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The association of air pollution in respiratory
allergy: Its impact in an industrial city
Cindy Elizabeth de Lira-Quezada, MD
a
, Sandra Nora González-Díaz, MD, PhD
a
*,
Angel Gabriel Cotera-de Lira, BSc
b
, Carlos Macouzet-Sánchez, MD, PhD
a
,
Natalhie Acuña-Ortega, MD
a
, Rosa Ivett Guzman-Avilán, MD, PhD
a
and
Alejandra Macías-Weinmann, MD
a
ABSTRACT
Background: Asthma and allergic diseases have increased in recent decades and are more
common in industrialized countries. Industrial areas with a considerably high number of in-
habitants and vehicles can favor the presence of serious air pollution and therefore the appear-
ance and exacerbation of respiratory allergy symptoms. The objective of this study was to
determine the relationship between exposure to environmental pollutants with exacerbation of
respiratory allergy.
Methods: A total of 240 subjects above 6 years old who lived in the metropolitan area of
Monterrey, Nuevo León, Mexico, with diagnosis of allergic rhinitis and/or asthma, were included.
The subject’s address was registered in the database and the rhinitis control assessment test
(RCAT) and the asthma control test (ACT) were applied. Environmental data were obtained from
the Environmental Monitoring System (SIMA) of Nuevo León. Geolocation of industries and ave-
nues in proximity of subject’s addresses and SIMA stations were obtained through geographic
information systems using ArcGis software.
Results: The relation between pollutants and subjects’RCAT, ACT, and spirometry results in the
14 stations was established. PM10 and forced vital capacity (FVC) had an r ¼0.074 with p ¼0.005,
PM10 and absolute FEV1/FVC ratio presented an r ¼0.102 with a p ¼0.000; The distance found
to be associated with a worsening of respiratory symptoms was living 165 m from a main road or
241 m from an industrial establishment.
Conclusions: Exposure to pollutants present in the environment are factors associated with
increased symptoms in subjects with respiratory allergies.
Keywords: Airway, Air pollution, Industrial, Northeastern Mexico, Respiratory allergy
a
Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital
Universitario "Dr. José Eleuterio González", Regional Center of Allergy and
Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro,
Monterrey, Nuevo León, CP 64460, Mexico
*Corresponding author. E-mail: sgonzalezdiaz@yahoo.com
Full list of author information is available at the end of the article
http://doi.org/10.1016/j.waojou.2023.100867
Received 1 September 2023; Received in revised from 23 November 2023;
Accepted 29 December 2023
Online publication date xxx
1939-4551/© 2024 The Author(s). Published by Elsevier Inc. on behalf of
World Allergy Organization. This is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
de Lira-Quezada et al. World Allergy Organization Journal (2024) 17:100867
http://doi.org/10.1016/j.waojou.2023.100867
INTRODUCTION
Asthma and allergic diseases have increased in
recent decades and are more common in indus-
trialized countries.
1
Currently, there are millions of
people in the world with allergies and over 340
million with asthma.
2
Pollution is the leading
environmental cause of disease and premature
death in the world today.
2
According to the
World Health Organization (WHO), 9 out of 10
people breathe air that contains high levels of
pollutants.
3
The most abundant components of air pollution
in urban areas are nitrogen dioxide (NO2), ozone
(O3) and particulate matter (PM). Sulfur dioxide
(SO2) is abundant in industrial areas.
4
PM
originates from industrial activities and traffic-
related sources, primarily from the combustion of
coal and petroleum fuel. Diesel exhaust has been
estimated to account for up to 80% of human
exposure.
5
Environmental exposures, now
considered as “the exposome”have been found
to greatly affect the balance of the respiratory
mucosae.
6
Outdoor pollution from traffic, industry, energy
production, and heating, etc, influence the respi-
ratory system either directly or through their role
as precursors of other polluting particles.
7
Air
pollution, diesel exhaust particulates (DEP), traffic
related air pollutants (TRAPs), O3, NO2, and SO2
may cause greater permeability, easier
penetration of allergens into mucous
membranes, and greater interaction with cells of
the immune system.
8
The National Institute of Statistics and Geogra-
phy (INEGI) in Mexico reported that in 2022 there
were 2 627 106 registered vehicles; in addition,
there are over 163 000 active units of industries.
