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Survey of airborne pollen in Hubei province of China
Chin Med Sci J December 2008
Vol. 23, No. 4 P. 212 217
CHINESE MEDICAL SCIENCES JOURNAL SURVEY OF AIRBORNE POLLEN IN HUBEI Ƹ PROVINCE OF CHINA Guang-hui Liu*, Rong-fei Zhu, Wei Zhang, Wen-jing Li, Zhong-xi Wang, and Huan Chen Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 Key words: airborne pollen; pollinosis; airway responsiveness Objective To study the genera and seasonal distribution of airborne pollen in Hubei province of China, and its relationship with pollinosis. Methods From November 2003 to October 2004, an airborne pollen investigation was performed in 16 chosen areas in 12 cities of Hubei province using gravity sedimentation technique. Meanwhile, univalent skin prick tests of pollens were performed and the invasion season was studied on 2 300 patients with pollinosis. Among them, 352 cases underwent the airway responsiveness measurements, and the correlation between airway responsiveness and results of pollen count was analyzed. Results A total of 61 pollen genera were observed and 257 520 pollens were collected. The peak of airborne pollen distribution occurred in two seasons each year: spring (March and April) and autumn (from August to October). The attack of pollinosis corresponded to the peak of pollen distribution. There was a significantly negative relationship between the provocation dose causing a 20% decrease of forced expiratory volume in one second (FEV1) from baseline and airborne pollen concentration (r = ˉ0.6829, P ˘ 0.05). Conclusion This study provides useful information for airborne pollen epidemiology of Hubei province, and it provides important insights to clinical prevention, diagnosis, and treatment of pollen-related allergic diseases.
A
IRBORNE pollen is one of the most important allergens leading to allergic diseases. Its significance has been highly evaluated by the experts. Since the distribution of airborne pollen has distinctive regionality, to find out the distribution features of airborne pollen is crucial for the prevention and treatment of
Received for publication March 27, 2008.
*
Corresponding author Tel: 027-83663666, E-mail: ghliu-3488@
163.com ƸSupported by Science Research Foundation of Health Department of Hubei Province (LJ200220).
pollen-related allergic diseases. A country-wide survey of airborne pollen had been carried out in early 1980s, which provided important scientific foundation to the research of airborne pollen in China.1 Twenty years passed by, and great changes have taken place in the species and amounts of airborne pollens with the continuing enlargement of vegetation and the increase of plant species. The population of pollen allergy also increases every year. In order to investigate the species, quantity, and distribution pattern of airborne pollen in Hubei province, a one-year survey was conducted in 16 sites of 12 cities in Hubei province.
Vol. 23, No.4
CHINESE MEDICAL SCIENCES JOURNAL
213
."5&3*"-4"/%.&5)0%4
3&46-54
Materials and reagents Unitive standardized 2 pollen samplers were adopted. Vaseline adhesive and agar glycerol basic fuchsin staining solution were prepared and stored in refrigerator. Time and sites From November 2003 to October 2004, 16 sites in 12 cites of Hubei province were chosen as the investigation spots, which included one spot in Ezhou, one in Huangshi, one in Yingshan, one in Xiaogan, one in Qianjiang, one in Jinmen, two in Jinzhou, one in Huanggang, one in Laohekou, one in Songzi, four in Wuhan, and one in Shiyan. Pollen sampling The samplers were placed 12 to 15 meters high from the ground (5 or 6 floors’ height). Every day, a glass slice with a thin layer of adhesive agent was placed in the sampler at fixed time. After 24 hours of exposure to the air, the slice was retrieved and dyed with the basic fuchsin staining solution. With the coverslip, the slice was observed under the microscope for morphological identification and record of the species and amounts of the pollens. Vegetation investigation Primary investigations were conducted on the vegetation of those areas mentioned above to figure out the species and seasons of pollination. Climate records The weather conditions, including temperature, wind, etc, were recorded. Skin prick test and investigation of onset season Totally, 2 300 cases of pollinosis accepted skin prick tests using the fast insertion liquor provided by Peking Union Medical College Hospital. The test method and result assessment were all complied with the unitive standard in China. Besides, the onset season of the disease was inquired and recorded. Airway responsiveness test In the season of Artemisia pollen dissemination, 352 patients with pollinosis who had no asthma underwent methacholine provocation tests to measure their airway responsiveness.3 The indexes of airway responsiveness were forced expiratory volume in one second (FEV1) and the provocation dose causing a 20% decrease of FEV1 from baseline using methacholine (PD20-FEV1).
