Relationships between long-term ozone exposure and allergic rhinitis and bronchitic symptoms in Chinese children

Pei En Zhou, Zhengmin Qian, Stephen Edward McMillin, Michael G. Vaughn, Zhong Yue Xie, Yu Jie Xu, Li Zi Lin, Li Wen Hu, Bo Yi Yang, Xiao Wen Zeng, Wang Jian Zhang, Ru Qing Liu, Gongbo Chen, Guang Hui Dong

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9 Citations (Scopus)


Numerous studies have demonstrated that exposure to ambient ozone (O3) could have adverse effects on children’s respiratory health. However, previous studies mainly focused on asthma and wheezing. Evidence for allergic rhinitis and bronchitic symptoms (e.g., persistent cough and phlegm) associated with O3 is limited, and results from existing studies are inconsistent. This study included a total of 59,754 children from the seven northeastern cities study (SNEC), who were aged 2 to 17 years and from 94 kindergarten, elementary and middle schools. Information on doctor-diagnosed allergic rhinitis (AR), persistent cough, and persistent phlegm was collected during 2012– 2013 using a standardized questionnaire developed by the American Thoracic Society (ATS). Information for potential confounders was also collected via questionnaire. Individuals’ exposure to ambient ozone (O3) during the four years before the investigation was estimated using a satellite-based random forest model. A higher level of O3 was significantly associated with increased risk of AR and bronchitic symptoms. After controlling for potential confounders, the OR (95% CI) were 1.13 (1.07–1.18), 1.10 (1.06–1.16), and 1.12 (1.05–1.20) for AR, persistent cough, and persistent phlegm, respectively, associated with each interquartile range (IQR) rise in O3 concentration. Interaction analyses showed stronger adverse effects of O3 on AR in children aged 7–17 years than those aged 2–6 years, while the adverse association of O3 with cough was more prominent in females and children aged 7–12 years than in males and children aged 2–6 and 13–17 years. This study showed that long-term exposure to ambient O3 was significantly associated with higher risk of AR and bronchitic symptoms in children, and the association varies across age and gender. Our findings contribute additional evidence for the importance of controlling O3 pollution and protecting children from O3 exposure.

Original languageEnglish
Article number221
Issue number9
Publication statusPublished - 2021 Sept

Bibliographical note

Funding Information:
Funding: The research was funded by the National Key Research and Development Program of China (No. 2018YFE0106900), the National Natural Science Foundation of China (No.81903279; No.82073502; No.81872583; No.81872582; No. 81950410633; No. M-0420), Guangdong Provincial Natural Science Foundation Team Project (2018B030312005), Fundamental Research Funds for the Central Universities (19ykjc01), Natural Science Foundation of Guangdong Province (No. 2021B1515020015; No. 2021A1515012212; No. 2021A1515011754; No. 2020A1515011131; No. 2019A050510017; No. 2018B05052007; No. 2017A090905042), Medical Scientific Research Foundation of Guangdong Province (20201123193141971).

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

All Science Journal Classification (ASJC) codes

  • Toxicology
  • Chemical Health and Safety
  • Health, Toxicology and Mutagenesis


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