9
The Monterrey metropolitan area is surrounded
by mountains which constitute a natural physical
barrier for the circulation of the wind and,
consequently, prevent the elimination of
atmospheric pollutants. These characteristics,
together with Monterrey being an industrial area
with a considerably high number of inhabitants
and vehicles, can favor the presence of serious
air pollution and therefore the appearance and
exacerbation of respiratory allergy symptoms. The
objective of this study was to determine the
relationship between exposure to environmental
pollutants and exacerbation of respiratory allergy.
METHODS
It is an observational, prospective, longitudinal
and descriptive study, carried out from March
2021 to October 2022. The study was submitted
and approved by the Ethics Committee of the
Faculty of Medicine of the Autonomous University
of Nuevo León with registration number AL21-
00004. Upon verbal informed consent obtained
by subjects or parents/legal guardians, subjects
above 6 years old who lived in the metropolitan
area of Monterrey with diagnosis of allergic rhinitis
and/or asthma, were included. These subjects
attended every 2 months the outpatient allergy
clinic for control of their respiratory allergy. After
inclusion, the subject’s address was registered in
the database and both the rhinitis control assess-
ment test (RCAT) and the asthma control test (ACT)
were applied. Spirometry was performed in every
patient, considering a volume exhaled fraction on
the first second (FEV1) according to GINA age
parameters.
Environmental data were obtained from the
Environmental Monitoring System (SIMA) of Nuevo
León, including meteorological parameters (tem-
perature, humidity, wind speed, and direction),
and air quality measurements (particulate matter
less than 10
m
m (PM10), particulate matter less
than 2.5
m
m (PM2.5), O3, SO2, NO2, and carbon
monoxide (CO), which are considered the main
particle pollutants in the region, according to SIMA
through the 14 stations that operate in Monterrey
and metropolitan area. Measurements were made
using CO with infrared photometry; O3 with UV
spectrophotometry; as well as gas phase chem-
iluminescence for NO2; SO2 with pulsating UV
fluorescence; PM10 by beta ray attenuation; and
PM2.5 with Beta ray attenuation and white light
scattering. The data obtained by the SIMA moni-
toring network equipment are extracted from each
of the stations to carry out an automatic validation
process; this allows it to be compared with the
requirements established by the Official Mexican
Standards as well as WHO standards.
The data were obtained initially by SIMA in
comma separated values (CSV) format and loaded
into a structured query language (SQL) Server
2de Lira-Quezada et al. World Allergy Organization Journal (2024) 17:100867
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database in master database file (MDF) format due
to its extent. SQL language was used to evaluate
the information and then the averaged data were
exported to Excel; a dynamic table was created
and the information was separated by variables.
Geolocation of industries and avenues in prox-
imity of subjects’addresses and SIMA stations as
well as dispersion models considering pollutants
and climatic factors (precipitation, humidity, wind
speed, wind direction, and temperature) were
obtained through geographic information systems
using ArcGis software. Each subject’s address was
mapped with the closest environmental moni-
toring station using spatial union analysis. Spatial
join through spatial analysis was applied between
layers that allowed the attribute tables of 2 layers
to be joined, based on the location of the objects
in 1 of them with respect to the other.
Analysis of the correlation between exposure to
pollutants and respiratory allergy was performed.
For continuous variables, contingency tables were
used; for numeric variables, Kruskal-Wallis H-
ANOVA and Bonferroni test was applied. Pearson
Correlation was used for pollutants and symptoms
relation; for categorical variables: chi square or
Fisher’s exact test was applied, with a value of
p<0.05 as statistically significant. Statistical anal-
ysis was performed with MegaStat and
SPSSv25IBM Corp.
RESULTS
A total of 249 subjects were included; however,
9 were eliminated due to incomplete information:
the remaining 240 subjects were evaluated; the
majority were female, 128 (53%), and 112 (47%)
were male. The subjects age ranged from 6 to 74
years old and they were divided into 3 groups: 42
(17.5%) were 6–11 years old; 36 (15%) were 12–17
years old, and 162 (67.5%) were over 18 years old.