Species and distribution of airborne pollens in Hubei province Sixty-one pollen genera were found, and the total number of collected pollens was 257 520. There were two peaks of airborne pollen distribution during the year, one was from March to April, and the other was from August to October. In spring, the main genera of airborne pollens included Pinus, Platanus, Cupressaceae, Salix, etc. In autumn, the main genera of airborne pollens included Artemisia, Ambrosia, Gramineae, etc (Table1). The airborne pollens of different areas were variable. For example, the pollen of Toxicodendron (Tourn.) Mill. was only found in Shiyan Area. The pollen of Paulownia Sieb. et Zucc. was only seen in Laohekou Area. And the Buxus could only been found in Huangshi and Wuhan Area. Besides, in different seasons, the dominant pollens changed. From March to April, Platanus was the dominant pollen of the city of Wuhan, Huangshi, Jinmen, and Shiyan. Pinus and Cupressaceae were the dominant pollens of Yingshan, Ezhou, Xiaogan, and Jinzhou. From August to October, Artemisia L. was the dominant pollen in most areas of Hubei province. However, in the city of Ezhou, the dominant pollen was Albizzia Durazz. Onset season of pollinosis The onset season of 2 300 patients with pollinosis was mainly from March to May in spring and from August to October in autumn. There were more patients with pollinosis in autumn than in spring. The peak of pollinosis onset was consistent with the dissemination peak of pollens (Fig. 1). Skin prick test results The prick test results of 2 300 patients with pollinosis showed that the pollens with the highest sensitization rate were Platanus in spring, Artemisia L. and Ambrosia L. in autumn (Table 2). Airway responsiveness test results Airway responsiveness tests on 352 cases of Artemisia L.-allergic patients showed that there was a significantly negative correlation between PD20-FEV1 values and the concentration of Artemisia L. pollen (r = ˉ0.6829, P ˘ 0.05, Fig. 2).
214
CHINESE MEDICAL SCIENCES JOURNAL
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2008
Table 1. Classification of airborne pollens in Hubei province Amount˄per month˅
Genera Jan
Feb
Larix
0
3
9
Pinus
98
1 662
Picea
0
Cedrus
Dec
Percentage ˄%˅
Jun
Jul
Aug
Sep
Oct
Nov
3
4
0
0
7
44
2
0
0
72
0.03
23 645
28 601
2 723
307
169
71
43
40
37
24
57 420
22.30
1
26
428
47
2
1
0
0
0
1
0
506
0.20
0
0
0
0
0
0
0
4
0
1
0
0
5
0.00
52
2 115
17 905
6 206
350
72
57
12
50
15
7
25
26 866
10.43
Taxodium
0
30
1 751
27
0
0
0
0
0
0
2
0
1 810
0.70
Cryptomeria
0
244
2 021
266
22
3
2
1
1
0
0
0
2 560
0.99
Cunninghamia
2
152
3 294
3 967
177
21
10
9
1
0
1
0
7 634
2.96
Ginkgo
17
78
594
877
111
36
20
30
20
49
13
1
1 846
0.72
Juglans
6
33
243
686
213
97
72
26
27
3
0
0
1 406
0.55
34
110
3 482
2 977
99
15
24
5
31
3
4
2
6 786
2.64
Quercus
2
17
252
915
211
3
6
10
59
3
1
2
1 481
0.58
Castanea
0
0
1
8
16
6
1
0
0
0
0
0
32
0.01
Ulmus
6
475
1602
476
73
44
7
22
101
2
0
2
2 810
1.09
Betula
0
6
183
518
456
35
8
12
58
0
0
0
1 276
0.50
Alnus
9
15
53
46
16
11
2
1
6
0
1
5
165
0.06
Corylus
0
102
473
174
49
12
6
4
14
13
0
0
847
0.33
Populus
18
307
1 182
2 111
499
86
48
14
18
6
1
1
4 291
1.67
Salix
43
1 555
11 437
5 283
457
132
48
13
3
21
1
7
19 000
7.38
Acer
0
0
133
231
118
4
0
0
6
0
0
0
492
0.19
Fraxinus
0
0
14
12
0
0
0
2
4
0
0
0
32
0.01
Oleaceae
0
0
4
22
12
6
0
11
29
0
0
0
84
0.03
Morus
4
35
