Air pollution tied to higher pediatric atopic dermatitis burden

Higher ambient levels of nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter are probably associated with more health care visits for atopic dermatitis (AD) and higher AD prevalence in children, according to a systematic review and meta-analysis published in JAMA Pediatrics.¹ The pooled data did not support links between air pollution and AD incidence or severity.¹

The findings "support policies aimed at reducing air pollution and mitigating climate change," wrote co–first authors Megan Park, MD, of the University of Toronto, and Samiha T. Mohsen, MD, of the University of Calgary, and colleagues.¹

Meta-analysis of air pollution and atopic dermatitis in children

Investigators searched MEDLINE, Embase, and Cochrane databases from inception to February 10, 2026, for observational studies of children younger than 18 years that examined at least 1 AD outcome in relation to NO2, SO2, PM10, PM2.5, ozone (O3), carbon monoxide (CO), or traffic-related pollution.¹ Of 2528 citations, 52 studies from 17 countries met inclusion criteria; most were conducted in China (n = 14) and South Korea (n = 8).¹ Data were pooled using random-effects models, certainty of evidence was rated with GRADE, and most studies had moderate risk of bias.¹

NO2, SO2, and PM linked to pediatric atopic dermatitis visits and prevalence

Across 7 studies of daily emergency department or outpatient visits, each 10-μg/m3 increase in NO2 (OR, 3.46; 95% CI, 1.06-11.31) and SO2 (OR, 3.96; 95% CI, 1.00-15.65) was probably associated with more AD-related visits (moderate certainty).¹ Neither association held when exposure was modeled per interquartile range (IQR) increase.¹ PM10, PM2.5, O3, and CO were not significantly associated with visits.¹

Among 23 studies of AD prevalence, each IQR increase in PM2.5 was associated with 4% higher odds of prevalent AD (OR, 1.04; 95% CI, 1.00-1.08) and each IQR increase in PM10 with 19% higher odds (OR, 1.19; 95% CI, 1.06-1.35), both at moderate certainty.¹ The PM10 association was not significant per 10-μg/m3 increase (OR, 1.01; 95% CI, 0.96-1.06).¹ Higher NO2 exposure may be associated with higher prevalence (OR per IQR increase, 1.20; 95% CI, 1.06-1.36; low certainty).¹

Atopic dermatitis incidence, severity, and traffic exposure findings

Evidence on incident AD was sparse and could not be pooled; PM2.5 was not associated with new-onset disease in 2 studies (very low certainty).¹ Six studies of severity, most using the SCORAD index, also could not be pooled, and evidence did not support associations for PM2.5, O3, SO2, or CO.¹ Fifteen studies of traffic-related exposures, such as living near a major road, did not show a consistent association with prevalence.¹

Pediatric atopic dermatitis burden and air pollution mechanisms

AD is common: in an 18-country survey of 65,661 respondents, 12-month prevalence of diagnosed pediatric AD ranged from 2.7% to 20.1%.² The authors noted that pollutants may disrupt the skin barrier through oxidative stress, transepidermal water loss, and immune dysregulation, and that children may be more susceptible because of more permeable skin and greater air intake relative to body weight.¹ The same group's earlier meta-analysis in adults found that 10-μg/m3 increases in PM10, PM2.5, NO2, and SO2 were associated with a 1% to 3% higher risk of AD-related health care visits.³

Pollutant concentrations in several Asian urban settings were substantially higher than in Europe, Canada, and the US, which the authors said may explain larger and more consistent associations in higher-exposure regions.¹ That geographic skew may limit how directly the pooled estimates apply to US practice.

Limitations of the air pollution and atopic dermatitis evidence

All included studies were observational and susceptible to confounding by socioeconomic status, indoor allergens, tobacco smoke, and genetic susceptibility.¹ Area-level pollutant estimates may misclassify individual exposure, AD definitions varied, and heterogeneity was high in several pooled analyses.¹ The wide CIs on the visit estimates also warrant caution. The authors called for large population-based studies, better exposure assessment, and evaluation of prenatal and early-life exposure windows.¹

References

1. Park M, Mohsen ST, Price E, et al. Air pollution and atopic dermatitis in children: a systematic review and meta-analysis. JAMA Pediatr. Published online November 9, 2026. doi:10.1001/jamapediatrics.2026.5020

2. Silverberg JI, Barbarot S, Gadkari A, et al. Atopic dermatitis in the pediatric population: a cross-sectional, international epidemiologic study. Ann Allergy Asthma Immunol. 2021;126(4):417-428.e2. doi:10.1016/j.anai.2020.12.020

3. Park M, Mohsen ST, Katz T, et al. Climate conditions, weather changes, and air pollutants and atopic dermatitis: a meta-analysis. JAMA Dermatol. 2025;161(8):828-839. doi:10.1001/jamadermatol.2025.1790