Regarding respiratory allergy, 156 (65%) were
diagnosed with allergic rhinitis, 80 (33.3%) with both
allergic rhinitis as well as asthma, and 4 (1.6%) had a
diagnosis of only asthma. In patients with asthma, the
level of control according to ACT was: well controlled
60 (71%) and not well controlled 5 (6%), and poorly
controlled corresponded to 19 (23%) subjects. Ac-
cording to RCAT, 170 (71%) reported a score below
21, with nasal congestion being the most commonly
reported (213 [89%] of subjects). Regardingsubjects’
results during the 6 visits completed in the 18-month
period, the mean RCAT was 24.80 with a SD of 4.50
and p ¼0.001; FEV1 had a mean of 87.76, SD: 12.86
and p ¼0.001; mean of forced vital capacity (FVC)
was 88.71, SD: 12.64 and p value of 0.003; absolute
FEV1/FVC ratio had a mean of 96.73, SD: 7.72 and p
value of 0.096, observing a difference in values
throughout the 18-month period. Subjects’ad-
dresses belonging to 1 of the municipalities in rela-
tion to proximity of SIMA stations, are represented in
Fig. 1. The average temperature registered
Fig. 1 Proximity of subject’s addresses to stations obtained by ArcGIS based on spatial union
Volume 17, No. 2, Month 2024 3
throughout the area in the period studied ranged
from 23.14 to 24.14C; relative humidity ranged
from 54.74 to 56.08%; wind direction was 127.09–
139.83, corresponding to a southeast direction,
and wind speed mean range was 9.06–9.72 km/h.
SIMA stations were ordered according to the
highest level of pollutant, being Santa Catarina, San
Bernabe, and Obispado, the highest results (Fig. 2).
The relation between pollutants and subjects’
RCAT, ACT, and spirometry results in the 14 sta-
tions was established. Pollutants analyzed were
matched to the days of the subjects’visits. PM10
and FVC had an r ¼0.074 with p ¼0.005, PM10
and absolute FEV1/FVC ratio presented an
r¼0.102 with a p ¼0.000; PM2.5 and absolute
FEV1/FVC ratio presented an r ¼0.93 with a
p¼0.004. The r value of O3 and RCAT score was
of 0.081 and a p¼0.002; O3 and FEV1 showed a
r¼0.112 and p¼0.005 (Table 1). The subjects of
the San Bernabe station perimeter, presented a
positive correlation with the pollutants SO2 and
O3 with RCAT (r¼0.415, p ¼0.014)(r ¼0.430,
p¼0.012), NO2 with FEV1 value (r ¼0.404,
p¼0.018) and FVC (r ¼0.506, p ¼0.002);
PM10 with FVC (r¼0.372, p ¼0.030).
Proximity analysis was performed to determine
the mean distance between subjects homes
and avenues as well as industrial establishments
related to worse or uncontrolled respiratory
symptoms (Figs. 3 and 4).
DISCUSSION
It is now recognized that the prevalence of
allergic diseases has increased in recent decades
throughout industrialized countries, and our re-
sults confirm a significant correlation between
exposure to pollutants and less controlled symp-
toms.
10
Climate change and pollutants may
influence aeroallergens, altering pollen into
highly allergenic particles.
11
Increases in air
pollution related to climate change can affect
plant physiology resulting in more allergenic
pollen. All these factors directly impact the
symptoms of allergy sufferers or can lead to
increased sensitization rates.
12
Pollutants may disrupt pollen, causing the
release of pauci-micronic molecules, being deliv-
ered to upper and lower airway.
13,14
An oxidant
overload generated by pollutants will result in
the accumulation of reactive oxygen species
(ROS) and nitrogen that will ultimately lead to
tissue inflammation and cell apoptosis; this has
been established in the oxidative stress
hypothesis. These factors therefore lead to an
increase in respiratory symptoms.