594
1 802
450
69
21
13
28
2
2
0
3 020
1.17
Broussonetia
4
50
2 173
3 441
440
85
19
36
142
173
6
0
6 569
2.55
Cannabis/Humulus
7
11
42
87
28
32
35
297
1145
337
36
9
2 066
0.80
Ailanthus
0
3
177
117
23
4
1
13
11
1
0
0
350
0.14
Platanus
2
242
23 045
22 570
1 122
329
137
47
27
12
2
0
47 535
18.46
Leguminosae
0
0
5
79
18
6
0
0
0
0
0
0
108
0.04
Albizia
0
0
5
5
1
12
2
0
103
551
300
0
979
0.38
Sophora
0
2
341
256
126
64
281
319
301
81
30
0
1 801
0.70
Amorpha fruticosa
0
0
0
0
14
0
0
0
0
0
0
0
14
0.01
Cruciferae
55
243
2 522
2 172
384
139
28
22
6
3
1
0
5 575
2.16
Liliaceae
1
3
110
158
25
24
3
14
22
2
0
0
362
0.14
Fontanesia
0
0
0
0
0
0
1
1
0
0
0
0
2
0.00
Buxus
0
0
224
194
9
3
0
0
0
0
1
0
431
0.17
Toxicodendron
0
6
36
48
140
172
21
11
2
0
0
436
0.17
Melia
0
0
6
5
6
5
0
0
39
4
0
0
65
0.03
Compositae
0
0
0
0
0
0
5
11
258
37
0
0
311
0.12
Cinnamomum
1
80
194
734
483
455
181
72
174
102
4
1
2 481
0.96
Pterocarya
Apr
Total
May
Cupressaceae
Mar
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CHINESE MEDICAL SCIENCES JOURNAL
215 (continued)
Amount˄per month˅ Genera
Total Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Artemisia
41
920
190
194
246
362
1 435
3 834
Ambrosia
31
55
194
309
127
204
359
Helianthus
3
0
1
0
0
28
Xanthium
0
0
1
0
16
Ricinus
0
35
189
208
Plantago
4
55
218
Ligustrum
0
0
Chenopodiaceae
0
Amaranthaceae
Percentage ˄%˅
Oct
Nov
Dec
10 938
2 654
210
72
21 096
8.19
2 794
1 986
465
146
50
6 720
2.61
44
39
81
12
5
3
216
0.08
40
68
89
167
7
15
4
407
0.16
265
83
50
54
84
58
7
1
1 034
0.40
186
65
48
12
33
64
31
1
0
717
0.28
0
38
58
274
44
41
17
10
4
1
487
0.19
16
169
220
269
210
87
138
203
95
53
3
1 463
0.57
0
4
13
23
22
23
36
86
183
61
4
0
455
0.18
34
118
730
1 056
1 030
1 020
790
2 184
2 435
1 684
102
22
11 205
4.35
Umbelliferae
0
0
20
5
3
1
1
4
50
9
1
0
94
0.04
Typha
0
0
11
67
209
88
68
112
169
54
7
0
785
0.30
Astragalus sinicus
0
2
0
0
0
0
0
0
0
0
0
0
2
0.00
Trachycarpus
0
8
470
616
319
173
25
3
1
2
0
1
1 618
0.63
Cyperaceae
0
2
47
38
68
27
11
37
62
37
2
0
331
0.13
Rumex
0
0
13
7
4
1
1
0
5
0
0
0
31
0.01
Cephalotaxaceae
0
2
28
3
0
0
0
1
0
0
0
0
34
0.01
Paulownia
6
12
150
160
37
13
0
0
0
0
0
0
378
0.15
Cucurbitaceae
0
0
1
2
3
2
16
10
7
1
0
0
42
0.02
Rosaceae
0
2
22
202
57
50
1
0
0
0
0
0
334
0.13
Robinia
0
0
0
0
0
0
0
5
13
2
5
0
25
0.01
10
50
87
221
25
3
13
30
63
15
0
3
520
0.20
490
8 861
100 332
89 057
11 745
4 941
4 277
10 604
19 301
6 660
1 013
239
257 520
Gramineae
Unknown Total
100
Table 2. Skin prick test results of pollinosis patients Pollen species
Positive cases
Positive rate (%)
600
Artemisia
1 182
51.4
100 000
500
Ambrosia
785
34.1
80 000
400
Platanus
621
27.0
60 000
300
Broussonetia
331
14.4
Pterocarya
282
12.3
40 000
200
Populus
275
12.0
20 000
100
Salix
204
8.9
Ulmus
186
8.1
Quercus
144
6.3
Pinus
122
5.3
Cupressaceae
109
4.7
Cryptomeria
97
4.2
0
Cases
Pollen amount
120 000
Pollen amount Pollinosis cases
0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Figure 1. Monthly distribution of pollen amount and pollinosis cases.
CHINESE MEDICAL SCIENCES JOURNAL
Pollen amount PD20-FEV1
3 000
Pollen amount
2 500 2 000 1 500 1 000 500 0 Jul
Aug
Sep
Oct
Nov
Dec
18 16 14 12 10 8 6 4 2 0
PD20-FEV1(ȝmol)
216
Figure 2. Monthly distribution of Artemisia pollen and the provocation dose causing a 20% decrease of forced expiratory volume in one second from baseline (PD20FEV1) of Artemisia pollinosis patients.
