mites in the Bedroom of Patients with Allergic Rhinitis in Pusan Area.: Soon Ock Choi, Baik Kee Cho, Jung Soon Moon; Korean J Epidemiol. 1997;19(2):190-199.

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Abstract PDF: Abstract
This study was conducted to investigate distribution of the house dust mites in the bedroom of allergic rhinitis patients in Pusan. From July to December 1995, 51 dust samples were drawn from the bedroom of the patients by using electronic vaccum cleaner. House dust mites were isolated from 50mg dust by applying the modified wet sieving method. The results were as follows: 1 Out of a total 49 dust samples(96.1%) were isolated house mites. 2 Total 977 mites were collected and identified the most prevalent house mites was Pyroglypidae mite with 92.2%. Among them D.pteronyssinus was predominant species. 3 In 1gm of the house dust, 100-499 mites were found in 17 samples(33.3%), more then 500 mites in 12 samples (23.6%). 4 The density of Pyoglypidae mite was close associated with the month. 5 The density of house dust mite was not affected by the type of house, region and the relative humidity of the bed room; Summary

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