Role of air pollution in rhinitis

Abstract

Air pollution is an increasing global concern with serious health and economic impacts. Among its many effects, respiratory health is particularly vulnerable. As the first point of contact with inhaled pollutants, the nasal passages play a crucial role in airway defense, making rhinitis one of the key inflammatory conditions linked to environmental pollution. This review explores the relationship between air pollution and rhinitis, highlighting key pollutants such as particulate matter (PM, PM_2.5, PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), which contribute to airway inflammation, epithelial barrier dysfunction, immune system dysregulation, and epigenetic changes. Epidemiological studies demonstrate a strong association between pollutant exposure and increased prevalence, severity, and healthcare utilization for allergic rhinitis. However, there is limited research focusing on non-allergic rhinitis. Beyond health concerns, air pollution also imposes a significant economic burden due to rising healthcare costs and lost productivity. Effective mitigation strategies include air quality monitoring, indoor air filtration, policy interventions, and lifestyle modifications. Addressing pollution-related rhinitis requires a multidisciplinary approach involving public health initiatives, clinical management, and environmental policies to reduce exposure and improve patient outcomes. Additionally, limitations in current research are discussed, and further studies are recommended to fill existing knowledge gaps.

Keywords

Rhinitis / allergic rhinitis / immunology / pollution / particulate matter / air pollutants

References

[1] Nan N, Yan Z, Zhang Y, Chen R, Qin G, Sang N. Overview of PM_2.5 and health outcomes: Focusing on components, sources, and pollutant mixture co-exposure . Chemosphere. 2023; 323: 138181.

[2] Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax. 2014; 69: 660-5.

[3] Aghapour M, Ubags ND, Bruder D, Hiemstra PS, Sidhaye V, Rezaee F, et al. Role of air pollutants in airway epithelial barrier dysfunction in asthma and COPD. Eur Respir Rev. 2022; 31: 210112.

[4] Shin S, Bai L, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, et al. Air Pollution as a Risk Factor for Incident Chronic Obstructive Pulmonary Disease and Asthma. A 15-Year Population-based Cohort Study. Am J Respir Crit Care Med. 2021; 203: 1138-48.

[5] Ratajczak A, Badyda A, Czechowski PO, Czarnecki A, Dubrawski M, Feleszko W. Air Pollution Increases the Incidence of Upper Respiratory Tract Symptoms among Polish Children. J Clin Med. 2021; 10: 2150.

[6] Baena-Cagnani CE, Canonica GW, Zaky Helal M, Gómez RM, Compalati E, Zernotti ME, et al. ; ISMAR Study Group. The international survey on the management of allergic rhinitis by physicians and patients (ISMAR). World Allergy Organ J. 2015; 8: 10.

[7] Pacheco SE, Guidos-Fogelbach G, Annesi-Maesano I, Pawankar R, D’Amato G, Latour-Staffeld P, et al. ; American Academy of Allergy, Asthma & Immunology Environmental Exposures and Respiratory Health Committee. Climate change and global issues in allergy and immunology. J Allergy Clin Immunol. 2021; 148: 1366-77.

[8] Air quality, energy and health [Internet]. WHO; c2025 [cited 2025 Jan 24]. Available from: https://www.who.int/teams/environment-climate-change-and-health/air-quality-and-health/health-impacts/types-of-pollutants#:~:text=Pollutants%20with%20the%20strongest%20evidence%20for%20public%20health,short-%20and%20long-term%20exposure%20to%20these%20various%20pollutants

[9] Karagulian F, Belis CA, Dora CFC, Prüss-Ustün AM, Bonjour S, Adair-Rohani H, et al. Contributions to cities’ ambient particulate matter (PM): A systematic review of local source contributions at global level. Atmos Environ. 2015; 120: 475-83.

[10] Amato F, Pandolfi M, Escrig A, Querol X, Alastuey A, Pey J, et al. Quantifying road dust resuspension in urban environment by Multilinear Engine: A comparison with PMF2. Atmos Environ. 2009; 43: 2770-80.

[11] Belis CA, Karagulian F, Larsen BR, Hopke PK. Critical review and meta-analysis of ambient particulate matter source apportionment using receptor models in Europe. Atmos Environ. 2013; 69: 94-108.

