Views expressed are my own and not that of WRNMMC, USA or USN

Transcription

1 Pollen Count Variation Within and Among Regions of North America COL Michael R. Nelson, MD, PhD Walter Reed National Military Medical Center

2 Disclosures Nothing to disclose i d d h f Views expressed are my own and not that of WRNMMC, USA or USN

3 Objectives Identify changes in pollen detection as a function of time in North America Identify factors contributing to pollen variation i Determine utility of pollen counts with respect to the care of patients

4 1. Do pollencounts actuallyvary beyond seasonal variation in various locales? 2. If so, how and over what time frame? 3. How can pollen counts best be utilized in the p care of patients?

5 BLUF: Pollen Count Variation Factors Temporal Daily Seasonal Annual Longer?? Geographic Local Regional National Global Clinical relevance Sensitization Onset & exacerbations Rate Magnitude Species vs aggregate Biphasic & offseason exacerbations

6 GEOGRAPHIC VARIATION Middleton's Allergy Principles & Practice, 7 th ed. 2008

7 Zone Grasses Weeds Trees Northern Region 1.Tundra Phleum, Poa, Agrostis 2.Boreal Forests 3.Pacific Coast Maritime Forest Western Region 4.California 5.California Prairie 6.Great Basin/ Columbia Plateau Phleum, Lolium, Poa, Festuca, Dactylis, Agrostis Rumex, Artemisia Pinus, Betula, Alnus, Populus, Salix Phleum, Lolium, Poa Chenopodium, Amaranthus, Ambrosia, Rumex, Artemisia Betula, Alnus, Ulmus, Acer, Quercus, Populus, Salix Phleum, Lolium, Poa, Festuca, Chenopodium, Amaranthus, Ambrosia, Rumex, Artemisia, Alnus, Ulmus, Acer, Quercus, Olea, Populus, Cynodon, Sorghum Salsola Fraxinus, Salix, Platanus Phleum, Lolium, Poa, Festuca, Cynodon, Sorghum Phleum, Lolium, Poa, Dactylis, Cynodon, Sorghum Chenopodium, Amaranthus, Atriplex, Ambrosia, Rumex, Salsola Chenopodium, Amaranthus, Atriplex, Ambrosia, Rumex, Artemisia, Salsola, Xanthium Ulmus, Acer, Quercus, Olea, Populus, Fraxinus Ulmus, Populus, Juniperus 7.Hot Desert Region Cynodon, Sorghum Chenopodium, Amaranthus, Atriplex, Ambrosia, Baccharis, Ulmus, Quercus, Populus, Juniperus, Acacia, Rumex, Artemisia, Salsola, Xanthium Fraxinus, Tamarix 8.Western Cordillera Festuca, Phleum, Dactylis, Lolium, Cynodon, Sorghum Chenopodium, Amaranthus, Atriplex, Ambrosia, Rumex, Plantago, Artemisia, Salsola, Xanthium Pinus, Ulmus, Quercus, Populus, Acer, Juniperus, Alnus Central Region 9.Short Grass Prairie Festuca, Phleum, Poa, Dactylis, Chenopodium, Kochia, Amaranthus, Ambrosia, Rumex, Quercus, Populus, Ulmus, Fraxinus Lolium, Cynodon, Sorghum Plantago, Artemisia, Salsola, Xanthium 10.Tall Grass Prairie 11.Lower Mississippi Valley Flood Plain 12.Central Hardwoods Eastern Region Festuca, Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum, Paspalum Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum 13.Upland SE Forests Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum 14.Lowland SE Forests 15.Northern Hardwood Forests Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum, Paspalum Phleum, Poa, Dactylis, Lolium, Cynodon, Sorghum Chenopodium, Kochia, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Salsola, Xanthium Chenopodium, Kochia, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Xanthium Chenopodium, Kochia, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Xanthium Chenopodium, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Xanthium Chenopodium, Kochia, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Salsola, Xanthium, Baccharis Chenopodium, Amaranthus, Ambrosia, Rumex, Plantago, Artemisia, Xanthium Quercus, Populus, Acer, Ulmus, Carya, Fraxinus Quercus, Populus, Acer, Ulmus, Salix, Taxodium, Carya Quercus, Populus, Acer, Ulmus, Carya, Celtis Quercus, Populus, Acer, Ulmus, Carya, Pinus Quercus, Populus, Acer, Ulmus, Carya, Myrica, Pinus, Liquidambar Quercus, Populus, Acer, Ulmus, Betula, Pinus 16.Southern Florida Cynodon, Sorghum, Paspalum Chenopodium, Amaranthus, Ambrosia Quercus, Casuarina, Myrica, Schinus, Taxodium