%*4$644*0/ Pollen is one of the most important allergens. It can induce allergic diseases, such as allergic rhinitis, asthma, urticaria, etc. In China, there is an annual increase of pollen-allergic people. The pollen-induced diseases greatly jeopardize people’s health. To find out the rules of distribution and dissemination of pollens is the precondition and foundation of specific prevention and treatment. Since the distribution of pollens has remarkable features of regionality and seasonality, the species and amounts of them vary with the territory. In the early 1980s, there was a country-wide pollen investigation in China. This investigation enormously improved the prevention and treatment of the pollen-induced allergic diseases. With the time going, the distribution of pollen has changed a lot. To provide scientific basis for the prevention and treatment of pollinosis in Hubei province, an airborne pollen investigation was conducted from 2003 to 2004. A total of 61 pollen genera were found during the investigation. The peak time of pollen dissemination was from March to April and from August to October. The springtime pollens had the largest quantity. Woody plants were the main sources of springtime pollens, such as Platanus, Pinus, Cupressaceae, Salix, etc. Herbage plants were the main sources of autumn pollens, such as Artemisia, Ambrosia, Gramineae, etc. Besides, the distribution of pollens had obvious regionality. For example, Toxicodendron Mill. was only found in Shiyan area, and Paulow-
December
2008
nia Sieb. et Zucc. was only seen in Laohekou area. These suggested that the investigation had important practicality to the prevention and treatment of pollinosis in different areas. Recently, due to the variety of vegetation in several cities of Hubei province, there are great changes in the genera composition compared to the results of investigation in 1984. Take Hankou area of Wuhan city for example, the main pollens were Platanus (50.84%), Broussonetia (11.82%), Pterocarya (7.40%), Quercus (5.51%), and Pinus (3.80%) during March to April in 1984.1 However, the main pollens were Platanus (50.84%), Cupressaceae (8.21%), Pinus (7.70%), Broussonetia (7.17%), and Taxodium (5.41%) during March to April in 2004. The present study showed that the onset season of pollinosis was obviously correlated with the monthly pollen amounts. The spring and autumn had the highest onset rates and the highest pollen dissemination amounts. Besides, there could be a correlation between the genera of pollens and the onset of pollinosis. The allergenicity of herbage plant pollens like Artemisia and Ambrosia might be higher than that of the woody plant pollens like Platanus, and the dissemination period of them was longer as well. These suggest that they might have more opportunity to induce allergy. But this conclusion still needs to be further proved. The results of univalent pollen prick test showed that the Platanus had the highest positive rate in spring, and Artemisia and Ambrosia had the highest positive rate in autumn. These provided important basis for the preparation of allergen for specific immunotherapy. However, in some areas, when a patient had typical symptoms of pollinosis, the prick tests of common pollens showed negative results. It suggested that there might be some unknown pollens in the area. Therefore, the investigation of airborne pollens should be preceded continuously and detailedly. The present study also showed that the airway responsiveness was correlated to the pollen amounts. It suggests that even without clinical symptoms, the airway responsiveness of pollinosis patients could increase after the provocation of pollens. This might be caused by the mild allergic inflammation of airway. Therefore, the research of specific early intervention should be paid more attention to.
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This investigation preliminarily found out the species, amounts, and distribution patterns of the airborne pollens in 16 areas of Hubei province. It provided important evidence to the epidemiological research, clinical diagnosis, prevention and treatment of the common allergic diseases. Acknowledgements: Many thanks to Mr. Bing-shan Qiao for his guidance, training, and check. Many thanks to the doctors in every investigation spot for their dedicated work, they are Wei Xu, Yao-guang Zeng, Hanzhong Xiong, Mei-ling Na, Qing-zheng Peng, Lian-gui Huang, Xue-song Wu, Ye-xin Xu, Ai-rong Sha, Qing-zhi Zou, Ling-ling Shen, Hong Su, Yun-he Yu, Zhi-qiang Li, Wen-zhu Shen, et al.
217
3&'&3&/$&4 1.
China Allergenic Airborne Pollen Investigation Group. Investigation of allergenic airborne pollen in China. Beijing: Beijing Publishing House Group; 1991.p.44-147.
2.
Qiao BS. Experiment technology of allergology. Beijing: Science Press; 1996.p.129-133, 176-180.
3.
Group of Asthma, Society of Respiratory Disease, Chinese Medical Association and editorial board of Chinese Journal of Tuberculosis and Respiratory Diseases. The measurements of airway responsiveness (tentative program). Chin J Tuberc Respir Dis, 1993; 16(supplement of asthma): 9.
4.