[12] Climate change: global temperature [Internet]. [Cited 2025 Jan 24]. Available from: https://www.climate.gov/news-features/understanding-climate/climate-change-global-temperature

[13] Li S, Wu W, Wang G, Zhang X, Guo Q, Wang B, et al. Association between exposure to air pollution and risk of allergic rhinitis: A systematic review and meta-analysis. Environ Res. 2022; 205: 112472.

[14] Wang J, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, et al. Asthma and allergic rhinitis among young parents in China in relation to outdoor air pollution, climate and home environment. Sci Total Environ. 2021; 751: 141734.

[15] Rosario Filho NA, Satoris RA, Scala WR. Allergic rhinitis aggravated by air pollutants in Latin America: A systematic review. World Allergy Organ J. 2021; 14: 100574.

[16] Liu L, Ma J, Peng S, Xie L. Prenatal and early-life exposure to traffic-related air pollution and allergic rhinitis in children: A systematic literature review. PLoS One. 2023; 18: e0284625.

[17] Luo P, Ying J, Li J, Yang Z, Sun X, Ye D, et al. Air Pollution and Allergic Rhinitis: Findings from a Prospective Cohort Study. Environ Sci Technol. 2023; 57: 15835-45.

[18] Maio S, Fasola S, Marcon A, Angino A, Baldacci S, Bilò MB, et al. ; BIGEPI group. Relationship of long-term air pollution exposure with asthma and rhinitis in Italy: an innovative multipollutant approach. Environ Res. 2023; 224: 115455.

[19] Savouré M, Lequy É, Bousquet J, Chen J, de Hoogh K, Goldberg M, et al. Long-term exposures to PM_2.5, black carbon and NO₂ and prevalence of current rhinitis in French adults: The Constances Cohort . Environ Int. 2021; 157: 106839.

[20] Carlsen HK, Haga SL, Olsson D, Behndig AF, Modig L, Meister K, et al. Birch pollen, air pollution and their interactive effects on airway symptoms and peak expiratory flow in allergic asthma during pollen season - a panel study in Northern and Southern Sweden. Environ Health. 2022; 21: 63.

[21] Li X, Wu H, Xing W, Xia W, Jia P, Yuan K, et al. Short-term association of fine particulate matter and its constituents with oxidative stress, symptoms and quality of life in patients with allergic rhinitis: A panel study. Environ Int. 2023; 182: 108319.

[22] Li J, Wu H, Xing W, Li X, Han Z, Ji R, et al. Air pollution mixture associated with oxidative stress exacerbation and symptoms deterioration in allergic rhinitis patients: Evidence from a panel study. Sci Total Environ. 2024; 930: 172688.

[23] Yum HY, Ha EK, Shin YH, Han MY. Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis. Clin Exp Pediatr. 2021; 64: 373-83.

[24] Scussiatto HO, Wroblewski KE, Pagel KL, Schumm LP, McClintock MK, Ramanathan M Jr, et al. Air pollution exposure is associated with rhinitis in older US adults via specific immune mechanisms. Int Forum Allergy Rhinol. 2024; 14: 68-77.

[25] Cui W, Gao H, Zhu L, Xu Y, Liu H. Short-term association between ambient air pollution and childhood non-allergic rhinitis: A time-series study at a National Children’s Regional Medical Center, in Hefei, China, from 2015 to 2021. Ecotoxicol Environ Saf. 2025; 290: 117590.

[26] Huang Y, Zhang Y, Wang J, Li X, Wang C, Chen R, et al. Impact of Air Pollutants and Pollen on the Severity of Nonallergic Rhinitis: A Data-Oriented Analysis. J Asthma Allergy. 2022; 15: 1045-54.

[27] Rosario CS, Urrutia-Pereira M, Murrieta-Aguttes M, D’Amato G, Chong-Silva DC, Godoi RHM, et al. Air pollution and rhinitis. Front Allergy. 2024; 5: 1387525.

[28] Holgate ST. Epithelium dysfunction in asthma. J Allergy Clin Immunol. 2007; 120: 1233-44.

[29] Wan H, Winton HL, Soeller C, Tovey ER, Gruenert DC, Thompson PJ, et al. Der p 1 facilitates transepithelial allergen delivery by disruption of tight junctions. J Clin Invest. 1999; 104: 123-33.