15
The results of
the highest pollutants detected by the SIMA
stations each portray specific characteristics
regarding their location. Santa Catarina, with
levels of NO2 far above WHO standards, is
surrounded by a condensed industrial area, as
well as avenues and highways leading out of
state with an increased circulation of large
diesel vehicles. San Bernabe, with high levels of
Fig. 2 Highest pollutant stations detected. Red arrows indicate the highest levels according to the different pollutants. Red squares mark
the three stations with the highest pollutants
4de Lira-Quezada et al. World Allergy Organization Journal (2024) 17:100867
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PM10, includes the city’s quarries and dense traffic
zones. The area of Obispado, with
elevated levels of CO, is the crossing point of
some of Monterrey’s main avenues (Gonzalitos,
Constitución, and Morones Prieto) which carry
heavy traffic from vehicles coming from every
cardinal direction. In Cadereyta, an oil refinery
has been part of the local scenery for years, with
regular emissions of SO2 into the air. The
region’s southeast wind direction was an
important factor in the transport of SO2
originating from the refinery and into the city and
its neighboring suburbs. However, once
pollutants are in the city’s atmosphere, decreased
wind velocity generally translated to a lower
dispersion of air pollutants —a factor seen
throughout the period studied. Ottaviano et al
reported a causal relationship between
aeroallergen concentration and ears, nose and
throat (ENT) admissions. They found that the
levels of PM10 at specific days preceding
emergency room admissions correlated with
certain upper airway disorders.
16
In our study,
PM10 was correlated particularly in lung function
values such as FVC. According to Lee S et al
outdoor air pollutants (PM10, NO2, O3, CO, and
SO2) had significant short-term effects in all age
groups (except for CO and SO2 in infants).
17
Traffic pollution is a major source of exposure in
homes close to a major road. People living near
traffic sites are exposed to high concentrations of
air pollutants including PM2.5 and NO2. Garcia
et al established that the evidence for adverse
NO2 effects is stronger for FEV1, representing
airway mechanical properties and/or airway
caliber, compared with that for FVC, representing
lung volume.
18,19
Eckel et al related FeNO
measured on 2143 children to 5 classes of
metrics of residential TRP: distances to freeways
and major roads. In children with asthma, length
of roads was positively associated with FeNO,
with stronger associations and higher FeNO for
100-, 300-, and 1000-m increases in the length of
all roads in 50-, 100-, and 200-m buffers, respec-
tively. In our study FeNO was not measured in the
subjects included, however it could be considered
as a variable for future follow-up studies.
20
Ierodiakonou et al reported in children from 8
cities in North America (Albuquerque, New
Mexico; Baltimore, Maryland; Boston,
RCAT ACT FEV1 value FVC value Absolute FEV1/FVC
ratio
r value
PM10 0.011, p¼0.664 0.032, p¼0.227 0.025, p¼0.343 0.074, p¼0.005 0.102, p¼0.000
PM2.5 0.021, p¼0.428 0.013, p ¼0.627 0.003, p¼0.897 0.036, p ¼0.167 0.093, p¼0.004
SO2 0.033, p¼0.207 0.004, p ¼0.868 0.020, p¼0.448 0.007, p¼0.801 0.019, p¼0.462
O3 0.081, p¼0.002 0.004, p¼0.867 0.112, p ¼0.005 0.122, p ¼0.003 0.016, p¼0.552
NO2 0.050, p¼0.059 0.000, p¼0.992 0.094, p¼0.000 0.084, p ¼0.001 0.069, p¼0.008
CO 0.017, p¼0.517 0.025, p ¼0.348 0.148, p¼0.003 0.150, p¼0.001 0.003, p¼0.894
Table 1. Correlation of pollutants from the 14 stations with respiratory assessment
Volume 17, No. 2, Month 2024 5
Massachusetts; Denver, Colorado; San Diego,
California; Seattle, Washington; St. Louis, Missouri;
and Toronto-Ontario, Canada) that longer-term 4-
month averages of CO were negatively associated
with prebronchodilator % predicted FEV1 and
FVC. Increased 4-month average NO2 levels were
associated with reduced post-bronchodilator FEV1
and FVC % predicted.
21
Bronner et al reported that living 50–200 m from
a main road has been associated with increased
risk of respiratory allergy.
22
Schulz et al reported
that people living within 800 m of an industrial
Fig. 3 Mean distance of 165 m from subjects‘addresses to avenues was observed as having the highest association between pollutants and
respiratory symptoms. The red stars indicate the SIMA stations and the teal squares represent the subjects included
Fig. 4 Proximity analysis with an average of 241 m between the homes of subjects with uncontrolled respiratory symptoms and industrial
establishments. The red stars indicate the SIMA stations, teal circles represent the subjects included, and the green circles belong to the
industrial establishments
6de Lira-Quezada et al. World Allergy Organization Journal (2024) 17:100867
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site are 47% more likely to have asthma.