Qiao BS. Color atlas of air-borne pollens and plants in China. Beijing: Peking Union Medical College Press; 2005.p.89-362.
Vol. 23, No. 4 P. 212 217
CHINESE MEDICAL SCIENCES JOURNAL SURVEY OF AIRBORNE POLLEN IN HUBEI Ƹ PROVINCE OF CHINA Guang-hui Liu*, Rong-fei Zhu, Wei Zhang, Wen-jing Li, Zhong-xi Wang, and Huan Chen Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 Key words: airborne pollen; pollinosis; airway responsiveness Objective To study the genera and seasonal distribution of airborne pollen in Hubei province of China, and its relationship with pollinosis. Methods From November 2003 to October 2004, an airborne pollen investigation was performed in 16 chosen areas in 12 cities of Hubei province using gravity sedimentation technique. Meanwhile, univalent skin prick tests of pollens were performed and the invasion season was studied on 2 300 patients with pollinosis. Among them, 352 cases underwent the airway responsiveness measurements, and the correlation between airway responsiveness and results of pollen count was analyzed. Results A total of 61 pollen genera were observed and 257 520 pollens were collected. The peak of airborne pollen distribution occurred in two seasons each year: spring (March and April) and autumn (from August to October). The attack of pollinosis corresponded to the peak of pollen distribution. There was a significantly negative relationship between the provocation dose causing a 20% decrease of forced expiratory volume in one second (FEV1) from baseline and airborne pollen concentration (r = ˉ0.6829, P ˘ 0.05). Conclusion This study provides useful information for airborne pollen epidemiology of Hubei province, and it provides important insights to clinical prevention, diagnosis, and treatment of pollen-related allergic diseases.
A
IRBORNE pollen is one of the most important allergens leading to allergic diseases. Its significance has been highly evaluated by the experts. Since the distribution of airborne pollen has distinctive regionality, to find out the distribution features of airborne pollen is crucial for the prevention and treatment of
Received for publication March 27, 2008.
*
Corresponding author Tel: 027-83663666, E-mail: ghliu-3488@
163.com ƸSupported by Science Research Foundation of Health Department of Hubei Province (LJ200220).
pollen-related allergic diseases. A country-wide survey of airborne pollen had been carried out in early 1980s, which provided important scientific foundation to the research of airborne pollen in China.1 Twenty years passed by, and great changes have taken place in the species and amounts of airborne pollens with the continuing enlargement of vegetation and the increase of plant species. The population of pollen allergy also increases every year. In order to investigate the species, quantity, and distribution pattern of airborne pollen in Hubei province, a one-year survey was conducted in 16 sites of 12 cities in Hubei province.
Vol. 23, No.4
CHINESE MEDICAL SCIENCES JOURNAL
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."5&3*"-4"/%.&5)0%4
3&46-54
Materials and reagents Unitive standardized 2 pollen samplers were adopted. Vaseline adhesive and agar glycerol basic fuchsin staining solution were prepared and stored in refrigerator. Time and sites From November 2003 to October 2004, 16 sites in 12 cites of Hubei province were chosen as the investigation spots, which included one spot in Ezhou, one in Huangshi, one in Yingshan, one in Xiaogan, one in Qianjiang, one in Jinmen, two in Jinzhou, one in Huanggang, one in Laohekou, one in Songzi, four in Wuhan, and one in Shiyan. Pollen sampling The samplers were placed 12 to 15 meters high from the ground (5 or 6 floors’ height). Every day, a glass slice with a thin layer of adhesive agent was placed in the sampler at fixed time. After 24 hours of exposure to the air, the slice was retrieved and dyed with the basic fuchsin staining solution. With the coverslip, the slice was observed under the microscope for morphological identification and record of the species and amounts of the pollens. Vegetation investigation Primary investigations were conducted on the vegetation of those areas mentioned above to figure out the species and seasons of pollination. Climate records The weather conditions, including temperature, wind, etc, were recorded. Skin prick test and investigation of onset season Totally, 2 300 cases of pollinosis accepted skin prick tests using the fast insertion liquor provided by Peking Union Medical College Hospital. The test method and result assessment were all complied with the unitive standard in China. Besides, the onset season of the disease was inquired and recorded. Airway responsiveness test In the season of Artemisia pollen dissemination, 352 patients with pollinosis who had no asthma underwent methacholine provocation tests to measure their airway responsiveness.3 The indexes of airway responsiveness were forced expiratory volume in one second (FEV1) and the provocation dose causing a 20% decrease of FEV1 from baseline using methacholine (PD20-FEV1).