[30] Xian M, Ma S, Wang K, Lou H, Wang Y, Zhang L, et al. Particulate Matter 2.5 Causes Deficiency in Barrier Integrity in Human Nasal Epithelial Cells. Allergy Asthma Immunol Res. 2020; 12: 56-71.

[31] Steelant B, Farré R, Wawrzyniak P, Belmans J, Dekimpe E, Vanheel H, et al. Impaired barrier function in patients with house dust mite-induced allergic rhinitis is accompanied by decreased occludin and zonula occludens-1 expression. J Allergy Clin Immunol. 2016; 137: 1043-53.e5.

[32] Nur Husna SM, Tan HT, Md Shukri N, Mohd Ashari NS, Wong KK. Nasal Epithelial Barrier Integrity and Tight Junctions Disruption in Allergic Rhinitis: Overview and Pathogenic Insights. Front Immunol. 2021; 12: 663626.

[33] Zhao R, Guo Z, Zhang R, Deng C, Xu J, Dong W, et al. Nasal epithelial barrier disruption by particulate matter ≤2.5 μm via tight junction protein degradation. J Appl Toxicol. 2018; 38: 678-87.

[34] Kim N, Han DH, Suh MW, Lee JH, Oh SH, Park MK. Effect of lipopolysaccharide on diesel exhaust particle-induced junctional dysfunction in primary human nasal epithelial cells. Environ Pollut. 2019; 248: 736-42.

[35] Celebi Sözener Z, Cevhertas L, Nadeau K, Akdis M, Akdis CA. Environmental factors in epithelial barrier dysfunction. J Allergy Clin Immunol. 2020; 145: 1517-28.

[36] Guo Z, Hong Z, Dong W, Deng C, Zhao R, Xu J, et al. PM_2.5-Induced Oxidative Stress and Mitochondrial Damage in the Nasal Mucosa of Rats . Int J Environ Res Public Health. 2017; 14: 134.

[37] Jia J, Xia J, Zhang R, Bai Y, Liu S, Dan M, et al. Investigation of the impact of PM_2.5 on the ciliary motion of human nasal epithelial cells . Chemosphere. 2019; 233: 309-18.

[38] Gu W, Hou T, Zhou H, Zhu L, Zhu W, Wang Y. Ferroptosis is involved in PM2.5-induced acute nasal epithelial injury via AMPK-mediated autophagy. Int Immunopharmacol. 2023; 115: 109658.

[39] Hong Z, Zeng P, Zhuang G, Guo Q, Cai C. Toxicological Effects of Artificial Fine Particulate Matter in Rats through Induction of Oxidative Stress and Inflammation. Tohoku J Exp Med. 2021; 255: 19-25.

[40] Ramanathan M Jr, London NR Jr, Tharakan A, Surya N, Sussan TE, Rao X, et al. Airborne Particulate Matter Induces Nonallergic Eosinophilic Sinonasal Inflammation in Mice. Am J Respir Cell Mol Biol. 2017; 57: 59-65.

[41] Shusterman D. The effects of air pollutants and irritants on the upper airway. Proc Am Thorac Soc. 2011; 8: 101-5.

[42] Diaz-Sanchez D, Dotson AR, Takenaka H, Saxon A. Diesel exhaust particles induce local IgE production in vivo and alter the pattern of IgE messenger RNA isoforms. J Clin Invest. 1994; 94: 1417-25.

[43] Diaz-Sanchez D, Tsien A, Casillas A, Dotson AR, Saxon A. Enhanced nasal cytokine production in human beings after in vivo challenge with diesel exhaust particles. J Allergy Clin Immunol. 1996; 98: 114-23.

[44] Diaz-Sanchez D, Garcia MP, Wang M, Jyrala M, Saxon A. Nasal challenge with diesel exhaust particles can induce sensitization to a neoallergen in the human mucosa. J Allergy Clin Immunol. 1999; 104: 1183-8.

[45] Diaz-Sanchez D, Tsien A, Fleming J, Saxon A. Combined diesel exhaust particulate and ragweed allergen challenge markedly enhances human in vivo nasal ragweed-specific IgE and skews cytokine production to a T helper cell 2-type pattern. J Immunol. 1997; 158: 2406-13.

[46] Fukuoka A, Matsushita K, Morikawa T, Takano H, Yoshimoto T. Diesel exhaust particles exacerbate allergic rhinitis in mice by disrupting the nasal epithelial barrier. Clin Exp Allergy. 2016; 46: 142-52.