23
In our
research, the distance we found to be associated
with a worsening of respiratory symptoms was
living 165 m from a main road or 241 m from an
industrial establishment. Rice et al published that
proximity of the home to a major roadway at
time of assessment, but not birth, was associated
with mid-childhood (age 7–10) asthma overall
and in sensitivity analyses confined only to those
who moved (62%).
24,25
Outdoor pollutants such as nitrogen oxides in-
crease the amount of pollen grains produced by
plants and are able to chemically modify them.
According to
S
cevková et al, among the atmo-
spheric pollutants, NO2 and CO were significantly
and positively interrelated with pollen and allergen
levels, respectively. They also observed a signifi-
cant negative association between PM10 and
allergen concentration.
26
A limitation to be considered in this research is
that although it was performed in 1 of the most
polluted and industrial areas in Mexico, it remains
a single-center study and a comparison with other
urban areas would aid in establishing a greater
association with subject’s response.
A relationship was found between subjects with
greater exposure to pollutants and worsening of
nasal symptoms, being nasal congestion the most
frequently reported in RCAT, as well as differences
in lung function values. As population that lives in
Monterrey and the metropolitan area, we find
ourselves immersed between avenues and indus-
trial establishments, which are associated with
worsening respiratory symptoms. Actions are
required among all government orders to estab-
lish concrete measures to reduce the pollution
rates that affect the population. Measures to
combat the effects of climate change is an
approach that has to be taken at the national and
international levels.
Abbreviations
ACT, asthma control test; CO, carbon monoxide; DEP,
diesel exhaust particulates; FEV1, volume exhaled fraction
on the first second; FEV1/FVC ratio, volume exhaled
fraction on the first second/forced vital capacity ratio;
INEGI, National Institute of Statistics and Geography; NO2,
nitrogen dioxide; PM, particulate matter; PM2.5, particulate
matter less than 2.5 micrometers; PM 10, particulate matter
less than 10 micrometers; O3, ozone; RCAT, rhinitis control
assessment test; ROS, reactive oxygen species; SIMA,
Environmental Monitoring System; SO2, sulfur dioxide;
TRAPs, traffic related air pollutants; UV, ultraviolet; WHO,
World Health Organisation
Acknowledgements
The authors would like to acknowledge and thank Gerardo
de Lira-Reyes, PhD, Geographic Information System expert,
for his guidance and most valuable contributions in this
research project.
Funding sources
Funding was provided by the authors.
Data availability statement
Any additional data is available upon request to the
authors.
Author contributions
Cindy de Lira-Quezada contributed to design of the study,
data collection, interpretation of the results, and manu-
script writing. Sandra Nora Gonzalez-Diaz: Design of the
study, manuscript elaboration, and revision. Angel Gabriel
Cotera-de Lira contributed to data collection and analysis.
Natalhie Acuña-Ortega, Alejandra Macias-Weinmann, Rosa
Ivett Guzman-Avilan, and Carlos Macouzet-Sánchez
contributed to manuscript writing.
All authors give consent for publication.
Ethics statement
The study was submitted and approved by the Ethics
Committee of the Faculty of Medicine of the Autonomous
University of Nuevo León, with registration number AL21-
00004. Upon verbal informed consent obtained by sub-
jects or parents/legal guardians (previously authorized by
Faculty of Medicine Ethics Committee), subjects above 6
years old who lived in the metropolitan area of Monterrey
with diagnosis of allergic rhinitis and/or asthma, were
included.
Declaration of competing interest
The authors have no conflicts of interest to declare.
Author details
a
Universidad Autónoma de Nuevo León, Faculty of
Medicine and Hospital Universitario "Dr. José Eleuterio
González", Regional Center of Allergy and Clinical
Immunology, Gonzalitos y Madero s/n Colonia Mitras
Centro, Monterrey, Nuevo León, CP 64460, Mexico.
b
Monterrey, Nuevo León, Mexico.
Volume 17, No. 2, Month 2024 7
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