Species and distribution of airborne pollens in Hubei province Sixty-one pollen genera were found, and the total number of collected pollens was 257 520. There were two peaks of airborne pollen distribution during the year, one was from March to April, and the other was from August to October. In spring, the main genera of airborne pollens included Pinus, Platanus, Cupressaceae, Salix, etc. In autumn, the main genera of airborne pollens included Artemisia, Ambrosia, Gramineae, etc (Table1). The airborne pollens of different areas were variable. For example, the pollen of Toxicodendron (Tourn.) Mill. was only found in Shiyan Area. The pollen of Paulownia Sieb. et Zucc. was only seen in Laohekou Area. And the Buxus could only been found in Huangshi and Wuhan Area. Besides, in different seasons, the dominant pollens changed. From March to April, Platanus was the dominant pollen of the city of Wuhan, Huangshi, Jinmen, and Shiyan. Pinus and Cupressaceae were the dominant pollens of Yingshan, Ezhou, Xiaogan, and Jinzhou. From August to October, Artemisia L. was the dominant pollen in most areas of Hubei province. However, in the city of Ezhou, the dominant pollen was Albizzia Durazz. Onset season of pollinosis The onset season of 2 300 patients with pollinosis was mainly from March to May in spring and from August to October in autumn. There were more patients with pollinosis in autumn than in spring. The peak of pollinosis onset was consistent with the dissemination peak of pollens (Fig. 1). Skin prick test results The prick test results of 2 300 patients with pollinosis showed that the pollens with the highest sensitization rate were Platanus in spring, Artemisia L. and Ambrosia L. in autumn (Table 2). Airway responsiveness test results Airway responsiveness tests on 352 cases of Artemisia L.-allergic patients showed that there was a significantly negative correlation between PD20-FEV1 values and the concentration of Artemisia L. pollen (r = ˉ0.6829, P ˘ 0.05, Fig. 2).
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Table 1. Classification of airborne pollens in Hubei province Amount˄per month˅
Genera Jan
Feb
Larix
0
3
9
Pinus
98
1 662
Picea
0
Cedrus
Dec
Percentage ˄%˅
Jun
Jul
Aug
Sep
Oct
Nov
3
4
0
0
7
44
2
0
0
72
0.03
23 645
28 601
2 723
307
169
71
43
40
37
24
57 420
22.30
1
26
428
47
2
1
0
0
0
1
0
506
0.20
0
0
0
0
0
0
0
4
0
1
0
0
5
0.00
52
2 115
17 905
6 206
350
72
57
12
50
15
7
25
26 866
10.43
Taxodium
0
30
1 751
27
0
0
0
0
0
0
2
0
1 810
0.70
Cryptomeria
0
244
2 021
266
22
3
2
1
1
0
0
0
2 560
0.99
Cunninghamia
2
152
3 294
3 967
177
21
10
9
1
0
1
0
7 634
2.96
Ginkgo
17
78
594
877
111
36
20
30
20
49
13
1
1 846
0.72
Juglans
6
33
243
686
213
97
72
26
27
3
0
0
1 406
0.55
34
110
3 482
2 977
99
15
24
5
31
3
4
2
6 786
2.64
Quercus
2
17
252
915
211
3
6
10
59
3
1
2
1 481
0.58
Castanea
0
0
1
8
16
6
1
0
0
0
0
0
32
0.01
Ulmus
6
475
1602
476
73
44
7
22
101
2
0
2
2 810
1.09
Betula
0
6
183
518
456
35
8
12
58
0
0
0
1 276
0.50
Alnus
9
15
53
46
16
11
2
1
6
0
1
5
165
0.06
Corylus
0
102
473
174
49
12
6
4
14
13
0
0
847
0.33
Populus
18
307
1 182
2 111
499
86
48
14
18
6
1
1
4 291
1.67
Salix
43
1 555
11 437
5 283
457
132
48
13
3
21
1
7
19 000
7.38
Acer
0
0
133
231
118
4
0
0
6
0
0
0
492
0.19
Fraxinus
0
0
14
12
0
0
0
2
4
0
0
0
32
0.01
Oleaceae
0
0
4
22
12
6
0
11
29
0
0
0
84
0.03
Morus
4
35
594
1 802
450
69
21