[47] Takafuji S, Suzuki S, Koizumi K, Tadokoro K, Miyamoto T, Ikemori R, et al. Diesel-exhaust particulates inoculated by the intranasal route have an adjuvant activity for IgE production in mice. J Allergy Clin Immunol. 1987; 79: 639-45.

[48] Sun N, Han Z, Wang H, Guo Z, Deng C, Dong W, et al. Effects of Ursolic Acid on the Expression of Th1-Th2-related Cytokines in a Rat Model of Allergic Rhinitis After PM2.5 Exposure. Am J Rhinol Allergy. 2020; 34: 587-96.

[49] Guo ZQ, Dong WY, Xu J, Hong ZC, Zhao RW, Deng CR, et al. T-helper type 1-T-helper type 2 shift and nasal remodeling after fine particulate matter exposure in a rat model of allergic rhinitis. Am J Rhinol Allergy. 2017; 31: 148-55.

[50] Sun N, Deng C, Zhao Q, Han Z, Guo Z, Wang H, et al. Ursolic Acid Alleviates Mucus Secretion and Tissue Remodeling in Rat Model of Allergic Rhinitis After PM2.5 Exposure. Am J Rhinol Allergy. 2021; 35: 272-9.

[51] Liu J, Ballaney M, Al-alem U, Quan C, Jin X, Perera F, et al. Combined inhaled diesel exhaust particles and allergen exposure alter methylation of T helper genes and IgE production in vivo. Toxicol Sci. 2008; 102: 76-81.

[52] Kumar RK, Shadie AM, Bucknall MP, Rutlidge H, Garthwaite L, Herbert C, et al. Differential injurious effects of ambient and traffic-derived particulate matter on airway epithelial cells. Respirology. 2015; 20: 73-9.

[53] Carlsten C, Blomberg A, Pui M, Sandstrom T, Wong SW, Alexis N, et al. Diesel exhaust augments allergen-induced lower airway inflammation in allergic individuals: a controlled human exposure study. Thorax. 2016; 71: 35-44.

[54] Naclerio R, Ansotegui IJ, Bousquet J, Canonica GW, D’Amato G, et al. International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies. World Allergy Organ J. 2020; 13: 100106.

[55] Ristovski ZD, Miljevic B, Surawski NC, Morawska L, Fong KM, Goh F, et al. Respiratory health effects of diesel particulate matter. Respirology. 2012; 17: 201-12.

[56] Noah TL, Zhou H, Zhang H, Horvath K, Robinette C, Kesic M, et al. Diesel exhaust exposure and nasal response to attenuated influenza in normal and allergic volunteers. Am J Respir Crit Care Med. 2012; 185: 179-85.

[57] Pawlak EA, Noah TL, Zhou H, Chehrazi C, Robinette C, Diaz-Sanchez D, et al. Diesel exposure suppresses natural killer cell function and resolution of eosinophil inflammation: a randomized controlled trial of exposure in allergic rhinitics. Part Fibre Toxicol. 2016; 13: 24.

[58] Portela A, Esteller M. Epigenetic modifications and human disease. Nat Biotechnol. 2010; 28: 1057-68.

[59] Lovinsky-Desir S, Jung KH, Jezioro JR, Torrone DZ, de Planell-Saguer M, Yan B, et al. Physical activity, black carbon exposure, and DNA methylation in the FOXP3 promoter . Clin Epigenetics. 2017; 9: 65.

[60] Jung KH, Lovinsky-Desir S, Yan B, Torrone D, Lawrence J, Jezioro JR, et al. Effect of personal exposure to black carbon on changes in allergic asthma gene methylation measured 5 days later in urban children: importance of allergic sensitization. Clin Epigenetics. 2017; 9: 61.

[61] Kohli A, Garcia MA, Miller RL, Maher C, Humblet O, Hammond SK, et al. Secondhand smoke in combination with ambient air pollution exposure is associated with increased CpG methylation and decreased expression of IFN-γ in T effector cells and Foxp3 in T regulatory cells in children. Clin Epigenetics. 2012; 4: 17.

[62] Hylkema MN, Blacquière MJ. Intrauterine effects of maternal smoking on sensitization, asthma, and chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2009; 6: 660-2.

