Multiplex Allergen Exposure, Air Pollution, and Atopic Dermatitis Severity in East Mediterranean School-Age Children
Asim Ahmed¹, Sophie Martin², Lefèvre Sylvain³, Dubois Dubois⁴, Marie Petit⁵
Keywords:
atopic dermatitis, air pollution, allergen sensitization, PM₂.₅, pediatric dermatologyAbstract
Atopic dermatitis (AD) affects up to 20% of children in the East Mediterranean, yet the combined role of allergen sensitization and air pollution on disease severity remains underexplored. In this cross-sectional study conducted between May 2023 and November 2024, 1,128 school-age children (6–12 years) from four urban centers were evaluated for AD severity, indoor/outdoor allergen exposure, and ambient pollution levels.
Of these children, 642 (56.9%) had physician-diagnosed AD. Serum IgE multiplex assays revealed that 74.6% of affected children were sensitized to at least three common allergens (house dust mite, pollen mixes, mold spores). Children with multi-sensitization experienced significantly higher Eczema Area and Severity Index (EASI) scores (median 14.2; IQR 10.1–19.8) versus monosensitized or non-sensitized peers (median 7.8; IQR 5.3–11.4, p < 0.001).
Ambient particulate matter (PM₂.₅) averaged 58 µg/m³ (SD ± 12) across study sites, exceeding WHO recommendations. A multivariate regression showed that every 10 µg/m³ increase in PM₂.₅ was associated with a 1.8-point rise in EASI score (95% CI: 1.3–2.3, p < 0.001)—children with both multisensory integration difficulties and high PM2.5.₅ (>60 µg/m³) had the most severe disease, with EASI scores 2.4-fold higher than those with single/no sensitization in low pollution areas (p < 0.001).
Predictive modeling combining sensitization count, PM₂.₅, indoor humidity, and family history achieved an AUC of 0.87 (95% CI: 0.84–0.90), with a sensitivity of 81% and a specificity of 78%. These findings underscore the synergistic effect of allergen exposure and pollution on AD severity, highlighting the need for integrated environmental and immunological management strategies.
This study is among the first in the East Mediterranean to quantify the concurrent effects of allergen sensitization and air pollution on pediatric atopic dermatitis (AD), supporting policies for air quality control and targeted therapeutic plans.