13
28
2
2
0
3 020
1.17
Broussonetia
4
50
2 173
3 441
440
85
19
36
142
173
6
0
6 569
2.55
Cannabis/Humulus
7
11
42
87
28
32
35
297
1145
337
36
9
2 066
0.80
Ailanthus
0
3
177
117
23
4
1
13
11
1
0
0
350
0.14
Platanus
2
242
23 045
22 570
1 122
329
137
47
27
12
2
0
47 535
18.46
Leguminosae
0
0
5
79
18
6
0
0
0
0
0
0
108
0.04
Albizia
0
0
5
5
1
12
2
0
103
551
300
0
979
0.38
Sophora
0
2
341
256
126
64
281
319
301
81
30
0
1 801
0.70
Amorpha fruticosa
0
0
0
0
14
0
0
0
0
0
0
0
14
0.01
Cruciferae
55
243
2 522
2 172
384
139
28
22
6
3
1
0
5 575
2.16
Liliaceae
1
3
110
158
25
24
3
14
22
2
0
0
362
0.14
Fontanesia
0
0
0
0
0
0
1
1
0
0
0
0
2
0.00
Buxus
0
0
224
194
9
3
0
0
0
0
1
0
431
0.17
Toxicodendron
0
6
36
48
140
172
21
11
2
0
0
436
0.17
Melia
0
0
6
5
6
5
0
0
39
4
0
0
65
0.03
Compositae
0
0
0
0
0
0
5
11
258
37
0
0
311
0.12
Cinnamomum
1
80
194
734
483
455
181
72
174
102
4
1
2 481
0.96
Pterocarya
Apr
Total
May
Cupressaceae
Mar
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CHINESE MEDICAL SCIENCES JOURNAL
215 (continued)
Amount˄per month˅ Genera
Total Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Artemisia
41
920
190
194
246
362
1 435
3 834
Ambrosia
31
55
194
309
127
204
359
Helianthus
3
0
1
0
0
28
Xanthium
0
0
1
0
16
Ricinus
0
35
189
208
Plantago
4
55
218
Ligustrum
0
0
Chenopodiaceae
0
Amaranthaceae
Percentage ˄%˅
Oct
Nov
Dec
10 938
2 654
210
72
21 096
8.19
2 794
1 986
465
146
50
6 720
2.61
44
39
81
12
5
3
216
0.08
40
68
89
167
7
15
4
407
0.16
265
83
50
54
84
58
7
1
1 034
0.40
186
65
48
12
33
64
31
1
0
717
0.28
0
38
58
274
44
41
17
10
4
1
487
0.19
16
169
220
269
210
87
138
203
95
53
3
1 463
0.57
0
4
13
23
22
23
36
86
183
61
4
0
455
0.18
34
118
730
1 056
1 030
1 020
790
2 184
2 435
1 684
102
22
11 205
4.35
Umbelliferae
0
0
20
5
3
1
1
4
50
9
1
0
94
0.04
Typha
0
0
11
67
209
88
68
112
169
54
7
0
785
0.30
Astragalus sinicus
0
2
0
0
0
0
0
0
0
0
0
0
2
0.00
Trachycarpus
0
8
470
616
319
173
25
3
1
2
0
1
1 618
0.63
Cyperaceae
0
2
47
38
68
27
11
37
62
37
2
0
331
0.13
Rumex
0
0
13
7
4
1
1
0
5
0
0
0
31
0.01
Cephalotaxaceae
0
2
28
3
0
0
0
1
0
0
0
0
34
0.01
Paulownia
6
12
150
160
37
13
0
0
0
0
0
0
378
0.15
Cucurbitaceae
0
0
1
2
3
2
16
10
7
1
0
0
42
0.02
Rosaceae
0
2
22
202
57
50
1
0
0
0
0
0
334
0.13
Robinia
0
0
0
0
0
0
0
5
13
2
5
0
25
0.01
10
50
87
221
25
3
13
30
63
15
0
3
520
0.20
490
8 861
100 332
89 057
11 745
4 941
4 277
10 604
19 301
6 660
1 013
239
257 520
Gramineae
Unknown Total
100
Table 2. Skin prick test results of pollinosis patients Pollen species
Positive cases
Positive rate (%)
600
Artemisia
1 182
51.4
100 000
500
Ambrosia
785
34.1
80 000
400
Platanus
621
27.0
60 000
300
Broussonetia
331
14.4
Pterocarya
282
12.3
40 000
200
Populus
275
12.0
20 000
100
Salix
204
8.9
Ulmus
186
8.1
Quercus
144
6.3
Pinus
122
5.3
Cupressaceae
109
4.7
Cryptomeria
97
4.2
0
Cases
Pollen amount
120 000
Pollen amount Pollinosis cases
0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Figure 1. Monthly distribution of pollen amount and pollinosis cases.
CHINESE MEDICAL SCIENCES JOURNAL
Pollen amount PD20-FEV1
3 000
Pollen amount
2 500 2 000 1 500 1 000 500 0 Jul
Aug
Sep
Oct
Nov
Dec
18 16 14 12 10 8 6 4 2 0
PD20-FEV1(ȝmol)
216
Figure 2. Monthly distribution of Artemisia pollen and the provocation dose causing a 20% decrease of forced expiratory volume in one second from baseline (PD20FEV1) of Artemisia pollinosis patients.