[63] Noakes PS, Holt PG, Prescott SL. Maternal smoking in pregnancy alters neonatal cytokine responses. Allergy. 2003; 58: 1053-8.

[64] Lu C, Wang F, Liu Z, Li B, Yang W, Liao H. Intrauterine and early postnatal exposure to air pollution associated with childhood allergic rhinitis. Chemosphere. 2023; 336: 139296.

[65] Li Y, Zhu L, Wei J, Wu C, Zhao Z, Norbäck D, et al. Intrauterine and early postnatal exposures to submicron particulate matter and childhood allergic rhinitis: A multicity cross-sectional study in China. Environ Res. 2024; 247: 118165.

[66] Deng Q, Lu C, Li Y, Sundell J, Dan Norbäck. Exposure to outdoor air pollution during trimesters of pregnancy and childhood asthma, allergic rhinitis, and eczema. Environ Res. 2016; 150: 119-27.

[67] Shukla A, Bunkar N, Kumar R, Bhargava A, Tiwari R, Chaudhury K, et al. Air pollution associated epigenetic modifications: Transgenerational inheritance and underlying molecular mechanisms. Sci Total Environ. 2019; 656: 760-77.

[68] Klibaner-Schiff E, Simonin EM, Akdis CA, Cheong A, Johnson MM, Karagas MR, et al. Environmental exposures influence multigenerational epigenetic transmission. Clin Epigenetics. 2024; 16: 145.

[69] Arshad SH, Karmaus W, Zhang H, Holloway JW. Multigenerational cohorts in patients with asthma and allergy. J Allergy Clin Immunol. 2017; 139: 415-21.

[70] Mørkve Knudsen T, Rezwan FI, Jiang Y, Karmaus W, Svanes C, Holloway JW. Transgenerational and intergenerational epigenetic inheritance in allergic diseases. J Allergy Clin Immunol. 2018; 142: 765-72.

[71] Shusterman D. Nonallergic Rhinitis: Environmental Determinants. Immunol Allergy Clin North Am. 2016; 36: 379-99.

[72] Beck I, Jochner S, Gilles S, McIntyre M, Buters JT, Schmidt-Weber C, et al. High environmental ozone levels lead to enhanced allergenicity of birch pollen. PLoS One. 2013; 8: e80147.

[73] Behrendt H, Kasche A, Ebner von Eschenbach C, Risse U, Huss-Marp J, Ring J. Secretion of proinflammatory eicosanoid-like substances precedes allergen release from pollen grains in the initiation of allergic sensitization. Int Arch Allergy Immunol. 2001; 124: 121-5.

[74] Reinmuth-Selzle K, Kampf CJ, Lucas K, Lang-Yona N, Fröhlich-Nowoisky J, Shiraiwa M, et al. Air Pollution and Climate Change Effects on Allergies in the Anthropocene: Abundance, Interaction, and Modification of Allergens and Adjuvants. Environ Sci Technol. 2017; 51: 4119-41.

[75] Lang-Yona N, Shuster-Meiseles T, Mazar Y, Yarden O, Rudich Y. Impact of urban air pollution on the allergenicity of Aspergillus fumigatus conidia: Outdoor exposure study supported by laboratory experiments. Sci Total Environ. 2016; 541: 365-71.

[76] Cuinica LG, Abreu I, Esteves da Silva J. Effect of air pollutant NO₂ on Betula pendula, Ostrya carpinifolia and Carpinus betulus pollen fertility and human allergenicity. Environ Pollut. 2014; 186: 50-5.

[77] Zhao F, Elkelish A, Durner J, Lindermayr C, Winkler JB, Ruёff F, et al. Common ragweed (Ambrosia artemisiifolia L.): allergenicity and molecular characterization of pollen after plant exposure to elevated NO2. Plant Cell Environ. 2016; 39: 147-64.

[78] Ackaert C, Kofler S, Horejs-Hoeck J, Zulehner N, Asam C, von Grafenstein S, et al. The impact of nitration on the structure and immunogenicity of the major birch pollen allergen Bet v 1.0101. PLoS One. 2014; 9: e104520.

[79] Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu NN, et al. The Lancet Commission on pollution and health. Lancet. 2018; 391: 462-512.

