Modeling of Temporal Exposure to the Ambient Environment and Eczema Severity

Bjorn R Thomas; Xiang L Tan; Shagayegh Javadzadeh; Elizabeth J Robinson; Bryan S McDonald; Malvina A Krupiczojc; Syedia R Rahman; Samiha Rahman; Rehana A Ahmed; Rubina Begum; Habiba Khanam; David P Kelsell; Jonathan Grigg; Robert J Knell; Edel A O'Toole

doi:10.1016/j.xjidi.2021.100062

Modeling of Temporal Exposure to the Ambient Environment and Eczema Severity

JID Innov. 2021 Oct 9;2(1):100062. doi: 10.1016/j.xjidi.2021.100062. eCollection 2022 Jan.

Authors

Bjorn R Thomas^{1

2}, Xiang L Tan¹, Shagayegh Javadzadeh¹, Elizabeth J Robinson², Bryan S McDonald^{1

2}, Malvina A Krupiczojc^{1

2}, Syedia R Rahman^{1

2}, Samiha Rahman^{1

2}, Rehana A Ahmed^{1

2}, Rubina Begum^{1

2}, Habiba Khanam^{1

2}, David P Kelsell¹, Jonathan Grigg^{1

2}, Robert J Knell³, Edel A O'Toole^{1

2}

Affiliations

¹ Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
² Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
³ School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom.

Abstract

Atopic eczema is a common and complex disease. Missing genetic hereditability and increasing prevalence in industrializing nations point toward an environmental driver. We investigated the temporal association of weather and pollution parameters with eczema severity. This cross-sectional clinical study was performed between May 2018 and March 2020 and is part of the Tower Hamlets Eczema Assessment. All participants had a diagnosis of eczema, lived in East London, were of Bangladeshi ethnicity, and were aged <31 years. The primary outcome was the probability of having an Eczema Area and Severity Index score > 10 after previous ambient exposure to commonly studied meteorological variables and pollutants. There were 430 participants in the groups with Eczema Area and Severity Index ≤ 10 and 149 in those with Eczema Area and Severity Index > 10. Using logistic generalized additive models and a model selection process, we found that tropospheric ozone averaged over the preceding 270 days was strongly associated with eczema severity alongside the exposure to fine particles with diameters of 2.5 μm or less (fine particulate matter) averaged over the preceding 120 days. In our models and analyses, fine particulate matter appeared to largely act in a supporting role to ozone. We show that long-term exposure to ground-level ozone at high levels has the strongest association with eczema severity.

Keywords: AIC, Akaike Information Criterion; EASI, Eczema Area and Severity Index; EseC, European Socio-Economic Classification; GAM, generalized additive model; IGA, Investigators Global Assessment; MAv, moving average; NO, nitric oxide; NO2, nitrogen dioxide; NOx, nitrogen oxide; O3, ozone; PM, particulate matter; SCORAD, SCORing Atopic Dermatitis; SE, standard error; THEA, Tower Hamlets Eczema Assessment; VOC, volatile organic compound.