Ferrante Giuliana, Asta Federica, Cilluffo Giovanna, De Sario Manuela, Michelozzi Paola, La Grutta Stefania
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, via del Vespro 129, 90127, Palermo, Italy.
Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Italy.
World Allergy Organ J. 2020 Jan 6;13(1):100096. doi: 10.1016/j.waojou.2019.100096. eCollection 2020 Jan.
Environmental exposures across the life course may be a contributor to the increased worldwide prevalence of respiratory and allergic diseases occurring in the last decades. Asthma and rhinoconjunctivitis especially contribute to the global burden of disease. Greenness has been suggested to have beneficial effects in terms of reduction of occurrence of allergic respiratory diseases. However, the available evidence of a relationship between urban greenness and childhood health outcomes is not yet conclusive. The current review aimed at investigating the current state of evidence, exploring the relationship between children's exposure to residential urban greenness and development of allergic respiratory diseases, jointly considering health outcomes and study design.
The search strategy was designed to identify studies linking urban greenness exposure to asthma, rhinoconjunctivitis, and lung function in children and adolescents. This was a narrative review of literature following PRISMA guidelines performed using electronic search in databases of PubMed and Embase (Ovid) from the date of inception to December 2018.
Our search strategy identified 2315 articles; after exclusion of duplicates (n = 701), 1614 articles were screened. Following review of titles and abstracts, 162 articles were identified as potentially eligible. Of these, 148 were excluded following full-text evaluation, and 14 were included in this review. Different methods for assessing greenness exposure were found; the most used was Normalized Difference Vegetation Index. Asthma, wheezing, bronchitis, rhinoconjunctivitis, allergic symptoms, lung function, and allergic sensitization were the outcomes assessed in the identified studies; among them, asthma was the one most frequently investigated.
The present review showed inconsistencies in the results mainly due to differences in study design, population, exposure assessment, geographic region, and ascertainment of outcome. Overall, there is a suggestion of an association between urban greenness in early life and the occurrence of allergic respiratory diseases during childhood, although the evidence is still inconsistent. It is therefore hard to draw a conclusive interpretation, so that the understanding of the impact of greenness on allergic respiratory diseases in children and adolescents remains difficult.
一生中的环境暴露可能是过去几十年全球范围内呼吸道和过敏性疾病患病率上升的一个因素。哮喘和鼻结膜炎尤其加重了全球疾病负担。已有研究表明，绿化对减少过敏性呼吸道疾病的发生具有有益作用。然而，关于城市绿化与儿童健康结局之间关系的现有证据尚无定论。本综述旨在调查现有证据的现状，探讨儿童接触城市居住绿化与过敏性呼吸道疾病发展之间的关系，同时考虑健康结局和研究设计。
搜索策略旨在识别将城市绿化暴露与儿童和青少年哮喘、鼻结膜炎及肺功能联系起来的研究。这是一项遵循PRISMA指南的文献叙述性综述，通过在PubMed和Embase（Ovid）数据库中从建库至2018年12月进行电子检索来完成。
我们的搜索策略共识别出2315篇文章；排除重复文章（n = 701）后，筛选了1614篇文章。在对标题和摘要进行审查后，确定了162篇可能符合条件的文章。其中，148篇在全文评估后被排除，14篇纳入本综述。发现了不同的绿化暴露评估方法；最常用的是归一化植被指数。在所识别的研究中评估的结局包括哮喘、喘息、支气管炎、鼻结膜炎、过敏症状、肺功能和过敏致敏；其中，哮喘是研究最频繁的结局。
本综述显示结果存在不一致性，主要原因在于研究设计、人群暴露评估、地理区域和结局确定方面的差异。总体而言，尽管证据仍不一致，但有迹象表明早年的城市绿化与儿童期过敏性呼吸道疾病的发生之间存在关联。因此，很难得出确凿的解释，对绿化对儿童和青少年过敏性呼吸道疾病影响的理解仍然困难。