%*4$644*0/ Pollen is one of the most important allergens. It can induce allergic diseases, such as allergic rhinitis, asthma, urticaria, etc. In China, there is an annual increase of pollen-allergic people. The pollen-induced diseases greatly jeopardize people’s health. To find out the rules of distribution and dissemination of pollens is the precondition and foundation of specific prevention and treatment. Since the distribution of pollens has remarkable features of regionality and seasonality, the species and amounts of them vary with the territory. In the early 1980s, there was a country-wide pollen investigation in China. This investigation enormously improved the prevention and treatment of the pollen-induced allergic diseases. With the time going, the distribution of pollen has changed a lot. To provide scientific basis for the prevention and treatment of pollinosis in Hubei province, an airborne pollen investigation was conducted from 2003 to 2004. A total of 61 pollen genera were found during the investigation. The peak time of pollen dissemination was from March to April and from August to October. The springtime pollens had the largest quantity. Woody plants were the main sources of springtime pollens, such as Platanus, Pinus, Cupressaceae, Salix, etc. Herbage plants were the main sources of autumn pollens, such as Artemisia, Ambrosia, Gramineae, etc. Besides, the distribution of pollens had obvious regionality. For example, Toxicodendron Mill. was only found in Shiyan area, and Paulow-
December
2008
nia Sieb. et Zucc. was only seen in Laohekou area. These suggested that the investigation had important practicality to the prevention and treatment of pollinosis in different areas. Recently, due to the variety of vegetation in several cities of Hubei province, there are great changes in the genera composition compared to the results of investigation in 1984. Take Hankou area of Wuhan city for example, the main pollens were Platanus (50.84%), Broussonetia (11.82%), Pterocarya (7.40%), Quercus (5.51%), and Pinus (3.80%) during March to April in 1984.1 However, the main pollens were Platanus (50.84%), Cupressaceae (8.21%), Pinus (7.70%), Broussonetia (7.17%), and Taxodium (5.41%) during March to April in 2004. The present study showed that the onset season of pollinosis was obviously correlated with the monthly pollen amounts. The spring and autumn had the highest onset rates and the highest pollen dissemination amounts. Besides, there could be a correlation between the genera of pollens and the onset of pollinosis. The allergenicity of herbage plant pollens like Artemisia and Ambrosia might be higher than that of the woody plant pollens like Platanus, and the dissemination period of them was longer as well. These suggest that they might have more opportunity to induce allergy. But this conclusion still needs to be further proved. The results of univalent pollen prick test showed that the Platanus had the highest positive rate in spring, and Artemisia and Ambrosia had the highest positive rate in autumn. These provided important basis for the preparation of allergen for specific immunotherapy. However, in some areas, when a patient had typical symptoms of pollinosis, the prick tests of common pollens showed negative results. It suggested that there might be some unknown pollens in the area. Therefore, the investigation of airborne pollens should be preceded continuously and detailedly. The present study also showed that the airway responsiveness was correlated to the pollen amounts. It suggests that even without clinical symptoms, the airway responsiveness of pollinosis patients could increase after the provocation of pollens. This might be caused by the mild allergic inflammation of airway. Therefore, the research of specific early intervention should be paid more attention to.
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CHINESE MEDICAL SCIENCES JOURNAL
This investigation preliminarily found out the species, amounts, and distribution patterns of the airborne pollens in 16 areas of Hubei province. It provided important evidence to the epidemiological research, clinical diagnosis, prevention and treatment of the common allergic diseases. Acknowledgements: Many thanks to Mr. Bing-shan Qiao for his guidance, training, and check. Many thanks to the doctors in every investigation spot for their dedicated work, they are Wei Xu, Yao-guang Zeng, Hanzhong Xiong, Mei-ling Na, Qing-zheng Peng, Lian-gui Huang, Xue-song Wu, Ye-xin Xu, Ai-rong Sha, Qing-zhi Zou, Ling-ling Shen, Hong Su, Yun-he Yu, Zhi-qiang Li, Wen-zhu Shen, et al.
217
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China Allergenic Airborne Pollen Investigation Group. Investigation of allergenic airborne pollen in China. Beijing: Beijing Publishing House Group; 1991.p.44-147.
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Qiao BS. Experiment technology of allergology. Beijing: Science Press; 1996.p.129-133, 176-180.
3.
Group of Asthma, Society of Respiratory Disease, Chinese Medical Association and editorial board of Chinese Journal of Tuberculosis and Respiratory Diseases. The measurements of airway responsiveness (tentative program). Chin J Tuberc Respir Dis, 1993; 16(supplement of asthma): 9.
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Qiao BS. Color atlas of air-borne pollens and plants in China. Beijing: Peking Union Medical College Press; 2005.p.89-362.