8 Northern Western Central Eastern 1.Tundra 2.Boreal Forests 3.Pacific Coast Maritime Forest 4.California 5.California Prairie 6.Great Basin/ Columbia Plateau 7.Hot Desert Region 8.Western Cordillera 9.Short-Grasss Prairie 10.Tall-Grasss Prairie 11.Lower Mississippi Plain 12.Central Hardwoods 13.Upland SE Forests 14.Lowland SE Forests 15.Northern Hardwood 16.Southern Florida Phleum (Timothy) Poa (June/blue) Dactylis (Orchard) Lolium (Rye) Cynodon (Bermuda) Sorghum (Johnson) Agrostis (Bent) Paspalum (Bahia)

9 16.Southern Florida Northern Western Central Eastern 1..Tundra 2.Boreal Forestss 3.Pacific Coast Maritime Forest 4..California 5.California Prairie 6.Great Basin/ Columbia Plateau 7.Hot Desert Region 8.Western Cordillera 9..Short-Grass Prairie 10.Tall-Grass Prairie 11.Lower Mississippi Plain 12.Central Hardwoods 13.Upland SE Forests 14.Lowland SE Forests 15.Northern Hardwood Chenopodium (lamb s quarter) Kochia (molly, burning bush) Amaranthus (pigweed,careless) Atroplex (satlbush) Ambrosia (ragweed) Rumex (dock) Plantago (plantain) Artemisia (sage, wormwood) Salsola (Russian thistle) Xanthium (cocklebur) Baccharis (broom)

10 Northern Western Central Eastern 1.Tundra 2.Boreal Forests 3.Pacific Coast Maritime Forest 4.California 5.California Prairie 6.Great Basin/ Columbia Plateau 7.Hot Desert Region 8.Western Cordillera 9.Short-Grass Prairie 10.Tall-Gras Prairie 11.Lower Mississippi 12.Central Hardwoods s 13.Upland SE Forests 14.Lowland Forests 15.Northern Hardwood Plain SE 16.Southern Florida Ulmus (elm) Acer (maple, elder) Quercus (oak) Olea (olive) Populus(poplar,aspen) Fraxinus (ash) Salix (willow) Platanus (sycamore) Pinus (pine) Betula (birch) Juniperus (cedar) Alnus (alder) Acacia (thorntrees) Tamarix (salt cedar) Carya (hickory) Taxodium(baldcypress Celtis (hackberry) Myrica (bayberry) y) Liquidambar(swtgum) Casuarina (sheoak) Schinus (peppertree)

11 TEMPORAL VARIATION

12 Last Glacial Maximum 18,000 BP

13 Temporal Changes: Ragweed Continental & more than yrs Lake Sediment Pollen NOAA Paleoclimatology/NCD; (accessed 30 AUG 2011)

14 Temporal Changes: Regional Location of study region in relation to modern Canada and the United States (inset). Munoz S E et al. PNAS 2010;107:

15 Associations between archaeological, climate, and vegetation records for the study region from initial settlement (13,500 yr BP) to E ropean contact European (500 yr BP) Munoz S E et al. PNAS 2010;107:

16 Regional-scale g pollen and charcoal records in relation to cultural periods and population size Munoz S E et al. PNAS 2010;107:

17 Temporal Changes: Regional (Accessed 30AUG2011)

18 Humans Pollen Modified from: Williams et al. Ecological Monographs, 2004;74(2):

19 Changes over time: Local US Army Centralized dall Allergen Extract Lb Laboratory

20 Local Pollen Species Pollen aeroallergens in the Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

21 Individual Pollen Species Variation Pollen aeroallergens in the Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

22 Pollenaeroallergens inthe Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Bimodal ELM Pollen Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

23 Pollen aeroallergens in the Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Bimodal Grass Pollen Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

24 Pollen Cycles Pollen aeroallergens in the Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

25 Total Seasonal Burden Pollen aeroallergens in the Washington, DC, metropolitan area: a 10 year volumetric survey ( ) Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

26 Pollen Calendar for Major Tree, Grass and Weed Pollen in the Washington, DC Area ( ) Week with >1% total annual pollen species during any year Week with >5% total annual pollen species during any year Week when "peak k dil daily averages were noted tdduring any year "Peak Week"= Week with the highest overall daily average Kosisky S, Marks M, Nelson M. Ann Allergy, Asthma Immun. 2010;104(3):

27 1. Dopollen counts actually vary beyond seasonal variation in various locales? 2. If so, how and over what time frame? 3. How can pollen counts best be utilized in p the care of patients?

28 Pollen changes and clinical implications Aeroallergen (lag days) Relative risk (95% CI)* Estimated increase in daily asthma visits ii (95% CI) Oak/maple pollen (3) 1.23 ( ) 23% (2 49%) Pinaceae pollen (5) 1.34 ( ) 34% (24 45%) Ragweed pollen (5) 1.54 ( ) 54% (2 133%) *RR for an increase of 100 counts/m 3 Questions raised 100 count increase from what baseline Individual vs aggregate pollen increases Within vs interseasonal pollen variation Local vs national data Sci Total Environ November 1; 370(2 3):

29 NAB Pollen Scale (#/cubic meter)

30 Local Percentile Low <50 th Moderate 50 th 75 th High 75 th 99 th Very high >99 th Trees Alder >30.13 Ash >205.4 Beech >69.46 Birch family > Cottonwood/poplar >70.50 Cedar/Cyp/Jun > Elm > Hackberry >25.08 Hemlock >11.64 Hickory >70.67 Linden >7.59 Maple/Boxelder > Mulberry Family > Oak , >1, Pine Family > Sweetgum > Sycamore > Walnut >49.08 Willow >18.52 Weeds Cattail >3.97 Chenopod/Amaranth >3.27 Dock/Sorrel >4.52 Nettle Family >8.71 Plantain >8.38 Ragweed >75.91 Sage >11.5 Grasses >51.79

31 Establishing Local Pollen Ranges in Wash DC Low <50 th Mod. 50 th 75 th High 75 th 99 th Very high >99 th Trees NAB ,499 >1,500 Wash, DC , >2, Grasses NAB >200 Wash, DC >51.79 Weeds NAB >500 Wash, DC >58.8 Kosisky et al. Annals Allergy Asthma & Immun 2011;107(3):

32 NAB Pollen Level Precautions ABSENT No symptoms LOW Very sensitive patients will experience symptoms MODERATE Many sufferers will experience symptoms HIGH VERY HIGH Most allergy sufferers will experience symptoms Almost all allergy sufferers will experience symptoms, those extremely sensitive could have severe symptoms

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34 Summary Pollen counts do vary beyond seasonal variation Geographic Temporal variation Multiple factors contribute to pollen variation Climate & cultural influences Clinical application of pollen count includes a balance of local vs national variation data

35 National Allergy Bureau/AAAAI

36 National Oceanic & Atmospheric Administration Global l Pollen Database

37 Resources 36 international links WAO World ldpollen Network Nt Director: Fares Hamad Zaitoun, MD Region Country Organization/Site Name North America North America North America North America North America North America North America North America Canada USA USA USA USA USA USA USA The Weather Network Allergy Report, CNN.com/Weather Betrocks Allergenica AAAAI National Allergy Bureau Pollen Count for Seattle/King County area Pollen.com, local and national counts The Pollen Counter, WebMD, National pollen counter calculator p// / / p The Weather Channel

38 Questions