[80] Wu R, Guo Q, Fan J, Guo C, Wang G, Wu W, et al. Association between air pollution and outpatient visits for allergic rhinitis: Effect modification by ambient temperature and relative humidity. Sci Total Environ. 2022; 821: 152960.

[81] Ji J, Chen K, Dong J, Yu H, Zhang Y. Associations between air pollution and outpatient visits for allergic rhinitis in Lanzhou, China. Environ Sci Pollut Res Int. 2023; 30: 91453-65.

[82] Vandenplas O, Vinnikov D, Blanc PD, Agache I, Bachert C, Bewick M, et al. Impact of Rhinitis on Work Productivity: A Systematic Review. J Allergy Clin Immunol Pract. 2018; 6: 1274-86.e9.

[83] Kim JY, Park Y, Kim SH, Kim SP, Park SW, Yoon HJ. Effect of Ambient Air Pollutants on the Medical Costs of Allergic Rhinitis in Seoul, Korea. Laryngoscope. 2023; 133: 1828-33.

[84] Li L, Du T, Zhang C. The Impact of Air Pollution on Healthcare Expenditure for Respiratory Diseases: Evidence from the People's Republic of China. Risk Manag Healthc Policy. 2020; 13: 1723-38.

[85] Liu YM, Ao CK. Effect of air pollution on health care expenditure: Evidence from respiratory diseases. Health Econ. 2021; 30: 858-75.

[86] Vieira RJ, Azevedo LF, Pereira AM, Nogueira-Leite D, Rocha Gonçalves FN, Larenas-Linnemann DE, et al. Impact of Allergic Rhinitis Control on Work Productivity and Costs: A Real-World Data MASK-air Study. J Allergy Clin Immunol Pract. 2024; 12: 3107-15.e13.

[87] Kulthanan K, Chusakul S, Recto MT, Gabriel MT, Aw DCW, Prepageran N, et al. Economic Burden of the Inadequate Management of Allergic Rhinitis and Urticaria in Asian Countries Based on the GA²LEN Model. Allergy Asthma Immunol Res. 2018; 10: 370-8.

[88] Johnson L, Ciaccio C, Barnes CS, Kennedy K, Forrest E, Gard LC, et al. Low-cost interventions improve indoor air quality and children’s health. Allergy Asthma Proc. 2009; 30: 377-85.

[89] Fisk WJ. Health benefits of particle filtration. Indoor Air. 2013; 23: 357-68.

[90] Heinrich J. Influence of indoor factors in dwellings on the development of childhood asthma. Int J Hyg Environ Health. 2011; 214: 1-25.

[91] Eguiluz-Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, et al. The need for clean air: The way air pollution and climate change affect allergic rhinitis and asthma. Allergy. 2020; 75: 2170-84.

[92] Bousquet J, Caimmi DP, Bedbrook A, Bewick M, Hellings PW, Devillier P, et al. Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study. Allergy. 2017; 72: 857-65.

[93] Burte E, Leynaert B, Bono R, Brunekreef B, Bousquet J, Carsin AE, et al. Association between air pollution and rhinitis incidence in two European cohorts. Environ Int. 2018; 115: 257-66.

[94] Sompornrattanaphan M, Thongngarm T, Ratanawatkul P, Wongsa C, Swigris JJ. The contribution of particulate matter to respiratory allergy. Asian Pac J Allergy Immunol. 2020; 38: 19-28.

[95] Lee YL, Shaw CK, Su HJ, Lai JS, Ko YC, Huang SL, et al. Climate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in Taiwan. Eur Respir J. 2003; 21: 964-70.

[96] Nikasinovic L, Momas I, Just J. A review of experimental studies on diesel exhaust particles and nasal epithelium alterations. J Toxicol Environ Health B Crit Rev. 2004; 7: 81-104.

[97] Orach J, Hemshekhar M, Rider CF, Spicer V, Lee AH, Yuen ACY, et al. Concentration-dependent alterations in the human plasma proteome following controlled exposure to diesel exhaust. Environ Pollut. 2024; 342: 123087.

[98] Orach J, Rider CF, Yuen ACY, Schwartz C, Mookherjee N, Carlsten C. Controlled Diesel Exhaust Exposure Induces a Concentration-dependent Increase in Airway Inflammation: A Clinical Trial. Ann Am Thorac Soc. 2023; 20: 834-42.